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Services and Assistance: Services in remote Aboriginal and Torres Strait Islander communities
Remote communities While most Aboriginal and Torres Strait Islander peoples live in Major Cities of Australia, Outer Regional Australia and Inner Regional Australia (74% in 2001), proportionally more Indigenous than non-Indigenous Australians live in Remote and Very Remote areas of Australia. At the 2001 Census, 26% of Aboriginal and Torres Strait Islander peoples lived in Remote and Very Remote Australia, compared with 2% of non-Indigenous Australians. Many of the Indigenous peoples living in Remote and Very Remote Australia live in discrete communities, referred to in this article as remote communities. There were 1,139 remote Indigenous communities across Australia in 2001, with a combined reported usual population of 93,000 people. Over half (54%) reported less than 20 people living in the community, and 23% had populations from 20 to 49 people. SIZE OF REMOTE INDIGENOUS COMMUNITIES - 2001 Source: ABS 2001 Community Housing and Infrastructure Needs Survey. While together these smaller communities accounted for over three-quarters (77%) of all communities, they comprised only 14% of all people living in remote Indigenous communities. Most people (72%) lived in larger communities of 200 people or more. POPULATION DISTRIBUTION IN REMOTE INDIGENOUS COMMUNITIES, BY COMMUNITY SIZE - 2001 Source: ABS 2001 Community Housing and Infrastructure Needs Survey. In 2001, 55% of remote Aboriginal and Torres Strait Islander communities were located in the Northern Territory, 24% in Western Australia and 12% in Queensland. Supply of essential services The provision and maintenance of essential services can affect the viability of remote communities, and the wellbeing of people living in these communities. Water supply, sewerage systems, power, and rubbish disposal, for example, are critical elements in the development of a healthy living environment.1 The supply of water of an adequate standard for drinking and washing is a basic health requirement. Electricity is a basic amenity for a range of purposes, including the refrigeration of food, while the disposal of sewage and rubbish is important in preventing the spread of disease. Most (98%) remote Aboriginal and Torres Strait Islander communities had access to an organised supply of drinking water in 2001. The 2% of communities without an organised supply accounted for less than 1% of the people living in remote communities. For communities with an organised drinking water supply, the proportion in which not all permanent dwellings were connected to the supply decreased from 9% to 6% between 1999 and 2001. In 68% of communities (supporting 66% of the population) bore water was the main source of drinking water. A further 12% of communities (12% of the population) were connected to a town water supply and 8% of communities (16% of the population) used a river or reservoir as their main source of drinking water. The number of communities with an organised supply of electricity increased between 1999 and 2001. In 2001, 93% of communities had some form of organised electricity supply, up from 89% in 1999 (for more information on service supply in 1999 see Australian Social Trends 2000, Housing in remote Aboriginal and Torres Strait Islander communities). The 7% of communities without an organised electricity supply in 2001 had relatively small populations, supporting less than 1% of the people living in remote communities. Among those communities with an organised electricity supply, the proportion of communities in which at least one permanent dwelling was not connected to the supply decreased from 9% in 1999 to 7% in 2001. While the majority (92%) of remote Indigenous communities had some form of organised sewerage, 1,100 people lived in communities without a sewerage system. In 2001, over half of communities (accounting for 36% of the population) used septic tanks as their main type of sewerage system. A further 20% of communities were reliant on pit toilets, with 3,500 people living in these communities. In 2001, over half (57%) of communities relied on an unfenced tip within the community as their main means of rubbish disposal. A further 20% disposed of rubbish in tips outside the community, while 2% had no organised form of rubbish disposal. ESSENTIAL SERVICES IN REMOTE INDIGENOUS COMMUNITIES - 2001
Source: ABS 2001 Community Housing and Infrastructure Needs Survey. Reliability of services The supply of essential services is necessary for creating a healthy living environment and poor quality or unreliable infrastructure in remote communities can both interrupt the supply and limit the usefulness of these services. To avoid breakdown and costly repair, the technology employed needs to be appropriate for use in rural and remote locations. Adequate regulatory systems are also needed to ensure services operate effectively.2 While most people living in remote Indigenous communities had access to essential services in 2001, many experienced disruptions to supply. Over a third (38%) of larger communities (i.e. those with a population of 50 people or more) had experienced water restrictions in the past year, with 31% of these communities experiencing water restrictions five or more times throughout the year. Water restrictions can include restrictions on the amount of water