‘Wealth determines health’: young median age in Indigenous areas reflects lower life expectancy | Indigenous Australians

The median age in Queenscliffe, a small, wealthy seaside region in Victoria, is 62 – almost three times higher than in Cherbourg, the Aboriginal community in south-east Queensland, where the median age is just 23.

Cherbourg was Australia’s most disadvantaged local government area the last time the Australian Bureau of Statistics calculated it in 2016. Queenscliffe was one of the most advantaged, and holds the honor of being the first local government area in Australia to reach the national Covid vaccination target.

Dr Jason Agostino, the National Aboriginal Community Controlled Health Organization’s medical adviser, said while a young median age is an indicator of the lower life expectancy of Aboriginal and Torres Strait Islander people, it’s also a source of hope.

With so many young people, and the right investment in them, “things can change quickly”, he said.

“That’s what I’ve heard elders at Yarrabah say as well – there’s an opportunity for change,” he said. Agostino works in an Aboriginal community controlled health service in Yarrabah, in far north Queensland.

Across Australia, the latest census data shows the lowest median ages are mainly in areas with higher Aboriginal and Torres Strait Islander populations. In the Torres Strait it’s 27, and in the Anangu Pitjantjatjara Yunkunytjatjara Lands, the Central Desert, and East and West Arnhem it’s 28.

The highest median age spots, by local government area, are distorted somewhat by popular retirement spots. In South Australia’s Victor Harbor (sometimes unkindly called “God’s waiting room”), for example, it’s 60.

Both life expectancy and fertility affect the median age of a population. Overall, Australia has an aging population with increased life expectancy and falling fertility, while Aboriginal people have a lower but increasing life expectancy, and a higher fertility rate.

According to the Australian Bureau of Statistics, the median age for Aboriginal and Torres Strait Islander people nationally has increased to 24 years, up from 21 years in 2011. For all Australians, the median age is 38.

On life expectancy, according to the latest report from the Australian Institute of Health and Welfare, Indigenous men can expect to live to 71.6 years and women to 75.6 years. That’s 8.6 fewer years for males and 7.8 for females than in the non-Aboriginal population.

Agostino said Aboriginal people have an “extremely young population” because they get chronic diseases early, and die of them young.

“That median age is a reflection that there’s not a whole bunch of people older than 60,” he said.

“We want people to live long and healthy lives, and to do that requires more investment.

“[Peak body] Naccho commissioned a report by Equity Economics that showed a gap in funding of $4.4bn each year for Aboriginal people. That’s because they have this burden of disease that’s more than double that of non-Aboriginal people.”

The census found an increase of more than 25% in the Aboriginal and Torres Strait Islander population, from 2.8% in 2016 to 3.2%. There was also an increase in people aged over 65 years who are Aboriginal and/or Torres Strait Islander, chief statistician David Gruen said. Gruen told the ABC it was “not just natural increase”.

“It’s also an increase in the number of people who are self-identifying,” he said.

Agostino said there was a “really complicated” interplay of factors affecting the health of Aboriginal people, from historical impacts to geographic location, socioeconomics, and more.

“The thing we’re focused on is how to change this,” he said.

Prof Carla Treloar, director of the Center for Social Research in Health and the Social Policy Research Center at UNSW Sydney, said there was a direct link between income level and health outcomes.

“This has been shown across the world and across time so what we see from the census is what we expect – there are numerous things that higher income does to protect health,” she said.

Wealth means more funds for preventive care, acute care, affordable housing, diet, ability to exercise, and the ability to avoid the chronic stress of being poor.

“There are particular places across the country where you just can’t use Medicare to go and see a GP. That’s a direct disincentive for someone to engage with primary care,” Treloar said.

“Where there are fewer choices, where services are fewer and further between, people might not have the money to travel to the next town or region to see someone about their health.”

Rosemary Calder, professor of health policy at Victoria University’s Mitchell Institute, said it was surprising how little attention was paid to the ways in which some communities have significant rates of premature and preventable deaths.

“It’s absolutely clear that wealth determines health,” she said.

“And that your geographical community, and to a degree your community of connection, determines your wealth.”

That won’t change until health is understood as “not just an individual good but a social and economic good that is fundamental to the wellbeing of the nation as well as the national economy”, she said, adding that with the “policy will” , that could be done through targeted preventive health measures, universal funding, an increased workforce, and the ongoing tracking of risk factors.

Agostino said he has seen firsthand the improvements that happen when greater control is given to the community.

“I’ve been working in Yarrabah for over a decade now, where it’s transitioned from state run to community run, and that’s led to a drastic change in how health services are provided, and who’s providing them,” he said.

“Similarly, through the pandemic we’ve been able to see Aboriginal and Torres Strait Islander leadership prevent the pandemic coming into the communities for a long time. So I’m optimistic, and the young median age can also be a reason for hope.

“If you get investment right for that population that’s under 25, improved education and employment, there’s opportunity for change,” he said.

“It’s really struck me. It’s true.”

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