Aboriginal Health in Victoria Research Summary

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Aboriginal health in Victoria Research summary

Identifying the determinants of physical and mental health

VicHealth is committed to helping close While the overall health of world Introduction the health gap between Aboriginal and populations is improving, there are non-Aboriginal Victorians. As part of significant inequalities between different In the 2006 census 30,143 Victorians this commitment, VicHealth established population groups across and within identified themselves as Aboriginal, a focus on improving Aboriginal health countries. In Australia, Aboriginal1 and representing 0.6 per cent of the total as a key priority area for action during non-Aboriginal people experience vastly Victorian population. Victorian Aboriginal 2009−2013. different health outcomes. people make up 6.6 per cent of the total Australian Aboriginal population (ABS 2007). This research summary presents a In fact, the greatest differences in synopsis of the latest published research health between peoples within a country These are some features of the Victorian examining the health status of Aboriginal anywhere in the world exist here in Aboriginal population: Victorians. It describes the burden of Australia (CSDH 2008). ‘Indigenous people • A lower life expectancy at birth than disease that arises from preventable are generally less healthy than other non-Aboriginal people (see page 2), chronic conditions, the risk factors that Australians, die at much younger ages, which is similar elsewhere in the contribute to this disease, and the social have more disability and a lower quality country (ABS & AIHW 2008). and economic factors that influence of life’ (AIHW 2008a, p. 62). • A median age of 21 years compared Aboriginal health and wellbeing. with a median age of 37 years for the The gap in health status between non-Aboriginal population (ABS 2008; Other research summaries in this series Aboriginal and non-Aboriginal Australians ABS & AIHW 2008). are available at www.vichealth.vic.gov.au/ is demonstrated by a significantly lower life publications. expectancy for Aboriginal men and women. • Almost half of Victoria’s Aboriginal This is largely the result of unequal access population lives in metropolitan areas to resources and opportunities necessary (47 per cent), with 53 per cent living for good health. These include factors in rural and regional areas (DrugInfo such as income, quality housing, education Clearinghouse 2009). and participation in community activities • The population is growing at a faster (VicHealth 2009). rate than the non-Aboriginal population (VicHealth 2005). Victoria has the highest Aboriginal population growth rate in the country (ABS 2006). • Aboriginal people are in the minority within their communities wherever they live in Victoria (Hall 2009).

1 In this research summary, the term ‘Aboriginal’ is used to refer to both Aboriginal and Torres Strait Islander peoples.

