Making progress 
The health, development and wellbeing of Australia’s children and young people
September 2008

Australian Institute of Health and Welfare
Canberra
Contents
Contents
Foreword
How are Australia’s children and young people faring?
Introduction
Purpose of this report
Mortality
Disability
Jobless families
Family economic situation
Child abuse and neglect
Homelessness
Infant mortality
Teenage births
Birthweight
Breastfeeding
Childhood immunisation
Access to child care
Early childhood education
Injury and poisoning
Chronic disease and mental health
Dental health
Physical activity/screen time
Overweight and obesity
Literacy and numeracy
Crime
Injury and poisoning
Mental health
Overweight and obesity
Substance use
Year 12 retention and completion
Youth participation
Crime
Appendix A: Mapping the indicators to Government priorities and reform
Appendix B: About the data
Abbreviations
Australian jurisdictions

Foreword
The health and wellbeing of Australia’s children and young people is at the centre of policy making in Australia today. Policy initiatives in the areas of health, productivity and social inclusion draw on the principles of early intervention and prevention. The effectiveness of these initiatives depends on the ability to track progress and provide regular feedback to inform the developing reform agendas. This has been recognised as a high priority by all Australian Government departments, and is a primary goal of the Australian Institute of Health and Welfare (AIHW).
This report builds on work undertaken by the AIHW over the last decade on the development and reporting of key national indicators of child and youth health, development and wellbeing, and more recently work undertaken on the Ministerial endorsed Headline Indicators. This report is distinct from previous AIHW reports, as it presents measures of progress for children and young people in a summary, indicator-based format. This report focuses on issues of importance for children and adolescents, including indicators of mental health, risk factors for chronic disease, hospitalisation, mortality, educational achievement in primary and high school, homelessness, jobless families and family economic situation. 
The analysis in this report shows that while many children and adolescents in Australia are doing well, some experience significant physical, social, educational and economic disadvantage, and numerous measures do not compare favourably with other developed countries. 
This report reveals that while much progress has been made, a great deal remains to be done to ensure that all children have the best possible start in life.
The AIHW would like to gratefully acknowledge the valuable input, advice and comments provided by numerous Australian Government Departments, particularly the Australian Bureau of Statistics (ABS), Australian Institute of Family Studies (AIFS), Department of Health and Ageing (DoHA), and the Department of Education, Employment and Workplace Relations (DEEWR),  as well as Professor George Patton (VicHealth Professor Adolescent Health Research, University of Melbourne).

Penny Allbon
Director, AIHW

How are Australia’s children and young people faring? 
This report shows that, while many children and adolescents in Australia are doing well, some experience significant health, social, educational and economic disadvantage, and there are many areas where further gains in health and wellbeing could be achieved. The table below summarises these key areas of concern, as well as some of the recent achievements, in the areas of health, education and wellbeing for different stages of development—early childhood, childhood, adolescence, and for the entire 0–19 age group. The report also identifies where data gaps exist in the national data for monitoring the health and wellbeing of Australian children and youth.

Age range	Achievements	Areas of concern	What don’t we know?	
Across the age span	Mortality rates falling in all age groups	Poor outcomes for Indigenous children and youth in multiple areas (both health and wellbeing)	Prevalence of child abuse and neglect, and whether rate has changed over time	
	Fewer children living in jobless families	High unmet requests for SAAP accommodation for children and youth	Prevalence of disability among Indigenous children and other disadvantaged populations	
Early childhood	Immunisation coverage for 1 and 2 year olds is over 90%	Preschool attendance and teenage fertility compare unfavourably with other OECD countries	Proportion of women exclusively breastfeeding to 4 and 6 months of age	
	Gap in Indigenous infant mortality rates narrowing	High unmet demand for child care due to accessibility barriers, particularly availability of places	Number of children attending early childhood education programs delivered by university qualified teacher in the year before school	
Childhood	Good dental health compared with other OECD countries	Gap in literacy and numeracy for Indigenous students remains high	How many children are physically active according to National Physical Activity Guidelines 
National prevalence of measured overweight and obesity, and whether rates have changed over time	
	Drop in asthma hospitalisation rate	Increase in hospitalisation rates for diabetes		
Adolescence	Reduction in rates of smoking, risky alcohol intake, illicit drug use	High youth unemployment and underemployment 	Rates of physical and sexual assault, and whether rate has changed over time	
	Increase in Year 12 retention rate for Indigenous students	Indigenous youth overrepresented in juvenile justice system, and no change in rates in 6 years	How Australia compares internationally on many of the  health and crime indicators	

In response to the Council of Australian Governments’ (COAG) ‘Closing the gap’ agenda, particular focus is given to Aboriginal and Torres Strait Islander children and young people.  Indigenous children and youth continue to be disadvantaged across a broad range of health and socioeconomic indicators, and have not shared the same improvements in health, education and wellbeing as that observed for children and youth generally. This report shows that while Indigenous students are gradually catching up in retention to Year 12, there has been no measurable progress in recent years in closing the gap in the Year 5 literacy and numeracy benchmark results. Immunisation coverage of Indigenous 2 year olds is similar to the national average, but Indigenous children are still twice as likely as other infants to be low birthweight, to be hospitalised for chronic conditions and to die before the age of 20. Similarly, children and young people living in regional and remote areas and the most socioeconomically disadvantaged areas also have worse health and education outcomes for many of the indicators where data are available.
The report has also shown that Australia does not compare favourably with other developed countries for many of the indicators presented, where comparable data are available. For example, Australia has the second highest percentage of children living in jobless families in the OECD and ranks in the bottom third in the under-5 mortality rate.
The table How does Australia compare…. summarises this information and those of other indicators presented in the report. Comparisons are made internally, that is, within population groups in Australia, and externally with other developed countries. The internal comparisons are based on rate ratios for each of the three population groups examined in the report, and indicate the level of inequality between population groups. A rate ratio above 1 indicates that the population of interest is at a disadvantage, the higher the ratio, the worse the disadvantage. However, in the case of childhood immunisation, breastfeeding, and education indicators disadvantage is indicated by ratios of below 1, the lower the rate ratio in these cases, the more the disadvantage for the population of interest. 
External comparisons have also been presented in the table, and show Australia’s ranking with other developed countries. International data and subpopulation data were not always available for each indicator presented in this report. 
  
How does Australia compare…
 
 Indicator	see page	internally: who fares worse than others? 	externally: how do we compare with like countries? 	
		Ratio ratios(a)  for 		
		Indigenous to non-Indigenous Australians	Remote/very remote areas to major cities	Most disadvantaged to least disadvantaged areas	OECD rankings (total number of countries)(b)	
HEALTH	
Mortality		2.0–3.1			24 (30)	
Disability 						
Teenage births		5.2	5.0		16 (24)	
Low birthweight		2.2	1.4	1.3	13 (30)	
Childhood immunisation (12, 24 months)		0.9, 1.0			14 (20)	
Breastfeeding (NSW)			1.1	0.4		
Dental decay (6 years, 12 years)		2.5, 1.8	1.7, 1.4	2.2, 1.5	8 (30)	
Chronic disease		2.1–2.7				
Obesity (6–11 years, 15–19 years)		1.4, 2.6		2.0(c)		
Physical activity/screen time						
Injury and poisoning		1.3				
Mental health		1.4				
Substance use						
WELLBEING	
Child care accessibility						
Early childhood education			0.7			
Literacy and numeracy		0.8, 0.9	0.6, 0.9		8 & 16(25)(d)	
Year 12 retention and completion		0.6, 0.5	0.4–0.6		19 (29)	
Youth participation					15 (25), 12(30)(e)	
Jobless families		2.8			23 (24)	
Family economic situation					13 (24)	
Child abuse and neglect		5.4				
Homelessness						
Crime		13–50				
(a)  	A rate ratio above 1 indicates that the population of interest is at a disadvantage, the higher the ratio, the worse the disadvantage. However, in the case of childhood immunisation, breastfeeding, and education indicators disadvantage is indicated by ratios of below 1, the lower the rate ratio in these cases, the more the disadvantage for the population of interest. The comparison groups included in the column headings may not apply to all the indicators, for example for some of the indicators the comparison is between Indigenous and other Australians, and not Indigenous and non-Indigenous Australians, and similarly different comparison groups may also apply for regional and disadvantaged areas. For information on the comparison groups see the relevant sections.
(b)	Green shading indicates a ranking in the top third, yellow in the middle third and red in the bottom third.
(c)	6–11 years only, based on school socioeconomic status.
(d)	Australia ranked 8th in science and 16th in maths. Includes some non-OECD countries. 
(e)      Unemployment rates for 15–24 year olds.
Introduction
Children grow up in an environment influenced by the cultural, educational and economic contexts around them. The world in which children and young people live plays an important role in shaping their health, development and wellbeing, both in the short-term and into adulthood. A reflection on progress made for children and adolescents therefore involves a consideration of outcomes achieved in the context of the environment in which they live. 
Ensuring children get the best possible start in life is central to the health, social inclusion and productivity agendas of the Australian Government. Meeting this goal will involve reforms in the areas of education, early childhood development and preventive health care. The benefits of investing in children and young people flow through to the entire population with outcomes as diverse as greater productivity, lower burden of disease, stronger families, and safer and more connected communities. Promoting the physical, social, emotional, and cognitive development of Australia’s children and young people is therefore a matter of national priority.
Purpose of this report
Good information is at the heart of good policy development. A great deal of detailed information exists about children and young people in Australia today. AIHW, in consultation with an expert advisory group and funding assistance from the Australian Government Department of Health and Ageing, has produced six comprehensive, national, statistical reports on the health, development and wellbeing of Australian children and young people over the last decade, with the next of these reports, focusing on children, to be released in May 2009. AIHW has also been contracted by the three Ministerial Councils (Australian Health Ministers Conference, the Community and Disability Services Ministers Conference, and the Australian Education Systems Officials Committee) to report on the 19 Headline Indicators of children’s health, development and wellbeing, which were endorsed by the Ministerial Councils in 2006. However, given current policy priorities there is increasing need to also have a timely, targeted indicator-based report drawing together key summary statistics integral to child and youth health and wellbeing in order to inform the COAG and social inclusion agendas. This report aims to fill that gap, by drawing heavily on the work that AIHW has previously undertaken in the areas of child and youth health, development and wellbeing. In doing so, the following questions have been central:
•	What aspects of health and wellbeing have changed for Australia’s children and young people in recent years—for better or for worse?
•	Where is there a clear need for improvement?
•	How do we compare with countries like ours?
•	And crucially, in the context of the social inclusion agenda which addresses multiple difficulties or levels of disadvantage, in what areas do some subpopulations within Australia fall behind their peers? 
Changing lives: children and young people in Australia
Children and young people in Australia today are growing up in a very different environment from 20, and even 10, years ago. Major social changes that have directly affected families include a rise in the number of blended and lone-parent families, a trend towards having fewer children and children later in life, increased workforce participation of women with children and the accompanying growth in the use of child care. For infants and young children, research about the importance of the first years of life has led to increasing focus on antenatal care, early learning and development, and early intervention for children at risk of health, educational or social problems. Among older children and adolescents, advances in information technology and increased exposure to the media and targeted marketing have changed the way they learn and interact with their friends and society at large. Changes in the labour market alongside increasing participation in post-secondary education has seen a rise in the proportion of young people combining study with work, and many remain in the family home well into their 20s4. In the area of health, far fewer children than in generations past die before the age of 20, most grow up free from infectious diseases such as measles and polio, and more survive serious illnesses such as cancer or live longer with genetic conditions such as cystic fibrosis1,2. However, these conditions have been replaced with rising concerns about obesity, chronic disease and mental and behavioural problems, and their associated disabilities.
The size and composition of the child and youth population has important implications for planning and policy development, and these, too, are changing. In 2006, there were 1.3 million children aged under 5 years (comprising 6% of the population), 2.1 million children aged 5–12 years (11%), and 1.9 million teenagers (10%)—in total, 5.3 million Australians aged under 20, comprising more than one-quarter (27%) of the population. By 2020 the number of children and youth is projected to be similar, but they will represent only 22% of the population. Some population groups have experienced greater growth than average—the proportion of Australians aged under 20 years who were Indigenous increased from 3.5% to 4.1%, while those born outside Australia rose from 8.2% to 8.8% between 1996 and 2006. If these trends continue, the need for culturally appropriate and accessible services for children and young people will increase. Understanding these changing demographic trends contributes to good policy decisions about the services required by children and young people, including schools, child care, and health and welfare services.
Framework
The indicators selected for this report take into account these different social, community and economic environments that children and young people are growing up in today. Each of the indicators presented relate to one or more high level objectives of the Social Inclusion and COAG Reform agendas, and have been chosen on that basis. A mapping of the indicators included in this report to these high level objectives is shown in the Appendix A. 
This report examines children and young people aged 0–19 years, and is divided into four sections reflecting different stages of development. The first section presents six indicators covering the entire 0–19 year age range. The chosen indicators represent topics of relevance to children and young people aged less than 20 years in the areas of health, development, wellbeing and family circumstance. Each of these indicators signify an issue that can have profound impact on the lives of children, young people, their families and society at large, and interact with many of the indicators covered in the later sections. The remaining three sections are dedicated to specific stages of growing up: infancy and early childhood, ‘school age’ childhood, and adolescence. These sections include indicators of particular significance and relevance to the age group concerned in the areas of health, development and wellbeing.

