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Indigenous Australians and the National Disability Insurance Scheme

2. Disability in the Indigenous population

It is well established that the prevalence of disability among Indigenous Australians is significantly higher than that of the general population (AIHW 2009a). Indigenous Australians are at greater risk of disability, in part because they are more frequently subject to predictive factors including low birth weight, chronic disease and infectious diseases (e.g. ear infections such as otitis media, especially in young children). In addition, the Indigenous population has an increased risk of acquiring disability through accidents and violence, mental health problems and substance abuse. There is greater prevalence of these factors in communities where there are higher rates of unemployment, lower levels of income, poorer diet and living conditions, and poorer access to adequate health care, early intervention and rehabilitation services. Indigenous people with a disability are also significantly over-represented among homeless people, in the criminal and juvenile justice systems, and in the care and protection system, both as parents and children.

Not only are rates of disability higher for Indigenous Australians than for other Australians, they also face significant additional barriers to accessing disability planning and support services. In part this is due to a lack of disability services and disability-friendly housing and transport in remote areas. However, even in non-remote areas there are barriers to access related to services not always being responsive to Indigenous cultural values.

This chapter explores the nature and extent of disability among the Indigenous population, including analyses by age, remoteness and State/Territory. Where relevant, comparisons with the non-Indigenous population and to Indigenous persons without disability are provided. Data on the use of disability support services by Indigenous Australians and the barriers faced in accessing services is provided. The final section assesses the strengths and gaps in available data sources and offers recommendations to fill these gaps in order to inform future data collection and analyses in this area.

Measuring disability

A disability may be an impairment of body structure or function, a limitation in activities, and/or a restriction in participation of a person in specific activities. A person’s functioning or disability is conceived as an interaction between health conditions and environmental and personal factors. The International Classification of Functioning, Disability and Health (ICF) describes functioning and disability in terms of three key components: body functions and structures, activities, and participation. These components are part of a complex interplay of individual health conditions and environmental factors, which together profoundly influence a person’s experience of functioning and disability.

Measuring disability in surveys

Disability is a complex and difficult concept to measure. It is especially difficult to assess the range of disability severity and to capture the full complexity of disability experience in a small number of questions in surveys. In both the Census and surveys, the ABS (2006: 174) defines the profound or severe disability population as: ‘those people needing help or assistance in one or more of the three core activity areas of self-care, mobility and communication, because of a long-term health condition (lasting six months or more), a disability (lasting six months or more), or old age’.

‘Severity of disability’ is a measure often used in surveys. It is based on limitations a person may experience in any tasks relating to the core activities of self-care, communication and mobility. These limitations may be:

  • • profound – the person always needs help with at least one core activity
  • • severe – the person needs help with at least one of the core activities some of the time
  • • moderate – the person has difficulties with at least one of the core activities but does not need assistance, and
  • • mild – the person uses aids but does not have difficulties with core activities.

An ABS information paper (2010c: 8) on sources of disability information recommends that the most useful measure of disability from surveys is ‘profound/severe core activity limitation’, the population for whom service delivery has the most consequence. Unfortunately, the measures of disability proposed by the Productivity Commission for estimating the disability population for the NDIS do not always correspond with those used in these surveys. The NDIS includes four main categories: persons with daily core needs, self-management limitations, psychiatric disabilities, and early intervention.

  • • ‘Persons with daily core needs’, are defined as persons whose main condition code is one of a set of assigned conditions and who receive core services at least once daily (based on whether received informally or formally, or required self-care, mobility, or communication assistance at least once daily).
  • • ‘Self-management limitations’ is defined as persons whose main condition code is one of a set of assigned conditions and disability status of profound, severe, moderate or mild, or a schooling or work limitation.
  • • ‘Psychiatric disabilities’ is defined as persons who need help or supervision in undertaking tasks due to mental illness or condition and have a disability status of profound, severe or moderate, or a schooling or work limitation.
  • • ‘Early intervention’ is defined as persons with whose main condition code is one of a set of specified conditions and a disability status of profound, severe, moderate or mild, or a schooling or work limitation.

Despite these limitations, a number of data sources are used to analyse disability. These are described in more detail below. Further information on how persons with a disability were identified in each of these data sources, including the questions that were asked in these surveys, is provided in Appendix 2.

Population Census

Census data from 2006 is used to provide disability prevalence estimates for the Indigenous and non-Indigenous populations by age and region.1 The 2006 Census collected data on one element of disability: the number of people with a ‘core activity need for assistance’. It included four questions which were based on the concept of ‘profound or severe core activity limitation’. These questions identified people who had a need for assistance with one or more of the core activity areas of self-care, communication or mobility because of a disability, long-term health condition or the effects of old age.

The 2006 Census enables estimates of disability prevalence (core activity need for assistance) for Indigenous persons of all ages. It should be considered the best source for small area estimates of disability prevalence, and for Indigenous/non-Indigenous comparisons.