This summary is available on the VicHealth website at www.vichealth.vic.gov.au/publications. Aboriginal life expectancy Self reported health is a strong predictor Cardiovascular disease is the leading Accurately determining life expectancy of the likely use of the health care system, cause of death and disability for Aboriginal of Aboriginal Australians was difficult and a strong indicator of mortality. When Victorians (Victorian Government because of unclear or inadequate data. adjusted for age differences, self reported Department of Human Services 2008): The common practice in the past of using health reveals that Aboriginal Australians • Of all Aboriginal deaths in Australia indirect methods indicated a 17 year life (30 per cent) are twice as likely as non- during 2002 and 2005, 27 per cent expectancy gap between Aboriginal and Aboriginal Australians (15 per cent) to were due to cardiovascular disease non-Aboriginal Victorians (ABS & AIHW perceive that their health is only fair or (AIHW 2008). 2 poor (AIHW 2008b). 2008) . Newer methods now indicate a • 63 per cent of deaths of Aboriginal life expectancy gap between Aboriginal The burden of chronic disease Australians due to cardiovascular and non-Aboriginal Australians of 11.8 disease occur before the age of years for men and 10 years for women for Aboriginal Victorians 65 years, compared to 10 per cent of (ABS 2006). However, there is currently Four preventable chronic conditions are non-Aboriginal Australians (Penm 2008). not enough information to produce among the biggest direct contributors to • The median age at death from reliable estimates in Victoria using this the life expectancy gap between Aboriginal cardiovascular disease for Aboriginal method. It is important to note that the and non-Aboriginal Victorians (Victorian Australians is 60 years, compared to differences in numbers reflect the better Government Department of Human 81 years for the general population methods available to measure the gap in Services 2009). These are cardiovascular (ABS 2002). life expectancy; it does not mean the life disease, diabetes, cancer and mental expectancy gap has been reduced. • 15 per cent of Aboriginal Victorian illness. adults report that they have cardiovascular disease, about 1.5 More than two-thirds of Aboriginal people times the number of non-Aboriginal Key definitions and concepts living in non-remote areas suffer from at people (Hall 2009). least one chronic condition (ABS 2006) and Health is often defined in Australia as this is increasing (Griew, Tilton et al. 2008). • High blood pressure is the most ‘a state of complete physical, mental commonly reported form of and social wellbeing, and not merely cardiovascular disease (Penm 2008). the absence of disease or infirmity’ More trips to hospital (WHO 1978, p. 1). A greater burden of disease also means It is estimated that more than six years of more visits to hospital for treatment. the life expectancy gap could be removed Describing the health of Aboriginal Time away from work, families if Aboriginal Australians experienced the Victorians involves looking at individual and communities creates a further same level of cardiovascular health as characteristics and behaviours, as well burden and contributes to a cycle of non-Aboriginal Australians (ABS 2002). as the broader social, economic and disadvantage. Effective primary health There is potential to make this reduction environmental factors that influence care can prevent unnecessary visits to now, simply by making existing medical health. It is also important to understand hospital (WHO 2008) and help stop the treatments equally available to Aboriginal the ‘history of colonisation and the Australians: subsequent disadvantage experienced cycle of disadvantage. [by Aboriginal people] over more than Cardiovascular disease, diabetes (and • Aboriginal Australians are more likely two centuries’ (VicHealth 2008, p. 6). associated renal failure), cancer and to die from a heart attack without being mental ill health are among the most admitted to hospital. They are also Aboriginal people view health as frequent reasons Aboriginal Victorians more than twice as likely to die even something that connects all aspects of life. are admitted to hospital (Victorian if admitted to hospital (AIHW 2006). It is ‘not just the physical wellbeing of the Government Department of Human • Aboriginal Australians have a individual but the social, emotional, and Services 2008). significantly lower chance of receiving cultural wellbeing of the whole community. key investigations and treatments for In Victoria, 18.5 per cent of trips to This is a whole-of-life view and it also heart disease such as angiography, hospital for Aboriginal Victorians were includes the cyclical concept of life-death- angioplasty or bypass surgery avoidable, compared with 4.2 per cent life’ (National Health Strategy Working (AIHW 2006). Party 1989, p. x). for non-Aboriginal Victorians, indicating inequality in access to primary health Diabetes Self reported health care services (The Allen Consulting Group 2008). Diabetes occurs among Aboriginal Self reported health is a measure of Australians at around three times the rate how people perceive their health to be of the non-Aboriginal population (Diabetes on a scale from poor to excellent. It is a Cardiovascular disease Australia Vic 2008): useful indicator of the general health • Diabetes is one of the leading causes of a population (The Allen Consulting Cardiovascular disease is any disease of Group 2008). the heart or blood vessels. This includes of death and disability for Aboriginal hypertension (high blood pressure), men and women (Victorian Government coronary heart disease and heart failure Department of Human Services 2008). (Australian Better Health Initiative 2009). • Aboriginal Victorians are hospitalised for diabetes at more than twice the rate of non-Aboriginal Australians

