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Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

2. Demographic and social context

According to national population estimates based on the 2021 Census, about 984,000 Australians identified as being Aboriginal and/or Torres Strait Islander, representing 3.8% of the population. Time series data based on the 2021 Census is expected to be released in 2024 (ABS 2021).

In 2021, about 3 in 5 (62%) First Nations people lived in New South Wales and Queensland.

New South Wales

339,710; 34.5% of the total First Nations population


273,119; 27.8%

Western Australia

120,006; 12.2%

Northern Territory

76,487; 7.8%


78,696; 8.0%

South Australian

52,069; 5.3%


33,857; 3.4%

Australian Capital Territory

9,525; 1.0%

Source: HPF Table D1 – AIHW analysis of Australian Bureau of Statistics (ABS) population estimates based on 2021 Census.

First Nations people are more likely to live in urban and regional areas than remote areas, though the proportion of the total population of First Nations people is generally higher in more remote areas. In 2021:

  • 84.6% (832,800 people) of First Nations people lived in non-remote areas: 40.8% lived in Major cities, 24.8% in Inner regional areas and 19.0% in Outer regional areas.
  • around 1 in 7 First Nations people (15.4% or 150,900 people) lived in Remote (6.0%) or Very remote areas (9.4%).
  • the proportion of the total population in each area who were First Nations increased with remoteness, from 2.2% in Major cities, to 47.1% in Very remote areas (Table 2.1).
Table 2.1: First Nations population by remoteness area, 2021

Remoteness area


Proportion (%) of total First Nations population

Proportion (%) of total population of each area

Major cities




Inner regional




Outer regional








Very remote




Source: HPF Table D2 — AIHW analysis of ABS population estimates based on 2021 Census.

The First Nations population is relatively young (Figure 2.1). In 2021, one-half of First Nations people were aged under 24 years (median age), and about 1 in 3 (33.1%) First Nations people (about 325,800) were aged under 15, compared with fewer than 1 in 5 (17.9%) non-Indigenous Australians aged under 15.

Figure 2.1: Age structure of First Nations and non-Indigenous populations, 2021

This figure shows the age structure of First Nations people and non-Indigenous Australians                  in 2021 within 5-year age groups. The first bar chart shows that for First Nations people, the population generally decreases with age. The second bar chart shows that for non-Indigenous Australians, the largest proportion of population is among those in the 25–29, 30–34 and 35–39 age groups. Comparison of the two charts shows that the First Nations population has a younger age profile than the non-Indigenous population.

Source: HPF Table D3 – AIHW analysis of ABS population estimates based on 2021 Census.

Cultural and social determinants

There is evidence that cultural factors – Country and caring for Country, knowledge and beliefs, language, self-determination, family and kinship, and cultural expression – can be protective, and positively influence First Nations people’s health and wellbeing (Bourke et al. 2018).

The Mayi Kuwayu Study of Aboriginal and Torres Strait Islander Wellbeing aims to provide more evidence of how culture is related to First Nations people’s health and wellbeing (Australian National University 2020; Thurber et al 2022).

In contrast to cultural protective factors, racism or racial discrimination are associated with poorer physical and mental health (see, for example, Priest et al. 2011 and Paradies et al. 2014). Colonisation is recognised as having a fundamental impact on disadvantage and health among indigenous peoples worldwide, through social systems that maintain disparities (see, for example, Paradies & Cunningham 2012 and Paradies 2016).

Racism can be interpersonal (such as through exclusion, abuse, or stereotyping), or systemic (through policies, conditions, and practices).

Experiences of racism can have an impact on health through:

  • reduced access to social resources, including employment, education, housing, health care, and other services
  • psychological distress and increased likelihood of engaging in risk behaviours, such as substance use
  • injury from assault (Paradies & Cunningham 2012).

Between March and May 2017, the Australian Government Department of Health, together with the Advisory Group on the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023, led a consultation process (My life my lead) across Australia that examined the role of cultural and social factors on a person’s health and wellbeing. These consultations provided an opportunity for First Nations communities and leaders, governments, the non-government and private sectors to inform the National Aboriginal and Torres Strait Islander Health Plan 2021–2031 (released in December 2021).

My life my lead—report on the national consultations

In 2017, the Australian Government released My life my lead – opportunities for strengthening approaches to the social determinants and cultural determinants of Indigenous health: report on the national consultations. Four main themes emerged from the consultations:

  • Culture is central to the wellbeing of First Nations people, and needs to be an integral part of First Nations-specific services and mainstream services.
  • Racism within health and other systems must be addressed to remove barriers and achieve better outcomes in health, education, and employment.
  • The effects of trauma across generations of First Nations people must be acknowledged and addressed.
  • Governments need to support long-term, coordinated, placed-based approaches that honour community priorities and embed participation  (Department of Health 2017).