Survey of Disability and Carers

The 2009 Survey of Disability and Carers (SDAC) defines disability as any limitation, restriction or impairment which restricts everyday activities and has lasted or is likely to last for at least six months. It was designed specifically to align with the international measures of disability as described in the ICF. The survey contains 149 questions designed to provide detailed information on the identification of disability and the underlying conditions causing disability. The questions address difficulties with sight, hearing, speech and breathing, chronic or recurrent pain, blackouts, fits, learning difficulties, as well as emotional or nervous conditions, physical conditions, disfigurement or deformity, mental illness, head injury, stroke and brain damage.

A series of screening questions are used to establish whether or not any members of a household may have a disability. Where a member of a household meets the SDAC definition of disability, seven criteria are used to determine the severity of the disability. Severity of disability is then classified using the following categories:

  • • profound core activity limitation
  • • severe core activity limitation
  • • moderate core activity limitation
  • • mild core activity limitation
  • • education/employment restriction
  • • no specific limitation or restriction, and long-term health condition.

The SDAC is considered to be the most detailed and comprehensive source of information on disability among the total Australian population (ABS 2010a). However, the sample size for the Indigenous population in the 2009 survey was too small to produce reliable estimates or to support comparative analysis of disability measures by Indigenous/non-Indigenous status (ABS 2010a). The SDAC also does not cover very remote areas of Australia.

National Aboriginal and Torres Strait Islander Social Survey

The 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) collected data on a number of elements of disability using two sets of criteria. A broad set of criteria was used in non-remote areas only, which included sensory, physical and learning difficulties, disfigurements and deformities, conditions which restrict physical activity or physical work, and a nervous or emotional condition and/or mental illness requiring supervision (psychological disability). A common set of criteria were used in both remote and non-remote areas. This measure included the same measures as the broad criteria. However, it does not include people whose only reported disability was psychological.

The disability module used in the NATSISS applies the same criteria as the SDAC to identify people with a disability and determine their severity of restriction, but uses 10 questions and a series of prompt cards. The resulting ‘severity of disability’ measure allows for the following measures to be ascertained and is intended to be broadly comparable to the same concept in the SDAC:

  • • profound/severe core activity limitation
  • • unspecified limitation or restriction
  • • education/employment restriction only
  • • no disability or long term health condition.

Disability type is also measured and is categorised according to responses provided concerning the type of condition(s) and whether the condition(s) restricted everyday activities.

The 2008 NATSISS is the most comprehensive source of information on disability for the Indigenous population, and is the only source that collects information on disability type and disability status other than profound/severe disability. However, the information on disability is limited to persons aged 15 years and over and the sample size is not large enough to produce reliable estimates for geographies lower than the State/Territory level. All Australian comparisons are available from the General Social Survey (GSS), although these cover non-remote areas only.

In this monograph, data from the 2008 NATSISS is used to provide detailed information on the types of disability among the Indigenous population and is also compared with 2006 GSS data for all Australians. Data from the 2008 NATSISS is also used to provide information on barriers to accessing services.

Other collections

The National Health Survey includes a disability module, which provides data for the general Australian population: however the comparable Indigenous survey (National Aboriginal and Torres Strait Islander Health Survey (NATSIHS)) does not include such a module for the Indigenous population. It only collects information on whether a person has a long-term health condition; it does not distinguish between those with a long-term health condition that restricts their everyday living (persons considered to have a disability), and those with a long-term health condition without a disability.

The Survey of Education and Training, the Time Use Survey and the National Survey of Mental Health and Wellbeing are other ABS surveys which collect information on severity of disability among the general population. However, none of these surveys include an Indigenous identifier. Finally, administrative data from the Disability Services National Minimum Data Set (DS NMDS) is used to provide information on users of disability services.

Estimates from the data collections

The strengths and limitations of these collections are outlined in Table 2.1. Further detail on data source gaps and limitations is discussed in Chapter 4.

Table 2.1 Data sources on disability prevalence among the Australian Indigenous population

Data collection

Number of questions related to disability status

Latest collection year

Expected future collections

Data for which the collection is the recommended source

Survey limitations

SDAC

75

2009

2015

Not recommended for Indigenous disability prevalence

Sample size for Indigenous population too small to produce reliable estimates

Does not cover very remote areas

No small area data

2006 and 2011 Census

4

2011

2016

Prevalence of disability for Indigenous persons of all ages

Comparisons of Indigenous and non-Indigenous population

Small area data

Only one disability measure is available (need for assistance) which is conceptually related to profound/severe core activity limitation

Non-response rate 6.4% for ‘need for assistance’, indicating possible response bias

NATSISS

10

2008

2014

Disability status

Type of disability measures

Relationship between disability and labour force, employment and health characteristics

