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ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH PERFORMANCE FRAMEWORK 2017 REPORT

2.13 Transport

Why is it important?

Transport is a key enabler for access to health care, goods and services, and supports Aboriginal and Torres Strait Islander peoples to achieve education and employment outcomes and maintain cultural obligations to travel to family commitments (Helps et al, 2010; Ivers et al, 2016).

Aboriginal and Torres Strait Islander peoples face various barriers to accessing appropriate health care (see measure 3.14) including logistics, cost and reliability of transport options. These challenges have a broader impact on the social and economic circumstances of both health service users who need to travel significant distances while unwell, and on carers who support attendance at services for antenatal care, young children, people with a disability, or people suffering from chronic health conditions, mental health or substance use issues (Lee et al, 2014). Limited or no public transport options significantly impact on the capacity to access specialist health care, particularly for patients with chronic health conditions (Teng et al, 2014) or requiring birthing services (Parker, S et al, 2014) in rural and remote areas (Kelly et al, 2014).

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Findings

Transport/distance was a reason 16% of Indigenous Australians reported they did not access health services when they needed to in 2012–13 (Health Survey). For specific types of services, transport/distance was a reported barrier to visiting a hospital (17%), a doctor (14%), a dentist (11%), counsellors (10%), and other health professionals (13%).

Logistical reasons (transport/distance, waiting time too long, availability of service in the area) were a greater barrier to accessing a health provider when needed (40%) than cost (36%) or cultural appropriateness of services (32%). Logistical reasons were a greater barrier to accessing hospital services (37%) than cultural appropriateness of services (27%) or cost (8%). Likewise, logistical reasons were a greater barrier to accessing a doctor (34%) than cultural appropriateness of services (23%) or cost (13%). Logistical reasons were second only to cost as a barrier to accessing dental services and other health professionals.

In 2014–15, 75% of Indigenous Australians aged 15 years and over reported they can easily get to places needed; an increase from 70% in 2002. For non-Indigenous Australians, 84% reported being easily able to get to places needed. There was a clear gradient by remoteness with the proportion of Indigenous Australians able to easily get to places when needed decreasing from 79% in both major cities and inner regional areas down to 61% in very remote areas. Rates were highest in NSW (81%) and lowest in the NT (60%). Age also had an effect, with 70% of 15–24 year olds reporting they can easily get to places needed rising to 79% for those aged 45 years and over.

In 2014–15, 8% of Indigenous Australians reported being unable to get to places needed/never go out/housebound compared with 1% of non-Indigenous Australians.

In 2014–15, Indigenous Australians aged 15 years and over were less likely to have access to a motor vehicle than non-Indigenous Australians (75% compared with 85% respectively). The gap was widest in remote/very remote areas combined where 67% of Indigenous Australians had access to a vehicle compared with 92% of non-Indigenous Australians; in non-remote areas the gap was smaller (78% compared to 85%). Rates varied across jurisdictions, with those living in the ACT reporting the highest rates of access to a vehicle (84%) and those in the NT the lowest (66%).

In 2014–15, 29% of Indigenous Australians aged 15 years and over had used public transport in the previous two weeks. Of those who hadn’t used it, 51% lived in an area in which there was no public transport available. Use of public transport was lower in remote areas (13%) than in non-remote areas (34%). Research has found that 35% of Aboriginal and Torres Strait Islander people were subjected to racism while using public transport (Ferdinand et al. 2012). This, along with availability of public transport, impedes access to services.
In 2014–15, transport services were provided by 84% of Commonwealth-funded Indigenous primary health care services (AIHW, 2016o).

Unsurprisingly, Indigenous Australians aged 15 years and over who can easily get to places needed were less likely to report having problems accessing services. They were also less likely to have a disability/long term health condition, to report high/very high levels of psychological distress or to rate their health as fair/poor.

While transport is a key enabler of access to health services, it also poses risks to health if the mode of transport is unsafe, such as a vehicle not in good working order, or a driver operating a vehicle while under the influence of alcohol or drugs (Symons et al, 2012; Fitts et al, 2013). Hospitalisation and deaths due to injuries from transport accidents remain a concern (see measure 1.03).