Overarching indicators (0–19)
•	Mortality	•	Jobless families	•	Child abuse and neglect
•	Disability	•	Family economic situation	• 	Homelessness	

Early childhood (0–4)
•	Infant mortality
•	Teenage births 
•	Birthweight
•	Breastfeeding
•	Childhood immunisation
•	Access to child care
•	Early childhood education 

Childhood (5–12)
•	Injury and poisoning
•	Chronic disease and mental health
•	Dental health
•	Physical activity 
•	Overweight and obesity
•	Literacy and numeracy 
•	Crime

Adolescence (13–19)
•	Injury and poisoning 
•	Mental health
•	Overweight and obesity
•	Substance use 
•	Year 12 retention and completion
•	Youth participation 
•	Crime

This section presents data on six indicator topics for the broad age group 0–19 years. The indicators included here represent issues that affect children and young people of all ages in the areas of health (mortality and disability), family socioeconomic status (jobless families and family economic situation), and safety/social breakdown (homelessness, and child abuse and neglect).
The following table shows how children and young people fare against various measures of the six indicator topics. Measures and trends are reported for the broad age group as well as each of the specific age groups on which this report is focused. Where time series data has been referred to on an indicator page, the direction of the recent trend is shown in the table.
Indicator	Measure	Value	Trend	
HEALTH	
Mortality	Deaths per 100,000 persons aged 1–19 years	20	ü	
		Deaths per 100,000 persons aged 1–4 years	21	ü	
		Deaths per 100,000 persons aged 5–12 years	10	ü	
		Deaths per 100,000 persons aged 13–19 years	31	ü	
Disability	Percentage of 0–19 year olds with disability	8	û	
		Percentage of 0–4 year olds with disability	4		
		Percentage of 5–12 year olds with disability	10		
		Percentage of 13–19 year olds with disability	10		
	Percentage of 0–19 year olds with severe or profound core activity limitation	4	û	
		Percentage of 0–4 year olds with severe or profound core activity limitation	3		
		Percentage of 5–12 year olds with severe or profound core activity limitation	5		
		Percentage of 13–19 year olds with severe or profound core activity limitation	3		
	Percentage of 5–19 year olds with schooling restriction	6		
		Percentage of 5–12 year olds with schooling restriction	7		
		Percentage of 13–19 year olds with schooling restriction	5		
WELLBEING	
Jobless families	Percentage of children aged 0–19 years living in jobless families	15	ü	
		Percentage of children aged 0–4 years living in jobless families	16	ü	
		Percentage of children aged 5–12 years living in jobless families	15	ü	
		Percentage of children aged 13–14 years living in jobless families	15	ü	
Family economic situation	Mean equivalised disposable household income of all low-income households with children aged 0–19 years	$346	ü	
		…where eldest child was aged 0–4 years	$353	ü	
		…where eldest child was aged 5–12 years	$347	ü	
		…where eldest child was aged 13–19 years	$342	ü	
Child abuse and neglect	Child protection substantiations per 1,000 children aged 0–17 years	7	?	
		Child protection substantiations per 1,000 infants aged less than 1 year	17	?	
		Child protection substantiations per 1,000 1–4 year olds	8	?	
		Child protection substantiations per 1,000 5–12 year olds	6	?	
		Child protection substantiations per 1,000 13–17 year olds	4	?	
Homelessness	Average daily number of 0–19 year olds with unmet requests for SAAP accommodation 	415		
	Average daily number of children aged 0–11 years with unmet requests for SAAP accommodation	221		
	Average daily number of young people aged 12–19 years with unmet requests for SAAP accommodation	167		
Key: ü = favourable trend; û = unfavourable trend; ~ = no change or clear trend; ? = Number of children has been increasing, but as data is a reflection of Departmental Child Protection activity it is unknown whether an increase indicates an unfavourable or favourable trend; blank cells = no trend data presented.

Mortality
Measure: Number of deaths of children and youth aged 1–19 years, per 100,000 population
Mortality rates and causes of mortality are key indicators of the health of a population and, as many deaths are potentially preventable, provide crucial information for public health policy and planning. They not only reflect circumstances around the time of death, but also provide insight into changes in social and environmental conditions, medical interventions, lifestyles and trends in underlying risk factors.
High rates of child mortality are strongly associated with social and economic disadvantage, including maternal age, health and parity, exposure to environmental contaminants, nutrition, risk of injury, personal preventive measures and access to medical treatment.,,, For older children and adolescents these factors are exacerbated by the increased independence that comes with adolescence, the period where new skills are developed, such as driving and job skills, and increased exposure to alcohol and other drugs. Injuries from traffic accidents, psychological problems and the harmful effects of alcohol and other drug use are prominent hazards for young people. 
Further reductions in infant and child death rates are possible through improvements to housing, sanitation, dietary intake, and access to maternal and child health services. 
As more than half of all deaths before the age of 20 occur in the first year of life, and the causes of mortality in infants are quite different from mortality in children and adolescents, infant mortality is addressed in a separate indicator (p.x), and is not included under this indicator.
COAG has committed to halving the mortality gap for children under five within a decade. Improvements in Indigenous child mortality require better access to antenatal care, teenage reproductive and sexual health services, child and maternal health services and integrated child and family services.
•	1,055 Australians aged 1–19 years died in 2006—a rate of 20 per 100,000 population. Indigenous children and youth were twice as likely to die between the ages of 1–19 as their non-Indigenous counterparts.
•	Among people aged 1–19 years, mortality rates were highest for teenagers.
•	Rates fell by around one-third (1997–2006), and to a greater extent among males (38%) than females (25%).

Deaths per 100,000 population 

•	The leading specific causes of death were cancers and accidental drowning (each at a rate of 3 per 100,000) for children aged 1–4 years; cancers and transport accidents for children aged 5–12 years (each 2 per 100,000); and transport accidents and intentional self-harm for teenagers (11 and 5 per 100,000).
•	Mortality rates were twice as high for teenage males as females, largely due to higher mortality from transport accidents, intentional self-harm and other injuries.

Leading causes of mortality, 2006 (deaths per 100,000 population)

1–4 years

5–12 years

13–19 years

Key messages
•	Australia’s under-5 mortality rate is in the best fifth of the world, but the worst third of the OECD (24th out of 30 countries). 
•	National mortality rates are decreasing, but among 1–19 year olds the Indigenous rate is still twice as high as the non-Indigenous rate.
•	Many of the leading causes of death in children and young people are potentially preventable: half of all deaths of 1–19 year olds were caused by injuries, and half of these were transport accidents.

Disability
Measure: Percentage of children and young people with disability, severe or profound core activity limitations, or schooling restrictions
Disability is a characteristic that goes beyond the presence or absence of particular health conditions; it relates to the way in which an individual functions in society and is strongly influenced by environmental factors. Disability is measured in terms of impairments, activity limitations and participation restrictions, covering the range of activities that people perform in everyday life. People who sometimes or always need assistance with one or more of the core activities of daily living (self-care, mobility or communication tasks) are referred to as having severe or profound core activity limitation.
People with disability may also experience restrictions in other aspects of their lives. For example, children and adolescents with disability may experience schooling restrictions that result in needing special assistance, arrangements or equipment at school, attending special classes or a special school, needing frequent time off school or having difficulty with aspects of schoolwork or the school environment.
Overall, people with disability achieve lower educational qualifications than people without disability, and often have poorer labour market outcomes. However, because the experience of disability stems from the interaction of individual and external factors, it is possible to reduce the impact of disability on the person’s participation in all aspects of life through early intervention, and environmental and societal modifications.

The new National Disability Reform Agenda aims to place people with disabilities, their families and carers at the centre of services across Australia and to improve the availability, flexibility and consistency of services across all jurisdictions. 
•	In 2003 440,300 young people (8%) aged 0–19 years had a disability, including almost 200,000 (4%) with severe or profound core activity limitations and more than 250,000 (6% of 5–19 year olds) with schooling restrictions. 
•	Boys aged 5–12 years were twice as likely as girls to have schooling restrictions or severe or profound core activity limitations.
•	Almost one in four children with disability had asthma
•	All children aged 5–12 years with autism had schooling restrictions, and 91% had severe or profound core activity limitations.
•	77% of children and youth aged 5 years or over with ADHD and 85% with intellectual disability experienced schooling restrictions, and half had severe or profound core activity limitations.
Estimated number of children with disability and selected health conditions, 2003
	Asthma	ADD/ADHD	Intellectual disability	Autism	All conditions	
Severe or profound core activity limitations	
0–4 years	6,900	—	*3,600	n.p.	35,900	
5–12 years	23,900	20,900	16,900	15,300	105,100	
13–19 years	10,400	11,200	15,700	n.p.	56,400	
Schooling restrictions	
5–12 years	35,500	32,500	28,900	16,700	154,500	
13–19 years	18,700	15,700	24,400	*3,900	101,200	
All with disability	
0–4 years	12,200	—	*3,700	n.p.	53,500	
5–12 years	51,200	34,800	31,900	16,700	207,300	
13–19 years	37,300	27,900	30,900	n.p.	179,500	
ADD/ADHD = Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder; n.p.= not published but included in totals.
*	Estimate has a relative standard error of between 25% and 50% and should be interpreted with caution.
Note: Children and young people with schooling restrictions may have also had severe or profound core activity limitations. 
Source: ABS 2003 Survey of Disability, Ageing and Carers, unpublished data.
Key messages
•	8% of Australians aged 0–19 years had a disability in 2003; rates were higher for boys than girls.
•	Reported rates of disability and severe/profound core activity limitations in children aged under 15 years have increased since the 1980s.
•	More than 90% of children with autism had severe or profound core activity limitations and all had schooling restrictions.

