3.12 Aboriginal and Torres Strait Islander people in the health workforce
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Why is it important?
Aboriginal and Torres Strait Islander peoples are significantly under-represented in the health workforce. This potentially contributes to reduced access to health services for the broader Indigenous Australian population. Various studies have found people prefer seeing health professionals from the same ethnic background and that improved health outcomes result (Powe & Cooper, 2004; LaVeist et al, 2003). The gender of the health provider is also important (Ware, 2013).
The Indigenous workforce is integral to ensuring that the health system has the capacity to address the needs of Aboriginal and Torres Strait Islander peoples. Indigenous health professionals can align their unique technical and sociocultural skills to improve patient care, improve access to services and ensure culturally appropriate care in the services that they and their non-Indigenous colleagues deliver (Anderson, I et al, 2009; West, R et al, 2010).
In a Queensland clinic, Aboriginal and Torres Strait Islander patient attendance increased markedly following the arrival of an Aboriginal doctor and in response to other changes in the service designed to make it more welcoming. An Indigenous doctor was said to be ‘more understanding of their needs’ (Hayman, N, 1999).
Findings
Analysis of the 2011 Census indicates that, at that time, there were around 8,500 Aboriginal and Torres Strait Islander people employed in health-related occupations. Between 1996 and 2011 the rate of Indigenous Australians employed in the health workforce increased from 96 per 10,000 to 155 per 10,000. In 2011, about 1.6% of the Indigenous population was employed in health-related occupations. However, this is below the proportion of the non-Indigenous population employed in the health workforce (approximately 3.4%).
In 2011, the health occupations with the largest number of Indigenous employees were nursing (2,189), followed by nursing support and personal care workers (1,435), and Aboriginal and Torres Strait Islander Health Workers (AHWs) (1,256). The health occupations with the largest gap between rates of Indigenous and non-Indigenous employees were nurses, medical practitioners and allied health professionals.
South Australia had the highest proportion of its Indigenous population employed in the health workforce (2%) and the NT had the lowest (1%). The 35–44, 45–54 and 55–64 year age groups had the highest rates of Indigenous Australians in the health workforce. Females accounted for 76% of the Indigenous health workforce—similar to the proportion of females in the total health workforce (75%).
Excluding visiting staff, Aboriginal and Torres Strait Islander peoples made up 53% of the workforce in Indigenous primary health care organisations as at May 2015. The proportion of staff who were Indigenous was less in some professions, for example doctors (7%) and nurses (14%). The occupations with the highest proportions of Indigenous staff were Aboriginal health workers and practitioners (99%) and field officers (88%) (AIHW, 2016o).
Under the National Registration and Accreditation Scheme, Aboriginal and/or Torres Strait Islander Health Practitioners commenced registration on 1 July 2012. By December 2015 there were 558 registered Aboriginal and/or Torres Strait Islander Health Practitioners in Australia, with the majority in the NT (219), followed by NSW (91), Qld (72), WA (71) and SA (27).
In 2015 workforce data, 409 employed medical practitioners (representing 0.5%) identified as being Aboriginal and/or Torres Strait Islander (AIHW, 2016g). The proportion of medical practitioners that identified as Indigenous was highest in the NT (1.5%) and lowest in Tasmania (0.2%). For nurses and midwives, the proportion was 1% (3,187). The NT (2.4%) and Tasmania (2.2%) had the highest proportion of nurses and midwives who identified as Indigenous, while Victoria had the lowest (0.5%).
In 2014, there were 818 employed Indigenous allied health professionals, which represented 0.7% of all allied health professionals. Aboriginal and Torres Strait Islander health practitioners had the largest numbers (266), followed by psychologists (136). In 2014, there were also 72 Indigenous dental practitioners, representing 0.4% of this profession.
