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1.14 Disability

Why is it important?

Disability may be an impairment of body structure or function, a limitation in activities and/or a restriction in a person's participation in specific activities. A person's functioning involves an interaction between health conditions and environmental and personal factors. Aboriginal and Torres Strait Islander peoples are at greater risk of disability due to increased exposure to factors such as low birthweight, chronic disease, infectious diseases (e.g. otitis media), injury and substance use. Along with limited access to early treatment and rehabilitation services, these factors increase the risk of a person acquiring a disability. Such factors tend to be more prevalent in populations where there are higher rates of unemployment, lower levels of income, poorer diet and living conditions, and poorer access to adequate health care.

Findings

The 2012–13 Health Survey collected data on a broad definition of disability (i.e. those reporting a limitation, restriction, impairment, disease or disorder that has lasted, or is expected to last, for 6 months or more, which restricts everyday activities). Results are self-reported and therefore could be under-stated. In 2012–13, 36% of all Indigenous Australians had a disability or restrictive long-term health condition. Disability increases with age, ranging from 19% of those aged 0–14 years to 67% of the 55 years and over age group. For Indigenous adults (aged 18 years and over), 47% reported disabilities/long-term conditions. Around 10% of Indigenous Australians had a profound, severe or moderate core activity limitation with at least one activity of everyday living (self-care, mobility or communication). A further 9% had schooling/employment restrictions only. Forty-three per cent of Indigenous students aged 5 years and over with a disability reported difficulty with pursuing their education, with 18% needing time off and 9% not attending school/further study due to their condition. Difficulties with employment were reported by 57% of Indigenous Australians aged 15–64 with a disability, including permanently being unable to work (17%) and restrictions in type of work can do (27%). The rates of disability for Indigenous males and females were similar. Of those with a disability, 57% had physical disabilities, 46% sight/hearing/speech disabilities and 19% intellectual disabilities. Variations in self-reported responses by jurisdiction and remoteness may be affected by factors such as perceptions of health and access to health care for diagnosis. Self-reported rates of disability or restrictive long-term health conditions were lowest in the NT (31%) and highest in the ACT (46%). Rates were slightly lower in remote areas (34%) than non-remote areas (36%).

In 2012–13, after adjusting for differences in the age structure of the two populations, Indigenous Australians were 1.5 times as likely to have a disability or restrictive long-term health condition as non-Indigenous Australians, and 1.6 times as likely to have a profound/severe/moderate core activity limitation. Indigenous rates peaked between the ages of 25 to 44 years when compared with non-Indigenous rates of profound/ severe/moderate core activity limitation. Forty-eight per cent of Indigenous Australians aged 18–64 years reporting disability were not in the labour force, compared with 27% of those without. Indigenous Australians aged 15 years and over with a disability were more likely to be in the lowest income quintile than those without (48% compared with 39%). In addition, 6% of Indigenous Australians aged 15 years and over reported serious disability as a personal or family stressor in the last 12 months, twice the non-Indigenous rate.

The 2011 Census collected data on one element of disability (i.e. those reporting the need for assistance with core activities). In the 2011 Census, 5.7% of the total Indigenous population were identified as needing assistance with a core activity (self-care, mobility or communication) some or all of the time. Rates were similar for males (6.1%) and females (5.4%). Variations in self-reported rates by jurisdiction and remoteness should be treated with caution. Rates ranged from 4.8% of Indigenous Australians in WA to 6.9% in Victoria. In 2011, Indigenous Australians were twice as likely to have a core activity need for assistance as non-Indigenous Australians. ACT had the largest gap followed by WA. The proportion of Indigenous Australians with a core activity need for assistance was higher in all age groups; however, rates increase from 40 years on for Indigenous Australians and from around 60 years for non-Indigenous Australians. In 2011, 13% of Indigenous Australians aged 15 years and over provided unpaid care to a person with a disability, long-term illness or problems related to old age, 1.2 times the non-Indigenous proportion.

Carers were less likely to be in the labour force (54%) than non-carers (59%). From the 2012 Survey of Disability, Ageing and Carers, it is estimated that 23% of Indigenous Australians (excluding very remote areas) had a disability; 1.7 times the non-Indigenous rate (SCRGSP 2014a). In 2012–13, 17,400 disability support service users were Indigenous (5.8%) (AIHW 2014p). This has increased from 4.8% in 2008–09. For persons aged under 65 years, Indigenous Australians used disability support services at twice the rate of non-Indigenous Australians (27 per 1,000 compared with 14 per 1,000). Rates of Indigenous service users were highest in the ACT and Victoria (42 and 41 per 1,000) and lowest in Tasmania (16 per 1,000). Rates were higher in non-remote areas (27 per 1,000) than remote areas (16 per 1,000). Intellectual disability was the most common primary disability group (29%), followed by physical (17%) and psychiatric (16%). Most Indigenous service users were aged under 50 years (84%) while for non-Indigenous service users this group was 74%. The most commonly used services were community support (54%) followed by employment services (35%). The disability support pension was the main income source for 52% of Indigenous service users and also non-Indigenous service users. Most Indigenous service users were unemployed (41%) or not in the labour force (28%) (similar to non-Indigenous service users).

