Determinants of health for First Nations people

Health is related to an individual’s environment and circumstances such as where they live, their education level, income and living conditions along with their access to and use of health services (WHO 2024). For Aboriginal and Torres Strait Islander (First Nations) people, factors such as cultural identity, family and kinship, Country and caring for Country, knowledge and beliefs, language and participation in cultural activities and access to traditional lands are also key determinants of health and wellbeing (AIHW 2025). These factors are interrelated and combine to affect the health of individuals and broader communities.

An overview of determinants of health for First Nations people is provided on this page. For more information, see the Aboriginal and Torres Strait Islander Health Performance Framework (HPF) (Tier 2). The HPF covers a range of measures of the determinants of health, including community, socio-economic, environmental, and health risk factors.

Historical context, culture and family connections

Colonisation has had a devastating impact on First Nations communities and culture. Violence and epidemic disease caused an immediate loss of life, and the occupation of land by settlers and the restriction of First Nations people to ‘reserves’ disrupted their ability to support themselves. Together with the forcible removal of First Nations children from their families and communities, First Nations people have suffered ongoing inter-generational trauma. These factors are recognised as having a fundamental impact on the disadvantage and poor physical and mental health of Indigenous peoples worldwide, through social systems that maintain disparities (see for example, Biles et al. 2024; ANU 2020; Paradies 2016).

For First Nations people, cultural identity and participation in cultural activities, access to traditional lands along with connection to family and kinship, are recognised as protective factors and can positively influence overall health and wellbeing (AIHW 2025). Based on the Australian Bureau of Statistics (ABS) National Aboriginal and Torres Strait Islander Health Survey 2022–23, an estimated 76% (439,600) of First Nations people aged 18 and over recognised an area as homelands or traditional Country, 66% (381,900 people) identified with a tribal group, language, clan, mission or regional group, and 22% (126,800 people) lived on their homelands or traditional Country (AIHW 2026i). See also Profile of First Nations people.

The importance of culture is recognised in the National Aboriginal and Torres Strait Islander Health Plan 2021–2031 which sets the policy direction for the health and wellbeing of First Nations people. The plan notes that implementation across each priority area will need a holistic approach that considers the cultural determinants across the life course. For example, it notes that to ensure the health and wellbeing of First Nations people, contemporary housing must embed culturally responsive design, including consideration of kinship, family and community living arrangements (Department of Health 2021).

Family connections are affected by child removal, family violence, incarceration and the pervasive effects of intergenerational poverty (Dudgeon et al. 2021).

Contact with the child protection and criminal justice systems

Experience of maltreatment during childhood has serious and long-term impacts on social and emotional wellbeing and health (Emerson et al. 2015). The experience of child welfare policies by First Nations people has historically been traumatic, in particular, the policy of forcible removal of children from their families (see also Profile of First Nations people).

The majority of First Nations children are being raised in safe and healthy environments. However, First Nations children are over-represented at all stages of child protection systems, reflecting a history of trauma and stressors which have impacted parents and communities.

The reasons for the overrepresentation of First Nations children in child protection systems are complex and must be understood in the context of colonialism and systemic racism. They include the intergenerational effects of previous separations from family, culture and land, and the legacy of past policies of forced removal of children from their families, known as the Stolen Generations (SNAICC et al. 2023; HREOC 1997).

First Nations people experience contact with the criminal justice system – as both offenders and victims – at much higher rates than non-Indigenous Australians. Detention and imprisonment compounds existing social and economic disadvantage and affects families and the broader community. 

Data on the child protection and criminal justice systems show that:

• In 2023–24, 57,789 First Nations children came into contact with the child protection system (a rate of 146 per 1,000 population) – of these 12,965 children were the subjects of substantiated maltreatment. The rate of substantiated maltreatment for First Nations children was 6 times as high as for non-Indigenous children (33 compared with 5.1 per 1,000 children).
• 25,021 First Nations children were on care and protection orders as of 30 June 2024. The rate of care and protection orders was 10 times as high for First Nations children as for non-Indigenous children (63 compared with 6.4 per 1,000 children).
• As of 30 June 2024, there were 19,987 First Nations children in out-of-home care. Among First Nations children in out-of-home care, 45% (or 9,018 children) had been continuously in care for 5 years or more, 26% (or 5,128 children) for between 2 and 5 years, and 29% (or 5,841 children) for 2 years or less. The rate of out-of-home care for First Nations children was 11 times as high as for non-Indigenous children (50 compared with 4.6 per 1,000 children) (AIHW 2026h). 
• The rate of community supervision for First Nations people aged 10–17 nationally (excluding the Northern Territory) in 2024–25 was 85 per 10,000 young people, 19 times the rate for non-Indigenous young people (4.4 per 10,000 young people).
• The rate of First Nations youth in detention on an average day in 2024–25 was 23 times as high as for non-Indigenous youth (26 compared with 1.1 per 10,000 population) (AIHW 2026k). 
• As at 30 June 2025, 17,432 First Nations people aged 18 and over were in prison at a rate of 2,643 per 100,000 population, with 76% having experienced prior adult imprisonment, 25 percentage points higher than non-Indigenous adults in prison (51%).
• First Nations adults made up 37% of all adults in prison, and after adjusting for differences in the age structure between the two populations, the imprisonment rate for First Nations adults was 17 times the rate for non-Indigenous adults (2,500 per 100,000 adults compared with 149 per 100,000 adults, respectively) (ABS 2025).