Jobless families
Measure: The number of children with no co-resident employed parent, as a percentage of all children
One of the notable results of labour market trends over the past generation has been what is termed ‘employment polarisation’. As the unemployment rate of individuals has fallen and an increasing number of families have two working parents, joblessness has become more concentrated within some households. Jobless households are disproportionately likely to be reliant on welfare, have low incomes and experience financial stress, and members of these households report worse physical and mental health and lower life satisfaction than members of households where someone is employed. 
Studies on the effects of unemployment on other family members have identified relationships between parental joblessness and family conflict, family breakdown and child abuse. Secure employment provides financial stability, self-confidence and social contact for parents, with positive effects flowing onto their children. Paternal employment in particular was associated with adolescent psychological wellbeing, sociability, satisfaction and happiness. Reducing jobless families would not only be a major improvement for society at the time, but could also have positive inter-generational effects, as the likelihood of a young person completing secondary school and finding secure employment is affected by their parent’s socioeconomic status. 

The Australian Government has identified addressing the incidence and needs of jobless families with children as an early priority for Australia’s Social Inclusion Agenda. 
•	15% of all children aged 0–14 years (544,000) lived in jobless families in 2006.
•	Half (51%) of all children in one-parent families did not live with an employed parent, compared with 6% in two-parent families.

Percentage of children living in jobless families, 2006

0–14 years

•	42% of Indigenous children lived in jobless families—the rate was 30% higher and more than 3 times as high as children generally in one- and two-parent families respectively.
•	The proportion of children without an employed parent decreased for all family types and for Indigenous children between 1996 and 2006.
Key messages
•	Australia had the second highest percentage of working-age jobless families out of 24 OECD countries in 2000, largely due to the relatively high rate of one-parent households in Australia and the high rate of joblessness among this group. 
•	Indigenous children were more likely than children generally to live in jobless families.
•	The proportion of children living in jobless families has decreased over the last decade, but half of all children in one-parent families still live with a jobless parent.

Family economic situation
Measure: Mean equivalised disposable household income of low-income households with dependent children aged 0–19 years
Children living in families without regular adequate income are at increased risk of poor health and educational outcomes, both in the short- and long-term., Living on a low income can affect a child’s nutrition, access to medical care, environmental safety, quality and stability of their care, and the provision of appropriate housing, heating and clothing. A primary concern for economically disadvantaged children is being excluded from activities that other children take for granted. 
Income disadvantage is also a relative concept, as some Australian families may have higher absolute incomes than people in the past, or in other countries, and still experience relative income disadvantage. 
Equivalised disposable household income is the after-tax total of all income sources, adjusted for the size and composition of the household. A household’s equivalised income shows how much income a person living alone would need to enjoy the same level of economic wellbeing as a household comprising more than one person. 
The average real equivalised disposable household income for households with children aged 0–12 years in the 2nd and 3rd income deciles has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator for children’s health, development and wellbeing.3 

The Australian Government has identified addressing the incidence and needs of jobless families with children and secure employment as early priorities for Australia’s Social Inclusion Agenda.20
•	Mean equivalised income of low-income households with dependent children ($346 per week in 2005–06) was $269 less than the average for all households with dependent children aged 0–19 years. 
•	Relative income growth for low-income households with dependent children was lower than that for all households with dependent children over last decade (27% vs. 37%).
•	20% of all households with dependent children under 20 years were low-income households. Relatively fewer households whose eldest child was aged 0–4 years were low-income households (16%) compared with households with older children.
•	Households with the eldest child aged 0–4 years were less likely to be low-income in 2005–06 than in 1996–97, but there was no significant change for households with older children and dependent youth.
Key messages
•	The mean equivalised income of low-income households with dependent children aged 0–19 years (more than half a million households) was $346 per week in 2005–06.
•	The income of low-income households with children and dependent youth has not grown as fast as that of all households with children and youth generally.
•	Australia ranked 13th of 24 OECD countries in terms of the percentage of children living in relative income poverty in 1999.21 

Child abuse and neglect
Measure: Number of children aged 0–17 years who were the subject of a child protection substantiation in a given year, per 1,000 population
‘Children everywhere have the right to survival…to protection from harmful influences, abuse and exploitation’.
There is a demonstrated relationship between the health and wellbeing of children and the environment in which they grow up. Children who are raised in supportive, nurturing environments are more likely to have better social, behavioural and health outcomes., The reverse is also true: children who have been abused or neglected often have poor developmental outcomes, such as lower social competence, poor school performance and a higher likelihood of criminal offending later in life. 
In Australia, child protection is the responsibility of state and territory governments. Child protection substantiation refers to the determination, after investigation, that a child has been, is being or is likely to be abused or neglected or otherwise harmed. Child abuse may include physical, sexual or emotional abuse or neglect. Due to variation in child protection legislation, policy and practice between jurisdictions and over time, the comparison of substantiation rates across time and across jurisdictions is problematic.
Child abuse and neglect has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator for children’s health, development and wellbeing.3 

The Australian Government has committed to developing a National Child Protection Framework which will focus on preventing abuse through early intervention and better integration of family services. COAG has also committed to identify joint reforms and implementation timetables for basic protective security from violence for Indigenous parents and children.
•	32,585 children aged 0–17 years were subject to child protection substantiations for notifications received during 2006–07—rate of 7 per 1,000 population.
•	Infants had the highest substantiation rate—twice that of other age groups.
•	Child protection substantiation rate for Indigenous children was 5 times that of other children.
•	The gap between substantiation rates for Indigenous and other children was greatest for infants, and declined with age.
Key messages
•	Indigenous children are over-represented in child protection substantiations.
•	Substantiation rates are highest for infants, due partly to an increased focus on early intervention. 
•	At the state and territory level, substantiation rates are not directly comparable due to differences in jurisdictional child protection policy, legislation and practice.

Homelessness
Measure: Average daily number of 0–19 year olds with unmet requests for accommodation from the Supported Accommodation Assistance Program (SAAP)
Children who are homeless, whether as part of a family unit or on their own, experience significant negative social and health consequences. Homelessness is associated with increased prevalence of a number of health conditions including gastroenteritis, bronchitis, asthma, depression and schizophrenia. Young people who become homeless face increased risk of exposure to physical and sexual assault, poor diet and inadequate shelter, and are more likely than other youth to engage in risky behaviours such as smoking, drug and alcohol abuse, and unsafe sex.
The factors contributing to homelessness are complex, and may be the result of domestic violence, family or relationship breakdown, poverty or financial crisis, mental illness or lack of affordable housing. Responding to homelessness requires a multi-sectoral approach.
The major government response to homeless people or people at risk of homelessness is SAAP. SAAP provides a range of assistance including emergency accommodation, meals and showers, counselling and advocacy. Children and young people may access SAAP services individually as a SAAP client, or they may accompany a parent or guardian who is a SAAP client.

The Australian government has identified addressing the incidence of homelessness as an early priority for Australia’s social inclusion agenda. COAG has committed to halving the number of homeless people turned away from shelters within 5 years, and building 600 new houses and units for homeless people through the Place to Call Home Program.9 
•	24,900 clients aged under 20 years and 69,100 accompanying children used SAAP services in 2006–07. 
•	On average, 415 people aged under 20 had a valid unmet accommodation request per day; two-thirds were accompanying a parent/guardian and half required accommodation within 24 hours.
•	Domestic/family violence was the most common reason for children accompanying a parent/guardian and for unaccompanied children under 13 years to seek SAAP assistance.
•	Relationship/family breakdown was also common among unaccompanied children seeking SAAP assistance, especially adolescents.
Key messages
•	More than 400 young people aged under 20 years have a valid unmet request for SAAP accommodation on an average day
•	Domestic violence and family breakdown are major drivers of children and families seeking SAAP assistance.
•	Indigenous accompanying children are overrepresented in SAAP and account for over a quarter of all accompanying children under 18 years (77 per 1,000 compared to 14). 

This section focuses on infants and young children (0–4 year olds). COAG, supported by a growing body of research into the importance of the early years of life, has initiated a series of reforms to maternal and child health care and early childhood education. With the principle of early intervention for children at risk of poor outcomes underpinning policy development in this area, many initiatives have particular focus on disadvantaged population groups. Improving maternal and child health services and early learning opportunities for Aboriginal and Torres Strait Islander children are important steps on the pathway to closing the gap in Indigenous disadvantage.
The following table presents national data for each of the measures of the five indicator topics relating to infant and child health, and for the indicators related to early learning and child care accessibility. Where time series data has been referred to on an indicator page, the direction of the recent trend is shown in the table.
Indicator	Measure	Value	Trend	
HEALTH	
Infant mortality	Deaths per 1,000 live born infants	5	ü	
Teenage births	Live births per 1,000 females aged 15–19 years	17	ü	
Low birthweight infants	Percentage of live born infants with low birthweight	6		
Breastfeeding	Percentage of infants fully breastfed at 4 months of age	46		
	Percentage of infants fully breastfed at 6 months of age	14		
Childhood immunisation	Percentage of 1 year olds on the ACIR fully immunised	92	ü	
 	Percentage of 2 year olds on the ACIR fully vaccinated	93	ü	
WELLBEING	
Access to child care	Number of 0–4 year olds with unmet demand for formal child care	110,000	~	
 	Number of 0–4 year olds with unmet demand for formal child care mainly due to cost	17,000	ü	
 	Number of 0–4 year olds with unmet demand for formal child care mainly due to lack of places	49,500	û	
	Number of 0–4 year olds with unmet demand for formal child care mainly due to lack of services locally	5,100	ü	
Early childhood education	Percentage of 3–4 year olds attending pre-school or long day care	68	ü	
	Percentage of 4 year-olds attending pre-school or long day care	80	ü	
Key: ü = favourable trend; û = unfavourable trend; ~ = no change or clear trend; blank cells = no trend data presented.

Infant mortality
Measure: Number of deaths of infants aged less than 1 year per 1,000 live births
A child’s risk of death is greatest in the first year of life, and the first month in particular. The infant mortality rate reflects the effect of structural factors on population health, such as the prevailing health and hygiene conditions, and accessibility and effectiveness of the health system in maternal and perinatal health. The infant mortality rate is used internationally as a key measure of population and child health. 
Infant deaths have fallen substantially over the last two decades, and are a result of the work of neonatal intensive care units, increased community awareness of the risk factors for SIDS and the importance of early and exclusive breastfeeding, and reductions in vaccine-preventable diseases through the national childhood immunisation program. 
Infant mortality has been chosen as the mortality indicator to report on for early childhood, as the vast majority of deaths (85%) in this age group occur within the first year of life, and the causes of mortality in infants are quite different from mortality in young children. See Mortality indicator (p x) for child mortality rates for 1–4 year-olds. 
Infant mortality has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator for children’s health, development and wellbeing.3

COAG has committed to halving the mortality gap for children under five within a decade.9 Improvements in Indigenous child mortality require better access to antenatal care, teenage reproductive and sexual health services, child and maternal health services and integrated child and family services.10
•	The infant mortality rate almost halved between 1986 and 1998, and has stabilised since, at 4.7 deaths per 1,000 live births in 2006 (1,262 infants died in 2006).
•	The Indigenous infant mortality rate was 3 times the non-Indigenous rate (2002–06).
•	The leading causes of infant mortality were perinatal conditions (such as complications of the placenta, cord and membrane) and congenital malformations, accounting for 80% of infant deaths.

