Groups experiencing health inequities: Aboriginal and Torres Strait Islander peoples - the nature and extent of the health inequities, sociocultural, socioeconomic and environmental determinants, the roles of individuals, communities and governments in addressing the health inequities

Aboriginal and Torres Strait Islander Australians experience the largest health inequity of any group in the country. This dot point covers the nature and extent of the inequity, the determinants that produce it, and what individuals, communities, and governments are doing about it.

This is also where social justice principles (equity, diversity, supportive environments) and the determinants of health concepts get tested most heavily in HSC extended responses.

The nature and extent of the inequity

The headline numbers from the AIHW Closing the Gap report and Aboriginal and Torres Strait Islander Health Performance Framework 2024:

• Life expectancy. 7-8 years lower for Aboriginal and Torres Strait Islander males, 6-7 years lower for females, compared to non-Indigenous Australians.
• Infant mortality. Roughly 5 per 1,000 live births versus roughly 3 per 1,000 for non-Indigenous infants.
• Burden of disease. Aboriginal and Torres Strait Islander people experience approximately 2.3 times the rate of disease burden (DALYs) as non-Indigenous Australians.
• Specific conditions. Diabetes prevalence is roughly 3 times higher. Chronic kidney disease prevalence is roughly 4 times higher. Rheumatic heart disease, almost eliminated in non-Indigenous Australians, persists at significant rates in remote Indigenous communities.
• Suicide. Indigenous suicide rates are roughly double the non-Indigenous rate, and the gap is widening rather than narrowing.
• Hospital admissions. Roughly 2-3 times the non-Indigenous rate, particularly for chronic and preventable conditions.

The determinants

The syllabus groups determinants into three categories. Use this scaffolding in extended responses.

Sociocultural determinants

• Family, peers and community. Strong family and community connection is protective. The Stolen Generations and ongoing intergenerational trauma weaken this protective factor in ways that compound across generations.
• Cultural connection and identity. Connection to country, language, and culture has strong protective effects on mental health and wellbeing. Loss of cultural identity, conversely, is a risk factor that the National Aboriginal Community Controlled Health Organisation (NACCHO) identifies as central to closing the gap.
• Religion and spirituality. Cultural and spiritual practice supports social and emotional wellbeing in ways that mainstream health services often fail to recognise.

Socioeconomic determinants

• Employment. Indigenous unemployment runs at 2-3 times the non-Indigenous rate, with much larger gaps in remote areas.
• Income. Median Indigenous household income is significantly lower than non-Indigenous, limiting access to private health insurance, healthy food, and safe housing.
• Education. Year 12 completion has improved markedly but remains below the non-Indigenous rate. Educational attainment correlates strongly with health outcomes.

Environmental determinants

• Housing. Overcrowding in remote communities supports transmission of respiratory infections, gastrointestinal infections, and the streptococcal infections that progress to rheumatic heart disease.
• Access to health services. Remote and very remote areas have fewer GPs per capita, longer travel to hospitals, and limited culturally appropriate services.
• Geographic location. Approximately 20% of Aboriginal and Torres Strait Islander Australians live in remote or very remote areas (versus 1-2% of non-Indigenous Australians). Remote location compounds every other determinant.

The roles of individuals, communities, and governments

Individuals

Individual choices (smoking, diet, exercise, screening attendance) matter, but the syllabus expects you to frame individual choices inside the determinant structure. A young Aboriginal woman in a remote community without a permanent GP, without safe housing, and on Newstart cannot reasonably be held individually responsible for not attending a 715 health check that does not exist locally.

The strongest framing is: individuals make better health choices when their environment supports them.

Communities

Aboriginal Community Controlled Health Organisations (ACCHOs) are the single most important community-level institution. They deliver primary health care designed by and for Aboriginal communities. There are around 145 ACCHOs nationally (NACCHO 2024). Evidence consistently shows ACCHOs deliver better outcomes per dollar than mainstream services because they are culturally safe, trusted, and locally responsive.

Other community-level actors include Land Councils, Indigenous-led suicide prevention programs (Black Dog Institute partnerships), and on-country healing programs.

Governments

Federal, state, and territory governments fund the bulk of Indigenous health spending and run national frameworks.

Closing the Gap is the long-running national framework. The refreshed 2020 agreement has 17 targets and four Priority Reforms. Annual reports show progress on smoking (down), child mortality (improving), and Year 12 completion (improving), but worsening on suicide, child protection, and adult incarceration.

The Indigenous Australians' Health Programme (IAHP) is the main federal funding stream for primary health care. It directs roughly $1.4 billion a year, largely to ACCHOs and mainstream primary care providers serving Indigenous patients.

Medicare includes specific item numbers for Aboriginal and Torres Strait Islander health (the 715 annual health check, follow-up items, mental health items). Uptake of the 715 check has grown substantially since introduction.

Voice to Parliament. The 2023 referendum proposed a constitutionally enshrined Aboriginal and Torres Strait Islander Voice to Parliament. The referendum was not passed. Government policy on Indigenous health continues under existing frameworks.

The judgment to make

If the question is "evaluate the role of governments", the honest answer is partial success. Specific gaps have closed (child mortality, smoking, education). The headline life-expectancy gap has not. The strongest evidence-based argument is that government action works when it funds Indigenous-led delivery and falters when it tries to mainstream-deliver to Indigenous communities. Markers reward an explicit judgment that is grounded in the data, not a generic "more needs to be done".