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2.02 Access to functional housing with utilities

Why is it important?

Housing is an important mediating factor for health and wellbeing. Functional housing encompasses basic services/facilities, infrastructure and habitability. These factors combined enable households to carry out healthy living practices including waste removal; maintaining cleanliness through washing people, clothing and bedding; managing environmental risk factors such as electrical safety and temperature in the living environment; controlling air pollution for allergens; and preparing food safely (Bailie et al. 2006; Nganampa Health Council 1987; Department of Family and Community Services 2003).

Children who live in a dwelling that is badly deteriorated have been found to have poorer physical health outcomes and social and emotional wellbeing compared with those growing up in a dwelling in excellent condition (Dockery et al. 2013). Comparisons between Indigenous and non-Indigenous children in the Longitudinal Study of Australian Children (LSAC) show improvements in housing can be expected to translate into gains for Indigenous children's health, social and learning outcomes (Dockery et al. 2013). As expected, housing variables are closely associated with socio­ economic status, including: crowding, renting rather than owning, and being in financial stress (see measures 2.01 and 2.08).

Infectious diseases are more common in households with poor housing conditions. For example, trachoma and acute rheumatic fever are present almost exclusively in the Indigenous population in remote areas (see measures 1.06 and 1.16). Domestic infrastructure, along with overcrowding and exposure to tobacco smoke increases the risk of otitis media in children (Jervis-Bardy et al. 2014) (see measures 1.15, 2.01 and 2.03).

Findings

The 2012–13 Health Survey collected data on household facilities and structural problems. In 2012–13, 22% of Indigenous households were living in houses of an unacceptable standard (more than two major structural problems and less than 4 working facilities for washing people, clothes/bedding, storing/preparing food, and sewerage). This has increased from 17% of Indigenous households in 2008. The highest proportion was in the NT (36%) followed by WA (26%) and NSW (22%).

In 2012–13, more than one-third (34%) of Indigenous households were living in dwellings with major structural problems (including problems such as sinking/ moving foundations, sagging floors, wood rot/termite damage and roof defects). Between 2008 and 2012–13, the proportion rose from 26% to 34%. The standard of housing condition decreased as remoteness increased, with 32% of Indigenous households in non-remote areas living in dwellings with major structural problems compared with 46% of households in remote areas. One in every 6 (15%) Indigenous households reported major cracks in walls/floors. Plumbing problems were more frequent for remote households (18%) compared with non-remote (7%), as were electrical problems (13% for remote compared with 5% for non-remote). Comparable data for non-Indigenous households is not available.

The condition of dwellings may impact on facilities that support healthy living practices including sewerage, washing (people and clothes/bedding) and food preparation. In 2012–13, the proportion of Indigenous households reporting a lack of working facilities increased with remoteness. In remote areas almost a quarter (24%) of households did not have working facilities for preparing food, compared with 8% in non-remote areas. Washing clothes and bedding is also a key issue for remote areas, where 12% of households do not have these facilities compared with 5% of households in non-remote areas. As with the findings for dwellings with major structural problems, the NT and WA have the highest proportions of households reporting a lack of food preparation and washing facilities for clothes/bedding.

Implications

Improved access to functional housing is associated with better health outcomes. An evaluation of the NSW Housing for Health Program found that 'those who received the Housing for Health intervention had a significantly reduced rate of hospital separations for infectious diseases—40% less than the hospital separation rate for the rest of the rural NSW Aboriginal population without the Housing for Health interventions' (NSW Health 2010). Research suggests that housing programmes need to be accompanied by health promotion and environmental programmes to support a reduction in the occurrence of common childhood infections (Bailie et al. 2011a; Bailie et al. 2011b).

The National Partnership Agreement on Remote Indigenous Housing (NPARIH) is a strategy to address overcrowding, homelessness, poor housing conditions and severe housing shortages in remote Indigenous communities. Over 10 years, the agreement will deliver construction of up to 4,200 new houses, and 4,876 upgrades/repairs to existing houses. At June 2014, over 2,556 new houses had been constructed and more than 6,726 houses had been refurbished under this agreement. The NPARIH reforms include standardised tenancy arrangements for all remote Indigenous housing that include repairs, ongoing maintenance and governance arrangements consistent with mainstream public housing standards.

In South Australia, the Aboriginal Environmental Health Worker Program delivers environmental health services in rural and remote communities. The role of Aboriginal environmental health workers is to develop community environmental health plans to guide improvements in community environmental health through interventions in dog control, water management, food safety, pest control and other environmental issues.

Figure 2.02-1 Proportion of Indigenous households in dwellings with major structural problems by remoteness, 2008 and 2012–13
Indigenous households in dwellings with major structural problems

Figure 2.02-1 shows that in 2012–13 over one third (34%) of Indigenous households were living in dwellings with major structural problems (including problems such as sinking/moving foundations, sagging floors, wood rot/termite damage and roof defects). Between 2008 and 2012–13, the proportion rose from 26% to 34%.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 2.02-2 Proportion of Indigenous households in dwellings with major structural problems, by select problem and remoteness, 2012–13
Indigenous households in dwellings with major structural problems

Figure 2.02-2 select structural problems in Indigenous households (major cracks in walls/floors, plubing problems and electrical problems) by remoteness in 2012–13. One in every 6 (15%) of Indigenous households reported major cracks in walls/floors. Plumbing problems were more frequent for remote households (18%) compared to non-remote (7%) as were electrical problems (13% for remote compared to 5% for non remote).

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 2.02-3 Proportion of Indigenous households reporting lack of working facilities for each of the first 4 Healthy Living Practices, by remoteness, 2012–13
Indigenous households reporting lack of working facilities

Figure 2.02-3 shows the proportion of Indigenous households reporting a lack of working facilities for each of the first 4 Healthy Living Practices (washing people; storing/preparing food; washing clothes/bedding; and sewerage facilities) in 2012–13. Data is presented separately for major cities; inner regional areas; outer regional areas; remote areas; very remote areas; and Australia as a whole. In remote areas almost a quarter (24%) of households did not have working facilities for preparing food, compared with 8% in non-remote areas.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 2.02-4 Proportion of Indigenous households living in houses of an unacceptable standard, by state/territory, 2012–13
Indigenous households living in houses of an unacceptable standard

Figure 2.02-4 shows the proportion of Indigenous households reporting housing of an unacceptable standard for each state and territory. In 2012–13, 22% of Indigenous households were living in houses of an unacceptable standard (more than two major structural problems and less than 4 working facilities for washing people, clothes/bedding, storing/preparing food and sewerage). The highest proportion was in the NT (36%) followed by WA (26%) and NSW (22%).

Source: ABS and AIHW analysis of 2012–13 AATSIHS