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3.12 Aboriginal and Torres Strait Islander people in the health workforce

Why is it important?

Aboriginal and Torres Strait Islander peoples are significantly under-represented in the health workforce. This potentially contributes to reduced access to health services for the broader Indigenous Australian population. International studies suggest that people prefer seeing health professionals from the same ethnic background (Powe et al. 2004).

The Indigenous Australian workforce is integral to ensuring that the health system has the capacity to address the needs of Aboriginal and Torres Strait Islander peoples. Indigenous health professionals can align their unique technical and sociocultural skills to improve patient care, improve access to services and ensure culturally appropriate care in the services that they and their non-Indigenous colleagues deliver (West et al. 2010; Anderson et al. 2009). In one clinic, the numbers of Aboriginal and Torres Strait Islander patients attending increased markedly following the arrival of an Aboriginal doctor and in response to other changes in the service designed to make it more welcoming. Indigenous patients reported that an Indigenous doctor was 'more understanding of their needs' (Hayman 1999). The gender of the health provider is also important (Ware 2013).

Findings

Analysis of the 2011 Census indicates that, at that time, there were around 8,500 Aboriginal and Torres Strait Islander people employed in health-related occupations. Between 1996 and 2011 the rate of Indigenous Australians employed in the health workforce increased from 96 per 10,000 to 155 per 10,000. In 2011, about 1.6% of the Indigenous population was employed in health-related occupations. However, this is below the proportion of the non-Indigenous population employed in the health workforce (approximately 3.4%).

In 2011, the health occupations with the largest number of Indigenous employees were nursing (2,189), followed by nursing support and personal care workers (1,435), and Aboriginal and Torres Strait Islander Health Workers (1,256). The health occupations with the largest gap between rates of Indigenous and non-Indigenous employees were nurses, medical practitioners and allied health professionals.

South Australia had the highest proportion of its Indigenous population employed in the health workforce (2%) and the NT had the lowest (1%). The 35–44, 45–54 and 55–64 year age groups had the highest rates of Indigenous Australians in the health workforce. Females accounted for 76% of the Indigenous health workforce—similar to the proportion of females in the total health workforce (75%).

Aboriginal and Torres Strait Islander peoples made up 54% of the workforce in Indigenous primary health care organisations as at June 2013 (AIHW 2014a).

Implications

Increasing the size of the Aboriginal and Torres Strait Islander health workforce is fundamental to closing the gap in Indigenous life expectancy.

In February 2011, the Australian Health Ministers' Advisory Council endorsed the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2011–2015). The framework underpins state and territory and Aboriginal community controlled health sector workforce strategic plans across all health disciplines. The framework embraces the aspirational target of 2.6% of the Australian health workforce being Aboriginal or Torres Strait Islander by 2015 (equal to the proportion of Indigenous Australians in the working age population).

The Health Heroes campaign (also known as the Attracting More People to Work in Aboriginal and Torres Strait Islander Health measure) was a component of the Aboriginal and Torres Strait Islander Chronic Disease Fund. The aim of this initiative was to encourage consideration of study and employment in the Indigenous health sector. Evaluation research found that 36% of the target audience was aware of the campaign messages, and as a result many have explored entering the sector through conversations with career counsellors, parents and teachers.

Under the National Registration and Accreditation Scheme, Aboriginal and Torres Strait Islander Health Practitioners commenced registration on 1 July 2012. As at 1 April 2014 there were 324 practitioners registered, with the majority of those being in the NT.

Improving the representation of Indigenous Australians in the health workforce will require collaboration between the health and education sectors and success across a range of fronts. Educational disadvantages faced by Aboriginal and Torres Strait Islander children can reduce options for further training (see measures 2.04 and 2.05). Strategies to address barriers to entry into health professional training, and strengthen support while in training, need to be implemented (see measure 3.20). Improved opportunities for employment, advancement, and retention also require attention.

Aboriginal and Torres Strait Islander health professionals should have access to employment in a broad range of settings within the health sector and attention to the type of occupation is required to avoid under-representation in better remunerated, more skilled and managerial positions.

