Health and wellbeing of First Nations people

For Aboriginal and Torres Strait Islander (First Nations) people, good health is more than the absence of disease or illness; it is a holistic concept that includes physical, social, emotional, cultural, and spiritual wellbeing, for both the individual and the community.

This page highlights some of the key issues in First Nations health and includes links to more detailed information.

Life expectancy and deaths

Life expectancy is widely used as an indicator of population health. Given current mortality patterns, First Nations males born in 2020–2022 could expect to live 71.9 years, and First Nations females 75.6 years (ABS 2023a). In general, life expectancy is lower in remote areas, with First Nations males and females living in Major cities expected to live around 5 years longer than those living in Remote and very remote areas. Due to significant changes in Indigenous identification over time in both the Census and in death records, it is not possible to compare estimates for 2020–2022 with those from earlier time periods (ABS 2023a).

Death rates among First Nations people have been falling in most age groups over the past 10 years, though the age-standardised death rate has risen by 4.1%. The median age at death for First Nations people in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined has increased from 57.2 years in 2012 to 62.3 in 2022 (ABS 2023c). In 2022, the leading causes of death among First Nations people in these 5 jurisdictions were coronary heart disease, diabetes, chronic lower respiratory diseases, cancers of the lung, bronchus and trachea, and intentional self-harm (ABS 2023b).

In the last few years, cancers have overtaken cardiovascular diseases as the most common group of diseases causing deaths among both First Nations and non-Indigenous Australians. Between 2006 and 2022, the age-standardised death rate for cardiovascular disease among First Nations people in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined fell by 22%, from 323 to 252 per 100,000, while the cancer death rate rose by 31%, from 205 to 269 per 100,000.

The Aboriginal and Torres Strait Islander Health Performance Framework provides detailed information on life expectancy and deaths among First Nations people, including infant and child mortality, leading causes of death, avoidable and preventable deaths, and changes over time.

Burden of disease

Conditions that generally cause illness and disability, rather than death, can have a major impact on the health of individuals and communities – for example, depression, arthritis, lower back pain, hearing loss, and asthma. One way of combining the fatal and non-fatal effects of diseases in a comparable way is through burden of disease analysis. This measures the impact of different diseases and injuries in terms of the number of years of healthy life lost due to living with illness or premature death.

The latest available data from the Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 (AIHW 2022) found that, in 2018, First Nations people as a whole lost almost 240,000 years of healthy life due to ill-health and premature death – equivalent to 289 years for every 1,000 people. Just over half (53%) of the total was non-fatal burden, with 47% being fatal burden. After adjusting for population growth and ageing, there was a 15% decrease in total burden between 2003 and 2018. This was driven by a 27% drop in fatal burden over the period, while there was no substantial change in the non-fatal burden.

The leading 5 disease groups contributing to burden in First Nations people in 2018 were:

• mental health & substance use disorders (such as anxiety, depression, and drug use), contributing 23% of total burden
• injuries (such as falls, road traffic injuries, and suicide), 12% 
• cardiovascular diseases (such as coronary heart disease and rheumatic heart disease), 10% 
• cancer and other neoplasms (such as lung cancer and breast cancer), 9.9%
• musculoskeletal conditions (such as back pain & problems and osteoarthritis), contributing 8.0% of total burden. 

Respiratory diseases also contributed substantially to non-fatal burden, and infant & congenital conditions to fatal burden (Figure 1).

Figure 1: Disease group contribution to total, fatal and non-fatal burden among First Nations people, 2018

Coronary heart disease (see glossary) was the leading individual disease contributing to burden among First Nations people in 2018, responsible for 5.8% of total burden. The burden due to coronary heart disease has fallen substantially since 2003, driven by a decrease in fatal burden. Considerable effort has been made to improve cardiac care for First Nations people in recent years through the Better Cardiac Care measures for Aboriginal and Torres Strait Islander people.

Comparison of burden of disease results for First Nations and non-Indigenous Australians shows that, overall, First Nations people experience burden at 2.3 times the rate of non-Indigenous Australians, but that the absolute gap narrowed between 2003 and 2018.

Social and emotional wellbeing

Social and emotional wellbeing is the foundation of physical and mental health for First Nations people. It is a holistic concept that encompasses the importance of connection to land, culture, spirituality and ancestry, and how these affect the wellbeing of the individual and the community (Gee et al. 2014).

First Nations people’s experience of social and emotional wellbeing varies across different cultural groups as well as across individuals. The concept of social and emotional wellbeing also recognises that a person’s wellbeing is influenced by the social determinants of health, engendered through the inequity of government policies, institutional racism, the effects of colonisation and other past events. For more information, see Determinants of health for First Nations people.

Social and emotional wellbeing is not the same as mental health and mental illness, but they can interact and influence each other (PM&C 2017). The National strategic framework for Aboriginal and Torres Strait Islander peoples’ mental health and social and emotional wellbeing 2017–2023 (the Framework) recognises this distinction and proposes a model of social and emotional wellbeing with 7 overlapping domains (Gee et al. 2014; PM&C 2017).

For many First Nations people, good mental health is indicated by feeling a sense of belonging, having strong cultural identity, maintaining positive interpersonal relationships, and feeling that life has purpose and value (Dudgeon et al. 2014; Dudgeon and Walker 2015). Conversely, poor mental health can be affected by major stressors such as removal from family, incarceration, death of a close friend or family member, discrimination, and unemployment, as well as stressors from everyday life (Gee et al. 2014; PM&C 2017).

In 2018–19, based on self-reported survey responses, an estimated 24% of First Nations people reported having a diagnosed mental health or behavioural condition and 3 in 10 (31%) First Nations adults reported ‘high or very high’ levels of psychological distress (ABS 2019). 