Key messages
•	Indigenous infants were 3 times as likely as other infants to die in their first year of life, but the gap is closing.
•	Australia’s infant mortality rate ranks 20th out of 30 OECD countries. Excluding the high Indigenous rate, Australia still ranks in the middle of the OECD (14th).
•	80% of infant deaths are caused by perinatal conditions (including SIDS) and congenital abnormalities. Mortality rates for Indigenous infants were particularly high for respiratory and parasitic or infectious diseases, compared to non-Indigenous infants.35 

Teenage births
Measure: Number of live births to teenage mothers, per 1,000 females aged 15–19 years
Teenage motherhood, particularly at younger ages, can pose significant long-term risks to both mother and child. Teenage mothers often delay having their pregnancy confirmed and/or seeking antenatal care, and are more likely to engage in risky behaviour including smoking and drinking alcohol during pregnancy. Consequently, teenage mothers face increased risk of miscarriage, preterm delivery, low birthweight and other complications, and perinatal mortality.
Parenthood during the teenage years often results in interrupted schooling, a high risk of single parenthood, greater dependence on government assistance, increased problems in engaging with the labour market, and poverty. All of these factors can affect the health, education and economic futures of children born to teenage parents. While not all teenage pregnancies result in negative outcomes for mother and child, the circumstances that often contribute to teenage pregnancy mean that many young mothers do not receive the support they need before and after birth.
Factors thought to contribute to teenage fertility include family history of teenage pregnancy, violence and sexual abuse in childhood, unstable housing arrangements, poor school attendance and performance, socioeconomic disadvantage, and absence of a father figure.37 
The teenage fertility rate has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator of children’s health, development and wellbeing.3
•	11,700 infants were born to teenage mothers in 2005.
•	The teenage fertility rate fell from 22 to 17 births per 1,000 between 1995 and 2005.
•	The Indigenous teenage fertility rate was 5 times the non-Indigenous rate in 2005.
•	The rate increases with geographical remoteness—the rate in inner and outer regional areas was twice as high, and in remote/very remote areas 5 times as high, as in major cities. 
Key messages
•	Australia’s teenage fertility rate was 16th out of 24 OECD countries in 2003.21 
•	Rates are substantially higher for Indigenous Australians and those living outside major cities.

Birthweight
Measure: Percentage of live born infants with a birthweight of less than 2,500 grams
Birthweight is an important indicator of a baby’s chance of survival and good health. Low birthweight increases the probability of lengthy hospitalisation after birth, the need for resuscitation, or death, and is a risk factor for neurological and physical disabilities. In 2005, 70% of high-risk infants admitted to level III neonatal intensive care units in Australia were of low birthweight. 
A baby may be small for its gestational age (intrauterine growth retardation) or due to being born early (preterm). Factors that contribute to low birthweight include maternal age, illness during pregnancy, low socioeconomic status, multiple fertility, maternal history of spontaneous abortion, harmful behaviours such as smoking or excessive alcohol consumption, poor nutrition during pregnancy and poor prenatal care.40,
Mothers aged less than 20 years, or 40 years or over, are at heightened risk of delivering a low birthweight infant. The increasing number of infants born to older mothers in Australia, and the disproportionate risk faced by certain population groups, including Indigenous women, makes this an important indicator of antenatal care and neonatal health. 
The proportion of live born infants of low birthweight has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator for child health, development and wellbeing.3 
•	6.4% of live born infants were of low birthweight in 2005 (17,241 infants), including 1.1% of very low or extremely low birthweight. 
•	The rate was double for Indigenous mothers (13.2%), and the gap between Indigenous and non-Indigenous mothers is growing.
•	The percentage of low birthweight infants was also higher in remote and very remote areas (8.7%) and the most socioeconomically disadvantaged areas (7.2%). 
•	Australia ranked 13th out of 30 OECD countries in the proportion of low birthweight infants in 2005.
Key messages
•	Australia ranked in the middle of the OECD in 2005 (13th out of 30 countries).
•	Indigenous mothers are twice as likely as non-Indigenous mothers to have a low birthweight infant, and gap is widening.
•	Infants born in remote areas or areas of high socioeconomic disadvantage were 30–40% more likely to be of low birthweight.

Breastfeeding
Measure: Percentage of infants fully or exclusively breastfed at 4 and 6 months of age
Breastfeeding is extremely important in promoting healthy development in children. Breast milk provides the best nutritional start for infants and helps to protect against infectious disease. Breastfeeding is also associated with long-term benefits including improved cognitive development and protection against immune-related diseases such as Type 1 diabetes, celiac disease, inflammatory bowel disease and possibly some forms of cancer. Breastfeeding has many positive health effects for mothers, as well as encouraging bonding between mother and child.44 
‘Exclusive’ breastfeeding is defined as the infant receiving only breast milk and no other food or drink, including water, while ‘fully’ breastfeeding infants can receive other fluids such as juice or water. The Australian dietary guidelines for children and adolescents44 recommend that all infants should be exclusively breastfed for the first 4 to 6 months of life to achieve optimal growth, development and health. 
Currently, Australia has no reliable national data collection to effectively monitor infant feeding practices, and the inconsistent use of definitions and terms makes it difficult to compare studies of the rates of breastfeeding. 
The proportion of infants exclusively breastfed at 4 months of age has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator of children’s health, development and wellbeing.3 
•	46% of infants were fully breastfed at 4 months of age, falling to 14% at 6 months, according to a longitudinal study of infants in 2004. 
•	According to state surveys, 18% of children in NSWError! Bookmark not defined. (2005–06) and 15% in Victoria (2006) had been exclusively breastfed up to 6 months of age.
•	Exclusive breastfeeding rates in NSW were substantially lower for infants with mothers younger than 25, mothers without tertiary qualifications and those living in areas of the greatest socioeconomic disadvantage.

Key messages
•	Rates of breastfeeding declined substantially within the first 6 months after birth.
•	One in seven infants were fully breastfed at 6 months of age, and there is currently no national data available on exclusive breastfeeding.
•	Rates of exclusive breastfeeding in NSW were half as high among younger and less educated women, and women living in the most disadvantaged areas.

Childhood immunisation
Measure: Percentage of children on the Australian Childhood Immunisation Register (ACIR) who are fully immunised at 1 and 2 years of age
Immunisation against childhood diseases is one of the most cost effective public health interventions in preventing childhood mortality and morbidity. Increased immunisation coverage has been one of the most important public health successes of the past three decades, and has resulted in significant declines in infant and child mortality.
Australian children are protected against a number of communicable diseases through routine immunisation as part of the Immunise Australia Program. Large-scale immunisation programs exist for a wide variety of communicable diseases including diphtheria, tetanus, pertussis (whooping cough), rotavirus, poliomyelitis, measles–mumps–rubella (MMR), Haemophilus influenzae type b (Hib), hepatitis B, varicella (chickenpox), meningococcal C and pneumococcal disease.
The ACIR, administered by Medicare Australia, records information on the immunisation status of approximately 99% of children aged less than 7 years. 
Immunisation coverage at 2 years of age of children on the ACIR has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator for children’s health, development and wellbeing.3 

Immunisation coverage goals for Australia, recommended by the National Health and Medical Research Council (NHMRC) in 1993, called for higher than 90% coverage of children at two years of age, and near 100% coverage of children at school entry age. The coverage target for 2 year olds was achieved in 2003.
•	92–93% of 1 and 2 year olds on the ACIR were fully immunised in 2007, meeting the 90% national coverage target.
•	Immunisation coverage has increased over the past decade, particularly among 2 year olds (almost a 50% increase since 1997).
•	In 2005, coverage for Indigenous children (84%) was lower than for other children (90%) at 1 year of age, largely due to lower coverage of diphtheria–tetanus–pertussis and poliomyelitis vaccines. 
•	Among 2 year olds, immunisation rates were similar for Indigenous and other children, meeting the 90% target.
Key messages
•	Immunisation coverage of 1 and 2 year olds is the highest on record and meets the 90% coverage target. However, coverage at 6 years (89%) is well below the target.
•	There is potential for further increases in immunisation coverage—Australia’s average coverage for 1 and 2 year olds ranked 14th out of 20 selected countries in 2006.

Access to child care
Measure: Number of 0–4 year olds who required formal child care or additional formal child care, and did not receive it because of accessibility barriers
Access to affordable, high-quality child care services is a major concern for both parents and governments. Child care services are increasingly being recognised as being of vital importance to society as they help parents participate in work or study, offer families an opportunity to be involved in the community, help create social networks and provide children with opportunities to develop their social and intellectual skills. Child care services also give parents respite from caring for children with behavioural difficulties, and provide early intervention for developmentally and socioeconomically disadvantaged children. 
In recent years there has been an expanding demand for child care services, reflecting trends in social factors such as family structure, employment patterns and population mobility4. Unmet demand for child care is an important indicator of accessibility, and this information is available from the ABS Child Care Surveys, where parents were asked whether their formal child care requirements were met. 

COAG has committed to improving the quality and availability of child care.9  The Australian Government is also committed to improving child care affordability for Australian families by increasing the Child Care Tax Rebate from 30% to 50%, and improving accessibility by establishing new long day care centres. 	
•	109,900 children aged 0–4 years had unmet demand for formal child care (including preschool) in 2005—has remained steady since 1999. 
•	Availability of places was the greatest single barrier (45% of unmet demand). Cost accounted for 15% of unmet demand.
•	Lack of available places as the main barrier to formal child care has doubled, but unmet demand due to cost of child care has halved (1999–2005).
•	Availability of places was a greater barrier in major cities than in other areas, while cost or availability of services was a greater barrier in areas outside major cities.
Key messages
•	Lack of available places (services booked out) was the main reason for unmet demand for child care in 2005, and has doubled has a barrier to accessing child care since 1999.
•	Children living outside major cities are more likely to have difficulty accessing formal child care or preschool due to cost or lack of services in the area.

Early childhood education
Measure: Percentage of children aged 3–4 years or 4 years attending preschool or long day care centres
Attendance at high-quality early educational programs before the first year of compulsory schooling is considered to have a number of developmental benefits that can help prepare children make a successful transition to school, achieve at school and more fully participate in society as adults. These include improved intellectual development and social, language and cognitive skills.
Quality Early Childhood Education programs are especially beneficial for children from disadvantaged backgrounds., However, not all parents with young children are able to access quality early educational programs equally, due to barriers such as cost and distance.
It is difficult to estimate the actual number of children who participate in quality early childhood education programs in the year before beginning primary school, due to differences in the way data are collected at the state and territory level and the varied nature of children’s services throughout Australia. Early education programs may be delivered in preschool or long day care facilities; however, the proportion of children receiving high-quality programs through these settings is uncertain, in particular whether the program is delivered by a university qualified teacher. 
Participation in early childhood education programs is usually for children in the year before school (generally 4 year olds) although it is open to three year olds in some jurisdictions.  Attendance at an early educational program in the 2 years before beginning primary school has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator for children’s health, development and wellbeing.3

COAG has committed to providing universal access to 15 hours of early childhood education programs a week, for a minimum of 40 weeks a year, delivered by degree-qualified teachers. In particular, COAG has committed to providing access to a quality early childhood education program for all Indigenous four year olds in remote Indigenous communities within five years.
•	Two-thirds of 3–4 year olds attended preschool or long day care in 2005, attendance at either preschool or long day care was greater for 4 year olds (80%) than 3 year olds (56%).
•	Attendance has increased by around one-quarter in both settings for 4 year olds, whereas 3 year old attendance increased in long day care (40% increase) and decreased in preschool (14%). 

•	Attendance at preschool increases with geographical remoteness for 4 year olds, but declines for 3 year olds. Long day care attendance for 3 year olds was also higher in capital cities than remote areas, while no clear pattern for 4 year-olds.
Key messages
•	Australia’s preschool attendance rate for 4 year olds ranked in the bottom third of OECD countries in 2005, the lower rate likely to be a considerable underestimate due to the large number of privately-operated child care facilities in Australia.
•	Attendance of 4 year olds at preschool and long day care centres is increasing.
•	Attendance at preschool and long day care centres declines with increasing remoteness for 3 year olds, while for 4 year olds in preschool it increases. 
•	
This section focuses on ‘school age’ childhood (5–12 year olds). For many children this is the first major transition in life from the family home and into other environments, such as full-time compulsory schooling. This brings about challenges and risks. Both their behaviour and the physical and social environment increase the risk of adverse events such as injuries, the development of chronic conditions, mental and behavioural problems, and risk factors that persist into adolescence and adulthood. This is a crucial time for learning, social and emotional development and social participation, and the acquisition of literacy and numeracy skills. It is also a critical time for establishing good health and social behaviours. 
The following table presents national data for each of the measures of the five indicator topics for health and key health risk factors, and for each of the indicators for education and crime. Where time series data has been referred to on an indicator page, the direction of the recent trend is shown in the table.