The Aboriginal and Torres Strait Islander Health Performance Framework has detailed information on contact with the criminal justice system and child protection among First Nations people. See Measure 2.11 Youth justice, Measure 2.12 Child protection system and Measure 2.23 Adult justice.

Socio-economic and environmental factors

Education, employment and income

A person’s educational qualifications can influence their health status and health outcomes. Specifically, higher levels of education can directly impact a person’s health through a greater understanding and application of health information, in addition to better prospects for employment and income which can help people access good quality housing, healthy food and health care services.

Levels of educational attainment among First Nations people have improved substantially over the past decade. Based on data from the ABS Census of Population and Housing, between 2011 and 2021:

• the proportion of First Nations people aged 20–24 who had attained at least a Year 12 or equivalent qualification increased from 52% to 68% 
• the proportion of First Nations adults aged 20–64 whose highest level of education was Certificate III to Advanced Diploma increased from 24% to 34%, and the proportion whose highest level was a Bachelor Degree or above increased from 6.6% to 9.8% (AIHW 2026d, 2026e).

In 2021, the employment rate – the number of employed people as a proportion of the working age population – was 56% for First Nations people aged 25–64. Between 2011 and 2016 the employment rate for First Nations people changed little; however, between 2016 and 2021, the employment rate for First Nations people aged 25–64 increased by 4.7 percentage points (51% to 56%). The proportion of First Nations people aged 25–64 who were employed was higher in non-remote areas than remote areas, and among those with higher levels of educational qualification (AIHW 2023f).

The employment rate remains considerably lower among First Nations people than non-Indigenous Australians (56% compared with 78%) (AIHW 2023f). 

An adequate income is fundamental to being able to live a healthy life – it gives a person greater access to nutritious food, better housing, health and other services, as well as a greater ability for social participation (Marmot 2016; World Health Organization 2024). Based on AIHW analysis of the Census of Population and Housing 2021:

• More than 1 in 3 (35%) First Nations adults lived in households in the lowest quintile (20%) of equivalised gross weekly household income (which adjusts for differences in income based on differences in household sizes).
• The average (median) equivalised gross weekly household income of First Nations adults was highest among those living in Major cities ($982/week) and lowest among those living in Very remote areas ($459/week) (AIHW 2026g).

The Aboriginal and Torres Strait Islander Health Performance Framework has detailed information on education, employment and income among First Nations people. See Measure 2.04 Literacy and numeracy, Measure 2.05 Education outcomes for young people, Measure 2.06 Educational participation and attainment of adults, Measure 2.07 Employment, Measure 2.08 Income and Measure 2.09 Socioeconomic indexes.  

Housing

Adequate housing – that is, housing that provides space for all members of the household and is in good structural condition with adequate working facilities – is essential to good health. Housing that is overcrowded or lacks facilities for washing and cleaning, increases the risk of infectious disease (Ali et al. 2018).

First Nations people have less access to affordable or secure housing than other Australians and are considerably more likely to live in overcrowded conditions, or to experience homelessness (AIHW 2019). While there have been improvements in overcrowding, home ownership and a reduction in homelessness, there is a continued need for public policy that aims to ensure access to affordable, safe and sustainable housing for First Nations people (NIAA 2026).

According to the ABS Census of Population and Housing, in 2021, 81% (569,400 people) of First Nations people lived in appropriately sized (not overcrowded) housing. This was an increase from 75% in 2011 (AIHW 2026b).

Functional housing encompasses basic facilities, infrastructure, and habitability. Poorly maintained infrastructure and inadequate basic facilities can lead to the spread of infectious diseases. In 2022–23:

• about 1 in 3 (31%; 148,600) First Nations households were living in housing with one or more major structural problems, such as major cracks in walls or floors, sinking or moving foundations, or major electrical or plumbing problems. This was a similar proportion to 2018–19
• the proportion of First Nations households living in housing with major structural problems was highest for those living in Remote and Very remote areas (43% and 54% respectively, compared with between 25% and 34% in non-remote areas) (AIHW 2026c). 

