About this topic
Aboriginal and Torres Strait Islander people (Indigenous Australians) consider the body, mind and spirit to be interconnected (Dudgeon et al. 2017; Gee et al. 2014). This means that physical health, including factors such as health conditions, infectious diseases and disability, can affect mental health and wellbeing (AIHW 2016a; Dudgeon et al. 2017).
Connection to body
Connection to body is 1 of the 7 domains of social and emotional wellbeing for Indigenous Australians.
Social and emotional wellbeing is a holistic way of looking at relationships between individuals, family, kin and community in the context of land, culture, spirituality and ancestry. Cultural groups and individuals each have their own interpretation of social and emotional wellbeing (Gee et al. 2014).
Access to healthy food and culturally safe health services can enhance connection to body. Poor diet, smoking, and chronic and communicable diseases can detract from connection to body (PM&C 2017).
Many Indigenous Australians experience good physical health as feeling strong and healthy and having respect for their body. A nutritious diet, physical activity, and avoiding the use of harmful substances are all positive influences on health (Dudgeon & Walker 2015; Dudgeon et al. 2017). Physical health can also be influenced by the environment in which an individual lives. This includes factors such as secure access to nutritious food and the absence of infectious diseases.
Indigenous Australian communities are a priority population in the Australian Government’s response to the COVID-19 virus. Key issues include food security, safety of remote communities, and access to support and services (Davy 2016; Furlong & Finnie 2020; NIAA 2021).
People with underlying medical conditions can be at higher risk of contracting COVID-19. Lockdowns affect Indigenous Australians who are deeply interconnected with family and community members, especially if caring responsibilities are disrupted. There are heightened impacts on:
- remote communities and those associated with them due to the increased isolation and loss of freedom of movement
- those who cannot access waterways, songlines and country
- those who cannot attend to cultural and sorry business (AIHW & NIAA 2020)
Physical health conditions
Some physical health conditions—such as diabetes and diseases associated with hearing loss—increase the risk of developing mental health problems (AIHW 2015; Burrow & Ride 2016; Hogan et al. 2011).
Hearing loss in childhood can lead to linguistic, social and learning difficulties and behavioural problems in school. Such difficulties may reduce educational achievements and have lifelong consequences for wellbeing, employment, income, social success, contact with the criminal justice system and attaining future potential (Burrow et al. 2009; Hogan et al. 2011; Williams & Jacobs 2009; Yiengprugsawan et al. 2013).
Vision loss can also lead to similar social difficulties, which can limit opportunities in education, employment and social engagement. Visual impairment can affect health-related quality of life, physical mobility and independent living (Access Economics 2010; George Institute for Global Health 2017; Hsueh et al. 2013) and the family dynamic (Alsehri 2016).
Indigenous Australians are at a higher risk of vision and hearing loss than non-Indigenous Australians. For example, Indigenous adults experience higher rates of eye disease (cataract, diabetic retinopathy and trachoma) (Landers et al. 2010; Razavi & Trzesinski 2018). Indigenous children have higher rates of ear infections (Edwards & Moffat 2014; Gunasekera et al. 2007).
Physical activity is important for maintaining good physical and mental health (ABS 2013). Regular participation in physical activity can reduce the risk of many chronic conditions, such as cardiovascular disease, type 2 diabetes and some forms of cancer (Brown et al. 2013; Gray et al. 2013; Sims et al. 2006; Wilmot et al. 2012).
Regular exercise can also help in treating or managing disease (Pedersen & Saltin 2015). It also contributes to overall quality of life through improved mental and social wellbeing, in particular by reducing stress, anxiety and depression (Poulsen et al. 2015; Sanchez-Villegas et al. 2008; Teychenne et al. 2008). Physical activity also helps to improve social and emotional health (Awick et al. 2017; Kantomaa 2010).
The concept of physical activity depends on context: where and how people live (Nelson et al. 2010; Thompson 2009). For example, in some remote Northern Territory communities, physical activity is linked to land management and seasonal cultural activities (Thompson 2009). Activities such as hunting, gathering, and participation in cultural activities are linked to different aspects of life, such as health, social structure, education, building and maintaining relationships, building and maintaining wealth and managing and preserving the environment (Thompson 2009). Physical activities such as dancing, hunting, fishing, and intergenerational programs can provide cultural links and can strengthen social connection and wellbeing (Macniven et al. 2014; Macniven et al. 2017).
Alcohol and other drugs
Alcohol is embedded in social culture for many Australians. Excessive consumption of alcohol is associated with health and social problems in all populations (NHMRC 2008). Indigenous Australians are more likely to abstain from alcohol than non-Indigenous Australians; however, those who do drink are more likely to do so at dangerous levels (ABS 2019). Indigenous Australians who drink alcohol excessively can experience poor mental health and wellbeing (ABS 2019; Gray et al. 2018; NHMRC 2009).
Harmful alcohol consumption can also affect families and communities. It has the potential to lead to anti-social behaviour, violence, family breakdown and contact with the criminal justice system (NHMRC 2009). The pathways between alcohol consumption and mental health and social and emotional wellbeing are complex. Harmful consumption of alcohol may cause or exacerbate mental health conditions. On the other hand, harmful levels of alcohol may be used to cope with poor mental health, as a form of self-medication (Gray et al. 2018; Nadew 2012; Wilkes et al. 2014).