Implications

Although disability prevalence varies across data sources, all show a higher rate of disability experience by Indigenous Australians compared with non-Indigenous Australians. The high levels of disability among Aboriginal and Torres Strait Islander peoples are consistent with the levels of disease and injury, socio-economic and environmental factors, health risk factors and lower access to health services relative to need. There is a clear link between disability and socio-economic disadvantage and the relationship between these factors is cyclical (Kavanagh et al. 2013; VicHealth 2012). Lower levels of educational attainment, lower levels of participation in the workforce and lower income are likely to be both the cause and consequence of disability (Biddle, N et al. 2013). Core activity restrictions occur earlier in life for Indigenous Australians.

The National Disability Strategy 2010–2020 provides a 10 year national policy framework for all levels of government to improve the lives of people with disability. The Strategy seeks to drive a more inclusive approach to the design of policies, programmes and infrastructure so that people with a disability can participate in all areas of Australian life and have the opportunity to fulfil their potential as equal citizens. A new plan for improving outcomes for Indigenous Australians with disability will be incorporated as a component of the Strategy's second implementation plan. Through the National Disability Agreement, all Australian governments developed a National Indigenous Access Framework, which aims to ensure the needs of Aboriginal and Torres Strait Islander peoples with disability are addressed through appropriate service delivery arrangements.

The Australian Government has committed $1 billion to support the first stage of a National Disability Insurance Scheme (NDIS). The funding saw NDIS start in mid-2013 for around 10,000 people with significant and permanent disabilities in select locations.

Figure 1.14-1 Disability status by Indigenous status and age group, 2012–13
chart showing Disability status

Figure 1.14-1 shows the proportion of profound/severe/moderate core activity limitation; total with disability/long term health condition or no disability or long-term health condition) among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Data is presented for the following age groups: 0-14 years; 15-24 years; 25-34 years; 35-44 years; 45-54 years; 55 years and over; and the total age-standardised rate. In 2012–13, after adjusting for differences in the age structure of the two populations, Indigenous Australians were 1.5 times as likely to have a disability or restrictive long term health condition as non-Indigenous Australians, and 1.6 times as likely to have a profound/severe/moderate core activity limitation. Indigenous rates peaked between the ages of 25 to 44 years when compared with non-Indigenous rates of profound/severe/moderate core activity limitation.

Note: Totals are age-standardised

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Table 1.14-1 Disability type, by age group, Aboriginal and Torres Strait Islander peoples 2012–13
Disability type 0–5 6–14 15–24 25–34 35–44 45–54 55–64 65+ Total
Sight, hearing, speech% 68% 52% 38% 32% 42% 50% 46% 64% 46%
Physical% 20%† 23% 49% 63% 69% 72% 78% 68% 57%
Intellectual% 20%† 36% 29% 19% 14% 14% 9% 4%† 19%
Psychological% 4%† 14% 21% 30% 25% 28% 19% 10% 21%
Head injury, stroke or brain damage% n.p% 1%† 2%† 5%† 7%† 8% 7%† 8%† 5%
Other% 29% 24% 20% 31% 36% 48% 56% 51% 35%
Total with a disability or long-term health condition (a) 100% 100% 100% 100% 100% 100% 100% 100% 100%

† Estimate has a relative standard error between 25% and 50% and should be used with caution.

(a) Note that more than one disability type may be reported and thus the sum of the components may add to more than the total.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 1.14-2 Proportion of persons with core activity need for assistance, by Indigenous status and age group, 2011
chart showing Proportion of persons with core activity need for assistance

Figure 1.14-2 shows the proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians with core activity need for assistance, by age. The proportion of Indigenous Australians with a core activity need for assistance was higher in all age groups, however rates increase from 40 years on for Indigenous Australians and from around 60 years for non-Indigenous Australians.

Source: ABS and AIHW analysis of 2011 Census data

Figure 1.14-3 Proportion of Aboriginal and Torres Strait Islander peoples with disability/long-term restrictive condition, by jurisdiction and remoteness, 2012–13.
with disability/long-term restrictive condition

Figure 1.14-3 shows the proportion of Aboriginal and Torres Strait Islander peoples with a disability or restrictive long-term condition by jurisidiction and remoteness for 2012–13. Self reported rates of disability or restrictive long term health conditions were lowest in the NT (31%) and highest in the ACT (46%). Rates were slightly lower in remote areas (34%) than non-remote (36%).

Source: ABS and AIHW analysis of 2012–13 AATSIHS