2 This estimate was obtained by combining NSW and Victorian data. (AIHW 2008).

2 Cancer The contribution of risk factors Physical inactivity Cancer is one of the leading causes of Four risk factors are estimated to make Physical inactivity is responsible for disease burden for Aboriginal Australians the greatest contribution to the disease 8.4 per cent of the total disease burden (Vos, Barker et al. 2007): burden suffered by Aboriginal Australians for Aboriginal Australians (Vos, Barker 3 • Aboriginal people have higher incidences (Vos, Barker et al. 2007) . These are et al. 2007) : of preventable cancers (Hall 2009). tobacco, physical inactivity, nutrition and • Of Aboriginal Australian adults living • Aboriginal people diagnosed with security of food supply, and alcohol. in non-remote areas in 2004–05, 32 cancer are significantly less likely to per cent reported doing moderate or receive surgery, chemotherapy and Tobacco vigorous exercise in the two weeks prior radiotherapy than non-Aboriginal Smoking contributes more to the burden to reporting (Penm 2008). patients and are much more likely of disease for Aboriginal Victorians than • Of Aboriginal Australian adults living in to die from cancer (Hall 2009). any other single risk factor (Hall 2009). non-remote areas in 2004–05, 49 per • Participation in cancer screening is Smoking is estimated to account for 10 per cent reported that they had not done lower among Aboriginal Victorians than cent of the health gap between Aboriginal any physical activity in the two weeks the wider Victorian population (Victorian and non-Aboriginal people (Vos, Barker prior to reporting (Penm 2008). Government Department of Human et al. 2007): • Between 1995 and 2005, the proportion Services 2008). • Of Aboriginal Victorian adults, 52 per of Aboriginal people living in non-remote cent smoke and the vast majority of areas who undertook moderate or high Mental illness these smoke daily (AIHW 2008). levels of exercise dropped significantly, Mental illness is broadly understood to • Of Aboriginal Victorian adults, 24 per from 30.3 per cent to 24.3 per cent mean ‘clinically recognisable symptoms cent are ex-smokers (AIHW 2008). (Steering Committee for the Review of Government Service Provision 2009). or behaviours that are associated with • Only 24 per cent of Aboriginal Victorian distress and interference with one’s ability adults have never smoked (AIHW 2008). Structural barriers such as limited access to cope with normal life stresses and • Smoking rates among Aboriginal to facilities and high costs associated with contribute to one’s community’ (Australian Victorians have not declined in the transport, membership and uniforms can Government Department of Health and past 10 years (Victorian Government decrease participation in sport. Racism Ageing 2005). Department of Human Services 2008). can also exclude participation of Aboriginal For many Aboriginal Australians, mental people in community-based activities Smoking also is detrimental to the health illness is linked to experiences of grief, (Thorpe & Browne 2009). of others due to second-hand smoke or loss and trauma (Victorian Government passive smoking (Victorian Government In 2002, while two-thirds of non-Aboriginal Department of Human Services 2009). Department of Human Services 2008): Australians took part in sport and physical Mental illness is estimated to contribute • Between birth and 14 years of age, recreation activities, less than half the 15 per cent of the burden of disease for 53 per cent of Aboriginal children live Aboriginal population participated Aboriginal Australians. This is second only in a household with regular smokers, (Thorpe & Browne 2009). to cardiovascular disease (Vos, Barker et compared to 35 per cent of non- al. 2007): Aboriginal children (AIHW 2008). Nutrition and security of • More than a quarter of Aboriginal • Compared to 9 per cent of non- food supply Australians are reported to have Aboriginal children, 28 per cent of Unhealthy eating can lead to being some form of mental illness (Victorian Aboriginal children live with a regular overweight or obese, which is the second Government Department of Human smoker who smokes at home indoors highest level of disease risk among Services 2009). (AIHW 2008). Aboriginal Australians (Vos, Barker • Twice as many Aboriginal Australians et al. 2007). Smoking in pregnancy harms unborn (21.4 per cent) suffer high or very children. It is associated with premature Diet-related issues such as high blood high levels of psychological distress birth, stillbirth, some birth defects and cholesterol, high blood pressure and compared to non-Aboriginal Australians sudden infant death syndrome (SIDS) (US low fruit and vegetable intake are major (10 per cent) (Victorian Government Department of Health and Human Services contributors to the Aboriginal Australian Department of Human Services 2008). 1989). It is a major contributing factor to disease burden (Vos, Barker et al. 2007): • One study found that one in five infants being born with a low birth weight: • More than half (56 per cent) of the Aboriginal Victorians suffering high • Of Aboriginal mothers in Victoria, Aboriginal Australian population levels of psychological distress were not 38 per cent reported that they were consumed less than the recommended able to work or undertake their usual smokers at the time their babies two serves of fruit and five serves of activities for at least one day in the four were born compared to 9 per cent of vegetables per day (Penm 2008). weeks prior to reporting (AIHW 2008). non-Aboriginal mothers (Victorian Reasons for distress included physical • Around one in seven Aboriginal Government Department of Human health problems, the death of family or Australians do not eat any fruit and/or friends, and alcohol related problems Services 2008). vegetables on a daily basis (Penm 2008). (AIHW 2008).