The Aboriginal and Torres Strait Islander Health Performance Framework has detailed information on housing among First Nations people. See Measure 2.01 Housing and Measure 2.02 Access to functional housing with utilities.

Health risk factors

Health risk factors, including smoking, alcohol consumption, overweight and obesity, dietary behaviours and insufficient physical activity, increase the likelihood of a person developing a chronic disease, or interfere with the management of existing conditions. Many health risk factors are preventable and modifiable and significant reduction is associated with improved health outcomes.

Overweight and obesity

A poorer quality diet – lacking in important nutrients and high in processed food – can contribute to obesity. Diet can be affected by what foods are affordable and readily available. For example, fresh fruit and vegetables can be difficult to access by people with low incomes and in more remote areas (Thurber et al. 2017).

Excess weight is a major risk factor for many diseases, such as cardiovascular disease, type 2 diabetes, kidney disease, some musculoskeletal conditions, and cancers. In 2022–23, 68% (450,000) of First Nations people aged 15 and over were overweight or obese (Figure 1). This was lower than in 2018–19 (71%). The small decrease was driven by declines in both non-remote and remote areas (from 73% and 64% to 69% and 59%, respectively) (ABS 2019, 2024).

The Aboriginal and Torres Strait Islander Health Performance Framework has detailed information on overweight and obesity among First Nations people. See Measure 2.22 Overweight and Obesity.

Alcohol consumption

Between 2012–13 and 2022–23, there was a slight increase in the proportion of First Nations people aged 18 and over reporting that they ‘had not consumed alcohol in the last 12 months or have never consumed alcohol’, from 23% to 25% (ABS 2013, 2024).

In 2022–23, based on data from the National Aboriginal and Torres Strait Islander Health Survey, a greater proportion of First Nations people aged 18 and over in remote areas reported that they did not consume alcohol in the last 12 months or have never consumed alcohol, than First Nations adults in non-remote areas (44% compared with 27%) (ABS 2024).

Harmful use of alcohol is a widespread problem for the Australian community. Long-term excessive alcohol consumption is associated with a variety of adverse health and social consequences (AIHW 2026a). High levels of alcohol consumption can increase the risk of lifetime harm. Exceeding alcohol risk guidelines can contribute to the risk of cancer, chronic liver disease and cardiovascular disease, among other health outcomes (NHMRC 2020).

In 2022–23, around 1 in 3 (36% or 218,900) First Nations adults reported drinking alcohol at levels exceeding the lifetime risk guideline in the previous week (Figure 1) (ABS 2024). In this survey, exceeding the guidelines was defined as consuming more than 10 standard drinks in the last week (component A) and/or consuming more than 4 standard drinks on at least 12 days in the last 12 months (component B). This is based on the National Health and Medical Research Council (NHMRC) 2020 guidelines which aim to reduce the lifetime risk of harm from alcohol-related disease or injury. This new methodology cannot be directly compared to the 2009 NHMRC guidelines used in previous iterations of the National Aboriginal and Torres Strait Islander Health Survey.

The Aboriginal and Torres Strait Islander Health Performance Framework has detailed information on alcohol consumption among First Nations people. See Measure 2.16 Risky alcohol consumption.

Tobacco smoking

Smoking is a major risk factor for cardiovascular disease, cancer, and respiratory disease (AIHW 2022). The proportion of First Nations people aged 15 and over who smoke every day has fallen from 2018–19 to 2022–23. In 2022–23, 29% of First Nations people aged 15 and over (about 192,300) smoked every day (Figure 1), compared with 37% in 2018–19. The largest falls in daily smoking rates have occurred among younger First Nations people (AIHW 2026j).

In 2022–23, 90% of First Nations people aged 15–17 reported that they had never smoked, compared with 85% in 2018–19. The decline in daily smoking rates among First Nations people aged 15 and over this period occurred in non-remote areas, where the percentage of First Nations daily smokers decreased from 35% to 26%, while there was a smaller change over this same period in daily smoking rates for First Nations adults in remote areas (49% to 46%) (AIHW 2026j).

The Aboriginal and Torres Strait Islander Health Performance Framework has detailed on tobacco smoking and second-hand smoking among First Nations people. See Measure 2.15 Tobacco use and Measure 2.03 Environmental tobacco smoke.

Where do I go for more information?

For more information, see:

• Aboriginal and Torres Strait Islander Health Performance Framework
• Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Health Survey, 2022–23 
• For more information on this topic, see First Nations people.