Indicator 	Measure	Value	Trend	
HEALTH	
Injury and poisoning	Total hospitalisations due to injury and poisoning per 100,000 5–12 year olds	1,366	~	
		Hospitalisations due to transport accidents per 100,000 5–12 year olds	232	~	
		Hospitalisations due to falls per 100,000 5–12 year olds	652	~	
		Hospitalisations due to burns and scalds per 100,000 5–12 year olds	16	û	
		Hospitalisations due to accidental poisoning per 100,000 5–12 year olds	10	ü	
		Hospitalisations due to accidental drowning per 100,000 5–12 year olds	3	~	
Chronic disease and mental heath	Hospitalisations for asthma per 100,000 5–12 year olds	331	ü	
	Hospitalisations for mental health and behavioural disorders per 100,000 5–12 year olds	178	~	
	Hospitalisations for diabetes per 100,000 5–12 year olds	85	û	
Dental health
 	Average number of decayed, missing or filled teeth in 6 year olds	2	û	
	Average number of decayed, missing or filled teeth in 12 year olds	1	~	
Physical activity
 	Percentage of children aged 5–12 years who did not participate in any organised sport or dancing in 2 weeks	42		
	Percentage of children aged 5–12 years with 40 hours or more 'screen time' in 2 weeks	16		
Overweight and obesity
 	Percentage of 6–11 year olds who were obese	6		
	Percentage of 6–11 year olds who were overweight but not obese	17		
WELLBEING	
Literacy and numeracy benchmarks
 	Percentage of Year 5 children meeting national reading benchmarks	88	~	
	Percentage of Year 5 children meeting national writing benchmarks	94	~	
	Percentage of Year 5 children meeting national numeracy benchmarks	90	~	
Crime
 	Children aged 0–9 years who were victims of robbery, per 100,000	2		
	Children aged 10–14 years who were victims of robbery, per 100,000	61		
	Children aged 0–9 years who were victims of kidnapping or abduction, per 100,000	4		
	Children aged 10–14 years who were victims of kidnapping or abduction, per 100,000	11		
	Children aged 10–12 years under juvenile justice supervision, per 100,000	44	ü	
Key: ü = favourable trend; û = unfavourable trend; ~ = no change or clear trend; blank cells = no trend data presented.

Injury and poisoning
Measure: Injury hospitalisations for 5–12 year olds due to selected causes, per 100,000 population
Injuries (including poisoning) are a major cause of acute care utilisation, long-term disability and mortality among children. They are the leading cause of death of children aged 1–14 years in every industrialised country, including Australia. Among 5–12 year olds injuries and poisoning accounted for one-third of all deaths in 2006 and almost 30,000 hospitalisations in 2006–07. Injuries can also result in permanent disability. In 2003, more than 120,000 Australians had a disability where their main disabling condition was caused by an injury that occurred before the age of 20. Therefore injuries, which are largely preventable, are responsible for a great deal of personal suffering and cost to the health system and wider community.
Children are exposed to a range of settings where there is potential for injury or poisoning to occur, including school, sporting environments, streets and neighbourhoods. Injuries sustained among older children are increasingly influenced by behaviour in addition to their physical and social environment. The compulsory use of bicycle helmets and seat-belts, safe playgrounds, and reduced speed limits and traffic-calming devices in school zones are examples of injury prevention initiatives relating to individual behaviour and physical and social environments.

Injury prevention and control has been a National Health Priority Area since 1986. A key priority of the National Injury Prevention and Safety Promotion Plan 2004–2014 is to create a positive safety culture and a safe environment, particularly for children.81
•	Almost 30,000 hospitalisations due to injury among 5–12 year olds in 2006–07 (1,366 per 100,000 population). 
•	Injury hospitalisation rates were 60% higher for boys than girls, and 30% higher for Indigenous than other children.
•	Falls (650 per 100,000 or 48% of injury hospitalisations) and transport accidents (mostly motor vehicle accidents; 230 per 100,000 or 17%) were the leading causes of injury hospitalisations. No clear recent trends for either of these causes.
•	Accidental poisoning rate has declined by 30%, but rate for burns and scalds has increased by 20% since 1998–99.
•	No clear trend in hospitalisation rates for accidental drowning.
Key messages
•	Around 30,000 children aged 5–12 years are hospitalised for injuries each year—there has been little change in the rate over the past decade. 
•	Boys 60% more likely than girls to be hospitalised for injuries; Indigenous children 30% more likely than other children. 
•	Hospitalisation rate due to burns and scalds has increased by 20% in a decade.

Chronic disease and mental health 
Measure 1: Hospitalisations for 5–12 year olds for selected chronic health conditions, per 100,000 population
Children and adolescents have the highest growth rates of chronic disease prevalence of all population cohorts. This section presents data on three chronic health conditions that are National Health Priority Areas. Asthma is the most common long-term health condition among children. Diabetes is less common but can have severe consequences in the short and long term, including diabetic coma, kidney failure, loss of limbs and premature death. Mental and behavioural disorders are also included as many of these are chronic conditions and may have health and social consequences for affected children later in life.
Broad measures of chronic conditions in children may be based on surveys (such as National Health Surveys), or diagnosed or treated populations (such as the National Diabetes Register). Hospitalisations due to specific conditions represent the extent to which chronic diseases require acute care and are presented here. Differences in hospitalisation rates between types of conditions or population groups, or over time, reflect a range of factors including prevalence, severity, access to and effectiveness of early intervention, and access to and effectiveness of management and treatment in the community.

Asthma, diabetes and mental health are all National Health Priority Areas. COAG has committed to establishing a Preventative Health Care Partnership, including addressing the major risk factors contributing to increasing rates of diabetes and poor mental health.9 Australian Health Minsters have established a National Asthma Strategy 2006–2008, which provides a framework for a collaborative approach towards improving asthma care in Australia. The Australian Government has also formulated a National Primary Health Care Strategy to improve management of chronic disease.
•	The hospitalisation rate due to diabetes increased by two-thirds since 1998–99 (85 per 100,000 in 2006–07, or 1,900 children aged 5–12 years). Almost all (98%) of hospital stays were for Type 1 diabetes.
•	Asthma hospitalisation rate decreased by one-third to 331 per 100,000 children.
•	There has been no real change in the hospitalisation rate for mental and behavioural disorders—178 per 100,000 (3,900 children aged 5–12) in 2006–07.
•	Hospitalisation rates were higher for boys than girls for asthma (1.5 times as high) and for mental and behavioural disorders (2.9 times).
•	Rates for Indigenous children were 2–3 times as high as for other children for each selected chronic condition.
Key messages
•	Children’s hospitalisation rates have fallen considerably for asthma, but risen for diabetes (mostly type 1 diabetes).
•	Indigenous children and boys generally are at increased risk of hospitalisation due to asthma, and mental and behavioural disorders. Indigenous children are also more than twice as likely as other children to be hospitalised for diabetes.

Dental health
Measure: Mean number of decayed, missing or filled teeth among 6 year olds and 12 year olds
Poor dental health adversely affects children’s health and overall wellbeing. Untreated dental caries facilitate abscess formation, cellulitis and systemic disease. Oral disease can lead to failure to thrive and school absences, negatively affecting educational performance. Poor nutrition or an unbalance diet high in sugar may place children at an increased risk of developing dental health problems such as gum disease and dental caries.   
The number of teeth decayed, extracted due to decay, or teeth with fillings is an indicator of oral disease in the population. Good oral health in childhood contributes to better dental outcomes in adulthood—less decay and the loss of fewer natural teeth. It also enhances children’s confidence, self-esteem, appearance, chewing ability and participation in social activities.
The dental health of Australia’s children has improved substantially since the mid-1970s.2 This trend can be attributed to a number of factors, including increased access to fluoridated toothpaste and drinking water, improved dental hygiene, and provision of clinical preventive services and ongoing monitoring through the School Dental Scheme. However, since the mid-1990s the decline in dental decay has been arrested or reversed.
The mean number of decayed, missing or filled teeth among 12 year olds has been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator of children’s health, development and wellbeing.3

COAG have committed to provide additional dental health services, delivering up to one million consultations and services over 3 years under the Commonwealth Dental Health Program, including 48,000 services over 4 years to Indigenous Australians.29 
•	Average number of decayed, missing or filled ‘permanent teeth’ among 12 year olds has been relatively stable at 1.0 since the mid-1990s.
•	Dental decay among 6 year olds has increased since the mid-1990s, from 1.7 to 2.0 (1996–2002).
•	On average, Indigenous children had more decayed, missing or filled teeth than other children in 2002 (2.5 and 1.8 times as many for 6 and 12 year olds respectively).
•	 Children living outside major cities (including those in regional areas) and in the most disadvantaged areas also experienced worse dental health than average.
Key messages
•	Australia compares favourably with other OECD countries, ranking 8th out of 30 countries in mean decay experience among 12 year olds in 2002.43
•	A long-term trend towards improved dental health has not continued in recent years.
•	Indigenous children and children living outside major cities or in areas of high socioeconomic disadvantage are at increased risk of dental health problems, with the gap between population groups higher for 6 year olds than 12 year olds. 

Physical activity/screen time
Measure 1: Percentage of children aged 5–12 years who did not participate in any organised sport or dancing in 2 weeks
Measure 2: Percentage of children aged 5–12 years who spent 40 or more hours participating in screen activities over 2 weeks
Regular physical activity has many benefits to health and wellbeing of children and is an important factor in maintaining good health. It reduces the risk of being overweight or obese; having high blood pressure, Type 2 diabetes and cardiovascular disease; protects against some forms of cancer; and strengthens the musculoskeletal system.58, Physical activity also has psychosocial benefits, reducing symptoms of depression, stress and anxiety, and improving self-confidence, self-esteem, energy levels, sleep quality and the ability to concentrate.
Physical activity includes any activity that requires children to expend energy, including sports, domestic duties or simply playing. It is important to consider children’s physical activity alongside information on the amount of screen time they engage in, as various studies have found a positive correlation between hours of television viewing and overweight.

The National Physical Activity Guidelines for Australian children recommend at least 60 minutes of moderate to vigorous physical activity and no more than 2 hours of screen time (for example, watching television or using a computer) per day. 
•	42% of 5–12 year olds (880,000 children) did not participate in any organised sport or dancing over a fortnight in April 2006.
•	Similar proportions of children spent 1–2, 3–4 and 5–9 hours in organised physical activities (15–16%), and 12% were involved for 10 or more hours over a 2-week period.
•	16% of children spent 40 or more hours in a fortnight on screen activities, excluding internet activities. The rate was almost twice as high for boys as girls.
•	49% of boys who spent 40 hours or more on screen activities participated in organised physical activities, compared with 58% of boys generally. The difference was less for girls.

Key messages
•	More than half of all 5–12 year olds were involved in organised sport or dancing outside school hours in 2006.
•	One in six children spent 40 hours or more on screen activities in a fortnight; the rate was higher for boys than girls.

