Latest information and statistics on Environmental health

Environmental health refers to the physical, chemical and biological factors which can impact a person’s health and wellbeing. These factors may include housing conditions, drinking water, air quality, sanitation, disease control, food safety and climate [1][2][3]. Health conditions associated with poor environmental health include intestinal infectious diseases; skin infections, such as scabies; middle ear infections; acute rheumatic fever; respiratory issues, such as asthma; and some cancers, such as lung cancer [4][5].

Aboriginal and Torres Strait Islander people are disproportionately affected by the diseases associated with environmental health due to a number of factors, including the remoteness of some communities, overcrowding and lack of adequate housing, poor infrastructure, lack of functioning health and home hygiene hardware1, lack of access to tradespeople and repairs, and the cost of infrastructure maintenance [2][4][5][6].

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 acknowledged that environmental health is an important issue and that addressing housing, waste management and water security are key priorities [2]. The Australian Government’s National Health and Climate Strategy, released in 2023, describes the disproportionate impacts that climate change has on the health of Aboriginal and Torres Strait Islander people, and identifies approaches to climate change adaptation which empower First Nations people’s wisdom and leadership [7].

This section will primarily cover housing, hospitalisation and mortality. For more detailed information about some of the health conditions associated with environmental health, see the Cardiovascular health section for information on ARF, the Eye health section for information on trachoma, the Respiratory health section for information on asthma, COVID-19 and other related conditions, the Cancer section for information on lung cancer, as well as the Skin health section for information about scabies and other skin health issues.

Housing

Housing issues such as overcrowding2 and poor infrastructure contribute significantly to ill-health and poor wellbeing among Aboriginal and Torres Strait Islander people [1][8][9].

Overcrowding

In the 2022-23 National Aboriginal Torres Strait Islander Health Survey (NATSIHS), 6.8% of Aboriginal and Torres Strait Islander people reported living in overcrowded conditions (requiring one or more additional bedrooms to properly accommodate the people usually living in the house) [10]. By jurisdiction (excluding the ACT), overcrowding was highest in the NT (22%), followed by WA (8.1%), Qld (7.3%), Vic (6.4%), SA and Tas (both 5.5%) and lowest in NSW (4.9). By remoteness, the proportion of housing with overcrowded conditions was higher in remote areas (20%) than non-remote areas (5.4%).

In the 2021 Census, 19% of Aboriginal and Torres Strait Islander people reported living in overcrowded conditions  [11]. The proportions of males and females who experienced overcrowded living were approximately the same (18% and 19% respectively) [12]. Living in overcrowded conditions was most common among young people aged 15-24 years (23%) and least common among those aged 65 years and over (8.2%). The highest prevalence was in the NT (57%) and WA (21%), while the lowest was in the ACT (9.2%) [11]. The prevalence of people living in overcrowded housing increased with remoteness, from 12% in major cities to 32% in remote areas and 55% in very remote areas [12].

Infrastructure

An important contributor to the health and wellbeing of Aboriginal and Torres Strait Islander people is access to sufficient, working and regularly maintained infrastructure in housing and communities, including health hardware, clean water supply, sewerage and electricity, which support and encourage healthy living practices for hygiene, safety and nutrition [1][13][14].

In the 2022-23 NATSIHS, 82% of Aboriginal and Torres Strait Islander households reported living in houses of an acceptable standard3 [10]. By jurisdiction (excluding the ACT), the highest proportion was in Tas (86%), followed by Vic (85%), Qld (84%), WA (83%), SA and NSW (both 81%) and lowest in the NT (69%). By remoteness, there was a greater proportion of houses of an acceptable standard in non-remote areas (84%) than remote areas (64%).

The latest information available for major structural issues within dwellings is from the 2018-19 NATSIHS. Thirty-three percent (39%) of Aboriginal and Torres Strait Islander households reported major structural issues within their dwelling [1]. The most significant issues for Aboriginal and Torres Strait Islander dwellings were major cracks in the walls/floors (12%), walls or windows not straight (10%), sinking/moving foundations (7.7%), major plumbing problems and wood rot/termite damage (both 6.6%). The most significant issues were reported in SA (44%) and the NT (41%) with the other jurisdictions reporting between 30% and 36%.

The latest information available for household facilities is from the 2018-19 NATSIHS. The majority of respondents reported having access to household facilities, including facilities for washing people (97%), washing bedding and clothes (96%), preparing/storing food (91%) and had working sewerage facilities (98%) (Table 1) [1]. Access to functioning facilities was lower in the NT than other jurisdictions, and lower in remote areas than non-remote areas.

Table 1. Aboriginal and Torres Strait Islander households’ access to facilities, by state and territory and remoteness, all jurisdictions, 2018-19, proportion (%)

	State/Territory								Remoteness
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Non-remote	Remote	Australia
Washing people	98	97	98	95	96	99	98	91	98	92	97
Washing bedding and clothes	98	98	97	92	94	97	99	85	97	86	96
Preparing/storing food	94	89	93	84	88	98	95	79	93	79	91
Working sewerage	100	99	99	98	97	100	100	93	99	94	98

Source:    SCRGSP, 2020 [1]

Hospitalisation

In 2018-19, the crude hospitalisation rates for Aboriginal and Torres Strait Islander people for selected diseases associated with poor environmental health were 9.2 per 1,000 for influenza and pneumonia, 9.0 per 1,000 for intestinal infectious diseases, 8.0 per 1,000 for bacterial diseases, 4.6 per 1,000 for acute upper respiratory infections, 2.7 per 1,000 for asthma and 1.8 per 1,000 for scabies [1].

In 2016-18, age-standardised hospitalisation rates for conditions associated with environmental health were higher in remote/very remote areas compared with major cities [1]. The highest differences were for scabies: 3.2 times higher in remote/very remote areas than in major cities (2.0 per 1,000 compared with 0.6 per 1,000) and influenza and pneumonia: 1.7 times higher in remote/very remote areas than in major cities (12 per 1,000 compared with 7.2 per 100,000).

Mortality

For 2014-2018, the age-standardised death rate for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT, from conditions associated with poor environmental health was 41 per 100,000 (44 per 100,000 for males and 40 per 100,000 for females) [1]. For the jurisdictions reported (NSW, Qld, WA, SA and the NT) the highest death rate was in the NT (71 per 100,000) followed by WA (64 per 100,000) with the lowest in NSW (26 per 100,000).

Footnotes

1 The kitchen, toilet, showers and laundry are recognised as home hygiene hardware [15].

2 As defined by The Canadian National Occupancy Standard, a measure widely used in Australia to estimate the proportion of dwellings that are overcrowded by assessing bedroom requirements [11][16].

3 Housing of an acceptable standard includes two components: having four working household facilities; and not more than two major structural problems [10].