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The numbers and availability of Aboriginal and Torres Strait Islander staff is an important factor in whether or not Indigenous peoples are able to effectively access health services (Ivers et al. 1997; Kowanko et al. 2003).

There are a number of sources of information about the participation of Indigenous Australians in the health workforce and in higher education courses in health and welfare-related fields. These include the Census, the Australian Government Department of Education, Science and Training's Student Statistics Collection, the AIHW Medical and Nursing Labour Force Surveys and the Australian Government Department of Health and Ageing's Service Activity Report (SAR). However these sources vary in coverage and not all of these data sources have accurate and consistent recording of Indigenous status. For example, Queensland is the only state to use the standard ABS question on Indigenous status in the Medical Labour Force Survey, whereas all other jurisdictions use a simpler version of the question (yes/no response). There has also not been consistency in the recording of Indigenous status across jurisdictions in the Nursing Labour Force Survey until the 2003 survey, for which data are not yet available. Because of issues surrounding the data, information from these two AIHW surveys is not presented here. Data in this section therefore comes from the Census, SAR and the Higher Education Student Statistics Collection.

The health workforce

At the time of the 2001 Census, Indigenous people comprised 2% of the Australian population aged 20 years or over and accounted for around 1% of all people employed in selected health-related occupations (table 10.7). Aboriginal and Torres Strait Islander people comprised 0.8% of all nursing workers, 0.6% of dental workers, 0.5% of allied health workers, 0.3% of medical workers, and 0.1% of pharmacists.

6.7 Indigenous persons aged 20 years or over, employment in selected health related occupations - 2001
		Indigenous	All persons	Proportion who were Indigenous
		no.	no.	%
Aboriginal and Torres Strait Islander Health Workers		838.0	900	93.1
Medical workers
	Health Services Managers	73	6 538	1.1
	Medical practitioners	88	48 180	0.2
	Medical Imaging Professionals	17	8 319	0.2
	Total	178	63 037	0.3
Dental workers
	Dental Practitioners	12	8 189	0.1
	Dental Associate Professionals	17	4 517	0.4
	Dental Assistants	107	11 602	0.9
	Total	136	24 308	0.6
Nursing workers
	Nurse Managers	29	7 389	0.4
	Registered Nurses	782	141 855	0.6
	Personal Care and Nursing Assistants	776	49 511	1.6
	Enrolled Nurses	200	19 337	1.0
	Other nurses	94	22 009	0.4
	Total	1 881	240 101	0.8
Pharmacists		8	13 742	0.1
Allied health workers
	Ambulance Officers and Paramedics	83	6 708	1.2
	Physiotherapists	29	10 235	0.3
	Psychologists	22	9 330	0.2
	Dietitians	17	1 996	0.9
	Other	22	9 972	0.2
	Total	173	38 241	0.5
Total		3 214	380 329	0.8
ABS, Census of Population and Housing

In 2001, there were 88 Indigenous people working as medical practitioners and 1,881 Indigenous people working as nurses, 982 of whom were registered or enrolled nurses. After nursing, Indigenous people were most commonly employed as Aboriginal and Torres Strait Islander health workers (838 people). Aboriginal and Torres Strait Islander health workers may be employed as specialists in such areas as alcohol, mental health, diabetes, eye and ear health, and sexual health, or they may work as generalist members of primary care teams, or as hospital liaison officers.

In 2002-03, 64% of the 'full time equivalent' positions paid by Australian Government funded Aboriginal and Torres Strait Islander primary health care Services were held by Aboriginal or Torres Strait Islander people. All traditional healers and most Aboriginal and Torres Strait Islander Health Workers (97%), drivers/field officers (96%) and environmental health workers (83%) were Indigenous people. Most doctors (98%), dentists (92%), allied health professionals (86%), and nurses (79%) were non-Indigenous people (DoHA, 2002-03 SAR).

The welfare and community services workforce

People employed in welfare and community service-related occupations such as counselling, disability and social work often support the work of other health professionals, and may also be working within the health industries (AIHW 2003b).