Overweight and obesity
Measure: Percentage of 6–11 year olds who are overweight or obese
Children who are overweight or obese are at increased risk of developing physical and mental health problems. In the short to medium term they may experience serious conditions such as gallstones, hepatitis, sleep apnoea, asthma, cardiovascular conditions and Type 2 diabetes., In the long term, consequences of childhood weight problems include adult obesity, increased rates of coronary heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis and endocrine disorders.1 In addition, overweight and obese children frequently experience discrimination, victimisation and teasing by their peers and are more likely to have mental health problems than children with other chronic health conditions.
Many interacting factors have led to the increase in body weight among Australian children. All children naturally gain body weight as they grow and develop. For excess weight gain to occur, an imbalance must exist between the amounts of energy children are consuming and the energy they expend over an extended period of time. While genetics plays a role, it is clear that cultural, environmental, economic, familial and individual behavioural factors also influence the likelihood of this imbalance occurring. 
Rates of overweight and obesity among children have been endorsed by Health, Community and Disability Services Ministers as a Headline Indicator of children’s health, development and wellbeing.3

COAG have committed to a National Obesity Strategy. The Australian Government has also established a National Preventative Health Strategy, aimed at reducing the burden of chronic disease caused by obesity.
•	6% of children aged 6–11 years were obese in 2006, and an additional 17% were overweight but not obese.
•	Obesity rates were higher for Indigenous boys than Anglo/Caucasian boys.
•	Students in the most disadvantaged schools had higher rates of overweight and obesity than students in the least disadvantaged schools.
•	The social gradient was greater for obese children than for overweight (excluding obese) children.

Key messages
•	6% of primary school-aged children (6–11 year olds) were obese, and 17% overweight but not obese in 2006.
•	Overweight and obesity rates in children increased with socioeconomic disadvantage.

Literacy and numeracy
Measure: Percentage of Year 5 students who achieve the national benchmarks for reading, writing and numeracy
The acquisition of literacy skills in the schooling years is the basis for further educational attainment, social development and employment. The concepts of literacy and numeracy encompass the skills required to identify, understand, interpret, create, communicate and compute using written and printed materials in various contexts, including information and communication technologies.
People with limited literacy and numeracy tend to experience greater difficulty in finding employment. In terms of business and the economy, low levels of functional literacy and numeracy are a recognised major barrier to growth. Educational outcomes measured through test scores during the school years, including literacy and numeracy scores, are predictive of social exclusion and there is a strong connection between health and socioeconomic gradients related to education, employment and income.,,6
Benchmark data exist for students in Years 3, 5, 7 and 9. The Year 5 curriculum builds on outcomes from earlier years, measured nationally in Year 3, and outcomes in Year 5 represent the skills of students nearing the transition to secondary school. 
Ministers for Health, Disability and Community Services have endorsed literacy and numeracy benchmarking results for Year 5 students as a Headline Indicator of children’s health, development and wellbeing3. 

COAG have committed to the development of a broad national strategy for early childhood development and reforms in schools. These aim to support all teachers and school leaders in improving the ability of all young Australians to engage, learn and achieve in schooling and ensure they are prepared for life and further learning.10 For Indigenous young people, COAG have committed to halve the gap in reading, writing and numeracy achievements within a decade.53
•	Around 9 in 10 Year 5 students met the national benchmarks in 2006—88% for reading, 94% for writing and 90% for numeracy.
•	Fewer Indigenous students met the benchmarks in each area—66% each for reading and numeracy, and 77%for writing. The gap has not changed significantly in recent years. 
•	Students living in remote and very remote areas were less likely to meet the reading, writing and numeracy benchmarks than students in metropolitan areas.
•	Indigenous students had lower than average rates of meeting the benchmarks within metropolitan, remote and very remote areas.
•	Two-thirds of Indigenous students in very remote areas did not meet the reading and numeracy benchmarks, and more than half did not meet the writing benchmark.

Key messages
•	Most Year 5 students met national literacy and numeracy benchmarks.
•	There is a significant gap between Indigenous students and the national average for literacy and numeracy. It is not limited to Indigenous students living in remote parts of Australia.
•	Australian Year 4 students ranked 8th in science and 16th in mathematics out of 25 participating countries in an international benchmarking study in 2003.,

Crime
Measure 1: Number of children aged 0–14 years who were victims of selected crimes, per 100,000 population
Measure 2: Number of children aged 10–12 years who are under juvenile justice supervision, per 100,000 population
Being a victim of crime can be detrimental to a child’s health, wellbeing, sense of security, safety and feelings about the future. For some children, being victimised may lead to diminished educational attainment and social participation in early adulthood, or result in physical injury, disability and even death. Experience of crime is central to issues of community safety in general, and even more so for children as the most vulnerable members of society. For many children, their personal experience of crime is as victims of child abuse and neglect.
Some children are themselves perpetrators of crime, and children who have been victimised are at greater risk of later offending.4 For most children engaged in criminal activities, the nature of the offence is relatively minor and the behaviour is short lived. However, for a small number of children this behaviour becomes more serious or persistent and results in contact with the juvenile justice system. Children whose first juvenile justice supervision order occurs before the age of 13 comprise less than 10% of all young people in the system, and represent a particularly disadvantaged and high-risk group of the Australian population.

The Australian Government has committed to developing a National Child Protection Framework which will focus on preventing abuse through early intervention and better integration of family services. COAG has also committed to identify joint reforms and implementation timetables for basic protective security from violence for Indigenous parents and children.29 
•	900 robbery victims were aged under 15 years in 2006–07—95% were aged 10–14 years. The victimisation rate was 5 times as high for boys as for girls.
•	267 kidnapping/abductions of children aged under 15 years—60% were aged 10–14 years. The rate was almost twice as high for girls as boys.

Victims of selected crimes, 2007 (per 100,000 population)

•	360 children aged 10–12 years were under juvenile justice supervision in 2006–07; 70% were Aboriginal or Torres Strait Islander children.
•	Supervision rate was 686 per 100,000 Indigenous children, compared with 14 per 100,000 for other children.
•	Juvenile justice supervision rate rose by 11% for Indigenous children, but fell by 14% for other children (2000–01 to 2006–07).

Key messages
•	Children aged 10–14 years are more likely to be victims of robbery or kidnapping/abduction than younger children (0–9 year-olds).
•	Boys are 5 times as likely as girls to be victims of robbery, and 6 times as likely to be under juvenile justice supervision.
•	Indigenous children are over-represented in the juvenile justice system, accounting for 70% of all 10–12 year olds under supervision.

This section focuses on adolescents (13–19 year olds). Teenagers are in transition between childhood and adulthood, and their increasing independence brings about new challenges and risks. Concerns about the health of adolescents often fall into two categories: the potentially negative effects on their health of certain behaviours (such as substance use or dangerous driving), and the emergence of long-term health conditions or risk factors for long-term conditions that may persist into adulthood. 
Secondary and post-school education, a good transition from school to work, no or limited exposure to or participation in criminal activities, preparation for parenthood, and economic and social participation are key factors contributing to the wellbeing of young adults.
The following table presents national data for each of the measures of the four indicator topics relating to health and key health risk factors and for each of the three indicators related to wellbeing (including education). Where time series data has been referred to on an indicator page, the direction of the recent trend is shown in the table.
Indicator 	Measure	Value	Trend	
HEALTH	
Injury and poisoning

 	Total hospitalisations due to injury and poisoning per 100,000 13–19 year olds	2,221	û	
		Hospitalisations due to transport accidents, per 100,000 13–19 year olds	490	û	
		Hospitalisations due to falls, per 100,000 13–19 year olds	386	~	
		Hospitalisations due to intentional self-harm, per 100,000 13–19 year olds	197	û	
		Hospitalisations due to assault in per, 100,000 13–19 year olds	180	û	
Mental health

 	Percentage of 13–19 year olds reporting mental or behavioural problems	10		
	Total hospital bed days, per 100,000 population for mental and behavioural problems	5,819 	ü	
		Hospital bed days, per 100,000 population for schizophrenia and related disorders	1,224 	ü	
		Hospital bed days, per 100,000 population for substance use-related disorders	515 	ü	
		Hospital bed days, per 100,000 population for mood disorders	1,503 	û	
		Hospital bed days, per 100,000 population for behavioural syndromes 	1,299 	û	
Overweight and obesity
 	Percentage of 15–19 year olds who were obese	5	û	
	Percentage of 15–19 year olds who were overweight but not obese	18	û	
Substance use

 	Percentage of 14–19 year olds who are current smokers	10	ü	
	Percentage of 14–19 year olds at risk of long-term harm to their health from alcohol	9	ü	
	Percentage of 14–19 year olds at risk of short-term harm to their health from alcohol	26	ü	
	Percentage of 14–19 year olds who had used illicit drugs in the past 12 months	17	ü	
	Percentage of 14–19 year olds who had been the victim of alcohol-related verbal abuse in the past 12 months	28		
	Percentage of 14–19 year olds who had been the victim of alcohol-related physical abuse in the past 12 months	7		
	Percentage of 14–19 year olds who had been the victim of other drug-related verbal abuse in the past 12 months	10		
	Percentage of 14–19 year olds who had been the victim of other drug-related physical abuse in the past 12 months	3		

WELLBEING	
Year 12 retention & completion	Apparent retention rate to Year 12 (%)	74	~	
	Percentage of 19 year olds who have completed Year 12	74		
 Youth participation	Percentage of 15–19 year olds who are not engaged in education or employment	7	~	
	Percentage of 15–19 year olds in the labour force who were unemployed	13	ü	
	Percentage of 15–19 year olds in the labour force who were underemployed	10	ü	
Crime
 
 	Persons aged 15–19 years who were victims of robbery, per 100,000	270 		
	Persons aged 15–19 years who were victims of kidnapping or abduction, per 100,000	10 		
	Percentage of young people aged 13–19 years under juvenile justice supervision	0.6 	ü	
Key: ü = favourable trend; û = unfavourable trend; ~ = no change or clear trend; blank cells = no trend data presented.

Injury and poisoning
Measure: Injury hospitalisations for 13–19 year olds due to selected causes, per 100,000 population
Increasing responsibility for decision making in adolescence creates more opportunities to engage in risky behaviours. This independence occurs simultaneously with exposure to alcohol and other drugs, and the development of new skills, such as driving and job skills, at a time when peer acceptance is important. Young people may experiment with illicit substances and alcohol, which can make them more prone to certain types of injuries, such as falls, transport accidents, accidental poisoning and assault. 
Injury (including poisoning) accounts for 18% of the burden of disease among 15–24 year olds—the second highest contributor after mental disorders. It is the leading cause of death and the third leading cause of hospitalisation in this age group79, and can result in significant disability: in 2003 more than 120,000 Australians had a disability where their main disabling condition was caused by an injury that occurred before the age of 20.56 Reducing the number and severity of injuries among adolescents and young adults is therefore key to preventive health initiatives. 
Injuries may be caused by a diverse range of factors, including transport accidents, falls from heights or during sport, assault and intentional self-harm. Consequently, injury prevention strategies intersect with initiatives in the areas of community safety, violence reduction and mental health care.

Injury prevention and control has been a National Health Priority Area since 1986. A key priority of the National Injury Prevention and Safety Promotion Plan 2004–2014 is to create a positive safety culture and a safe environment, particularly for children and youth. 
•	45,000 injury hospitalisations for teenagers in 2006–07 (2,221 per 100,000 population, 7% increase since 1998–99). Around one in five were caused by transport accidents (mostly motor vehicle accidents) and one in six by falls.
•	Hospitalisation rates have increased for assault (by 18%) and intentional self-harm (27% increase—increase much greater for females (33%) than males (9%)) since 1998–99.
•	Transport accident hospitalisation rate fell by 10% (1998–99 to 2002–03), but has since increased.
•	Young males were 3–4 times as likely as young females to be hospitalised for transport accidents, falls and assault, while females were 3 times as likely to be hospitalised for intentional self-harm.
•	Overall hospitalisation rate for Indigenous teenagers was 30% higher than for other teenagers, largely due to a 5 times as high rate for assault.

