Physical health

About this topic

Aboriginal and Torres Strait Islander (First Nations) people consider the body, mind and spirit to be interconnected (Dudgeon et al. 2017; Gee et al. 2014). This means that physical health, including factors such as long-term health conditions and infectious diseases, can affect mental health and wellbeing (AIHW 2016a; Dudgeon et al. 2017).

Connection to body

Connection to body is one of the 7 domains of social and emotional wellbeing for First Nations people.

Social and emotional wellbeing is a holistic way of looking at relationships between individuals, family, kin and community in the context of land, culture, spirituality and ancestry. Cultural groups and individuals each have their own interpretation of social and emotional wellbeing (Gee et al. 2014).

Access to healthy food and culturally safe health services can enhance connection to body. Poor diet, smoking, and chronic and communicable diseases can detract from connection to body (PM&C 2017).

Many First Nations people experience good physical health as feeling strong and healthy and having respect for their body. A nutritious diet, physical activity, and avoiding the use of harmful substances are all positive influences on health (Dudgeon & Walker 2015; Dudgeon et al. 2017). Physical health can also be influenced by the environment in which an individual lives. This includes factors such as secure access to nutritious food and the absence of infectious diseases.

First Nations communities are a priority population in the Australian Government’s response to the COVID-19 virus. Key issues include food security, safety of remote communities, and access to support and services (Davy 2016; Furlong & Finnie 2020; NIAA 2021).

People with underlying medical conditions can be at higher risk of contracting COVID-19. Lockdowns have affected First Nations people, who are deeply connected with family and community members, especially if caring responsibilities are disrupted. There were heightened impacts on:

remote communities and those associated with them due to the increased isolation and loss of freedom of movement
those who could not access waterways, songlines and country
those who could not attend to cultural and sorry business (AIHW & NIAA 2020).

Physical health conditions

Some physical health conditions – such as diabetes and diseases associated with hearing loss – increase the risk of developing mental health problems (AIHW 2015; Burrow & Ride 2016; Hogan et al. 2011).

Hearing loss in childhood can lead to linguistic, social and learning difficulties and behavioural problems in school. Such difficulties may reduce educational achievements and have lifelong consequences for wellbeing, employment, income, social success, contact with the criminal justice system and attaining future potential (Burrow et al. 2009; Hogan et al. 2011; Williams & Jacobs 2009; Yiengprugsawan et al. 2013).

Vision loss can also lead to similar social difficulties, which can limit opportunities in education, employment and social engagement. Visual impairment can affect health-related quality of life, physical mobility and independent living (Access Economics 2010; George Institute for Global Health 2017; Hsueh et al. 2013) and the family dynamic (Alsehri 2016).

First Nations people are at a higher risk of vision and hearing loss than non-Indigenous Australians. For example, First Nations adults experience higher rates of eye disease (cataract, diabetic retinopathy and trachoma) (Landers et al. 2010; Razavi & Trzesinski 2018). First Nations children have higher rates of ear infections (Edwards & Moffat 2014; Gunasekera et al. 2007).

In 2020, all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations worked in partnership to develop the National Agreement on Closing the Gap- external site opens in new window (the National Agreement), built around 4 Priority Reforms. The National Agreement also identifies 19 targets across 17 socioeconomic outcome areas. Two of these targets directly relate to physical health, monitored annually by the Productivity Commission.

National Agreement on Closing the Gap: physical health-related targets

Outcome area 1: Aboriginal and Torres Strait Islander people enjoy long and healthy lives

Target: Close the Gap in life expectancy within a generation, by 2031 (from 11.4 years for males and 9.6 years for females in 2005–2007 to 0.0 years by 2030–2032 for both males and females).
Status: Nationally, Aboriginal and Torres Strait Islander males born in 2020–2022 are expected to live to 71.9 years and females to 75.6 years, and non-Indigenous males and females to 80.6 years and 83.8 years respectively. This was a gap of 8.8 years for males and 8.1 years for females.

Outcome area 2: Aboriginal and Torres Strait Islander children are born healthy and strong

Target: By 2031, increase the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to 91% (from 88.8% in 2017).
Status: Nationally in 2021, 89.6% of Aboriginal and Torres Strait Islander babies born were of a healthy birthweight. This is about the same as the target trajectory of 89.4%.

Source: Closing the Gap information repository

Physical activity

Physical activity is important for maintaining good physical and mental health (ABS 2013). Regular participation in physical activity can reduce the risk of many chronic conditions, such as cardiovascular disease, type 2 diabetes and some forms of cancer (Brown et al. 2013; Gray et al. 2013; Sims et al. 2006; Wilmot et al. 2012).