3 Physical inactivity and unhealthy eating both contribute to high body mass, and given this, high body mass is not explored separately other than to note that 58.5 per cent of Aboriginal Victorians are overweight or obese compared to 48.2 per cent of all Victorians (Victorian Government Department of Human Services 2008). 3 • Of Aboriginal Victorians, 58.5 per cent Risk factors are also linked: chronic Educational attainment are overweight or obese compared to or high risk alcohol consumption is Poor health reduces the educational 48.2 per cent of all Victorians ((Victorian associated with higher rates of tobacco attainment of Aboriginal Australians Government Department of Human smoking and high levels of psychological (Carson, Dunbar et al. 2007). It is Services 2008). distress (ABS & AIHW 2008). therefore not clear ‘whether higher Exclusive breastfeeding is recommended levels of educational attainment lead to The social and economic better health, or better health leads to by the World Health Organization as the determinants of health best source of food for infants up to six higher educational attainment’ (Carson, months of age (WHO 2009): While individuals are able to make some Dunbar et al. 2007, p. 148). The path between educational attainment and • In Victoria, while most Aboriginal choices about health behaviours, it is the health for Aboriginal people is complex mothers (85 per cent) initiate social and economic conditions in which and less well understood than that of breastfeeding after birth, only 32 per they live that have a far greater influence non-Aboriginal people. cent of mothers are still breastfeeding on health (Carson, Dunbar et al. 2007). Established determinants of health when their babies are six months old Mainstream education can have a include educational attainment, social (Thorpe & Browne 2009). detrimental impact on the emotional and and community connections, income and social wellbeing of Aboriginal Australians. Having limited access to safe, healthy employment, housing and freedom from Such education is usually delivered to an and culturally acceptable food – known as race-based discrimination. Aboriginal minority and can be culturally ‘food insecurity’ – has an impact on eating and linguistically alienating with significant patterns (VicHealth 2009): Aboriginal Victorians also experience historical disadvantage, along with the implications for the wellbeing of Aboriginal • Of Aboriginal Victorians, 21 per cent dispossession of land, culture and identity young people (Carson, Dunbar et al. 2007). ran out of food and could not afford to that followed colonisation (National Health buy more in the previous 12 months Strategy Working Party 1989; Carson, (2004−05) compared to 5 per cent of ‘Education systems in Australia and Dunbar et al. 2007; VACKH 2009). non-Aboriginal Victorians (Thorpe & elsewhere, historically-speaking, often Browne 2009). aimed to reduce Indigenous peoples’ power ‘The socioeconomic disadvantage and authority over their children, and Alcohol experienced by Aboriginal and Torres Strait helped to lower the status of Aborigines Islander peoples compared with other in society. The pattern of alcohol use is different Australians places them at greater risk between Aboriginal and non-Aboriginal ‘These systems often devalued Indigenous of exposure and vulnerability to health people (Victorian Government 2008): laws, languages and cultures, and most risk factors such as smoking and alcohol importantly, denied the basis on which • Alcohol was associated with misuse, and other risk factors such as people legitimated their ownership of the approximately 7 per cent of all exposure to violence. vital economic resources of land and sea. Aboriginal Australian deaths and over 6 per cent of the total disease ‘However, socioeconomic disadvantage ‘The education system has been, in other burden for Aboriginal Australians alone does not explain all the differences in words, heavily implicated in the processes (Vos, Barker et al. 2007). health status that exist between Indigenous of dispossession and cultural genocide and non-Indigenous Australians. Numerous • Aboriginal Australians are less likely which were major causes of increasing ill other aspects of the living, working and to be drinkers than non-Aboriginal health’ (Boughton 2000, cited in Carson, social conditions of Indigenous Australians, Australians (Victorian Government Dunbar et al. 2007, p. 145). along with a reduced sense of control over 2008; ABS & AIHW 2008). their own lives, may help to explain the It is generally understood that people • Aboriginal Australians who do drink generally poorer health of Aboriginal with lower educational attainment rate are more likely to drink at harmful and Torres Strait Islander peoples’ levels (ABS & AIHW 2008). their own health more poorly and report (AIHW 2008, p. 67). • Of Aboriginal Victorians, 58 per cent a number of illnesses more often than report drinking at levels considered to those with a bachelor degree or higher pose short-term risk4 at some time in (VicHealth 2008). the year prior to reporting (AIHW 2008). Further, it is thought that ‘better education 5 • The rates of chronic or high risk leads to better overall self-assessed health drinking were similar for both status, which in turn leads to higher labour Aboriginal and non-Aboriginal force participation’. In particular, having Australians in 2004−05 (ABS & a degree or a higher qualification strongly AIHW 2008). improves labour force participation (VicHealth 2008, p. 3).

4 Those considered at short-term risk have consumed ‘five or more (for females) or seven or more (for males) standard drinks on any one occasion in the last 12 months’ (ABS & AIHW 2008, p. 140).