Key messages
•	Males had higher rates of hospitalisations than females due to transport accidents, falls and assault, while females had higher rates of hospitalisations due to intentional self-harm.
•	Hospitalisation rates are increasing for assault and intentional self-harm.
•	Injury hospitalisation rates are higher for Indigenous youth, young people living in remote or very remote areas and those living in areas of the greatest socioeconomic disadvantage, particularly for assault and intentional self-harm.79

Mental health
Measure 1: Percentage of 15–19 year olds who report having a mental or behavioural problem
Measure 2: Hospital bed days per 100,000 population for mental and behavioural disorders among 13–19 year olds
Mental health disorders are the leading cause of disability among young Australians aged 15–24 years and account for almost 50% of the burden of disease in this age group. More specifically, anxiety and depression contribute 17% of the male disease burden and 32% of the female disease burden.80 
Young people with a mental health disorder are more likely to have lower educational attainment, experience joblessness and have poor physical health. It is not possible to determine causality from these associations; and conversely experiencing adverse situations, especially during youth, may contribute to the development of a mental disorder. The reasons why some people develop mental disorders are complex, but a range of possible influences include individual attributes, family and social factors, school context, life events and situations, and community and cultural factors.
Many people living with mental health problems are undiagnosed or do not access specialist services; others manage their condition largely through primary health care. Measures of the extent to which people with mental disorders receive treatment as hospital inpatients and the duration of their hospital stay (bed days) therefore represent the acute care-treated prevalence of mental illness.

Mental health is a National Health Priority Area. The COAG National Action Plan on Mental Health 2006–2011 aims to reduce the prevalence and severity of mental illness and its’ risk factors.
•	Mental and behavioural problems were reported by 11% of males (100,000 people) and 9% of females (80,000 people) aged 15–19 years in 2004–05.
•	Mood disorders were the most common problem for females, while problems of psychological development were most common among males.
•	The prevalence of mental and behavioural problems was 40% higher among Indigenous teenagers than non-Indigenous teenagers.
•	There were 19,400 hospitalisations for mental and behavioural disorders for 13–19 year olds in 2006–07 (973 per 100,000), with a bed day rate of 5,800 per 100,000 population. The female bed day rate was twice the male rate.
•	Female bed day rate was higher for mood disorders and behavioural syndromes such as eating disorders; male rate higher for schizophrenia-type disorders and disorders due to psychoactive substance use.
•	Bed day rate for substance use-related and schizophrenic disorders fell by more than one-third but rose by 15% for mood disorders and 20% for behavioural syndromes (1989–99 to 2006–07).
Key messages
•	1 in 10 Australians aged 15–19 years reported a mental or behavioural problem.
•	Reported prevalence and hospital bed day rate for mental and behavioural problems are each 40% higher among Indigenous than non-Indigenous teenagers.
•	Male hospital bed day rate for mental and behavioural disorders fell by 28%, but female rate rose by 7% between 1998–99 and 2006–07.

Overweight and obesity
Measure: Percentage of adolescents aged 15–19 years who were overweight or obese
Overweight and obesity in young people are linked to a range of immediate and long-term health problems. In the short term, overweight and obesity affects young people’s psychological wellbeing and increases their risk of developing cardiovascular conditions, asthma and Type 2 diabetes. Long-term consequences include adult obesity, increased risk of coronary heart disease, diabetes, some cancers, gall bladder disease, osteoarthritis and endocrine disorders1. Negative social consequences of teenage obesity include social isolation and lower educational and income attainment throughout life.,
Risk factors associated with obesity in childhood and adolescence include genetic makeup, ethnicity, television viewing, extent and types of physical activity, dietary intake and eating patterns, artificial feeding as infants, and presence of other health conditions.66
While overweight and obesity accounted for less than 1% of the burden of disease in youth, they contributed 7.5% to the total disease burden in 2003.80 Young people who are overweight or obese are more likely to be obese as adults, therefore reducing youth overweight and obesity is key to early intervention and prevention of chronic disease.
The overweight and obesity data in this section is based on self-reported height and weight, which is less accurate than measured height and weight. For younger children the overweight and obesity data presented in this report is based on measured height and weight, and hence it is not appropriate to accurately compare the prevalence of overweight and obesity between these different age groups.

COAG have committed to a National Obesity Strategy. The Australian Government has also established a National Preventative Health Strategy, aimed at reducing the burden of chronic disease caused by obesity.
•	5% of 15–19 year olds (almost 55,000 teenagers) were obese in 2004–05; 18% (200,000 teenagers) were overweight but not obese and the rate was higher among males than females.
•	Rates of overweight and obesity have increased significantly since 1995.
•	Indigenous teenagers were 2.6 times as likely to be obese as non-Indigenous teenagers.
•	Similar proportions of Indigenous and non-Indigenous teenagers were overweight but not obese.

Key messages
•	1 in 20 Australians aged 15–19 years were obese in 2004–05.
•	18% of 15–19 years olds were overweight but not obese, up from 15% in 1995. 
•	Indigenous teenagers are more than twice as likely to be obese as non-Indigenous teenagers in 2004–05.

Substance use
Measure 1: Percentage of 14–19 year olds who consume alcohol at risky or high risk levels for short and long term harm, who smoke tobacco, and who have used an illicit drug recently
Measure 2: Percentage of 14–19 year olds who have been the victim of an alcohol or other drug-related incident 
Misuse of alcohol and use of other drugs (including tobacco) by young people can cause immediate and long-term health and social problems. In the short term, it may result in hospitalisations due to acute intoxication and related injuries, dependence, withdrawal symptoms, psychotic disorders and amnesia. In the long term, alcohol and other drug use can lead to depression, infections with blood-borne diseases, damage to the liver, heart and brain, and increased risk of cancers and other serious health conditions., Drug abuse has also been associated with family and relationship conflict, and legal and financial problems.
Many factors can put young people at risk of problematic drug use. Some of these occur before they reach adolescence, such as maternal drug use during pregnancy, early behavioural and emotional problems and early exposure to drugs.88,89 Other factors include peer antisocial behaviour; poor parental control and supervision; poor family bonding; drug use among family members; poor connection with family, school and community; academic failure; low self-esteem; and leaving school early.89 

COAG have identified reducing alcohol and substance abuse and its impact on families, safety and community wellbeing as a priority area for the 2008 forward work-plan.9 COAG has also acknowledged the importance of tackling alcohol misuse and binge drinking among young people and commissioned the Ministerial Council on Drug Strategy to investigate options to reduce binge drinking.29 
•	Teenage smoking rates have halved (2001–2007) to around 1 in 10 persons for 14–19 year olds; risky alcohol intake and illicit drug use have also reduced.
•	One-quarter of teenagers risk short-term harm to their health from alcohol intake and one in ten are at risk of long-term harm. One in six have used an illicit drug recently.
•	More than one-quarter of 14–19 year olds had been the victim of alcohol-related verbal abuse in a 12-month period, and 7% had experienced alcohol-related physical abuse.
•	Being the victim of alcohol-related incidents was more common than incidents related to other drugs.
•	Males were more likely than females to have experienced alcohol and other drug-related verbal or physical abuse, but females were more likely to feel fear from alcohol and drug use of others.
Key messages
•	Adolescent smoking rates have halved and risky alcohol intake and illicit drug use have also declined since 2001.
•	1 in 4 teenagers regularly risk short-term harm to their health from alcohol consumption; 1 in 10 are at risk of long-term harm.
•	Almost 300,000 teenagers have felt or experienced threats to their safety through the alcohol use of others.

Year 12 retention and completion
Measure 1: Number of full-time students who continued to Year 12 as a percentage of those who commenced secondary schooling (apparent retention rate)
Measure 2: Percentage of 19 year olds who have completed Year 12 (completion rate)
As the number of low-skilled jobs in the employment market decreases, the importance of educational qualifications increases. Early school leavers often have trouble finding stable, full-time employment and tend to work in a narrow range of jobs. 
In Australia, individuals with higher levels of education report fewer illnesses and have better mental health than those with lower levels of education. Educational attainment may directly affect health by providing young people with greater knowledge and understanding about health, particularly awareness of health risk and protective factors, or indirectly through its association with typically safe, secure and generally better paid and rewarding employment. These benefits positively influence health-related factors such as stress level, injury risk, diet and ability to acquire medical care.
While the apparent retention rate provides information about the proportion of young people who stay in school, it is not a measure of successful completion of Year 12. Young people who did not finish high school have fewer post-school education, training and employment options, and are more likely to experience unemployment than those who completed Year 12.,

COAG has requested Commonwealth and State implementation plans for lifting the Year 12 or the equivalent retention rate to 90 per cent by 2020.9  For Indigenous youth, COAG have committed to at least halve the gap for Year 12 attainment or equivalent attainment rates by 2020.53
•	Overall retention rate more than doubled throughout the 1980s, but has remained steady at 74–75% for the past 5 years.
•	Retention to Year 12 is consistently higher for females than males (80% compared with 69% in 2007).
•	
Apparent retention rate from Year 7/8 to Year 12 (per cent)

Indigenous students are almost half as likely to stay in school until Year 12 (43% retention rate), but the gap is closing.
•	Year 12 completion rates among 19 year olds were half as high for Indigenous than non-Indigenous youth (37% compared with 74%) in 2006.
•	Indigenous 19 year olds were less likely than non-Indigenous youth to have completed Year 12, regardless of whether they lived in remote, regional or metropolitan Australia.
•	Year 12 completion rates were also lower for non-Indigenous 19 year olds in regional and remote areas than in major cities.

Key messages
•	Australia ranked 19th out of 29 OECD countries in high school completion rates for 25–34 year olds in 2005.
•	Retention rate to Year 12 much lower for Indigenous students, but the gap has narrowed over the past decade.
•	Year 12 completion rates are lower for 19 year olds in regional and remote areas, and Indigenous young people throughout Australia.

Youth participation
Measure 1: Percentage of 15–19 year olds not engaged in education or employment
Measure 2: Unemployment and underemployment rates for 15–19 year olds
Young people not involved in school or employment may have decreased opportunities to fully participate in society and are considered at risk of social exclusion. Youth inactivity is linked to dependency on parents or social welfare, family problems, substance abuse, physical and sexual abuse, violence and crime., 
Secure and satisfactory employment offers young people not only financial independence but also a sense of self-control, self-confidence and social contact. In contrast, unemployment, insecure employment and unfavourable working conditions have all been associated with low self-esteem and poor physical and mental health., Young people in the labour force are often also participating in education, and while students who are unemployed are not considered to be inactive, many rely on work as a source of income and so face significant financial pressures as a result of unemployment or underemployment.
Underemployed workers, or those with inadequate wages or insufficient number of working hours, may also be at risk of low self-esteem, alcohol abuse and depression. Underemployment is also a concern from social and economic perspectives, as it can have a significant detrimental effect on the financial, personal and social lives of young people.

COAG have requested Commonwealth and State implementation plans for improving and expanding vocational and technical education, creating an additional 450,000 training places over the next four years.9 A further 50,000 vocational education and training places for national priority health occupations will be available through the COAG Productivity Places Program.10 COAG have also committed to lifting the Year 12 or equivalent retention rates (see Youth Participation, p.x).  	
•	7% of 15–19 year olds were neither working nor studying (96,500 adolescents) in 2007. This proportion has not changed significantly since 2001.
•	One in three had more than a full-time load, either full-time study with additional work or full-time work with additional study.
•	In September 2007, the unemployment rate of 15–19 year olds was 13.3%—3 times that of all people aged 15 years and over in the labour force (4.2%).
•	The youth underemployment rate (10.0%) was more than twice that for the overall labour force (4.7%).
•	Youth unemployment and underemployment rates have fallen by a quarter since 2001. 