No small area data

Non-Indigenous comparisons only available for non-remote areas using common criteria

Source: Author’s analysis

The data collections discussed above employ different methods to identify persons with disability, and use incompatible criteria for classifying a person as having a disability. In addition, the way in which information is collected affects the number of people identified as having a disability. The NATSISS interviewed one adult per household. In the Census, information is collected via a paper questionnaire generally completed by one person on behalf of an entire household. As a consequence, the number and proportion of Indigenous persons with a disability estimated or enumerated varies. It is important to note that the short disability module used in the NATSISS does not separately identify people with a long-term health condition only and without disability. The module does include the concept ‘with disability or long term health conditions’. It should also be noted that the surveys considered in the analysis cover different collection periods. However, as prevalence rates only change slowly over time, it is unlikely that this creates a significant margin of error in regard to impact on the identified disability populations.

Table 2.2 Need for assistance compared with severe/profound core activity limitation, Indigenous and all Australians, by age-group, 2006 and 2008

Needs assistance with core activities (Census 2006)a

Severe/profound core activity limitations (NATSISS 2008, GSS 2006)b

Age group

Indigenous

Non-Indigenous

Indigenous Australians (NATSISS 2008)

All Australians (GSS 2006)

0–4

620

10 467

not collected

not collected

5–14

3 025

49 467

not collected

not collected

15–24

4 133

68 096

5 218

15–17 not collected

25–34

1 522

31 911

3 904

62 056

35–44

2 533

51 110

4 223

114 503

45–54

3 116

74 377

4 676

112 025

55–64

2 991

105 588

3 994

188 515

a. Self-reported.

b. Survey administered by interviewer. NATSISS 2008 did not collect disability status 0–14 years, GSS 2006 reports 18 years onward.

Source: AIHW 2011b

For Indigenous persons aged 15 years and over, the number and rate for profound or severe activity limitation was higher for the NATSISS (around 8%) than the Census (6%) (Table 2.2). The number of Indigenous persons with a severe or profound core activity limitation is higher in the 2008 NATSISS than the 2006 Census for all age groups. Similarly, the number of non-Indigenous persons estimated to have severe/profound core activity limitations is higher in the 2006 GSS than the 2006 Census for all age groups. The Indigenous to non-Indigenous rate ratios of severe or profound limitation were fairly consistent between the two surveys, indicating disability rates for Indigenous Australians approximately twice that for non-Indigenous Australians.

A likely explanation for these differences is that while the NATSISS is designed to collect data on the full range of disability severity, the census uses a collapsed question set that specifically targets those with a need for assistance in at least one of the core activity areas. The more the concept of ‘need for assistance’ is collapsed into a reduced number of questions, the less opportunities there are for people to be identified and correctly categorised, resulting in lower proportions. The census with its four questions produces lower estimates of people being identified as needing assistance with core activities than the NATSISS with its 10 question set.

Profile of disability among Indigenous Australians

This section’s disability prevalence data is sourced from the 2006 Census of Population and Housing (Census 2006) and the 2008 NATSISS. Census data is used to provide information on the age profile of Indigenous persons with a disability, and regional analysis on where they live. NATSISS data is used to provide information on disability type and socioeconomic and health characteristics of Indigenous persons with disability.

Number of persons with a disability

According to the 2006 Census, 19 600 Indigenous Australians (4.6%) had a core activity need for assistance, which is conceptually equivalent to severe or profound core activity limitation. After adjusting for differences between the two populations in terms of both age structure and the rate of ‘unstated’ need for assistance, Indigenous Australians were 1.8 times as likely as non-Indigenous Australians to need assistance with activities of daily living.

Among Indigenous Australians aged under 65 years (15 700), 3.8 per cent had a core activity need for assistance, and were 2.4 times as likely as non-Indigenous Australians of the same age to need assistance with activities of daily living. According to the 2008 NATSISS, around 26 000 Indigenous Australians aged 15 years and over (7.9%) had a severe or profound core activity limitation. This survey however highlights that this group only represents the ‘tip of the iceberg’ with regard to Indigenous disability and disadvantage. More generally it found that of the total Indigenous population aged 15 years and over almost half (49.8%)—some 163 000 people—had some type of disability or long-term health condition.

Age profile of Indigenous persons with disability

The age profile of the Indigenous disability population may vary depending on the area in which they live, and this may affect the services that are most appropriate for their needs. The age distribution of Indigenous persons who had a core activity need for assistance by remoteness using data from the 2006 Census is shown in Table 2.3. Australia-wide, 18 per cent of the Indigenous disability population were aged 0–14 years, 10 per cent were aged 15–24 years, 21 per cent were aged 25–44 years, 31 per cent were aged 45–64 years, and 20 per cent were aged 65 years and over. The age profile of Indigenous persons requiring assistance with core activities in remote areas was older, with around double the proportion being aged 65 years and over in remote areas compared to regional areas and major cities. Not surprisingly, rates of disability among the total Indigenous population increased with age, with 28 per cent of Indigenous persons aged 65 years and over having a core activity need for assistance.