5 Long-term risk was measured by the number of people reporting high levels of average daily consumption of alcohol in the week prior to reporting (ABS & AIHW 2008, p. 140). High levels for males would be greater than 29 standard drinks per week and greater than 15 standard drinks per week for females (AIHW 2009).

4 Victorian statistics indicate that: Income Housing • for 22.8 per cent of Aboriginal Aboriginal Australians are more likely to Access to adequate housing impacts on Victorians, year 12 or equivalent is have lower incomes than non-Aboriginal health. Issues around inadequate housing the highest year of school completed, Australians (AIHW 2008): are particularly significant for Aboriginal compared to 44 per cent of non- • The average weekly income for Australians because of the association Aboriginal Victorians (ABS 2007) Aboriginal Australian families is $395 between shelter and dispossession from • young Aboriginal Australians are compared to $665 for non-Aboriginal land (Carson, Dunbar et al. 2007). about 15 times less likely to have a families (VACKH 2009). Key issues related to the adequacy of bachelor degree or above and around • In 2002, only 7 per cent of Aboriginal housing include: 23 per cent less likely to have a Australian adults were in the highest • availability certificate or diploma (AIHW 2008). individual income bracket compared to 20 per cent of non-Aboriginal • affordability Social and community Australians (AIHW 2008, p. 768). • security of tenure connections • overcrowding Income is also related to education Social connection is broadly defined and housing: • functionality, in terms of design and as having supportive relationships, construction and ongoing maintenance involvement in community and group • Aboriginal Australians who complete year 12 are more likely to have a higher • the immediate surroundings of houses activities and civic engagement and community including accessibility to (VicHealth 2009). income than those who only complete year 9 (AIHW 2008). services and cultural suitability (Carson, Dunbar et al. 2007; VicHealth 2008). Engaging in meaningful social connections • Aboriginal Australians who own their is a determinant of social and emotional own home are more likely to have a Recent housing data indicates: wellbeing and a prerequisite for good higher income than those who rent • of Aboriginal Victorian households, physical health (Keleher & Armstrong (AIHW 2008). 54 per cent are living in rented 2005). Employment dwellings, while 40 per cent are living Information on social and community in dwellings that were owned, either Aboriginal Victorians are less likely to connections among Aboriginal Australians with or without a mortgage (ABS 2008) participate in the labour force (63.7 indicates that: per cent) compared to non-Aboriginal • Aboriginal people are more likely • in a time of crisis, 90 per cent of Victorians (73.7 per cent) (AIHW 2008): to move house than non-Aboriginal Aboriginal Australians report having people. In the 2006 census, 34.2 per • In 2006, 15.8 per cent of Aboriginal support cent of Aboriginal Australians were Victorians were unemployed compared living at a different address one year • involvement with an Aboriginal to 5.4 per cent of the overall Victorian prior to the census, compared to 17 organisation is reported by 26 per cent population (The Allen Consulting per cent of non-Aboriginal Australians of Aboriginal Australians Group 2008). • of Aboriginal Australians, 65.1 per cent • around 87 per cent of Aboriginal • Of Aboriginal Australians who are were at a different address five years Australians aged over 15 years were unemployed, 91 per cent report before the census compared to 42.6 not removed from their natural family having trouble finding work. The main per cent of non-Aboriginal Australians and 44 per cent reported that their reason reported for this is due to (Hall 2009) relatives were not removed from their insufficient education, training and natural family skills (AIHW 2008). • there is an average of three people • in the 12 months prior to reporting, living in Aboriginal Victorian households 68 per cent of Aboriginal Australians Unemployment increases the burden of compared to 2.6 for non-Aboriginal participated in at least one cultural financial stress on Aboriginal families: households (ABS 2008) event (AIHW 2008). • Unemployment means that people • of Aboriginal households, 9.1 per are less able to buy goods and services cent are classified as overcrowded, Income and employment that can create health and it has compared to 3.1 per cent of all detrimental psychological and social households (Hall 2009). Lower income levels and employment impacts (AIHW 2008). status explain from one-third to one-half of the gap in self-assessed health between • In 2004–05, 49 per cent of Aboriginal Race-based discrimination Aboriginal and non-Aboriginal Australians Australians aged over 15 years reported Race-based discrimination can be defined (Carson, Dunbar et al. 2007). being unable to raise $2000 within a as ‘those behaviours and practices that week in a time of crisis (AIHW 2008). result in avoidable and unfair inequalities This compared to 10.1 per cent of the across groups in society based on race, wider Victorian population aged over ethnicity, culture or religion’ (VicHealth 18 years in 2007 (Victorian Government 2009, p. 14)6. Department of Human Services 2008).