In 2001, Indigenous people were more likely to have been employed in selected welfare and community service-related occupations than in health-related occupations. About 3% of people employed in community and welfare service-related occupations were Indigenous (table 10.8). Within this sector, Aboriginal and Torres Strait Islander people accounted for 5.5% of all welfare and community workers, 4.5% of welfare associate professionals, 2.6% of counsellors, 2.1% of special care workers and 2.0% of all child care workers (table 10.8).

6.8 Employment in selected welfare and community service-related occupations, Indigenous persons aged 20 years or over - 2001
	Indigenous	All persons	Proportion who were Indigenous
	no.	no.	%
Child care coordinators	70	6 401	1.1
Children's care workers	1 217	60 754	2.0
Welfare and community workers	1 444	26 304	5.5
Welfare associate professionals	813	18 038	4.5
Counsellors	311	11 997	2.6
Social workers	166	9 116	1.8
Special care workers	1 182	56 143	2.1
Other	534	35 978	1.5
Total	5 737	224 731	2.6
ABS, 2001 Census of Population and Housing

Undergraduate studies in health, welfare and community service-related courses

The future involvement of Indigenous people in health and welfare services will be influenced by their current participation in health and welfare-related education. In 2003, Indigenous students made up a larger proportion of all undergraduate students enrolled in welfare-related courses (2.5%) than of those enrolled in health-related courses (1.5%) (table 10.9). In the health-related field, most Indigenous enrolments were in nursing (29%) and public health (e.g. environmental health and Indigenous health) (23%). Most enrolments of Indigenous students in welfare-related courses were in the fields of early childhood education (36%), social work (32%) and behavioural studies (17%), which includes psychology.

Overall in 2003, 167 Indigenous students completed health-related undergraduate courses, and 105 completed welfare-related courses, representing 1.0% and 1.5% of all students completing undergraduate courses in these fields respectively. In 2003, 10 Indigenous students completed a degree in medicine, 61 in nursing and 40 in public health.

The numbers of Indigenous students completing health and welfare-related courses in 2003 had increased slightly since 2000; but enrolments had decreased. It is difficult to determine if this is a real increase and decrease in numbers or if it is due to a change in classification from ‘field of study’ to ‘field of education’.

6.9 Health and welfare-related courses, Undergraduate students - 2003
		Enrolled			Completed
		Indigenous	Total	Indigenous as a proportion of total	Indigenous	Total	Indigenous as a proportion of total
		no.	no.	%	no.	no.	%
Health
	Medical Studies	27	2 016	1.3	10	1 726	0.6
	Nursing	117	10 594	1.1	61	7 496	0.8
	Pharmacy	. .	1 114	. .	1	769	0.1
	Dental studies	2	387	0.5	2	306	0.7
	Optical science	. .	141	. .	2	120	1.7
	Public health(a)	94	1 130	8.3	40	648	6.2
	Radiography	3	707	0.4	. .	468	. .
	Rehabilitation therapies	9	3 070	0.3	12	2 187	0.5
	Complementary therapies(b)	4	717	0.6	. .	408	. .
	Other health(c)	148	3 944	3.8	39	1 955	2.0
	Total health	404	23 820	1.7	167	16 083	1.0
Welfare
	Early childhood education	103	2 746	3.8	45	1 971	2.3
	Special education	. .	230	. .	3	253	1.2
	Social work	62	2 192	2.8	19	1 213	1.6
	Counselling	20	264	7.6	4	146	2.7
	Behavioural science(d)	48	4 944	1.0	24	3 048	0.8
	Other welfare(e)	52	846	6.1	10	445	2.2
	Total welfare	285	11 222	2.5	105	7 076	1.5
. . not applicable
(a) Includes occupational health and safety, environmental health, Indigenous health, health promotion, community health, epidemiology and public health n.e.c.
(b) Includes naturopathy, acupuncture, traditional Chinese medicine, complementary therapies n.e.c.
(c) Includes nutrition and dietetics, human movement, paramedical studies, first aid and health n.e.c.
(d) Includes psychology and behavioural science n.e.c.
(e) Includes children's services, youth work, care for the aged, care for the disabled, residential client care, welfare studies and human welfare studies and services n.e.c.
AIHW analysis of Department of Education, Science and Training data, Higher Education Student Statistics Collection