Drug and other substance use is a contributing factor to illness and disease, accident and injury, violence and crime, family and social disruption, education and workplace problems (SCRGSP 2014). Illicit drug use includes the use of illegal drugs, misuse of pharmaceuticals, and use of psychoactive substances (including inhalants) (AIHW 2018).
Substance use is associated with mental health problems (Catto & Thomson 2008) and has been found to be a factor in suicides (Robinson et al. 2011). For communities, there is increased potential for social disruption, such as that caused by family and domestic violence, other community violence, and property crime. Drugs and other substance use play a significant role in Indigenous Australians’ involvement in the criminal justice system (AIHW & NIAA 2020).
In 2014–15, surveyed Indigenous Australians aged 15 and over who reported experiencing a mental health condition were:
- less likely to have exceeded alcohol consumption guidelines for lifetime risk (14.3%) than those with no long‑term health conditions (15.6%)
- more likely to be a daily smoker (46%) than those with no long-term health conditions (39%)
- more likely to have used substances in the last 12 months (39%) than those with no long-term health conditions (29%) (ABS 2016).
From 2011 to 2015, 37% (274 of 746 suicide deaths) of Indigenous suicides were related to alcohol use (Gray et al. 2018).
In 2018–19, among Indigenous users of National Disability Agreement disability support services (12,079 people), the most common types of disability reported were:
- psychiatric disability (37% of service users or 4,496 people)
- physical disability (24% or 2,916 people)
- intellectual disability (15% or 1,842 people) (AIHW 2020).
In 2014–15, based on self-reported survey responses, Indigenous Australians aged 15 years and over with a disability or long-term health condition were more likely to experience ‘high or very high’ psychological distress in the previous 4 weeks (45% or 89,200 people) compared to those with no disability or long-term health condition (23% or 56,300 people) (ABS 2016). Nine per cent (38,900) of people reported having a psychological disability (ABS 2016).
Lifetime risk alcohol consumption guidelines advise healthy males and females to drink no more than 2 standard drinks per day to reduce the risk of harm from alcohol-related disease or injury over their lifetime. In this survey, a person was considered to have exceeded the lifetime risk guideline if they had consumed more than 2 standard drinks per day on average in the previous week. It was assumed the level of alcohol consumption in the previous week was typical.
A current long-term health condition is an illness, injury or disability that was current at the time of the interview and had lasted at least 6 months or was expected to last for 6 months or more (ABS 2019).
National Disability Insurance Scheme (NDIS) provides general support to all Australians who experience disability by referring them to other government services and local or community-based supports. For people with severe and persistent mental health issues, the NDIS provides individualised NDIS plans. These plans include mainstream supports (services provided by other government systems), informal supports (assistance from family, friends, carers and community), and funded support from the NDIS (NDIA 2020).
Psychiatric disability is defined in the AIHW’s Disability Services National Minimum Data Set (DSNMDS) data guide. Psychiatric disability includes recognisable symptoms and behaviour patterns, frequently associated with distress, which may impair personal functioning in normal social activity. It includes the typical effects of conditions such as schizophrenia, affective disorders, anxiety disorders, addictive behaviours, personality disorders, stress, psychosis, depression and adjustment disorders (AIHW 2016b).
Psychological disability is the term used in the National Aboriginal and Torres Strait Islander Social Survey (NATSSIS) to describe a type of disability. A disability refers to a limitation, impairment, disease or disorder that had lasted or was likely to last for at least 6 months or more and restricts everyday activities (ABS 2016).
Information about alcohol and other drugs was compiled from the following data sources: National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19, National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2014–15, and ABS Causes of Death through Gray et al. (2018). More information is available in Data sources.
For more information about the use of alcohol, tobacco and other drugs by Indigenous Australians, see the ABS reports NATSIHS 2018–19 and NATSISS 2014–15 and Gray et al. (2018).
Information about disability was compiled from the following data sources: Disability Services National Minimum Data Set (DSNMDS) and the National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2014–15. More information is available in Data sources.
For more information about disability support for Indigenous Australians, see the AIHW (2019) report Australia’s Welfare 2019 snapshot: Disability support for Indigenous Australians.
For more information about Indigenous Australians and NDIS supports and services, see the Aboriginal and Torres Strait Islander participants report.
Care has been taken to ensure that the results of survey data presented above are as accurate as possible. However, the following factors should be considered when interpreting these estimates:
- Data are collected from a self-report survey, and responses may differ from information available from other sources.
- Results of previous surveys have shown a tendency for people to under-report when asked about certain topics, such as alcohol consumption, smoking and substance use.
- Accuracy of responses may be affected by the length of time between events experienced and participation in the survey.
- Some people may have provided responses they felt were expected, rather than those that accurately reflect their own situation (ABS 2019).
The National Disability Insurance Scheme (NDIS) was launched in trial sites from 1 July 2013, before progressively moving to the full scheme from 1 July 2016, except in Western Australia, where the state-wide roll-out of the NDIS began in 1 July 2018. As expected, many National Disability Agreement service users transitioned to the NDIS and hence exiting the Disability Services National Minimum Data Set (DS NMDS) collection over this time. This transition to the NDIS has affected data from 2013–14 onwards (AIHW 2020).
There is limited information on the mental health of carers in Australia. For Indigenous Australians, the mental health of carers is particularly important for those with disability and children and young people who are cared for by non-parent carers (for example kinship care arrangements).
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