Table 2.3 Indigenous persons with a core activity need for assistance, by age group and Indigenous status, Australia, 2006

Needs assistance with core activities (Census 2006)a

Severe/profound core activity limitations (NATSISS 2008, GSS 2006)b

Age group

Indigenous

Non-Indigenous

Indigenous Australians (NATSISS 2008)

All Australians (GSS 2006)

0–4

620

10 467

not collected

not collected

5–14

3 025

49 467

not collected

not collected

15–24

4 133

68 096

5 218

15–17 not collected

25–34

1 522

31 911

3 904

62 056

35–44

2 533

51 110

4 223

114 503

45–54

3 116

74 377

4 676

112 025

55–64

2 991

105 588

3 994

188 515

Source: AIHW analysis of 2006 Census data (unpublished)

The ratio of the rate of needing assistance with core activities, for Indigenous and non-Indigenous Australians by age group is shown in Fig. 2.1. The disparity in rates between Indigenous and non-Indigenous is greatest for the 45–54 and 55–64 year age groups, with Indigenous Australians in these age groups being almost three times as likely to require assistance as non-Indigenous Australians. This reflects the pattern of premature ageing seen among the Indigenous population, expressed in a greater chronic disease burden in middle and later life, and shorter life expectancy (Vos et al. 2009).

Fig04_NDIS.tif

Fig. 2.1 Need for assistance with core activities by Indigenous Australians compared to non-Indigenous Australians, 2006

Based on rates standardised to the age- and sex-distribution of the Australian population.

Excludes people who did not respond to the census questions concerning disability.

A rate ratio greater than 1 means that Indigenous Australians were more likely than non-Indigenous Australians of the same age to need assistance with core activities. Higher rate ratios mean larger differences.

Source: AIHW 2009a; see Appendix Table A5.1

Where do Indigenous people with a disability live?

Of the close to 20 000 Indigenous persons counted in the 2006 Census as needing assistance with core activities, approximately 7 000 (36%) lived in major cities, 9 000 (46%) in regional areas, and 3 500 (18%) in remote/very remote areas. At a State level, differences in the number of Indigenous persons with disability largely reflected differences in the population of each State, with the largest number of Indigenous persons with disability being in New South Wales and Queensland and the smallest number in the Australian Capital Territory and Tasmania (Table 2.4). At the statistical division level, Sydney had the highest numbers of Indigenous persons requiring assistance with core activities, followed by the balance of the Northern Territory, and Brisbane (see Appendix Table A5.2).

Slightly more Aboriginal and Torres Strait Islander people living in major cities and inner regional areas of Australia were suggested by the 2006 Census as needing assistance with a core activity (around 5%), as compared with remote (4%) and very remote areas (3.3%). Rates of disability ranged from 5.7 per cent of Indigenous Australians in Victoria to 3.6 per cent in the Northern Territory.

Reported rates of disability were highest in remote areas of Victoria (31.6%) and lowest in very remote areas of Queensland (2.5%). The Statistical Divisions with the highest proportion of Indigenous persons needing assistance with core activities was Wimmera in Victoria (7.6%), followed by Barton in New South Wales (6.6%) and East Gippsland in Victoria (6.6%).

Table 2.4 Number and proportion of Indigenous persons with a core activity need for assistance, by State/Territory and remoteness, Australia, 2006

NSW

Vic

Qld

SA

WA

Tas

NT

ACT

Aust

Number of Indigenous persons with a core activity need for assistance

Major cities

3 074

760

1 574

654

801

na 

na

150

7 013

Inner regional

2 294

614

1 152

95

172

486

na

0

4 824

Outer regional

1 218

209

1 309

294

343

355

376

na

4 104

Remote

242

12

315

44

343

25

484

na

1 465

Very remote

37

na

433

155

606

7

883

na

2 121

Total

6 901

1 602

4 806

1 253

2 274

876

1 746

150

19 619

Proportion of Indigenous population with a core activity need for assistance (%)

Major Cities

5.5

5.5

4.6

5.6

4.3

na

na

4.0

5.1

Inner regional

5.3

6.3

4.7

4.4

4.0

5.7

na

0.0

5.2

Outer regional

5.1

4.8

3.9

5.4

4.3

5.1

4.0

na

4.5

Remote

4.2

31.6

3.2

4.4

4.1

6.5

4.5

na

4.0

Very remote

3.7

na

2.5

4.5

4.2

3.6

3.1

na

3.3

Total

5.3

5.7

4.0

5.3

4.2

5.4

3.6

4.0

4.6

Distribution by State of Indigenous population with core activity need for assistance (%)

Major cities

44.5

47.4

32.8

52.2

35.2

na

na

100.0

35.7

Inner regional

33.2

38.3

24.0

7.6

7.6

55.5

na

0.0

24.6

Outer regional

17.6

13.0

27.2

23.5

15.1

40.5

21.5

na

20.9

Remote

3.5

0.7

6.6

3.5

15.1

2.9

27.7

na

7.5

Very remote

0.5

na

9.0

12.4

26.6

0.8

50.6

na

10.8

Total

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

na = combination of State/Territory and remoteness category not defined.

