Closing the Gap targets: key findings and implications

Target

The target associated with Outcome 1 of the 2020 National Agreement is to close the gap in life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians within a generation (by 2031).

Background

Research confirms that life expectancy is affected by several factors, including health risk behaviours, socioeconomic factors (including education) and environmental factors (such as overcrowded housing and sanitation). It has been found that:

• family/community, country and place, cultural identity and self-determination all have strong protective effects on health and wellbeing
• factors posing risks to good health include the long-term effects of colonisation and its ongoing impact on matters such as self-determination, the disruption of ties to land, and the adverse impact of direct and systemic racism
• racism can lead to reduced access to resources associated with health outcomes, such as education, employment, housing and medical care. Studies have also found a strong association between experiences of racism and ill health, psychological distress, mental health conditions and risk behaviours (such as substance use)
• 49% of the burden of disease in First Nations Australians in 2018 was due to potentially modifiable risk factors (AIHW 2022). Tobacco use was the risk factor that contributed most to deaths and fatal burden among First Nations people (over 800 deaths or about 23% of all First Nations deaths, and 19% of fatal burden)
• social determinants account for around 35% of the health gap according to estimates based on an AIHW analysis (AIHW 2024). Employment status and hours worked, equivalised household income and highest level of school completed accounted for 14%, 13% and 8.9%, respectively, of the gap in health outcomes between First Nations and non-Indigenous adults aged 18 to 64.

Current status

Australia has one of the highest life expectancies in the world – in 2020–2022, estimated life expectancy for men was 81.2 years (second in the world) and 85.3 years for women (sixth in the world). However, this high national rate is not one shared equally across society, with one of the largest sources of variation being that between First Nations people and non‑Indigenous Australians.

In 2020–2022, estimated First Nations life expectancy at birth was 71.9 years for First Nations males and 80.6 years for non-Indigenous males, a gap of 8.8 years. Life expectancy was higher for females (75.6 years for First Nations females and 83.8 years for non-Indigenous females), and the gap was slightly smaller (8.1 years).

For both First Nations males and females, remoteness of residence was related to life expectancy, with life expectancy highest for those living in Inner and outer regional areas (72.8 for males and 76.7 for females) and lowest for those in Remote and very remote areas (67.3 for males and 71.3 for females).

Life expectancy was lowest for those in the most disadvantaged areas – the bottom quintile of Australian Bureau of Statistics’ (ABS) derived Index of Relative Socioeconomic Disadvantage (IRSD) (69.5 for males and 74.0 for females). Even though life expectancy estimates for non-Indigenous Australians are also lowest for those living in the most disadvantaged areas, they are still higher than estimates for First Nations people in every socioeconomic area.

According to the Productivity Commission (2024): ‘… the target shows improvement but is not on track to be met for males or females. However, this assessment should be used with caution as it is based on a limited number of data points’.

Key findings

The analyses carried out in this chapter have found:

• If First Nations people had had the same age-specific mortality rates as non-Indigenous Australians between 2017 and 2021, there would have been 9,200 fewer deaths in this period – equivalent to about 1,006 deaths among First Nations males and 834 among First Nations females per year.
• Excess numbers of deaths (hereafter referred to as excess deaths) were primarily concentrated among those aged 35–74. For this age group, 2 broad causes of death were responsible for the largest number of excess deaths for both First Nations males and females – cardiovascular diseases (CVD) and cancer.
• Rates of deaths amenable to changes in health risk factors increased with age from 25 years onwards as risks accumulate. Among both First Nations men and women, deaths in this category are strongly related to smoking exposure, accounting for the majority of deaths of those aged from 45 onwards (such as through cancer of the trachea, bronchus and lung; deaths from chronic lower respiratory disease; and cancer of the buccal cavity, pharynx and oesophagus).
• Mortality rates have distinct age and sex patterns – for example, First Nations males have considerably higher mortality rates for deaths amenable to injury prevention than First Nations females (especially in the 15–34 age group) – particularly deaths from suicide and self-inflicted injuries. Among the types of injuries, deaths due to falls start to increase for both First Nations males and females around age 55.
• Among deaths amenable to both medical interventions and changes in health risk factors, ischaemic heart disease and type 2 diabetes were the 2 causes of deaths with the highest age-specific mortality rates, rising from age 35 onwards. The highest rates were for ischaemic heart disease for males and diabetes for females, with both diseases also affected by tobacco use.

Strategies for improvement

Access to appropriate, high-quality, timely and culturally responsive health care throughout life that acknowledges the impact of social, cultural and historical determinants is essential to improving health outcomes for First Nations people. This improvement comes through increasing health literacy and self-management of chronic disease, providing links to services within and outside the health system and improving screening and treatment of acute and chronic illnesses.

Research has shown that medium to high use of primary health care is associated with greater reductions in hospitalisations and deaths than low use. Recent gains in life expectancy among First Nations people in the Northern Territory and in Queensland have come, at least partly, from a reduction in deaths due to chronic conditions; this positive outcome has benefited from investment in health services focused on primary prevention, early detection, and secondary and tertiary prevention of chronic conditions.

Some evidence suggests that care delivered through Aboriginal Community Controlled Health Services (ACCHS) is associated with lower rates of preventable hospitalisations among remote First Nations communities. The ACCHS care is likely to be more efficient than mainstream services in providing health care to First Nations communities by employing more comprehensive and integrated approach, and meeting the cultural needs and expectations of First Nations communities (Dalton and Carter 2018).

In addition to individual health benefits, it has been estimated that investing in primary care in remote communities could result in from 3 to 10-fold savings in hospital costs. An important driver for change is therefore identifying service gaps for primary health care and considering filling such service gaps with ACCHS.  

Nonetheless, while targeted health care can improve life expectancy, it will have a limited effect on the life expectancy gap unless socioeconomic disadvantage and its associated risks are also reduced (Georges et al. 2017).