Introduction

According to the 2021 Census of Population and Housing (2021 Census), more than 7 million people (28%) in Australia were born overseas – an increase from 6.1 million (26%) in 2016 (ABS 2022a). Between 2016 and 2021, the number of people who reported speaking a language other than English at home also increased from almost 5 million people in 2016 (22%) to around 6 million (23%). In 2021, 3.4% of the Australian population indicated they spoke English not well or not at all. 

People from CALD backgrounds are identified as a priority population in multiple Australian Government strategies (AIHW 2022a). This includes the National Strategic Framework for Chronic Conditions, which identifies people from CALD backgrounds as a priority population for the prevention and management of chronic conditions. People from CALD backgrounds have varied health needs and may experience inter-connected health and social disadvantages, and greater challenges when dealing with the health-care system and services (Australian Health Ministers’ Advisor Council 2017; Henderson et al. 2011; Khatri and Assefa 2022). Challenges can include trust, language barriers and cultural sensitivities around some health issues such as sexual and mental health.

Although Aboriginal and Torres Strait Islander (First Nations) people are diverse in language and culture, their experiences and needs are unique and are therefore considered distinct from the CALD population for the purposes of this report.

Chronic health conditions among CALD Australians, 2021

The AIHW report Chronic health conditions among culturally and linguistically diverse Australians, 2021, used descriptive analysis of the 2021 Census to show the proportion of people reporting long-term health conditions in relation to the four CALD variables, used individually and in combination. This report showed on average, a higher proportion of people born in Australia reported one or more of any long-term health condition(s), compared with those born in any other country. One of the reasons for this may be the ‘healthy migrant effect.’ However, there were several exceptions when analysing the specific reported long-term health conditions and countries of birth at the most detailed level of data.

Healthy migrant effect

For first generation immigrants, in the early years following migration, some people have relatively better health than the Australian-born population (known as the ‘healthy migrant effect’) due to the combination of health screening checks and strict eligibility requirements before they migrate and through immigrant self-selection, particularly under the skilled migration stream (AIHW 2018; Jatrana et al. 2017; Kennedy et al. 2006; Kennedy et al. 2014; Khatri and Assefa 2022). Some studies suggest that the healthy migrant effect can disappear after immigrants have lived in a host country for a long time, and acculturation can vary for different immigrant populations depending on differences in education, income and language (AIHW 2018; Hamilton 2015; Jatrana et al. 2017).  For more information on the healthy migrant effect, see the AIHW report Reporting on the health of culturally and linguistically diverse populations in Australia: An exploratory paper.

Data

This report uses the Australian Bureau of Statistics’ (ABS) Person-Level Integrated Data Asset (PLIDA) to investigate data from the 2021 Census which contains comprehensive data on:

  • social determinants of health including education, labour force status, income, housing tenure, housing suitability, occupation, marital status, citizenship and remoteness
  • CALD variables including country of birth of person, year of arrival in Australia, languages used at home and proficiency in spoken English
  • long-term health conditions.

Further details of the CALD variables and long-term health conditions reported in the 2021 Census, including limitations, are provided in the Technical notes.

The concepts of health literacy, intersectionality, and accessibility of culturally appropriate services are not examined in this report but could be considered in a future program of work. 

Statistical models

The binomial logistic regression (statistical) models used in this report included:

  • unadjusted models the odds ratios of reporting specific long-term health conditions were modelled based on the individual CALD variables (Country of birth, proficiency in spoken English, Age at arrival, time since arrival and Language used at home)
  • adjusted separately for the CALD variable and a specific social determinant (including age) approach - the CALD variables and age and the social determinants of health (income, education, labour force status, housing tenancy, housing suitability, marital status, and remoteness) were modelled individually
  • fully adjusted models used the individual CALD variables, age, and the social determinants of health.

Analysis published in Chronic health conditions among culturally and linguistically diverse Australians, 2021 suggest there may be an interaction occurring between proficiency in spoken English and time since arrival, so similar models were also produced for the interactions between these two variables.

More details are described in the Methods section of the Technical notes.

In these analyses, the odds ratio is the ratio of the odds of reporting a long-term health condition in one group compared with the odds of reporting the same long-term health condition among those in the reference (or comparison) group.

An odds ratio of less than 1 means that the odds of an outcome occurring for a group with a certain characteristic is lower than that for the reference group.

An odds ratio of 1 means that the odds of an outcome occurring for a group with a certain characteristic is not different than that for the reference group for the respective characteristic.

An odds ratio of greater than 1 means that the odds of an outcome occurring for a group with a certain characteristic is higher than that for the reference group.

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