Source: ABS Census of Population and Housing 2006

After adjusting for differences in age structure, Indigenous persons were more likely to require assistance with core activities than non-Indigenous persons in all States and Territories (Fig. 2.2). The greatest disparity in rates was observed in the Northern Territory and Western Australia, with Indigenous Australians just over twice as likely to need assistance with core activities as non-Indigenous Australians. Remote and very remote areas had the greatest disparity in rates of disability, with Indigenous persons 2.3 and 2.5 times more likely than non-Indigenous persons in these areas to have a core activity need for assistance.

Fig05_NDIS.tif

Fig. 2.2 Need for assistance with core activities, by State/Territory and Indigenous status, Australia, 2006

Source: AIHW analysis of 2006 Census (unpublished); Appendix 5 (this volume), Table A5.3

Fig06_NDIS.tif

Fig. 2.3 Need for assistance with core activities, by remoteness and Indigenous status, Australia, 2006

Source: AIHW analysis of 2006 Census (unpublished); See Table A5.a

In 2006, 10 per cent of Indigenous Australians who needed assistance with core activities were living in a hospital, residential aged care facility, hostel for the disabled, or other non-private dwelling, compared to 19 per cent of non-Indigenous Australians (ABS and AIHW 2008). This may reflect the very different age profile of the Indigenous population with a disability, as well as the greater spread across the population.

What types of disability are experienced by Indigenous people?

The 2008 NATSISS provides information on the types of disability experienced by Indigenous Australians. Physical disability is the most common type of disability group among Indigenous Australians with severe or profound core activity limitations, consistent with the experience of Australians generally (AIHW 2009a). Among Indigenous Australians aged 15–64 years with severe or profound disability, 82 per cent experience physical disability. Sight, hearing and speech related disability is the next most common among those with severe or profound core activity limitations, at 42 per cent; and around 30 per cent experience intellectual or psychological-related disability (Table 2.5).

Table 2.5 Indigenous Australians aged 15–64 with severe or profound core activity limitations, by disability group, 2008a

Disability group (note people can identify multiple groups)b

Number

Per cent

Sight, hearing, speech

9 167

41.6

Physical

18 061

82.0

Intellectual

6 362

28.9

Psychological

6 196

28.1

Total

22 015

a. 2008 NATSISS excluded special dwellings where higher proportions of people with severe and profound disability may be found.

b. The disability types are not mutually exclusive.

Source: AIHW analysis of 2008 NATSISS; AIHW 2011b

According to the 2008 NATSISS, half of all Indigenous Australians aged 15 years and over had some type of disability or long-term health condition. Approximately one-third (33%) were classified as having a physical disability, 17 per cent with sight, hearing or speech impairments, 8 per cent with an intellectual impairment, and 8 per cent with a psychological disability. Rates of intellectual and psychological disability were statistically significantly higher in non-remote than remote areas, while rates of sight, hearing and speech-related disability were significantly higher in remote than non-remote areas (Table 2.6).

Table 2.6 Indigenous Australians aged 15 years and over with disability or long-term health condition, by remoteness, 2008a

Disability type

Remote

(%)

Non-remote

(%)

Total

(%)

Sight, hearing, speech

21.1*

15.7*

17.0

Physical

30.5

33.3

32.6

Intellectual

3.8*

9.0*

7.7

Psychological

5.1*

8.7*

7.8

Type not specified

22.6

25.0

24.4

Total with a disability or long-term health condition

48.8

50.2

49.8

No disability or long-term health condition

51.2

49.8

50.2

Total

100.0

100.0

100.0

a. Data presented in this table are limited to the common set of criteria used in remote and non-remote areas. Data are therefore not comparable with 2002 or 2008 NATSISS data for people in non-remote areas only, nor with disability data from the 2002 GSS or 2007–08 National Health Survey (NHS).

* Statistically significant difference at the 5% level of significance in the remote/non-remote comparisons.

Source: AIHW analysis of 2008 NATSISS; Steering Committee for the Review of Government Service Provision (SCRGSP) 2011)

While rates of physical disability and sight, hearing and speech impairment increased with age among Indigenous persons aged 15 years and over, rates of intellectual and psychological-related disability were fairly similar across all age groups (Fig. 2.4).