Regular exercise can also help in treating or managing disease (Pedersen & Saltin 2015). It also contributes to overall quality of life through improved mental and social wellbeing, in particular by reducing stress, anxiety and depression (Poulsen et al. 2015; Sanchez-Villegas et al. 2008; Teychenne et al. 2008). Physical activity also helps to improve social and emotional health (Awick et al. 2017; Kantomaa 2010).

The concept of physical activity depends on context: where and how people live (Nelson et al. 2010; Thompson 2009). For example, in some remote Northern Territory communities, physical activity is linked to land management and seasonal cultural activities (Thompson 2009). Activities such as hunting, gathering, and participation in cultural activities are linked to different aspects of life, such as health, social structure, education, building and maintaining relationships, building and maintaining wealth and managing and preserving the environment (Thompson 2009). Physical activities such as dancing, hunting, fishing, and intergenerational programs can provide cultural links and can strengthen social connection and wellbeing (Macniven et al. 2014; Macniven et al. 2017).

Key statistics

Good physical health is a key component of social and emotional wellbeing. First Nations people currently experience higher levels of morbidity and mortality from potentially avoidable conditions than other Australians (AIHW & NIAA 2021). An AIHW analysis of Australian Bureau of Statistics (ABS) 2017–18 National Health Survey and 2018–19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) data estimated that over one-third (35%) of the health gap between First Nations people and non-Indigenous Australians was due to social determinants (employment and hours worked, highest non-school qualification, level of schooling completed, housing adequacy and household income) and about 30% of the gap was due to health risk factors (risky alcohol consumption, high blood pressure, overweight and obesity status, inadequate fruit and vegetable consumption, physical inactivity and smoking). The remaining health gap (of around 35%) unexplained by this analysis may include differences in access to health services and the impact of cultural and historical factors on health (AIHW 2024, forthcoming).

The Indigenous Mental Health and Suicide Prevention Clearinghouse (the Clearinghouse) has used 3 social and emotional wellbeing measures – psychological distress, level of mastery and perceived social support – from the 2018–19 NATSIHS to identify relationships between health risk factors, self-assessed health, musculoskeletal conditions, mental health conditions and SEWB. For more information about these measures, see the topic page on Social and emotional wellbeing.

The data presented in this section is sourced from the 2018–19 NATSIHS and is for persons aged 18 and over, unless otherwise stated. Estimates are calculated using a sample selected from a population rather than all members of that population. See the data tables in the Download data section for notes related to these data.

Health risk factors

Health risk factors, including overweight and obesity, alcohol consumption, smoking, inadequate nutrition and physical inactivity, 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 (AIHW 2022).

Smoking

In 2018–19, the proportion of First Nations people who were a current daily smoker was greatest for those aged 35–44 (47%). It was smallest among those aged 15–17 (9.7%). The proportion of current daily smokers was almost the same between males and females (39% and 36%, respectively). Around half (49%) of people in remote areas reported daily smoking, compared with just over one third (35%) of people in non-remote areas (Table PH.1).

Alcohol

First Nations people are more likely to abstain from alcohol than non-Indigenous Australians; however, those who do drink are more likely to do so at dangerous levels (ABS 2019). In 2017–18 and 2018–19, males were more likely than females to have exceeded the 2009 alcohol consumption guidelines for lifetime risk (28% and 9.6%, respectively) and single occasion risk (61% and 40%, respectively). First Nations people aged 45–54 were most likely to have exceeded guidelines for lifetime risk (23%); whereas, people aged 18–24 were most likely to have exceeded guidelines for single occasion risk (65%) (Table PH.1).

Substance use

Substance use was similar across all age groups between the ages of 15 and 54, ranging from 28% among people aged 35–44 to 37% among people aged 25–34. First Nations people aged 55 and over had the lowest reported substance use (15%). Males were more likely to report using substances than females (37% and 27%, respectively). Proportions were about the same between non-remote and remote areas (29% and 27%, respectively) (Table PH.1).

Physical activity

In non-remote areas, 11% of First Nations people aged 18–64 met the 2016 Physical activity and exercise guidelines for Australians. The proportion was lower for people who had a current, diagnosed mental health condition (9.1%), compared with those who did not (13%) (Table PH.2).

Food security

About half (50%) of First Nations people who reported running out of food in the previous 12 months also reported High/Very high psychological distress. This compared with around a quarter (26%) of people who did not run out of food (Table PH.3).

Among people who ran out of food, those who went without food when they ran out were more likely to report High/Very high psychological distress than those who did not go without food when they ran out (57% compared with 45%) (Table PH.3).

First Nations people in non-remote areas were more likely to report High mastery if they did not run out of food (72% compared with 43%) (Figure 1). Similarly, people who did not run out of food were more likely to report High perceived social support (65% compared with 43%) and less likely to report Low perceived social support (8.2% compared with 13%) (Table PH.4).

