All is not equal

Where you live, how much you earn, whether you have a disability, your access to services and many other factors can affect your health.

Overall, Aboriginal and Torres Strait Islander people, people from areas of socioeconomic disadvantage, people in rural and remote locations, and people with disability experience more health disadvantages than other Australians. These disadvantages can include higher rates of illness and shorter life expectancy.

Progress for Aboriginal and Torres Strait Islander people, but gaps remain

For Aboriginal and Torres Strait Islander people, good health is holistic—it includes physical, social, emotional, cultural, spiritual and ecological wellbeing, for individuals and for the community. In 2014–15, an estimated 40% of Indigenous Australians aged 15 and over rated their health as ‘excellent’ or ‘very good’, 35% as ‘good’ and 26% as ‘fair’ or ‘poor’.


Overall, Indigenous Australians experience widespread socioeconomic disadvantage and health inequality. However, in recent years, there have been a number of improvements.

Health outcomes

There has been a significant decline in child mortality rates (aged 0–4), from 217 deaths per 100,000 Indigenous children in 1998 to 146 deaths per 100,000 in 2016.

Between 2005–2007 and 2010–2012, the gap in life expectancy at birth between Indigenous and non-Indigenous Australians decreased from 11.4 to 10.6 years for males, and from 9.6 to 9.5 years for females.

Health behaviours

Smoking rates among Indigenous Australians have declined from 51% in 2002 to 42% in 2014–15. This decline was concentrated in non-remote areas.

Fewer young Indigenous people aged 15–17 are smoking now than in the past—30% in 1994 compared with 17% in 2014–15.

In 2014–15, 15% of Indigenous people aged 15 and over reported that they drank alcohol at lifetime risky levels— a decrease from 19% in 2008.

Health services

The number of Medical Benefits Schedule health checks among Indigenous Australians rose significantly from around 22,500 in 2006–07 to nearly 197,000 in 2015–16.

Indigenous-specific primary health care services provided 3.9 million episodes of care to around 461,500 clients in 2015–16 in 368 sites throughout Australia.

Better education leads to better health, and in 2016, 47% of Indigenous Australians aged 20–24 had completed Year 12, compared with 37% in 2011.

There are still gaps

While many aspects of Indigenous health have improved, challenges still exist. Indigenous Australians have a shorter life expectancy than non-Indigenous Australians and are at least twice as likely to rate their health as fair or poor.

Compared with non-Indigenous Australians, Indigenous Australians are also:

  • 2.9 times as likely to have long-term ear or hearing problems among children
  • 2.7 times as likely to smoke
  • 2.7 times as likely to experience high or very high levels of psychological distress
  • 2.1 times as likely to die before their fifth birthday
  • 1.9 times as likely to be born with low birthweight
  • 1.7 times as likely to have a disability or restrictive long-term health condition

Explaining the Indigenous health gap

Differences between Indigenous and non-Indigenous Australians in three key areas help explain the well-documented health gap:

  • Social determinants: Indigenous Australians, on average, have lower levels of education, employment, income, and poorer quality housing than non-Indigenous Australians
  • Health risk factors: Indigenous Australians, on average, have higher rates of smoking and risky alcohol consumption, exercise less, and have a greater risk of high blood pressure than non-Indigenous Australians
  • Access to appropriate health services: Indigenous Australians are more likely to report difficulty in accessing affordable health services that are nearby than non-Indigenous Australians.

Social determinants are estimated to be responsible for more than one-third (34%) of the health gap between Indigenous and non-Indigenous Australians, and health risk factors such as smoking and obesity are estimated to account for about one-fifth (19%) of the health gap.

Main contributors to the health gap

This pie chart shows the proportions of the contributors to the health gap between Indigenous and non-Indigenous adults. This chart presents the contributions to the health gap by health risk factors, by social determinants and by unexplained component due to other factors.  
This figure shows that an estimated 34%25 of the health gap between Indigenous and non-Indigenous adults was due to social determinants, 19%25 due to health risk factors, and 47%25 could not be explained by the selected factors. Around 11%25 of the total health gap was estimated to be attributed to the overlap between the social determinants and health risk factors.

If Indigenous adults were to have the same household income, employment rate and hours worked, and smoking rate as non-Indigenous Australians, the health gap would be reduced by more than a third—from 27 percentage points to around 17 percentage points.

These determinants also help explain the variation in health and health behaviours within the Indigenous population.

  • Indigenous Australians who were most likely to report ‘very good’ or ‘excellent’ health in 2014–15 lived in the highest socioeconomic areas, were employed, had higher educational attainment (Year 12 or higher), and felt safe or very safe alone in their homes after dark.
  • Indigenous Australians who were employed in 2014–15 were less likely to smoke, less likely to use illicit substances, and more likely to have an adequate daily fruit intake than Indigenous Australians who were unemployed.