Key messages
•	Australia ranked 15th in the percentage of 15–19 year olds not engaged in education or employment (out of 25 OECD countries), and 12th in the unemployment rate for 15–24 year olds (out of 30 OECD countries) in 2005.36,
•	7% of 15–19 year olds are neither working nor studying, while a third have more than a full-time load.
•	15–19 year olds in the labour force are 3 times as likely to be unemployed and twice as likely to be underemployed as the overall labour force population.

Crime
Measure 1: Number of persons aged 15–19 years who were victims of selected crimes, per 100,000 persons aged 15–19 years
Measure 2: Percentage of persons aged 13–19 years who were under juvenile justice supervision 
Young people are vulnerable to becoming victims of crime and becoming involved in criminal activities, and adolescence is the peak period for both being victimised and offending. Of major concern is that children and young people who are victimised are at greater risk of later victimising others. Being victimised can lead to diminished educational attainment and have wide-ranging effects on socioeconomic attainment in early adulthood, suicidal ideation and behaviour, and depression.4
International approaches to crime prevention are increasingly recognising the strong links between youth victimisation and offending. Young people in the criminal justice system represent a particularly disadvantaged population, characterised by high levels of socioeconomic stress, significant physical and mental health needs, and a history of physical abuse and childhood neglect. , Childhood neglect is considered one of the strongest predictors of later youth offending. 
Early intervention for young people at risk and effective rehabilitation of those in the juvenile justice system has significant benefits for community safety at large. Research indicates that serious and persistent adult offenders  are likely to have been in juvenile detention..

The Australian Government has committed to developing a National Child Protection Framework which will focus on preventing abuse through early intervention and better integration of family services.78 COAG has also committed to identify joint reforms and implementation timetables for basic protective security from violence for Indigenous parents and children.29 
•	3,900 15–19 years olds were victims of robbery in 2007, representing one-quarter of all robbery victims.
•	The rate for teenage males being robbery victims was 4 times as high as males generally; for teenage females it was 3 times as high. 
•	The rate of kidnapping/abduction was 3 times as high for young females (15 per 100,000) as young males (6 per 100,000).
•	11,900 teenagers (13–19 years) were under juvenile justice supervision in 2006–07 (0.6% of all teenagers).
•	The supervision rate for Indigenous teenagers was 13 times that of other teenagers.
•	No change in the Indigenous supervision rate in 6 years, but the rate for other Australian youth fell by 20%.

Key messages
•	Teenagers, particularly males, experience high rates of being victims of robbery.
•	No national data are available on rates of physical or sexual assault for young people.
•	Indigenous teenagers are over-represented in juvenile justice supervision, and there has been no change in the Indigenous supervision rate as observed for other Australian teenagers in recent years.

Appendix A: Mapping the indicators to Government priorities and reform 
The following high-level objectives, set by government, underpin current reforms that will impact on the health and wellbeing of children and adolescents, as well as the broader society. While COAG have established seven Working Groups to drive the reform work program, only four of these relate directly to children and youth, and have been described below.
To improve health outcomes for all Australians and the sustainability of the Australian health system
—COAG Working Group on Health and Ageing
To pursue substantial reform in the areas of education, skills and early childhood development, to deliver significant improvements in human capital outcomes for all Australians. To strengthen Australia’s economic and social foundations through this reform workplan
—COAG Working Group on the Productivity Agenda 
(Education, Skills, Training & Early Childhood Development)
To halve the number of homeless people turned away from shelters within five years (one of the 5 objectives of this Working Group)
—COAG Housing Working Group
To close the gap on Indigenous disadvantage and in particular close the life expectancy gap within a generation; halve the gap in mortality rates for Indigenous children under 5 within a decade; and halve the gap in reading, writing and numeracy achievements within a decade —in partnership between all levels of government and Indigenous communities. The pathway to closing the gap is inextricably linked to economic development and improved education outcomes
—COAG Working Group on Indigenous Reform
All Australians need to be able to play a full role in all aspects of Australian life. 
—The Social Inclusion Agenda
The following table shows how the indicators presented in this report relate to each of these high level objectives. A number of indicators are of relevance to more than one area of reform.
	COAG Working Groups			
Indicators	Health & Ageing	The Productivity Agenda	Housing	Indigenous Reform		Social inclusion	
Mortality							
Disability							
Jobless families							
Family economic situation							
Child abuse & neglect							
Homelessness							
Teenage births							
Birthweight							
Breastfeeding							
Childhood immunisation							
Access to child care							
Early childhood education							
Injury and poisoning							
Chronic disease							
Mental health							
Dental health							
Physical activity							
Overweight & obesity							
Literacy & numeracy							
Crime							
Substance use							
Year 12 retention & completion							
Youth participation							

Appendix B: About the data
The data and analysis included in this report builds on previous work that the AIHW has undertaken in the areas of child and youth health, development and wellbeing. Over the last decade the AIHW has produced six comprehensive national statistical reports on patterns and trends in child and youth health, development and wellbeing1,2,3. The indicators included in these reports cover a broad range of areas including health and health risk factors, learning and development, family and community environments, and safety and security (further information on these reports can be found at www.aihw.gov.au/publications/index.cfm). This report builds on the work of these detailed reference documents by drawing together key summary statistics on selected indicators integral to child and youth health and wellbeing. 
Data sources
Various data sources were used to compile this report, including administrative data (for example, hospital and mortality data), survey data, longitudinal data and published data. In all cases, the data used in this report have been the most recently available at the time of writing. For many of the selected indicators more than one data source was available to report on the specific indicator, and the data source chosen for a particular indicator was dependent on the availability of data for the selected age groups and for the subpopulations examined in this report. 
 Table 1 provides information on the data sources used, in terms of data availability and where further information can be found for each of these data sources. 
Table 1: National data sources used in this report for the child and youth indicators
Data source	Data availability	Further information	
AIHW and collaborating units data sources	
AIHW Child Protection Database	Annual from 1991 onwards	www.aihw.gov.au/childyouth/childwelfare/childprotection/index.cfm	
AIHW National Drug Strategy Household Survey (NSDHS)	1985, 1988, 1991, 1993, 1995, 1998, 2001, 2004 and 2007	http://www.aihw.gov.au/drugs/ndshs07.cfm	
AIHW National Hospital Morbidity Database (NHMD)	Annual from 1993–94 onwards	www.aihw.gov.au/hospitals/nhmdatabase.cfm	
AIHW National Mortality Database	Annual from 1964 onwards	www.aihw.gov.au/mortality/index.cfm	
Child Dental Health Survey	Annual from 1990	AIHW DSRU: Armfield et al. 2007 	
Juvenile Justice National Minimum Data Set (JJ NMDS)	Annual from 2000–01	www.aihw.gov.au/childyouth/juvenilejustice/index.cfm	
National Diabetes Register (NDR)	Annual from 1999 onwards	www.aihw.gov.au/diabetes/ndr.cfm	
National Perinatal Data Collection (NPDC)	Annual from 1991 onwards	www.npsu.unsw.edu.au/NPSUweb.nsf/page/NPDC	
Supported Accommodation Assistance Program (SAAP) National Data Collection	Annual from 1996–97	www.aihw.gov.au/housing/sacs/saap/index.cfm	
ABS data sources	
ABS Census of Population and Housing	Five-yearly from 1981	www.abs.gov.au/WEBSITEDBS/D3310114.nsf/Home/census 	
ABS Child Care Survey	Three-yearly from 1993	http://www.abs.gov.au/ausstats/abs@.nsf/mf/4402.0	
ABS National Aboriginal and Torres Strait Islander Health Survey (NATSIHS)	2001, 2004–05	http://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0	
ABS National Health Survey (NHS)	1995, 2001, 2004–05	http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0	
ABS Recorded Crime—Victims	Annual from 1993	http://www.abs.gov.au/ausstats/abs@.nsf/mf/4510.0	
ABS Schools, Australia	Annual from 1960	http://www.abs.gov.au/ausstats/abs@.nsf/mf/4221.0	
ABS Survey of Children's Participation in Cultural and Leisure Activities	Three-yearly from 2000	http://www.abs.gov.au/ausstats/abs@.nsf/mf/4901.0	
ABS Survey of Disability, Ageing and Carers (SDAC)	1981, 1988, 1998 and 2003	http://www.abs.gov.au/ausstats/abs@.nsf/mf/4430.0 	
ABS Survey of Education and Work (previously Transition from Education to Work)	Annual from 1994 (except 1995)	http://www.abs.gov.au/ausstats/abs@.nsf/mf/6227.0	
ABS Survey of Income and Housing (SIH)	Annual from 1994–95 to 2003–04 (except 1998–99 and 2001–02), 2005–06	www.abs.gov.au/AUSSTATS/abs@.nsf/DOSSbyTopic/F0CDB39ECC092711CA256BD00026C3D5?OpenDocument	
Other data sources	
Australian Childhood Immunisation Register	Quarterly from March 1998 onwards	www.medicareaustralia.gov.au/provider/patients/acir/statistics.jsp	
Other data sources (continued)	
OECD Education Database	Varies by indicator	www.oecd.org/education/database 	
OECD Family Database	Varies by indicator	www.oecd.org/els/social/family/database	
OECD Health Data	Selected indicators from 1960 onwards	www.oecd.org/health/healthdata	
Data analysis
Various statistical methods have been used in the analysis and presentation of data in this report. The majority of the rates presented are age-specific or crude rates, either presented as a percent or as a rate indexed to 1,000 or 100,000 (see the AIHW report Australia’s health 2008 for definitions of these methods). 
The ABS estimated resident population (ERP) data were used to calculate most rates presented in this report, except for rates by Indigenous status. The ABS experimental projections, based on the 2001 Census, were the most recent available population data for the Aboriginal and Torres Strait Islander population. 
Measures presented by geographical remoteness (such as major cities versus remote and very remote areas) use the Accessibility-Remoteness Index of Australia Plus (ARIA+), except for breastfeeding data, which was based on the classification of area health services in NSW, and literacy and numeracy data which uses the MCEETYA Schools Geographic Location Classification Scale.
Trend data has been presented where available, and has been calculated by examining the percentage change between the two time-periods. 
The mortality classification for coding causes of death used in Australia, and in this report, is the International Statistical Classification of Diseases and Related Health Problems (ICD-10). This international classification has been modified for morbidity coding in health services in Australia, and the ICD-10-AM has been used as the classification for hospital data in the National Hospital Morbidity Database. Specific ICD and ICD-AM codes used throughout the report can be supplied on request. 
 Abbreviations
ABS	Australian Bureau of Statistics
ACER	Australian Council for Educational Research
ACIR	Australian Childhood Immunisation Register
AIHW	Australian Institute of Health and Welfare
CDSMC	Community and Disability Services Ministers’ Conference
COAG	Council of Australian Governments
DoHA	Australian Government of Health and Ageing
MCEETYA	Ministerial Council on Education, Employment, Training and Youth Affairs
NHMRC	National Health and Medical Research Council
OECD	Organisation for Economic Co-operation and Development
SAAP	Supported Accommodation Assistance Program 
SES	socioeconomic status
UN	United Nations
UNESCO	United Nations Educational, Scientific and Cultural Organization
UNICEF	United Nations International Children’s Emergency Fund
WHO	World Health Organization
Australian jurisdictions
ACT	Australian Capital Territory
NSW	New South Wales
NT	Northern Territory
Qld	Queensland
SA	South Australia
Tas	Tasmania
Vic	Victoria
WA	Western Australia