Fig07_NDIS.tif

Fig. 2.4 Type of disability, Indigenous persons aged 15 years and over in non-remote areas, by age group, Australia, 2008

Source: 2008 NATSISS; see Appendix Table A5.5

Information on disability type for the non-Indigenous population is available from the 2006 GSS for non-remote areas only. After adjusting for differences in age structure between the Indigenous and non-Indigenous populations, Indigenous persons living in non-remote areas had higher rates of disability than non-Indigenous Australians living in non-remote areas for all types of disability except for sight, hearing and speech impairment, for which rates were similar for the two population groups. The greatest disparity in rates was for intellectual disability, for which rates were 3.2 times higher among the Indigenous population.

Fig08_NDIS.tif

Fig. 2.5 Persons aged 15 years and over in non-remote areas, by type of disability, Australia, 2006 (non-Indigenous) and 2008 (Indigenous)

Source: 2008 NATSISS and 2006 GSS; see Appendix Table A5.5

Impact on education and employment

The 2008 NATSISS collected additional information from Indigenous persons who were classified as having a disability, on whether they had an education or employment restriction due to disability. Approximately 5 per cent of Indigenous persons aged 15–64 years with a disability were classified as having an education restriction due to disability, and 16 per cent were classified as having an employment restriction (Table 2.7 and Table 2.8). Rates of education restriction were highest among those aged 15–24 years (14.4%). Rates of employment restriction were highest among those aged 45–54 years (19.7%).

Table 2.7 Indigenous persons with a disability or long-term health condition aged 15–64 years, by education restriction due to disability and age group, Australia, 2008

Age group

Has an education restriction due to disability

Does not have an education restriction due to disability

Total with a disability

No.

%

No.

%

No.

%

15–24

5 339

14.4

31 775

85.6

37 113

100.0

25–34

907

3.0

28 896

97.0

29 803

100.0

35–44

479

1.5

32 382

98.5

32 862

100.0

45–54

532

1.7

30 682

98.3

31 214

100.0

55–64

310

1.5

19 965

98.5

20 275

100.0

Total

7 567

5.0

143 701

95.0

151 267

100.0

Source: AIHW analysis of 2008 NATSISS (unpublished data)

Table 2.8 Indigenous persons with a disability or long-term health condition aged 15–64 years, by employment restriction due to disability, and age group, Australia, 2008

Age group

Has an education restriction due to disability

Does not have an education restriction due to disability

Total with a disability

No.

%

No.

%

No.

%

15–24

5 339

14.4

31 775

85.6

37 113

100.0

25–34

907

3.0

28 896

97.0

29 803

100.0

35–44

479

1.5

32 382

98.5

32 862

100.0

45–54

532

1.7

30 682

98.3

31 214

100.0

55–64

310

1.5

19 965

98.5

20 275

100.0

Total

7 567

5.0

143 701

95.0

151 267

100.0

Source: AIHW analysis of 2008 NATSISS (unpublished data)

Fig09_NDIS.tif

Fig. 2.6 Education or employment restriction due to disability, Indigenous persons aged 15–64 years, Australia, 2008

Source: AIHW analysis of 2008 NATSISS; see Appendix Table A5.6

A higher proportion of Indigenous persons with disability living in non-remote areas had an education restriction compared to those living in remote areas (5.8% compared to 2.3%). The proportion of Indigenous persons who had an employment restriction due to disability was similar for remote and non-remote areas. Interpreting this data is somewhat difficult due to the fact that educational restrictions only tend to be identified in the case of individuals for whom education may be seen as an option. This data may thus be affected by low levels of educational participation and aspirations. In addition the NATSISS does not contain data in this regard for those aged under 15 years.

Has disability among the Indigenous population changed over time?

The 2002 NATSISS provides some comparable data on disability with the 2008 NATSISS, based on the common criteria used in remote and non-remote areas.

The prevalence of severe or profound core activity limitation remained fairly stable between 2002 (7.7%) and 2008 (7.9%) among Indigenous Australians in remote or non-remote areas (Table 2.9). Data indicates the possibility of an increase in rates of ‘disability /restriction not defined’ and ‘total with disability or long-term health condition’, in both remote and non-remote areas. Rates of disability or long-term health conditions increased from 35 per cent to 49 per cent in remote areas, and from 37 per cent to 50 per cent in non-remote areas.

Table 2.9 Severity of disability, Indigenous Australians aged 15 years and over by remoteness, 2002 and 2008a

Remote (%)

Non-remote (%)

Total (%)

2002

Total with profound/severe core activity restriction

8.9

7.3

7.7

Disability/restriction not defined

26.5*

29.6*

28.7*

Total with disability or long-term health condition

35.4*

36.9*

36.5*

2008

Profound/severe core activity restriction

8.1

7.9

7.9

Disability/restriction not defined

40.7*

42.3*

41.9*

Total with disability or long-term health condition

48.8*

50.2*

49.8*

a.Data presented in this table are limited to the common set of criteria used in remote and non-remote areas. Data are therefore not comparable with 2002 or 2008 NATSISS data for people in non-remote areas only, nor with disability data from the 2002 GSS or 2007–08 NHS.