used, the purposes for which water can be used, or restrictions to the times at which water can be used. Equipment breakdown was the most common cause of water restriction (reported by 63% of communities which had experienced a water restriction). Electricity interruptions were also frequent in the larger remote Indigenous communities. In 2001, 85% of these communities had experienced electricity interruptions of one hour or more, with 40% of these affected communities experiencing 10 or more interruptions throughout the past year. The most commonly reported reason for electricity interruptions in remote Indigenous communities was equipment breakdown (reported by 63% of communities experiencing interruptions), followed by storms (reported by 58%). In 2001, nearly half (49%) of remote Indigenous communities with a population of 50 people or more experienced sewerage system overflows or leaks, a decrease from 59% in 1999. Blocked drains were the most commonly reported reason for these overflows and leaks (52%), followed by equipment failure (29%) and design or installation problems (29%). Other reasons included factors related to the natural environment, such as wet seasons (27%), and increased demand through population increase (20%). SERVICE DISRUPTIONS IN REMOTE INDIGENOUS COMMUNITIES(a) - 2001
Source: ABS 2001 Community Housing and Infrastructure Needs Survey. Health services A variety of indicators, such as the lower life expectancy of Aboriginal and Torres Strait Islander peoples and their higher rates of hospitalisation,3 demonstrate that Indigenous Australians continue to suffer greater ill health than non-Indigenous Australians (see Australian Social Trends 2002, Mortality of Aboriginal and Torres Strait Islander peoples). Geographic remoteness can be a barrier to health care services for many Aboriginal and Torres Strait Islander peoples, as accessing particular health services may involve multiple forms of transport and overnight stays. These can add to health care costs and reduce the patient's contact with family and friends.4 In 2001, 48% of all remote Indigenous communities were located 250 kilometres or more from the nearest hospital, with a further 26% located between 100 and 249 kilometres from a hospital. Distance barriers to hospital access were potentially alleviated for some communities through access to medical emergency air services. In 2001, 51% of the communities (supporting 88% of the population) located 100 kilometres or more from a hospital, had access to both an airstrip and the communications technology (such as radio or telephone) needed to access an emergency air service. Community health centres were more likely to be located near or within remote Indigenous communities than were hospitals. In addition to the 8% of communities with a hospital located either in, or within 10 kilometres of the community, 23% of communities were located within 10 kilometres of a community health centre. On a population basis, 85% of people in remote communities were living within 10 kilometres of either a hospital or a community health centre. A further 34% of communities (8% of the population) were located within 50 kilometres of a community health centre. Distance to health services gives some indication of the accessibility of health services for remote Indigenous communities. However, if transport is not available or road access is affected by factors such as flooding, comparatively short distances can become an impediment to service usage. The presence of health professionals within communities is one means of alleviating such problems. In 2001, information about how often health professionals worked within communities, including those working in community health centres, was collected for communities with a population of 50 people or more located 10 kilometres or more from the nearest hospital. Registered nurses were the most frequently available health professionals, working in 91% of the remote Indigenous communities surveyed, and on a daily basis in 55%. While doctors worked in 88% of communities, only 12% had doctors working on a daily basis. Cultural differences, and different understandings of the concepts of health, disease and medicine, can exist between non-Indigenous health providers and Indigenous patients.4, 5 Access to Indigenous health workers, and health workers of the same sex as the patient, can help provide effective health services for Indigenous communities. Of the remote communities surveyed in 2001, 78% reported that a female Indigenous health worker worked in the community, although the frequency varied. In 56% of the surveyed communities, female Indigenous health workers worked in the community on a daily basis. In comparison, 27% of communities had male Indigenous health workers working on that basis. Male Indigenous health workers were among the least available health professionals, with half of remote communities not having a male Indigenous health worker in the community at all. HEALTH PROFESSIONALS WORKING IN REMOTE INDIGENOUS COMMUNITIES(a) - 2001
