Background
This report explores the prevalence of chronic health conditions reported by people from culturally and linguistically diverse (CALD) backgrounds in Australia using data on long-term health conditions and 4 CALD indicators collected through the Australian Bureau of Statistics (ABS) 2021 Census of Population and Housing.
Australia is one of the most culturally and linguistically diverse countries in the world and has grown to be even more multicultural in recent years. According to the 2021 Census of Population and Housing (the Census), more than 7 million people (28%) in Australia were born overseas – an increase from 6.1 million (26%) in 2016 (ABS 2022a). Between 2016 and 2021, the number of people who reported speaking a language other than English at home also increased from almost 5 million people in 2016 (22%) to around 6 million (23%). In 2021, 3.4% of the Australian population indicated they spoke English not well or not at all.
There is great heterogeneity among CALD people in Australia as they have diverse cultures, languages, and migration trajectories (Khatri and Assefa 2022). There is no universally accepted or official operational definition of CALD, and approaches to identifying and reporting on CALD populations are inconsistent between organisations (Pham et al. 2021). Country of birth (excluding 'main English-speaking countries’) and language used at home are commonly used criteria for identifying people from CALD backgrounds (FECCA 2020). Consequently, significant numbers of people from CALD backgrounds, such as those who were born in Australia, were born in main-English speaking countries or who have good English language proficiency, may be under-represented in Australian reporting.
Cultural and linguistic diversity and health
People from CALD backgrounds are identified as a priority population in multiple key Australian Government strategies (AIHW 2022). Some CALD populations face inter-connected health and social disadvantages, and greater challenges when dealing with the health-care system and services (Henderson et al. 2011; Khatri and Assefa 2022). For first generation immigrants, in the early years following migration, some people have relatively better health than the Australian-born population (known as the ‘healthy migrant effect’) due to the combination of health screening checks and strict eligibility requirements before they migrate and through immigrant self-selection, particularly under the skilled migration stream (AIHW 2018; Jatrana et al. 2017; Kennedy et al. 2006; Khatri and Assefa 2022; Kennedy et al. 2014). Some studies also suggest that the healthy migrant effect can disappear after immigrants have lived in a host country for a long time, and acculturation can vary for different immigrant populations depending on differences in education, income and language (AIHW 2018; Hamilton 2015; Jatrana et al. 2017). For more information on the healthy migrant effect, see the AIHW report Reporting on the health of culturally and linguistically diverse populations in Australia: An exploratory paper.
The ABS (2022b) recommends the ‘Standards for Statistics on Cultural and Language Diversity’ (the Standards) to standardise the collection and reporting of information on CALD. The Standards include a Minimum Core set of indicators including country of birth of person, main language other than English spoken at home, proficiency in spoken English and Indigenous status. The Standards also recommend a set of non-core indicators, which includes year of arrival in Australia. For more information on other CALD indicators of the Standards, visit the ABS web page Standards for Statistics on Cultural and Language Diversity, Australia.
Each CALD indicator has its unique strengths and limitations, and the use of a single indicator from the Standards is generally inadequate to account for the socio-cultural differences within the CALD population (ABS 1999; AIHW 2022). Combining the CALD indicators can provide additional information on a person’s socio-cultural identity and a more accurate measure of cultural and language background and diversity.
The 2021 Census, for the first time, collected information on selected long-term health conditions experienced by the Australian population (ABS 2022c). The inclusion of long-term health conditions in the 2021 Census allows for the analysis of chronic health conditions reported by CALD populations at more detailed levels than is currently possible from existing health surveys, across a wide range of CALD indicators. A limitation is that the data rely on self-reported responses from a single question which may result in under-reporting compared to other interviewer-facilitated surveys using detailed sets of questions. See Technical notes for more details on long-term health conditions measured in the 2021 Census.
This report investigates the prevalence of long-term health conditions in relation to 4 CALD indicators collected in the 2021 Census, individually and in combination as follows:
- country of birth of person
- year of arrival in Australia
- language used at home
- proficiency in spoken English (if report a language used other than English)
- country of birth of person and year of Arrival in Australia
- year of arrival in Australia and proficiency in spoken English
- language used at home and proficiency in spoken English.
