This review of the health status and needs of migrant Australians was commissioned as part of the National Agenda for a Multicultural Australia. It is also a response to the 1988 National Ethnic Health Policy Conference, in that it provides a database for the Conference's recommendation for 'urgent development of a national policy, plan and resource base for Ethnic Health'.

The ultimate impact of these policies is shown by comparisons of the health of immigrant groups with those born in Australia. How such comparisons in future times differ from those today will be of particular interest (Chapter 2).

Defining membership of an ethnic community is not easy. Depending on the context, members of ethnic communities may be so regarded because they share characteristics such as geographic origin, language, religion, customs or a sense of distinctiveness. Specific ethnic groups form small proportions of the population. Collecting information from adequate numbers of any group may require studies focused on that group; such studies are difficult because groups do not always live in single communities, and findings can be hard to interpret because of internal diversity in ethnic communities.

An alternative approach is to extract information on ethnic group members participating in large-scale surveys. However, the only indicators of ethnicity which are usually collected in these large surveys are country of birth and language spoken at home, and sometimes length of residence in Australia. A third source of statistical information is routine statistical collections, in which country of birth is usually the only indicator of ethnicity (Chapter 3).

Other simple measures of ethnicity such as self-assessed ancestry or more complex ones taking into account, for example, the birthplace, language and religion of parents are used in demography but not in Australian health data collections.

The latest (1986) Census data show that 20.8 per cent of Australia's population was born overseas, and 11.6 per cent in countries where English was not the main language. Source countries have changed over time so that demographic characteristics of birth­ place groups, particularly their duration of residence and their age structure, vary widely.

The socioeconomic status of birthplace groups also varies widely. Although there is a perceived concentration of ethnic groups in unskilled labouring jobs, in fact there is great variation with birthplace in the proportions in these occupations. The proportions with post-school qualifications, and income levels, are just as diverse. On some measures certain immigrant groups are better off than the Australian-born.

Lack of proficiency in spoken English poses special problems in provision of and access to health and welfare services. The 1986 Census showed that 9.2 per cent of Australian residents aged 5 years and over did not speak English well, and 1.8 per cent did not speak it at all. Ethnic women are more disadvantaged in this way than are men, and some with little or no English are elderly and unlikely ever to learn it (Chapter 4).

Most ethnic groups have lower, and in many cases significantly lower, total mortality than the Australian population as a whole. These findings apply across all age groups studied (15-74 years). Ethnic group mortality has been decreasing in parallel with that of the Australian-born.

For some birthplace groups, the level of mortality increases with longer duration of residence. This should be interpreted with care because those migrating at one time period may differ from those migrating at another period. Almost all birthplace populations in Australia experience lower mortality than in their countries of origin.

People who apply to migrate to another country may be among the healthier members of their original societies. Certainly migration to Australia depends on a successful application, and the likelihood of that is lower for applicants with existing health problems. The lower mortality of migrant groups probably partly results from these two factors. There has also been speculation that once in Australia, the sick are more likely to return to their country of origin, but there are no data relating to this. Neither is there any information on mortality of children of migrant parents.

Each country of birth group has its own cause of death profile which is related to the profile of causes in that country. Some of the major immigrant groups with the lowest levels of mortality are also those with the lowest socioeconomic status (Chapter 5).

Age standardised hospital separation ratios for country of birth were calculated from hospital utilisation data for New South Wales for 1986. The Australian-born have the highest separation ratios for all non-obstetric causes combined. Separation ratios were also examined for some major disease groups; most ratios relating to the overseas-born were lower than those for the Australian-born, and in many cases substantially lower (Chapter 6).

The 1989-90 National Health Survey collected interview data on about 57,000 persons, or about 1 in every 300 Australia residents. Topics in the long interview which were regarded as most relevant were selected for study. The first group of these related to women's health: whether those interviewed had had a breast examination or examined their own breasts, and their knowledge or experience of a mammogram; whether they had had a hysterectomy; and their use of oral contraception. Knowledge relating to cancer screening was limited in some groups, and participation in it was correspondingly low. Some groups with low levels of effective contraception had higher than average numbers of children.