*Statistically significant difference in the 2002 and 2008 comparisons at the 5% level of significance.

Source: 2002 and 2008 NATSISS; SCRGSP 2011

Socioeconomic characteristics of Indigenous persons with a disability

Income

Financial circumstances strongly influence the degree to which an individual with disability can participate in society. People with disability tend to have fewer financial resources than those without disability. Figure 2.7 gives the per cent of the Indigenous population both with and without a disability who fall into each of the five income quintiles, calculated using the distribution of the total population. While both groups are under-represented in the highest income quintiles (reflecting the lower income of Indigenous compared to non-Indigenous households), those with severe or profound core activity limitations are much more likely to be found in lower income households than those without a disability. Among Aboriginal and Torres Strait Islander peoples in the 25–54 years age groups, the median income for those who needed assistance with a core activity was around 60 per cent of that for Indigenous Australians who did not need assistance.

Fig10_NDIS.tif

Fig. 2.7 Disability status by equivalised gross household income, Aboriginal and Torres Strait Islander people aged 15 years and over, Australia, 2008a.

a. Total with a disability or long-term health condition as determined by the common (remote + non-remote) criteria.

Source: 2008 NATSISS; ABS 2011; see Appendix Table A5.7

Employment

The level of employment among Indigenous Australians aged 15–64 years with core activity assistance needs was only about one-quarter that of other Indigenous Australians of the same age (13% and 51% respectively) (AIHW 2011b). Of Aboriginal and Torres Strait Islander people aged 15–64 years reporting core activity limitations, 80 per cent were not in the labour force, compared with 38 per cent of those not reporting core activity limitations.

Although employment levels were higher, a similar pattern was evident among non-Indigenous people aged 15–64 years, where 17 per cent of those with a need for assistance were employed, compared with 73 per cent of those without need for assistance (Table 2.10).

Table 2.10 Employment status by Indigenous status and need for assistance, Indigenous and non-Indigenous Australians aged 15–64 years, 2006

Need for assistance

No need for assistance

Employment status

Indigenous

Non-Indigenous

Indigenous

Non-Indigenous

Proportion of the population (%)

Employed

12.9

16.5

51.3

73.2

Unemployed

3.4

2.5

9.4

3.9

Not in the labour force

83.7

81.0

39.3

22.9

Sub-total: not participating in the labour force

87.1

83.5

48.7

26.8

Total persons (no.)

11 592

285 198

230 723

11 711 602

Source: AIHW 2011b

These data suggest that disability strongly influences employment outcomes among Indigenous people, to a degree similar to that experienced by non-Indigenous people with the same severity of disability.

Source of income

With such low employment it is not surprising that there is a much greater reliance on government pensions and allowances among Indigenous Australians with severe or profound disability. Nearly two-thirds (64%) of Indigenous Australians aged 18–64 years with severe or profound core activity limitations relied on government pensions and allowances as their principal source of income: double that of Indigenous Australians without disability or long term health conditions (32%) (Table 2.11).

The 2006 GSS of all Australians found 56 per cent of those aged 18–64 years with severe or profound disability relied on government pensions and allowances as their principal source of income, compared with 10 per cent of those without disability (Table 2.11).

Table 2.11 Principal source of income by disability level and Indigenous status, Australia, 2006 and 2008a

Principal source of income

Severe or profound core activity limitations

No disability or long-term health conditions

Indigenous Australians (%)

All Australians (%)

Indigenous Australians (%)

All Australians (%)

Employee income

20.2

20.2

50.9

66.7

Government pensions & allowances

64.4

56.3

31.9

9.9

Otherb

15.4

23.5

17.2

23.4

Total persons (no.)

20 721

516 487

135 441

8 477 923

a. Includes unincorporated business income, CDEP income, investment income, other income and undefined.

b. 2008 NATSISS and 2006 GSS excluded special dwellings where higher proportions of people with disability may be found, and 2006 GSS excluded very remote and sparsely settled areas.

Source: AIHW analysis of 2008 NATSISS and 2006 GSS; AIHW 2011b

These findings are consistent with 2006 Census data indicating that people with disability are clustered at the lower-income levels. The income patterns for Indigenous and non-Indigenous Australians with disability are very similar, reinforcing the suggestion that there is a strong relationship between income and disability.