For more information on the CALD indicators used in this report, their strengths and limitations, see Technical notes.
Although Aboriginal and Torres Strait Islander people are diverse in language and culture, their experiences and needs as First Australians are unique and are therefore considered distinct from the CALD population for the purposes of this report. For more on the health of Indigenous Australians, see Indigenous Australians Overview.
Accounting for age effects
There is a strong association between the prevalence of chronic conditions and increasing age. In the 2021 Census, most long-term health conditions were more common in older age groups (ABS 2022d).
It is important to account for this age effect when comparing CALD groups in Australia as migration patterns have varied over time, including both the number of immigrants and the types of visas and countries which people have arrived from. This has produced different age structures for Australia’s contemporary CALD population groups (Wilson et al. 2020). Therefore, differences in the prevalence of chronic conditions between CALD population groups could be due to their different age structures.
The influence on age structure is demonstrated in Table 1 showing the median ages for the 20 most common overseas countries of birth plus those born in Australia from the 2021 Census. In general, older immigrants are more likely to have been born in European countries, while younger immigrants are more likely to have arrived in Australia from Asian countries.
|
Country |
Males |
Females |
Persons |
|
Australia |
33 |
35 |
34 |
|
China (excludes SARs and Taiwan) |
39 |
40 |
39 |
|
England |
57 |
58 |
58 |
|
Germany |
67 |
65 |
66 |
|
Greece |
73 |
75 |
74 |
|
Hong Kong (SAR of China) |
42 |
44 |
43 |
|
India |
35 |
35 |
35 |
|
Iraq |
40 |
39 |
40 |
|
Italy |
71 |
73 |
72 |
|
Lebanon |
54 |
55 |
54 |
|
Malaysia |
41 |
43 |
42 |
|
Nepal |
29 |
28 |
28 |
|
New Zealand |
45 |
45 |
45 |
|
Pakistan |
32 |
33 |
33 |
|
Philippines |
39 |
42 |
41 |
|
Scotland |
60 |
62 |
61 |
|
South Africa |
45 |
45 |
45 |
|
South Korea |
39 |
40 |
39 |
|
Sri Lanka |
42 |
43 |
42 |
|
USA |
40 |
38 |
39 |
|
Vietnam |
49 |
46 |
48 |
Notes
1. Persons who were overseas visitors at the time of the Census were excluded from analysis.
2. Australia includes External Territories. South Korea reflects the ‘Korea, Republic of (South)’ and USA reflects the ‘United States of America’ classification of the SACC, 2016.
Source: Multi-Agency Data Integration Project (MADIP), 2006 - 2020, MADIP Modular Product, ABS DataLab. Findings based on use of MADIP Data.
The effects of age can be accounted for through presenting age-standardised results and explored by examining age-specific results; see Technical notes for information on age-standardisation. This report presents both crude and age-standardised percentages of people who reported having each of these conditions among the CALD populations described above.
The commentary on the findings in this report refers to the prevalence of long-term health conditions defined as the percentage of people who reported long-term health conditions in the 2021 Census. All comparisons are based on age-standardised results. However, crude prevalence results are also presented in the interactive data visualisations. Results for specific age groups can be found in Data tables.
ABS (Australian Bureau of Statistics) (1999) Standards for statistics on Cultural and Language Diversity, ABS website, accessed 22 August 2022.
ABS (Australian Bureau of Statistics) (2022a) Cultural diversity of Australia, ABS website, accessed 22 August 2022.
ABS (2022b) Standards for statistics on Cultural and Language Diversity, ABS website, accessed 22 August 2022.
ABS (2022c) Comparing ABS long-term health conditions data sources, ABS website, accessed 14 October 2022.
ABS (2022d) Long-term health conditions, ABS website, accessed 21 November 2022.
Australian Institute of Health and Welfare (AIHW) (2022) Reporting on the health of culturally and linguistically diverse populations in Australia: An exploratory paper, AIHW, Australian Government, accessed 17 October 2022. doi:10.25816/fd8z-0b84
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