Social determinants of health among culturally and linguistically diverse people in Australia

Country of birth of person

‘Country of birth of person’ is coded using the ‘Standard Australian Classification of Countries (SACC), 2016’. For more information on the ‘Country of birth of persons’ data item in the 2021 Census, see Country of birth of person (BPLP). In the set of logistic regression models that used the country of birth as the specific CALD variable of interest, people ‘born in Australia’ were selected as the reference group.

Country of birth is the most commonly used CALD variable, and the one for which most information is collected and reported (ABS 1999; AIHW 2022a). It is easy to define and is consistent over time, however it has its limitations. For example, country of birth alone does not provide information on the year that people arrived in Australia, which can impact their settlement and connection to community and health and support services. 

Year of arrival in Australia

‘Year of arrival in Australia’ reports the year in which a person born overseas first arrived in Australia to live for one year or more. For more information on this indicator, see Year of arrival in Australia (YARP). Time since arrival in Australia was calculated as the difference between the year of arrival and 2021, the Census year. This variable was categorised as ‘0 to 10 years’, ‘11 to 20 years’, and ‘more than 20 years’. People who were born in Australia were also included as a separate category. In the set of logistic regression models that used the time spent time in Australia as the specific CALD variable of interest, people who first arrived in Australia ‘0 to 10 years’ before the 2021 Census were selected as the reference group.

The length of time migrants have been in Australia can give an indication of how familiar they are with Australian society and health practices (ABS 1999; AIHW 2022a). It is also useful to explore how the social characteristics of migrants change with length of time spent in Australia (ABS 1999), such as changes in their risk of chronic disease. However, when used individually, it fails to inform on socio-cultural differences between the populations. It also does not take into account the fact that as an individual spends more time in the host country, their proficiency in the language can improve, thereby enhancing their ability to access healthcare (AIHW 2022a).

Language used at home

‘Language used at home’ identifies whether a person uses a language other than English at home and if so, records the main non-English language which is used. This indicator is coded, using the ‘Australian Standard Classification of Languages (ASCL) 2016’. For more information on the ’Language used at home’ data item in the Census see Language used at home (LANP). In the set of logistic regression models where the language used at home was used as the specific CALD variable of interest, people who spoke ‘English only’ at home were selected as the reference group.

Proficiency in spoken English

‘Proficiency in spoken English’ in the 2021 Census was collected only for those who nominated speaking a language other than English at home and the indicator classifies a person's self-assessed proficiency in spoken English where they identified that they use a main language other than English at home. This item also includes the ‘English (only)’ category referring to people who use only English at home. For more information on this Census data item including measurement issues, see Proficiency in spoken English (ENGLP). Proficiency in spoken English were categorised as high (very well or well) English proficiency, low (not well or not at all) English proficiency and ‘English only’. In the set of logistic regression models where proficiency in spoken English was used as the specific CALD variable of interest, people with ‘high English proficiency (Very well or well)’ were selected as the reference group.

This information is useful to identify those who may experience barriers in accessing services due to their lack of ability in spoken English (ABS 1999). It is important to note that the indicator does not provide information on other aspects of communication such as listening, reading, writing, and comprehension, which are also relevant to understanding health information. Additionally, a person’s assessment of their ability to speak English is subjective, as different people may have different requirements for spoken English proficiency in everyday life (ABS 1999; AIHW 2022a).

Proficiency in spoken English and Year of arrival combined

Combining the proficiency in spoken English and the year of arrival data may provide information on migrants for whom English language proficiency may have been a barrier to access health services over longer periods of time (ABS 1999; AIHW 2022a). It can help account for the differences in potential disadvantage between population groups by the years spent in Australia. In the set of logistic regression models that combined time spent in Australia and proficiency in spoken English, separate models were run for each category of proficiency in spoken English, with people who first arrived in Australia ‘0 to 10 years’ before the 2021 Census selected as the reference group.