Figures
Table 3.12-1
Employed persons aged 15 years and over, by selected health related occupation, by Indigenous status, Australia,
1996, 2001, 2006 and 2011
Occupation | No. | Rate (per 10,000) | Rate difference (per 10,000) | Period linear % change |
||||
---|---|---|---|---|---|---|---|---|
2011 | 1996 | 2001 | 2006 | 2011 | 2011 | |||
Indigenous | Non-Indigenous | |||||||
Aboriginal and Torres Strait Islander health workers | 1,256 | 19.1 | 21.0 | 21.3 | 23.0 | 0.1 | -23.0 | 19.1* |
Nurses | 2,189 | 35.9 | 27.6 | 32.0 | 40.1 | 129.0 | 88.9 | 16.1 |
Registered nurses | 1,713 | 18.3 | 20.5 | 24.5 | 31.4 | 103.0 | 71.6 | 75.9* |
Nurse managers and nursing clinical directors | 94 | 0.6 | 0.9 | 1.3 | 1.7 | 7.5 | 5.7 | 204.2* |
Midwives | 76 | 0.8 | 1.0 | 1.1 | 1.4 | 7.0 | 5.7 | 77.2* |
Enrolled and mothercraft nurses | 284 | 16.1 | 5.0 | 4.8 | 5.2 | 8.8 | 3.6 | -77.7 |
Nurse educators and researchers | 22 | 0.2 | 0.3 | 0.4 | 0.4 | 2.6 | 2.2 | 104.6* |
Medical practitioners | 171 | 1.7 | 2.2 | 2.3 | 3.2 | 35.0 | 31.8 | 78.2* |
Generalist medical practitioners | 123 | 1.2 | 1.4 | 1.8 | 2.3 | 21.8 | 19.5 | 103.3* |
General medical practitioners | 93 | 0.8 | 1.2 | 1.3 | 1.7 | 16.9 | 15.2 | 100.5* |
Resident medical officers | 30 | 0.3 | 0.2 | 0.5 | 0.6 | 4.9 | 4.3 | 112.1 |
Other medical practitioners | 48 | 0.6 | 0.8 | 0.4 | 0.9 | 13.2 | 12.3 | 31.3 |
Allied health professionals | 724 | 5.1 | 6.7 | 9.7 | 13.3 | 43.9 | 30.6 | 179.9* |
Dieticians | 25 | n.p. | 0.4 | 0.2 | 0.5 | 1.8 | 1.4 | n.a. |
Optometrists | 6 | n.p. | n.p. | 0.2 | 0.1 | 1.8 | 1.7 | n.a. |
Psychologists | 82 | 0.4 | 0.5 | 1.0 | 1.5 | 9.3 | 7.8 | 478.9* |
Physiotherapist | 75 | 0.5 | 0.7 | 1.2 | 1.4 | 8.0 | 6.6 | 215.3* |
Podiatrists | 6 | 0.2 | 0.2 | 0.1 | 0.1 | 1.4 | 1.3 | -39.2 |
Speech professionals and audiologists | 17 | 0.2 | 0.2 | 0.4 | 0.3 | 3.4 | 3.1 | 62.8* |
Occupational therapists | 24 | n.p. | n.p. | 0.3 | 0.4 | 4.6 | 4.2 | n.a. |
Social workers | 463 | 3.2 | 4.1 | 5.9 | 8.5 | 8.3 | -0.2 | 189.6* |
Other health therapy professionals | 26 | 0.3 | 0.3 | 0.5 | 0.5 | 5.2 | 4.8 | 60.5 |
Dental and dental allied workforce | 323 | 4.2 | 3.8 | 4.5 | 5.9 | 18.0 | 12.1 | 46.4 |
Dental practitioners | 24 | 0.3 | 0.3 | 0.4 | 0.4 | 5.5 | 5.1 | 34.7* |
Dental hygienists, technicians and therapists | 32 | 0.5 | 0.4 | 0.3 | 0.6 | 3.2 | 2.6 | 7.4 |
Dental assistants | 267 | 3.3 | 3.1 | 3.8 | 4.9 | 9.3 | 4.4 | 54.2* |
Health diagnostic and promotion professionals | 981 | 4.7 | 4.6 | 14.1 | 18.0 | 29.6 | 11.6 | 510.2 |
Medical imaging professionals | 21 | 0.2 | 0.3 | 0.4 | 0.4 | 6.6 | 6.3 | 77.9* |
Pharmacists | 29 | 0.2 | 0.2 | 0.2 | 0.5 | 10.0 | 9.5 | 237.1* |
Occupational health and safety advisers | 193 | 0.6 | 0.6 | 1.1 | 3.5 | 7.6 | 4.0 | 3114.4* |
Health promotion officers | 567 | n.a. | n.a. | 9.7 | 10.4 | 2.2 | -8.2 | n.a. |
Environmental health officers | 104 | 3.5 | 2.8 | 2.2 | 1.9 | 1.7 | -0.2 | -47.5* |
Other health diagnostic & promotion professionals | 67 | 0.2 | 0.5 | 0.5 | 1.2 | 1.5 | 0.2 | 573.6* |
Other | 2,812 | 25.6 | 32.6 | 43.4 | 51.6 | 88.4 | 36.8 | 106.9* |
Health service managers | 54 | 0.6 | n.p. | 0.4 | 1.0 | 1.3 | 0.3 | n.a. |
Nursing support worker and personal care workers | 1,435 | 16.5 | 19.9 | 21.7 | 26.3 | 34.5 | 8.2 | 56.9* |
Ambulance officers and paramedics | 216 | 1.4 | 2.0 | 3.4 | 4.0 | 5.9 | 1.9 | 201.6* |
Drug and alcohol counsellor | 156 | 2.3 | 2.4 | 2.6 | 2.9 | 0.7 | -2.2 | 26.2* |
Others | 951 | 4.7 | 6.8 | 15.3 | 17.4 | 46.0 | 28.5 | 342.6* |
Total health occupations | 8,456 | 96.3 | 98.6 | 127.3 | 155.1 | 344.1 | 189.0 | 69.5* |