Table 3.12-1 Employed persons aged 15 years and over, by selected health-related occupation, by Indigenous status, Australia, 1996, 2001, 2006 and 2011
Occupation No.
2011
Indigenous
Rate (per 10,000)
1996
Indigenous
Rate (per 10,000)
2001
Indigenous
Rate (per 10,000)
2006
Indigenous
Rate (per 10,000)
2011
Indigenous
Rate (per 10,000)
2011
Non Indig.
Rate difference 2011 (per 10,000) Period linear % change
Aboriginal and Torres Strait Islander Health Worker 1,256 19.1 21.0 21.3 23.0 0.1 -23.0 19.1*
Nurses 2,189 35.9 27.6 32.0 40.1 129.0 88.9 16.1
Registered nurses 1,713 18.3 20.5 24.5 31.4 103.0 71.6 75.9*
Nurse managers and nursing clinical directors 94 0.6 0.9 1.3 1.7 7.5 5.7 204.2*
Midwives 76 0.8 1.0 1.1 1.4 7.0 5.7 77.2*
Enrolled and mothercraft nurses 284 16.1 5.0 4.8 5.2 8.8 3.6 -77.7
Nurse Educators and Researchers 22 0.2 0.3 0.4 0.4 2.6 2.2 104.6*
Medical practitioners 171 1.7 2.2 2.3 3.2 35.0 31.8 78.2*
Generalist medical practitioners 123 1.2 1.4 1.8 2.3 21.8 19.5 103.3*
General medical practitioner 93 0.8 1.2 1.3 1.7 16.9 15.2 100.5*
Resident medical officer 30 0.3 0.2 0.5 0.6 4.9 4.3 112.1
Other medical practitioners 48 0.6 0.8 0.4 0.9 13.2 12.3 31.3
Allied health professionals 724 5.1 6.7 9.7 13.3 43.9 30.6 179.9*
Dieticians 25 n.p. 0.4 0.2 0.5 1.8 1.4 n.a.
Optometrists 6 n.p. n.p. 0.2 0.1 1.8 1.7 n.a.
Psychologists 82 0.4 0.5 1.0 1.5 9.3 7.8 478.9*
Physiotherapist 75 0.5 0.7 1.2 1.4 8.0 6.6 215.3*
Podiatrist 6 0.2 0.2 0.1 0.1 1.4 1.3 -39.2
Speech professionals and audiologists 17 0.2 0.2 0.4 0.3 3.4 3.1 62.8*
Occupational therapist 24 n.p. n.p. 0.3 0.4 4.6 4.2 n.a.
Social Worker 463 3.2 4.1 5.9 8.5 8.3 -0.2 189.6*
Other health therapy professionals 26 0.3 0.3 0.5 0.5 5.2 4.8 60.5
Dental and dental allied workforce 323 4.2 3.8 4.5 5.9 18.0 12.1 46.4
Dental practitioner 24 0.3 0.3 0.4 0.4 5.5 5.1 34.7*
Dental hygienists, technicians and therapists 32 0.5 0.4 0.3 0.6 3.2 2.6 7.4
Dental assistant 267 3.3 3.1 3.8 4.9 9.3 4.4 54.2*
Health diagnostic and promotion professionals 981 4.7 4.6 14.1 18.0 29.6 11.6 510.2
Medical imaging professionals 21 0.2 0.3 0.4 0.4 6.6 6.3 77.9*
Pharmacists 29 0.2 0.2 0.2 0.5 10.0 9.5 237.1*
Occupational health and safety adviser 193 0.6 0.6 1.1 3.5 7.6 4.0 3,114.4*
Health promotion officers 567 n.a. n.a. 9.7 10.4 2.2 -8.2 n.a.
Environmental health officer 104 3.5 2.8 2.2 1.9 1.7 -0.2 -47.5*
Other health diagnostic & promotion professionals 67 0.2 0.5 0.5 1.2 1.5 0.2 573.6*
Other 2,812 25.6 32.6 43.4 51.6 88.4 36.8 106.9*
Health service managers 54 0.6 n.p. 0.4 1.0 1.3 0.3 n.a.
Nursing support worker and personal care workers 1,435 16.5 19.9 21.7 26.3 34.5 8.2 56.9*
Ambulance officers and paramedics 216 1.4 2.0 3.4 4.0 5.9 1.9 201.6*
Drug and alcohol counsellor 156 2.3 2.4 2.6 2.9 0.7 -2.2 26.2*
Other 951 4.7 6.8 15.3 17.4 46.0 28.5 342.6*
Total health occupations 8,456 96.3 98.6 127.3 155.1 344.1 189.0 69.5*

*represents results that are statistically significant

Source: ABS and AIHW analysis of ABS census data