The next group of topics related to use of services. A hist01y of recent hospital admissions was studied in relation to country of birth, the language in which the interview was conducted, and duration of residence. Recent use of medical and other services, absence from work, recent accidents, and use of common medications were similarly examined. So were the lifestyle factors of exercise habits, alcohol consumption and smoking, and a history of obesity and the more prevalent chronic diseases.

These findings were, where relevant, related to the findings presented elsewhere in the report. There was an interesting contradiction that most Southern European populations rate poorly on lifestyle factors, yet they also have the lowest mortality among the groups studied. There are also birthplace differences between the level of reported illness in relation to the level of mortality from that condition. Some findings may be explained by the heterogeneity of the health outcomes studied and by differing perceptions of illness in the birthplace groups (Chapter 7).

Over 9,000 Australians were examined in the 1989 Risk Factor Prevalence Survey con­ ducted by the National Heart Foundation. This survey collected information on biomedical risk factors for coronary heart disease, such as blood pressure, plasma lipid levels, and weight for height, as well as lifestyle behaviours.

Analysis of the data from this survey and from the 1989-90 National Health Survey showed that immigrants generally have a better risk factor profile than the Australian-born population with regard to blood pressure, hypertension, total cholesterol levels and alcohol consumption, but not with regard to exercise. The overall differences with regard to smoking and being overweight were small, but there was marked variation among countries of birth.

Because of the considerable change in the birthplace composition of immigrants arriving during the last decade compared with earlier years, the risk factor levels observed for migrants who have been in Australia for less than 10 years and for those who have been here for more than 10 years cannot be taken as an indication of a cohort trend or of a convergence to the Australian norm. The recent arrivals include a much higher pro­ portion of Asian immigrants and a lower proportion of British and other European immigrants compared with the composition of the migrant stream before the late 1970s. Therefore the changes observed between recent arrivals and longer established settlers are probably due more to birthplace differences than to a convergence to the Australian-born experience. This is particularly evident in the figures relating to body mass index (Chapter 8).

Differentials in disability by country of birth were investigated using the 1988 Survey of Disabled and Aged Persons. This interview survey covered all self-reported disabilities from the very minor (e.g. visual defects corrected by wearing glasses) to the most severe. It also covered the degrees of handicap and social disadvantage resulting from these disabilities.

Disability and handicap are defined in a physical sense, but they also have a social con­ text not easily assessed in interview surveys. Interpretation of self-reported disability and handicap in different cultural groups is discussed (Chapter 9).

After adjustment for age differences, disability was most frequently reported by those born in Greece. All other major migrant groups reported 1ess disability than the Australian-born. For immigrants from both all English-speaking countries grouped and all other countries grouped, reported disability was more frequent in those resident in Australia for more than 15 years than for those resident for less than 15 years.

Findings on prevalence of all handicaps were generally similar to those for disability. However, severe handicap was reported much more frequently by those from Greece, Italy and Yugoslavia than by the Australian-born.

Information on private health insurance has been obtained from the 1989-90 National Health Survey and from the 1990 Health Insurance Survey. Some immigrant groups had coverage levels similar to the Australian-born; others had very much lower levels. The coverage level for some source countries differed greatly from that for other countries in the same region. The coverage levels were usually lower among persons from non-English-speaking countries. Reasons for being insured did not vary greatly among ethnic groups.

Having private health insurance is more frequent among longer-settled immigrants. It is also most frequent at ages 45 to 54 years in most ethnic groups. There are some groups where coverage is particularly low at ages 65 and over. Single persons with de­ pendants are the least likely to be insured. Coverage is low among unemployed immigrants, and generally increases with income, except for a fall-off among the highest earners.

With the exception of those from New Zealand, where the relationship is more complex, immigrants reporting the most favourable perceptions of their own health are the most likely to have private health insurance (Chapter 10).