Health is also influenced by social determinants – the circumstances in which people grow, live, work, and age (Commission on Social Determinants of Health 2008) – and individual health risk factors. Income, employment, and education are key social determinants of health that account for a large part of the disparity in First Nations and non-Indigenous health outcomes. Obesity and smoking are identified as the 2 most significant key health risk factors. Section 5 (Tier 2 – Determinants of Health) looks at these and other social determinants of health and risk factors.

Recent events

During 2020, 2 major events with global effects occurred – the COVID-19 (coronavirus disease 2019) pandemic, and the Black Lives Matter protests that followed the death of George Floyd, a 46-year-old African American man, during a police arrest in the United States.

In Australia, there were concerns about the potential impact of COVID-19 on First Nations communities, particularly in remote areas. Black Lives Matter rallies in Australia protested against racism and deaths in police custody of First Nations people.

COVID-19 among First Nations people

During the first 18 months of the pandemic (January 2020 to June 2021), 171 cases of COVID-19 were confirmed among First Nations people, representing less than 1% of all cases in Australia. Case numbers began increasing after this period, due to outbreaks of the Delta and then the Omicron variants.

By the end of 2021, the cumulative number of cases among First Nations people was around 14,400 (AIHW 2022b).

In the subsequent Omicron wave, from 15 December 2021 to 23 October 2022, there have been 316,068 cases of COVID-19 notified for First Nations people (3.5% of all cases in Australia) (Department of Health and Aged Care 2022).

Note that the accuracy of counts of COVID-19 cases has varied over the course of the pandemic, and there has also been variation in the proportion of cases of COVID-19 for which Indigenous status was missing: 3% of records when there were relatively few new cases in Australia; at least 19% between September and December 2021; just under one-half (49%) by mid-January 2022; and 20% by 10 April 2022.

As at 23 October 2022, 279 deaths had been reported among First Nations people, and 521 cases had been admitted to intensive care units (ICUs) (Department of Health and Aged Care 2022) . The overall rate of severe disease (defined as ICU admission or death) for First Nations people during the Delta wave (16 June to 14 December 2021) was 16.5 per 100,000, and rose to 76.3 per 100,000 by 23 October 2022 during the Omicron wave (Department of Health and Aged Care 2022). Based on surveillance data supplied by the Department of Health and Aged Care, the rate of severe disease during the Omicron wave to 3 July 2022 for First Nations people was 1.4 times as high as for non-Indigenous Australians (54.0 per 100,000 compared with 37.8 per 100,000 respectively).

For more information on the course of the pandemic among First Nations people, including changes in the use of health services, see  Australia’s Health 2022: Data insights.

The COVID-19 pandemic and response, and the Black Lives Matter protests, have highlighted recurring themes from First Nations health policy and research in Australia over the past 3 decades, including:

  • continuing health inequalities between First Nations people and non-Indigenous Australians
  • broader social inequalities between First Nations people and non-Indigenous Australians in areas that can affect health, including housing, education, employment, income, and access to adequate health care and other goods and services
  • how well the health system serves the needs of First Nations people
  • how governments can work in partnership and share decision-making with First Nations communities and leadership in identifying and responding to health priorities.

In Australia, 2020 also saw the signing of the National Agreement on Closing the Gap. This agreement is based on governments and First Nations people working in partnership and sharing decision-making to support better health and wellbeing outcomes among First Nations people.

More recently in 2023 and 2024, Australia has been experiencing high levels of inflation, with increased cost of living and higher interest rates impacting on housing costs and household disposable income (Reserve Bank of Australia 2023). Higher inflation has the potential to disproportionately impact the lowest income households and contribute to greater inequality, as lower income households spend a greater proportion of their income on essentials, tend to have fewer savings buffers, and have less scope to adjust spending patterns in response to rising costs (Wood et al. 2023).

On 14 October 2023, Australians voted in a referendum – the first of the 21st century – on whether to amend the Constitution to recognise Aboriginal and Torres Strait Islander peoples by establishing a body known as the Aboriginal and Torres Strait Islander Voice. The referendum did not pass. The Australian Government respects this democratic decision and has reaffirmed its commitment to continue efforts to work with First Nations communities to achieve better outcomes. Moreover, the National Agreement on Closing the Gap and other initiatives will continue to ensure practical progress in areas such as health, education, employment, housing and justice for First Nations peoples.