*represents results that are statistically significant n.p. data not available for publication but included in totals n.a. data not available
Source: ABS and AIHW analysis of ABS Census
Implications
Indigenous patients have identified the absence of Indigenous workers as a barrier to the availability of health care (Lawrence et al, 2009). Increasing the number of Indigenous Australians in the health workforce is fundamental to closing the gap in Indigenous life expectancy. While numbers have increased in the past decade, Indigenous Australians remain under-represented.
The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2016–2023) provides a guide to assist planning, prioritising, target setting, monitoring and reporting of progress in Aboriginal and Torres Strait Islander health workforce capacity building. A key aim of the Framework is to improve recruitment and retention of Aboriginal and Torres Strait Islander health professionals in clinical and non-clinical roles across all health disciplines, including through ensuring workplace environments are culturally safe for Aboriginal and Torres Strait Islander health workers. The Framework also suggests strategies for increasing the number of Aboriginal and Torres Strait Islander people studying and completing qualifications in health.
The Commonwealth funds four Aboriginal and Torres Strait Islander health professional organisations to support the Indigenous workforce and culturally appropriate health care services. This includes:
- improving retention rates of Indigenous health professionals
- increasing the number of health care providers delivering culturally appropriate care
- increasing the number of Aboriginal and Torres Strait Islander students studying for qualifications in health
- improving completion rates for Aboriginal and Torres Strait Islander health students
- providing advice to Government and other stakeholders on issues affecting the Aboriginal and Torres Strait Islander health workforce.
The Indigenous Employment Initiatives provides funding to Indigenous specific aged care services to employ Aboriginal and Torres Strait Islander aged care workers in rural and remote areas. Over 100 participating aged care services are funded directly for wages and are able to allocate this funding to full or part-time personal aged care workers according to the workforce needs of individual health services.
Access to employment in a broad range of settings and occupations is needed to avoid under-representation in better remunerated, more skilled and managerial positions for Indigenous health professionals. It is also important for the non-Indigenous workforce to receive enhanced training programs in cultural awareness (Aspin et al).
The Indigenous Remote Service Delivery Traineeship NT Program provides a Diploma of Leadership and Management contextualised to the remote NT setting and has assisted to develop a remote NT-based pool of potential future health service managers and CEOs.
Improving the representation of Indigenous Australians in the health workforce will require collaboration between the health and education sectors and success across a range of fronts. Addressing educational disadvantages faced by Indigenous children can assist them to develop skills and be ready to pursue a career in the health sector (see measures 2.04 and 2.05). Strategies to address barriers, highlight pathways into health careers, and strengthen support for and retention rates of Indigenous students while studying and training, need to be implemented (see measure 3.20). Improved opportunities for employment, advancement, and retention also require attention.