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2.13 Transport

Why is it important?

Transport is a key enabler for access to health care, goods and services and supports Aboriginal and Torres Strait Islander peoples in maintaining cultural obligations to travel to family commitments (Helps et al. 2010).

Aboriginal and Torres Strait Islander peoples face various barriers to accessing appropriate health care (see measure 3.14) including logistics, cost and reliability of transport options. These challenges have a broader impact on social and economic circumstances of both health-service users who need to travel significant distances while unwell, along with carers who support attendance at services for antenatal care, young children, people with a disability, or people suffering from chronic health conditions, mental health or substance use issues (Lee et al. 2014). Limited or no public transport options significantly impact on the capacity to access specialist health care, particularly for patients with chronic health conditions (Teng et al. 2014) or requiring birthing services (Parker et al. 2014) in rural and remote areas (Kelly et al. 2014).

Findings

In the 2012–13 Health Survey, transport/ distance was a reason 16% of Indigenous Australians reported they did not access health services when they needed to.For specific types of health services, transport/distance was a reported barrier to visiting the dentist (11%), the doctor (14%), other health professionals (13%), counsellors (10%) and hospital (17%). Logistical reasons (transport/ distance, waiting time too long, availability of service in the area) were a greater barrier to accessing a health provider when needed (40%) than cost (36%) or cultural appropriateness of services (32%). Logistical reasons were a greater barrier to accessing hospital services (37%) than cultural appropriateness of services (27%) or cost (8%). Likewise, logistical reasons were a greater barrier to accessing a doctor (34%) than cultural appropriateness of services (23%) or cost (13%). Logistical reasons were second only to cost as a barrier to accessing dental services and other health professionals.

Logistical reasons were a bigger barrier to accessing health services for those living in remote areas (54%) than those living in non-remote areas (37%). This difference was mainly due to the service required not being available in the area; however, transport/distance was also a reason specified by 22% of people in remote areas and 15% in non-remote areas. Of those who did not access dental services, transport/distance was the reason given by 22% of Indigenous Australians in remote areas compared with 9% in non-remote areas.

Since 2004–05 there has been no change in the proportion of Indigenous Australians reporting they did not access dentists and doctors when they needed to because of transport/distance barriers. The proportion not accessing hospitals due to transport/distance problems has reduced by 2 percentage points and the proportion for other health professionals has increased by 5 percentage points.

The 2011 Census found that Indigenous households were less likely than other households to have access to a motor vehicle (81% compared with 91%). In very remote areas 46% of Indigenous households did not have access to a motor vehicle compared with 8% of other households in very remote areas. Indigenous Australians aged 17 years and over were less likely to live in households with a motor vehicle compared with non-Indigenous Australians (77% compared with 94% respectively). This rate did not vary by age.

The 2008 Social Survey found 26% of Aboriginal and Torres Strait Islander adults had used public transport (a regular public or community bus, boat or ferry or train, tram/light rail) in the previous two weeks. Of those who had not used public transport in the previous two weeks, 43% lived in an area in which there was no local public transport available. Use of public transport by Indigenous adults was lower in remote areas (13% in the last two weeks) than in non-remote areas (30%). Of the 65,000 Indigenous adults in remote areas who had not used public transport in the previous two weeks, 83% lived in an area where there was no public transport available. Research has found that 34% of Aboriginal and Torres Strait Islander people were subjected to racism while using public transport (Ferdinand et al. 2012) that, along with availability of public transport, impedes access to services.

In 2012–13, 89% of Aboriginal and Torres Strait Islander primary health care services provided transport to clients as part of their health-related and community programmes. While transport is a key enabler of access to health services, it also poses risks to health if the mode of transport is unsafe, such as a vehicle not in good working order, or a driver operating a vehicle while under the influence of alcohol or drugs (Symons et al. 2012; Fitts et al. 2013). Hospitalisation and deaths due to injuries from transport accidents remain a concern (see measure 1.03).

Implications

While public transportation may compensate for the lack of private transport in non-remote areas, a higher proportion of Indigenous Australians in both remote and non-remote areas have less access to a motor vehicle compared with non-Indigenous Australians. Schemes to assist patients with travel and associated accommodation operate in the various jurisdictions. Other approaches have also been adopted, such as support for specialist services flying into remote localities.

Patient transport services designed to assist patients with chronic illnesses to access health services on a regular basis are an important aspect of health service delivery. This is particularly the case for Indigenous households where private and public transport options are often restricted. Patient transport services are provided by a broad range of services including voluntary groups, Aboriginal Community Controlled Health Organisations (ACCHOs), hospitals and ambulance services. For example, the WA Department of Health has funded patient transport officers and patient journey officers in ACCHOs and area health services to ensure that Aboriginal patients have adequate transport to medical appointments at all levels of the health system (primary, secondary and tertiary). Unfortunately, the provision of these services varies significantly across Australia and access is not always assured. Queensland Health provides the Indigenous Cardiovascular Outreach Program and the Indigenous Respiratory Outreach Care Program to deliver a range of primary, secondary and tertiary health-care services in locations with limited access to specialist services.

Table 2.13-1 Indigenous Australians who did not access health services when needed to and reasons relating to logistics, 2012–13
Dentist Doctor Other health professional Hospital Counsellor

Did not access service when needed to in last 12 months

21% 14% 9% 6% 9%

Reason(s) did not access service

Waiting time too long or not available at time required

20% 22% 17% 25% 12%

Transport/distance

11% 14% 13% 17% 10%

Service not available in area

9% 5% 6%† 3%† 6%

Logistical reasons (subtotal)

33% 34% 28% 37% 22%

Note: Comprehensive significance testing results are published in the Detailed Analyses

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

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 2.13-1 Proportion of households without access to a motor vehicle, by Indigenous status and remoteness, 2011
households without access to a working motor vehicle

Figure 2.13-1 shows the proportion households without access to a working motor vehicle. Data is presented separately for Indigenous households and other households by major cities; inner regional areas; outer regional areas; remote areas; and very remote areas. Refer to the findings section of this measure for a description of key results found in this figure.

Source: ABS and AIHW analysis of 2011 Census

Table 2.13-2 Use of public transport, by remoteness, Indigenous persons aged 18 years and over, 2008
Non remote
(per cent)
Remote
(per cent)
Total
(per cent)
Used public transport in last 2 weeks 30 13 26
Used transport but not public transport in last 2 weeks 69 79 72
Did not use any transport in last 2 weeks 1 7 3
Total 100 100 100
Main reason did not use public transport (a)
Prefer to use own transport or walk 58 13 44
Costs too much/takes too long 3 1.0‡ 3
No suitable services 7 2.3‡ 6
Personal reasons 3 0.3‡ 2
Other 3 0.9‡ 2
Total with access to public transport in local area 74 17 57
No public transport available in local area 26 83 43
Total 100 100 100

a) Proportion calculation excludes 'used public transport in last 2 weeks'

‡ Estimate has a relative standard error greater than 50% and is considered too unreliable for general use.

Source: ABS analysis of 2008 NATSISS.