Find out more: Chapter 6.1 ‘Profile of Indigenous Australians’, 6.2 ‘Indigenous health and wellbeing’, 6.3 ‘Indigenous child mortality and life expectancy’, 6.4 ‘Ear health and hearing loss among Indigenous children’, 6.5 ‘Health behaviours of Indigenous Australians’, 6.6 ‘Social determinants and Indigenous health’, 6.7 ‘The size and sources of the health gap’ and 6.8 ‘Indigenous Australians’ access to and use of health services’ in Australia’s health 2018.

The socioeconomic ladder of good health

The living and working conditions that make up our social environment influence our health and wellbeing. Generally, the higher a person’s socioeconomic position, the better their health. If all Australians experienced the same disease burden as people in the highest socioeconomic group (that is, people living in the areas of least disadvantage), the total burden could be reduced by about one-fifth (21%).

Compared with people in the highest socioeconomic group, people in the lowest group are:

  • 2.7 times as likely to smoke
  • 2.6 times as likely to have diabetes
  • 2.4 times as likely to state cost as a barrier to seeing a dental professional
  • 2.3 times as likely to state cost as a barrier to filling a prescription
  • 2.1 times as likely to die of potentially avoidable causes

Find out more: Chapter 4.2 ‘Social determinants of health’, 5.1 ‘Socioeconomic groups’ and 7.5 ‘Primary health care’ in Australia’s health 2018.

Poorer health outcomes experienced outside major cities

Around 3 in 10 (29%, or 7 million) Australians live in rural and remote areas where they can face  a number of challenges due to geographic isolation, including difficulty accessing services. As a result, they often experience poorer health outcomes than people in Major cities.

People in rural and remote areas are also more likely to engage in behaviours associated with poorer health. For example, around 1 in 5 smoke, compared with 1 in 8 in Major cities.

Proportion of people with selected health risk factors
  Current daily smoker Overweight or obese No/low levels of exercise Lifetime risky drinking High blood pressure
Major cities 13% 61% 64% 15% 22%
Inner regional 18% 67% 69% 18% 24%
Outer regional/Remote 22% 68% 72% 24% 22%

Rural and remote Australians experience higher age-adjusted death rates, which increase with greater remoteness. People in Very remote areas have a death rate nearly one and a half times as high as people in Major cities (759 per 100,000 population compared with 524 per 100,000).

Potentially avoidable deaths are deaths among people aged under 75 that may have been preventable through health care. The rate of potentially avoidable deaths also increases with remoteness. The age-adjusted rate for people in Very remote areas is more than two and a half times as high as the rate for people in Major cities (256 per 100,000 population compared with 96 per 100,000).

Find out more: Chapter 5.2 ‘Rural and remote Australians’ in Australia’s health 2018.

Disability can affect health

There are around 1 in 5 (18% or 4.3 million) Australians with disability. Disability and health have a complex relationship—long-term health conditions might cause disability, and disability can contribute to health problems.

On the whole, people with disability have poorer health than people without disability. They also use more health services, although this varies with the nature and severity of their disability.

People with disability are about 6 times as likely as people without disability to rate their health as ‘poor’ or ‘fair’ (41% compared with 6.5%). This rises to 10 times as likely for people with severe or profound limitation (61%).

How people with disability rate their health

This figure shows two stacked horizontal bar charts showing that people with disability were more likely than people without disability to assess their health as poor or fair. And a higher proportion of people without disability rated their health as ‘very good’ and ‘excellent’ (67%25) compared with people with disability (27%25). Fifteen percent of people with disability rated their health as poor compared with 1%25 of people without disability.

Find out more: Chapter 5.4 ‘People with disability’ in Australia’s health 2018.

Prisoner health reflects a range of social issues

On average, prisoners have poorer health and show signs of ageing 10–15 years earlier than the general Australian population. Prisoners tend to face greater socioeconomic disadvantage than the general adult population before they enter prison—1 in 4 (24%) was homeless, 1 in 4 (27%) was unemployed in the month before entering prison, and 2 in 3 (68%) had an education level of Year 10 or below.

Indigenous Australians are over-represented in Australia’s prisons (27% of the prison population, compared with 3% of the adult population).

Prisoner health compared with the Australian adult population
  Mental health condition Hepatitis C Current smoker Used illicit drugs in previous year
Prison entrants 50% 31% 74% 67%
General adult population 19% 2% 16% 19%

Find out more: Chapter 5.7 ‘Prisoners’ in Australia’s health 2018.