1. Data reported for persons 18 years and over.
2. Total excludes Unable to determine.
3. Percentages may not sum to 100 due to confidentialisation and rounding.
4. Data were collected from a survey sample and converted into estimates for the whole population. The overall coverage of the 2018–19 NATSIHS was approximately 33% of Aboriginal and Torres Strait Islander persons in Australia. The survey results were weighted to the projected Aboriginal and Torres Strait Islander population at 31 December 2018, which was 814,013.
5. For information about the measurement of level of mastery in the NATSIHS, see Explanatory notes in the Download data tables.

Self-assessed health

Self-assessed health status is a subjective measure dependent on an individual’s awareness and expectations regarding their health and their comparisons with others around them. It is influenced by various factors, including access to health services and information, the extent to which health conditions have been diagnosed, health literacy and level of education (AIHW 2018; Delpierre et al. 2009).

In 2018–19, 42% (202,700) of First Nations people 18 years and over assessed their health as Very good or Excellent; 25% (123,100) assessed their health as Fair or Poor. People with a current, diagnosed mental health condition were less likely to assess their health as Excellent (6.9%) or Very good (23%) than people who did not have a mental health condition (18% and 31%, respectively) (Table PH.5).

The proportion of people reporting Low/Moderate psychological distress was greatest among people who self-assessed their health as Excellent (86% or 55,500 out of 64,800). It decreased with less favourable self-assessments of health, with the smallest proportion among people who assessed their health as Poor (32% or 13,500 out of 42,200 people) (Figure 2; Table PH.6).

1. Data reported for persons 18 years and over.
2. Percentages may not sum to 100 due to confidentialisation and rounding.
3. Total excludes Unable to determine.
4. Data were collected from a survey sample and converted into estimates for the whole population. The overall coverage of the 2018–19 NATSIHS was approximately 33% of Aboriginal and Torres Strait Islander persons in Australia. The survey results were weighted to the projected Aboriginal and Torres Strait Islander population at 31 December 2018, which was 814,013.
5. For information about the measurement of psychological distress in the NATSIHS, see Explanatory notes in the Download data tables.

The NATSIHS survey measured the level of mastery felt by First Nations people in non-remote areas; that is, how much a person feels in control of life events and outcomes. High levels of mastery are important because they can reduce the effect of stress on a person’s physical and mental wellbeing (ABS 2019).

In non-remote areas, level of mastery followed a similar pattern to psychological distress, with people who rated their health as Excellent also scoring High mastery (86%). The proportion reporting High mastery decreased with less favourable self-assessments of health, with the smallest proportion among people who rated their health as Poor (30%) (Figure 3; Table PH.6).

1. Data reported for persons 18 years and over.
2. Percentages may not sum to 100 due to confidentialisation and rounding.
3. Total excludes Unable to determine.
4. Data were collected from a survey sample and converted into estimates for the whole population. The overall coverage of the 2018–19 NATSIHS was approximately 33% of Aboriginal and Torres Strait Islander persons in Australia. The survey results were weighted to the projected Aboriginal and Torres Strait Islander population at 31 December 2018, which was 814,013.
5. For information about the measurement of level of mastery in the NATSIHS, see Explanatory notes in the Download data tables.

Musculoskeletal conditions

Chronic musculoskeletal conditions are large contributors to illness, pain and disability in Australia. People with these conditions report higher rates of poor health, psychological distress and pain, after adjusting for age (AIHW 2022). This may affect their ability to participate in social, community and occupational activities (Briggs et al. 2016). In the general Australian population, the prevalence of musculoskeletal conditions generally increases with increasing socioeconomic disadvantage (AIHW 2022).

In 2018–19, around one third (34%) of First Nations people reported having arthritis and/or another musculoskeletal condition. Among people with a current, diagnosed mental health condition, around one half (49%) of people also reported having arthritis and/or another musculoskeletal condition. This compared with around one quarter (25%) for people without a mental health condition (Table PH.7).

First Nations people with arthritis and at least one other musculoskeletal condition were more likely to report High/Very high psychological distress (48%), Low mastery (60%) and Low perceived social support (18%) than people with Arthritis only or Other musculoskeletal conditions only. This compared with 27% for High/Very high psychological distress, 27% for Low mastery and 7.5% for Low perceived social support, for people with No arthritis or other musculoskeletal conditions (Figure 4; Table PH.8).