6 More information about race-based discrimination can be found in VicHealth’s Ethnic and race-based discrimination as a determinant of mental health and wellbeing (VicHealth 2007) and Building on our strengths: a framework to reduce race-based discrimination and support diversity in Victoria (VicHealth 2009) at www.vichealth.vic.gov.au/publications.

5 Individuals can experience multiple forms While there is little information on Culture and identity of discrimination (VicHealth 2005), such as: Aboriginal Victorians’ experience of Aboriginal Australians are as varied in • racist taunts and insults, physical discrimination, a recent report from South culture as any other population, with many violence, being refused service in shops Australia (Gallaher, Ziersch et al. 2009) different cultural and language groups and and poor expectation of academic ability identified that: social systems (VicHealth 2005): at school (Priest & Paradies 2009) • for Aboriginal people, 93 per cent • Just over half (54 per cent) of Aboriginal • differential treatment in hospital care reported experiencing racism at least Australians identify with a tribal group (AIHW 2006). sometimes and 66 per cent experienced or clan (AIHW 2009). racism often • Of Aboriginal Australians, 21 per cent The experience of discrimination has a • racism was more often experienced report that they speak an Aboriginal negative impact on health and wellbeing in formal settings such as justice or language (AIHW 2008). (VicHealth 2005; Paradies, Harris et al. education. 2008; VicHealth 2008): • The majority of Aboriginal Australians participated in at least one cultural • race-based discrimination is known to Land, culture and identity event in the past 12 months be associated with poor mental health, ‘Land is an essential part of an Aboriginal (AIHW 2008). physical health and self-rated health. view of health, with personal identity It is particularly associated with an considered inseparable from place. Today, Aboriginal people’s identity is increased risk of anxiety and depression Interaction with country is understood derived from cultural heritage and and has possible associations with to enable an adult to develop mastery the ability to survive despite the odds, diabetes, obesity and cardiovascular and control over their lived environment’ rather than from the negative factors disease. (Burgess & Morrison 2007, cited in that resulted directly from colonisation VicHealth 2008). Given this relationship, (VicHealth 2005). The ways in which race-based it is clear that disconnection from land discrimination can lead to ill health has a profound effect on identity for Conclusion: preventing ill include: Aboriginal people. health and unequal health • reduced access to resources that can Land outcomes create and protect health such as This research summary provides a education, employment, housing, In the 200 years following European foundation for understanding the most good medical care and social support settlement in Australia, Aboriginal people were denied rights to their own land. Early important issues for Aboriginal Victorians’ • increased exposure to factors that policies of extermination and massacre health and wellbeing. The next step is to intensify health risks were followed by policies of ‘protection’ take action. • direct physical assault causing injury and assimilation including forced VicHealth and the Victorian Government • stress and emotional responses that removal from land (VicHealth 2005). Department of Health have developed impact poorly on mental health For many Aboriginal people, this caused Life is health is life: taking action to close an irreparable disconnection with land: • risky health behaviours such as the gap – Victorian Aboriginal evidence- smoking, alcohol and other drug use • In Victoria today, only 0.04 per cent based health promotion resource. This 2 2 (Paradies, Harris et al. 2008). of land (100km out of 227,416km ) resource provides an overview of the is Aboriginal-owned or controlled evidence for interventions that will (Steering Committee for the Review of A survey examining race-based address the issues described in this Government Service Provision 2009). discrimination found that: research summary. It will be available • Of Aboriginal Australians living in non- • of Victorian respondents, 25 per cent in April 2011. remote areas, 60 per cent recognise were more likely to be concerned if a specific area as their homelands or a relative married someone with an traditional country, but the majority of Aboriginal background as compared these (73 per cent) did not live on their to marrying someone from another homelands (AIHW 2008). cultural background • The number of Aboriginal Australians • of Victorians, 1.7 per cent ‘identified who do not recognise their homelands Indigenous Victorians as not is highest in inner-regional areas belonging’ despite the fact that they (40 per cent) (AIHW 2008). are the original inhabitants of the land (VicHealth 2007, p. 36).

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