Figures

Table 2.13-1
Indigenous Australians who did not access health services when needed to and reasons relating to logistics, 2012–13
Dentist Doctor Other health professional Hospital Counsellor
Per cent
Did not access service when needed to in last 12 months 21 14 9 6 9
Reason(s) did not access service
Waiting time too long or not available at time required 20 22 17 25 12
Transport/distance 11 14 13 17 10
Service not available in area 9 5 6 3 6
Logistical reasons (subtotal) 33 34 28 37 22

Source: ABS and AIHW analysis of 2012–13 AATSIHS

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Figure 2.13-1
Perceived level of difficulty with transport for persons aged 15 years over, by Indigenous status, 2014–15

Figure 2.13-1 shows the perceived level of difficulty with transport for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 15 years and over in 2014-15. Categories presented are: can easily get to places needed; sometimes have difficulty getting to places needed; often have difficulty getting to places needed; can't get to places needed/never go out/housebound. 75% of Indigenous Australians reported they can easily get to places needed compared to 84% of non‐Indigenous Australians. 8% of Indigenous Australians reported being unable to get to places needed/never go out/housebound compared with 1% of non‐Indigenous Australians.

Source: ABS and AIHW analysis of 2014–15 NATSISS

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Figure 2.13-2
Proportion of Indigenous Australians aged 15 years and over who can get to places needed, by remoteness, 2014–15

Figure 2.13-2 shows the proportion of Indigenous Australians aged 15 years and over who could get to places when needed in 2014-15. Data are presented by: major cities; inner regional; outer regional; remote; very remote; and Australia. There was a clear
gradient by remoteness with the proportion of Indigenous Australians able to easily get to places when needed decreasing from 79% in both major cities and inner regional areas down to 61% in very remote areas.

Note: Includes people who never go out and are housebound

Source: ABS and AIHW analysis of 2014–15 NATSISS

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Figure 2.13-3
Proportion of persons aged 15 years and over with access to a motor vehicle, by Indigenous status and remoteness, 2014–15

Figure 2.13-3 shows the proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 15 years and over with access to a motor vehicle in 2014-15. Data are presented by: major cities; inner regional; outer regional; remote; very remote; and Australia. Indigenous Australians were less likely to have access to a motor vehicle than non‐Indigenous Australians (75% compared with 85% respectively). In remote areas 72% of Indigenous Australians had access to a vehicle compared with 93% of non-Indigenous Australians. In major cities the gap was smaller (76% compared to 84%).

Source: ABS and AIHW analysis of 2014–15 NATSISS

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Figure 2.13-4
Relationship between being easily able to get to places needed and selected health outcomes, Indigenous Australians 15 years and over, 2014–15

Figure 2.13-4 shows the relationship between being easily able to get to places needed and selected health outcomes for Indigenous Australians aged 15 years and over in 2014-15. The selected health outcomes displayed are: psychological distress; self-assessed health; disability/long term health condition; and problems accessing services. Indigenous people with high/very high levels of psychological distress were less likely than those with low/moderate levels to report being easily able to get to places when needed (62% compared to 82%). Indigenous people who reported they had trouble accessing services were less likely than those who reported not having trouble accessing services to say they were easily able to get to places when needed (59% compared to 82%).

Source: ABS and AIHW analysis of 2014–15 NATSISS

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Implications

While public transportation may compensate for the lack of private transport in non-remote areas, a higher proportion of Indigenous Australians in both remote and non-remote areas have less access to a motor vehicle compared with non-Indigenous Australians.

Indigenous Australians also experience barriers to obtaining a driver’s licence, including financial hardship; literacy and language issues; identity requirements; driving practise requiring access to a car, an experienced driver and being able to afford petrol; and cyclical fine defaults (Cullen et al, 2016). Schemes to assist patients with travel and associated accommodation operate in the various jurisdictions. Other approaches have also been adopted, such as support for specialist services flying into remote localities.

Patient transport services designed to assist patients with chronic illnesses to access health services on a regular basis are an important aspect of health service delivery. This is particularly the case for Indigenous households where private and public transport options are often restricted. Patient transport services are provided by a broad range of services including voluntary groups, Aboriginal Community Controlled Health Organisations (ACCHOs), hospitals and ambulance services.

For example, the WA Department of Health has funded patient transport officers and patient journey officers in ACCHOs and area health services to ensure that Aboriginal patients have adequate transport to medical appointments at all levels of the health system (primary, secondary and tertiary). Unfortunately, the provision of these services varies significantly across Australia and access is not always assured.

Queensland Health provides the Indigenous Cardiovascular Outreach Program and the Indigenous Respiratory Outreach Care Program to deliver a range of primary, secondary and tertiary health care services in locations with limited access to specialist services.

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