Source: ABS 2001 Community Housing and Infrastructure Needs Survey. In addition to health professionals working in communities, a number of health promotion programs are conducted in remote Indigenous communities. In 2001, most (83%) larger communities located 10 kilometres or more from a hospital reported that one or more programs were conducted. The most frequently reported health programs were immunisation (conducted in 75% of communities), women's health (74%), sexual health (68%) and well babies (67%) programs. Connections to the wider community Transport and communication technologies enable people living in remote communities to access a wider range of information and services than may otherwise be available. In 2001, 4% of remote Indigenous communities were located within towns with services such as shopping and banking. Among the communities not located in such towns, 89% of communities (68% of the population) mainly used road transport to access the closest town. Air transport was the main form of transport to the nearest town for 8% of communities (25% of the population). Given this reliance on road transport, cuts to road access can substantially affect service availability for Indigenous people in remote communities. In 2001, 76% of communities with a population of 50 people or more, that were not located in towns with major services, could not use roads into or out of the community for at least one day in the previous 12 months. Of these communities, nearly one-quarter (24%) were cut off by road on five or more occasions. Communications infrastructure such as telephones, postal services and television are a means for people in remote communities to access services and information, and to communicate with family and friends in the wider community. In 2001, 18% of larger communities had mail delivered to within the community on a daily basis and a further 47% had mail delivered into the community at least weekly. However, 34% of larger communities did not have mail delivered to within the community. These communities accessed mail from a post office box, or other central point, located outside the community. COMMUNICATION SERVICES IN REMOTE INDIGENOUS COMMUNITIES(a) - 2001 (a) Communities with a population of 50 people or more. Source: ABS 2001 Community Housing and Infrastructure Needs Survey. In the wider Australian community virtually all households have a telephone and at least one television (see Australian Social Trends 2001, Household amenities). In contrast, communications technology in remote Indigenous communities is less widely available. In 2001, 80% of larger Indigenous communities had at least one public telephone within the community. However, these telephones can sometimes be located in community offices, or other places with restricted opening hours. Further, where telephones are available, these are not always in working order. In 16% of larger communities all of the public telephones were not working, while in a further 6% of larger communities some of the public telephones were not working. In 2001, 93% of larger remote Indigenous communities received television broadcasts and 91% received radio broadcasts. The most common broadcasts received were Australian Broadcasting Commission (ABC) television (88% of communities), commercial television (87%) and ABC radio (85%). Around two-thirds of remote communities received Indigenous broadcasts including Indigenous radio (68%) and Indigenous television (62%). Other community facilities In addition to essential services, other facilities such as sports grounds and halls contribute to community wellbeing through providing meeting places and spaces for recreation and cultural activities. In 2001, the majority of remote Indigenous communities with a population of 50 people or more had an administrative building (71%), hall or meeting area (63%) or store (63%). Over half of communities had outdoor sports courts (56%) or sports grounds (55%). However, 32% of larger remote Indigenous communities (supporting 12% of the population) had no sporting facilities within the community. Other public facilities available within Indigenous communities of 50 people or more included women's centres (available in 43% of communities), child care centres (34%), and art or cultural centres (27%). Facilities which were less common included youth centres (19% of communities), canteens (17%) and libraries (16%). In 2001, 15% of larger remote Indigenous communities (supporting 4% of the population) did not have any of these public facilities available within the community.
Endnotes 1 Aboriginal and Torres Strait Islander Commission, Community Housing and Infrastructure Program Policy 1997-2000 <www.atsic.gov.au/programs/ Social_and_Cultural/Community_ Housing_and_ Infrastructure>, accessed 14 August 2002. 2 Aboriginal and Torres Strait Islander Commission, Annual Report 2000-01 <www.atsic.gov.au/About_ATSIC/annual_report>, accessed 15 August 2002. 3 Australian Bureau of Statistics and Australian Institute of Health and Welfare 2001, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2001, ABS cat. no. 4704.0, AIHW Cat. No. AIHW 6, ABS, Canberra. 4 Gruen, R., Bailie, R., d'Abbs, P., O'Rouke, I., O'Brien, M. and Verm, N. 2001, 'Improving access to specialist care for remote Aboriginal communities: evaluation of a specialist outreach service', The Medical Journal of Australia, Vol. 174, No. 10, pp. 507-511. 5 The National Health and Medical Research Council Australia - Health Advancement Standing Committee 1996, Promoting the health of Indigenous Australians: A review of infrastructure support for Aboriginal and Torres Strait Islander health advancement, National Health and Medical Research Council, Canberra.
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