Furthermore, disruptions to family and kinship connections, including inter-generational trauma, have been linked to increased suicide and suicidal behaviour in First Nations communities (Dudgeon et al. 2021). 

For more information on the Framework and social and emotional wellbeing, see the Indigenous Mental Health & Suicide Prevention Clearinghouse.

Suicide and self-harm

Reducing deaths by suicide and suicidal behaviour among First Nations people is an issue of major concern for many First Nations communities and a public health priority for all Australian governments. Suicide was the fifth leading cause of death among First Nations people in 2022, accounting for 4.6% of all deaths (data for New South Wales, Queensland, Western Australia, South Australia and the Northern Territory only), and the 17th leading cause of death for non-Indigenous Australians in these 5 jurisdictions (1.6% of all deaths). It was also the leading cause of death for First Nations children aged 5–17 during the period 2018–2022 (ABS 2023b). Although suicide rates have increased in both the First Nations and non-Indigenous populations over the past 15 years, these data should be interpreted with caution due to data quality issues including changes in Indigenous identification over time (AIHW 2023a, 2023b). Data from 2018–2022 show that the rate of suicide deaths among First Nations people was more than twice that for non‑Indigenous Australians, with the differences being greater for people aged under 45 (AIHW 2023b).

Suicide and self-harm behaviours arise from a complex web of personal, social, and historical factors (Dudgeon et al. 2017), but they can be prevented. For more information on suicide prevention among First Nations people, see the Indigenous Mental Health and Suicide Prevention Clearinghouse.

The impact of chronic conditions

Chronic conditions are long-term health conditions (that is, lasting for at least 6 months) that contribute to ill-health and may lead to premature death. People with one or more chronic condition can have complex health needs, and may require assistance with daily living activities. Examples of chronic conditions include heart disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, arthritis, depression, hearing problems, and dementia. Many chronic conditions are more common among First Nations people than among non-Indigenous Australians, and occur at a younger age.

In the 2018–19 National Aboriginal and Torres Strait Islander Health Survey, 2 in 3 First Nations respondents (67%) reported at least one long-term health condition, with 36% reporting 3 or more (ABS 2019). Commonly reported conditions included eye/sight problems (38%, an estimated 307,000 people), asthma (16%, 128,000), ear/hearing problems (14%, 112,000), back problems (13%, 102,000) and arthritis (10%, 86,000). An estimated 64,000 First Nations people (7.9%) had diabetes, 28,000 (3.4%) had COPD, and 15,000 (1.8%) had kidney disease (Figure 2).

Hearing health, eye health and oral health

Oral and hearing health problems are 2 issues that particularly affect First Nations children, especially those living in remote areas. Eye health problems causing preventable vision loss also have a substantial impact on First Nations adults.

Otitis media (inflammation and/or infection of the middle ear) is the main condition contributing towards hearing loss in First Nations children. Experiencing hearing loss in childhood can affect speech and language development, and may lead to behavioural problems, early school leaving, limited employment options and increased contact with the criminal justice system (Burns and Thomson 2013).

First Nations children are more likely than non-Indigenous children to experience tooth decay and to be hospitalised for dental problems (AIHW 2023a). Several factors contribute to the poorer oral health of First Nations children, including social disadvantage and lack of access to appropriate diet and dental services.

Specific programs such as the Northern Territory Remote Aboriginal Investment Oral Health Program, the Northern Territory hearing health outreach program, and the Queensland Deadly Ears program aim to diagnose and treat these problems and reduce their impact on the First Nations community.

Vision loss has a profound impact on a person’s quality of life and ability to perform everyday activities, for example, by limiting opportunities for physical mobility, work, education, and social engagement (Razavi et al. 2018). Preventable vision problems, such as trachoma, diabetic retinopathy and cataracts (see glossary), affect First Nations people aged 40 and over at much higher rates than non-Indigenous Australians of the same age. The Eye health measures for Aboriginal and Torres Strait Islander people annual report provides an evidence base for monitoring changes in eye health among First Nations people, identifying inequalities and highlighting potential gaps in service provision.

It’s not the same for everyone everywhere

On average, First Nations people living in remote areas have higher rates of disease burden and lower life expectancy compared with those in non-remote areas. Key contributors to this include differences in educational and employment opportunities, in access to health services, in housing circumstances, and in other factors that support healthy behaviours (such as the availability and cost of fresh fruit and vegetables). But areas of relative advantage and disadvantage also exist within these regions. Local areas and communities may experience different issues and outcomes to others and have different needs and priorities. Looking at variations across smaller geographic areas can help to highlight specific areas of need, so that programs and services can be directed where they will be of most benefit.

The Stolen Generations and their families are a particular group of Aboriginal and Torres Strait Islander people who experience greater disadvantage than other First Nations people. Analysis of data from the 2014–15 National Aboriginal and Torres Strait Islander Social Survey showed that people who reported being removed from family were more likely than those who did not to have been imprisoned or arrested in the previous 5 years, to have low income, to have poor self-assessed health, to have poor mental health, and to have experienced homelessness in the previous 10 years. This disadvantage persisted through the generations, with adult descendants and co-resident children also experiencing poorer health and wellbeing outcomes compared with other First Nations people (AIHW 2019a, 2019b).

Where do I go for more information?

For more information on the health and wellbeing of First Nations people, see:

• Aboriginal and Torres Strait Islander Health Performance Framework
• Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018
• Indigenous Mental Health & Suicide Prevention Clearinghouse
• Department of Health and Aged Care Aboriginal and Torres Strait Islander health

For more on this topic, see First Nations people.