1. Data reported for persons 18 years and over.
2. Level of mastery includes people in non-remote areas only.
3. Percentages may not sum to 100 due to confidentialisation and rounding.
4. Total excludes Unable to determine.
5. Data were collected from a survey sample and converted into estimates for the whole population. The overall coverage of the 2018–19 NATSIHS was approximately 33% of Aboriginal and Torres Strait Islander persons in Australia. The survey results were weighted to the projected Aboriginal and Torres Strait Islander population at 31 December 2018, which was 814,013.
6. For information about the measurement of psychological distress and level of mastery in the NATSIHS, see Explanatory notes in the Download data tables.

Key terms

Chronic diseases and conditions covers a diverse group of diseases and conditions that tend to be long lasting and persistent in their symptoms or development. Examples include heart disease, cancer and arthritis.

Although some communicable diseases (infectious diseases) are chronic, the term is usually confined to non-communicable (non-infectious) diseases.

Level of mastery was determined using the Pearlin Mastery Scale, which is a set of seven statements used to measure how much a person feels in control over life events and outcomes. Higher levels of mastery can lessen the impact of stress on a person’s physical and mental wellbeing. Respondents were asked to respond to each statement by selecting one of four responses presented on a prompt card, ranging from ‘strongly agree’ to ‘strongly disagree’. Responses to the statements were combined to produce an overall score between seven and 28. The scores were then grouped to describe the level of mastery as low (7–19) or high (20–28). The Pearlin mastery scale was asked of people living in non-remote areas only (ABS 2019).

A current long-term health condition is an illness, injury or disability that was current at the time of the interview and had lasted at least 6 months or was expected to last for 6 months or more (ABS 2019).

Mental health is a key component of health and wellbeing. It refers to our collective and individual ability to think, feel and interact with each other. Mental health is a state of wellbeing in which every person realises their own potential, can cope with the normal stresses of life, and is able to contribute to their community. Mental health can affect and is affected by socioeconomic, biological and environmental factors. These can include a person’s access to services, living conditions, discrimination experienced and employment status. Mental health affects not only the individual but also their families and carers.

Psychological distress was determined using the Kessler 5 (K5), which is a measure of non-specific psychological distress, derived from a modified version of the Kessler Psychological Distress Scale (K10). It is designed for use in surveys of Aboriginal and Torres Strait Islander peoples. Respondents were asked questions about how often they had experienced negative emotional states in the previous four weeks by selecting one of five responses, ranging from ‘all of the time’ to ‘none of the time’. Responses were combined to produce an overall score between five and 25. The scores were then grouped to describe the level of psychological distress as low/moderate (5–11) or high/very high (12–25).

Remoteness: Each state and territory is divided into regions based on their relative accessibility to goods and services (such as to general practitioners, hospitals and specialist care) as measured by road distance.

These regions are based on the Accessibility/Remoteness Index of Australia and defined as Remoteness Areas by either the Australian Standard Geographical Classification (ASGC) (before 2011) or the Australian Statistical Geographical Standard (ASGS) (from 2011 onwards) in each Census year. The 5 Remoteness Areas are Major cities, Inner regional, Outer regional, Remote and Very remote.

Where do I go for more information?

This information was compiled from the following data sources: ABS National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19 and the AIHW and NIAA Aboriginal and Torres Strait Islander Health Performance Framework. More information about these data sources and data quality is available in Data sources.

Data quality issues

Care has been taken to ensure that the results of survey data presented above are as accurate as possible. However, the following factors should be considered when interpreting these estimates:

Data are collected from a self-report survey, and responses may differ from information available from other sources.
Results of previous surveys have shown a tendency for people to under-report when asked about certain topics, such as alcohol consumption, smoking and substance use.
Accuracy of responses may be affected by the length of time between events experienced and participation in the survey.
Some people may have provided responses they felt were expected, rather than those that accurately reflect their own situation (ABS 2019).

References

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AIHW (Australian Institute of Health and Welfare) 2016. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra: AIHW.

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Data tables

Table number and title	Source	Reference period
Table PH.1: Prevalence of health risk factors among First Nations people aged 15 and over	ABS NATSIHS, as published in AIHW Aboriginal and Torres Strait Islander Health Performance Framework data tables	2018–19
Table PH.2: Physical activity among First Nations people aged 18–64 years, by presence of mental health conditions, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table PH.3: Psychological distress among First Nations people, by food security, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table PH.4: Social and emotional wellbeing among First Nations people, by food security, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table PH.5: Self-assessed health among First Nations people, by presence of mental health conditions, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table PH.6: Social and emotional wellbeing among First Nations people, by self-assessed health, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table PH.7: Musculoskeletal comorbidities among First Nations people, by presence of mental health conditions, 2018–19	AIHW analysis of ABS NATSIHS	2018–19
Table PH.8: Social and emotional wellbeing among First Nations people, by musculoskeletal comorbidities, 2018–19	AIHW analysis of ABS NATSIHS	2018–19