Education

Education plays a significant role in developing the skills and abilities of people with disability; supporting them in their learning goals, providing a foundation for breaking free from the type of entrenched disadvantage financial hardship causes, and fostering their participation in Australian society (AIHW 2009a; National People with Disabilities and Carer Council 2009). As seen in Fig. 2.8 (from AIHW 2011b), Year 12 attainment rates were much lower among 18–64 year old Indigenous Australians with severe or profound disability (16%), compared with Indigenous Australians without disability (28%). The rates for all Australians are significantly higher and the 2006 GSS showed that 31 per cent of all Australians with more severe disability and 58 per cent of those without disability completed Year 12. Of particular note is that an estimated 45 per cent of Indigenous Australians aged 18–64 years with severe or profound disability left school at Year 9 or below, almost double that of other Indigenous Australians (24%). This pattern is even more pronounced among the Australian population generally.

Fig11_NDIS.tif

Fig. 2.8 Highest school attainment, by disability and Indigenous status, age 18–64 years, 2006 and 2008a

a. 2008 NATSISS and 2006 GSS excluded special dwellings where higher proportions of people with disability may be found and 2006 GSS excluded very remote and sparsely settled areas.

Source: AIHW analysis of 2008 NATSISS and 2006 GSS; AIHW 2011b; see Appendix Table A5.8

Just under one-third (30%) of Indigenous Australians aged 18–64 years with severe or profound core activity limitations had an interest in further study in the 12 months preceding the survey. This is slightly higher than Indigenous people without disability in the same age range (27%). The most frequently cited reason among Indigenous Australians with severe or profound disability for not studying further was personal caring and other family reasons (see Appendix Table A5.9).

The health and wellbeing of Indigenous persons with a disability

Self-assessed health status

While self-assessed health status is a subjective measure, perceptions of health are important to mental and physical wellbeing. As Fig. 2.9 reveals, Indigenous Australians with severe or profound core activity limitations are far more likely to assess their health as fair or poor (59%) than Indigenous Australians without disability (8%). This is consistent with the pattern seen among the Australian population generally, where 55 per cent of all people with severe or profound disability assess their health as fair or poor compared with 3 per cent of all people without disability. Among Indigenous Australians without disability, perceptions of health are more closely aligned with those of Australians without disability than with Indigenous Australians with severe or profound disability (Fig. 2.9).

Fig12_NDIS.tif

Fig. 2.9 Self-assessed health, by disability and Indigenous status, age 18–64 years, Australia, 2006 and 2008a

2008 NATSISS and 2006 GSS excluded special dwellings where higher proportions of people with disability may be found and 2006 GSS excluded very remote and sparsely settled areas.

Source: AIHW analysis of 2008 NATSISS and 2006 GSS; AIHW 2011b; see Appendix Table A5.10

Stressors

Stressors have a significant impact on quality of life and over time and may influence mental and physical wellbeing. They include stressful life events such as divorce, domestic violence, losing one’s job, and overcrowding at home. Along with lower perceptions of health, Indigenous Australians with severe or profound core activity limitations experience such events at greater rates than other Indigenous Australians (Fig. 2.10). This is consistent with findings of the 2007–08 National Health Survey (NHS), that among all Australians, people with a disability are more likely than those without disability to experience stressful life events.

Fig13_NDIS.tif

Fig. 2.10 Number of stressors experienced in the previous 12 months, Indigenous Australians, 2008a

a. 2008 NATSISS included remote, very remote and indigenous communities but excluded special dwellings where higher proportions of people with severe and profound disability may be found.

Source: AIHW analysis of 2008 NATSISS; AIHW 2011b; see Appendix Table A5.11

Health risk factors

It has been reported elsewhere that Indigenous Australians are more likely than non-Indigenous Australians to be smokers, and that among Australians generally, people with a disability are more likely than those without a disability to smoke (AIHW 2011b). Consistent with this evidence, the 2008 NATSISS shows that Indigenous Australians aged 15–64 years with severe or profound core activity limitations have higher rates of daily smoking (52%), compared with Indigenous Australians without disability (42%). The latest ABS figures suggest that Indigenous Australians aged 15 years and over were twice as likely as non-Indigenous people to be current daily smokers (ABS 2010c). Rates of risky alcohol consumption and substance use have also been found to be slightly higher among Australians aged 15–64 years who have severe or profound disability (AIHW 2011a). However, this pattern is not seen among Indigenous Australians (Table 2.12).

Table 2.12 Indigenous Australians aged 15–64 years, health risk factors by disability status, 2008a

Severe/profound core activity limitations

No disability or long-term health conditions

Factor

No.

%

No.

%

Smoker daily

11 380

52

67 989

42

Medium to high risk alcohol consumption

3 134

14

26 893

17

Substance use in last 12 months

4 665

21

32 181

20

Total

22 015

100

160 990

100

a. 2008 NATSISS included remote, very remote and indigenous communities but excluded special dwellings where higher proportions of people with severe and profound disability may be found.

Source: AIHW analysis of 2008 NATSISS; AIHW 2011b

1 Since the analysis for this monograph was undertaken, some data on disability prevalence from the 2011 Census has been released.


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