Indigenous demography and the regional and remote nursing workforce.
Indigenous demography has several distinct features such as: relatively high population growth; a large representation in regional and remote areas; shorter life expectancy coupled with higher rates of illness and disease; and distinct patterns of migration both within and between regional and remote centres and larger cities. Demographic issues such as population growth in regional/remote areas, increasing levels of chronic disease and rapid population ageing are projected to have a large impact on the demand for health care services in these areas with implications both for nursing and the wider health care workforce.
Indigenous Australians make up 44% of the population in very remote areas but only 1% in the major cities. The effect of the lower life expectancy of Indigenous persons is much greater in very remote areas than in other areas.
For those seeking to improve Indigenous health, it is important to appreciate the significant proportion of the Indigenous population living in very remote areas. Demographic factors show many different features between Indigenous and non-indigenous Australians. Many of these demographic factors imply an increased demand for health care services including nursing care. Indigenous Australians have a relatively high birth rate (2.06 births per woman) compared to non-Indigenous people (1.81 births per woman) which is likely to impact on relative demands for medical and nursing services such as midwifery and obstetric care (ABS, 2006).
The demographic variable known as life expectancy has also shown a well publicised discrepancy between Indigenous and non-Indigenous Australians. Life expectancy for Indigenous Australians is around 17 years less than for the entire Australian population (ABS and AIHW, 2005). This difference in life expectancy reflects the relatively poor health of Indigenous Australians and is also reflected in an increased level of observed health risk factors in the Indigenous population.
Chronic disease levels are much higher for Indigenous than non-lndigenous Australians. AIHW (2008:9) stated that "in 2005, Indigenous Australians in major cities were significantly more (three times as) likely to report diabetes than the general population in major cities ... the prevalence of reported diabetes increased significantly with increasing remoteness; in all remote areas rates were 5.5 times as high as in major cities".
Health risk factors such as smoking rates, alcohol consumption, physical inactivity, risky behaviours, diabetes rates and obesity all show elevated rates for both remote and Indigenous populations in Australia (AIHW, 2008). High rates of fertility have been coupled with higher rates of foetal and neonatal death in very remote areas.
Migration is another demographic variable that has shown a different pattern for Indigenous Australians. Patterns of internal migration in Australia have recently seen a movement of Indigenous people toward larger regional centres and away from the more remote areas (Taylor, 2002). These movements, together with the demographic pressure from increasing population and increasing rates of chronic disease are likely to put pressure on the health workforce in these areas, including the nursing workforce. The effect on the nursing workforce is likely to be particularly important in regional areas where such a large proportion of health services are provided by nurses (AIHW, 1998).
The distribution of the nursing workforce, it has been said, is less biased toward urban areas than some other health professions however there is a distinctly lower rate of nurses per 100,000 population in very remote areas. On the face of it, this is surprising given the relatively lower health status of much of the population in these areas, and the higher reliance on nurses to provide medical services in these areas and may be indicative of a need for action. This pattern may also partly reflect that a large proportion of the nursing workforce is employed in hospitals which may not be observed in very remote areas without such facilities. Recent trends have been pointing to a relative improvement in nurse numbers as a proportion of the population in such areas. AIHW (2008a:12) states that between 2001 and 2005, "nurse numbers in outer regional areas and very remote areas rose by 15.7% and 13.3% respectively, while population growth was 2.9% and 0.6% respectively". In the whole of Australia, nurse numbers grew by 7.1% and population growth was 4.8% over the same period.
Australia as a whole is experiencing rapid population ageing. To some extent population ageing as a proportion of the population is reduced through migration of relatively young migrants in the short to medium term. Patterns of migrant settlement in the larger cities and urban areas means that population ageing is generally intensified in regional and remote areas of Australia.
High levels of population growth, population ageing, and the degree to which changing behaviour is acting to prevent or induce disease are also likely to fuel future demand for nursing workforce in these areas. A project has recently commenced at the University of South Australia which will examine the future health workforce needs of selected urban and regional centres in light of demographic trends such as: population ageing; changing disease patterns including increasing prevalence of chronic disease; and advances such as new medical practices, changes in medical technology and best practice care. The regional centre of Whyalla has been chosen as an illustrative study area because of its high concentration of both chronic disease and relatively high Indigenous population. Results will be published as they become available.
Australian Bureau of Statistics and Australian institute of Health and Welfare, 2005. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples. Cat. No. 4704.0; Cat. No. IHW11. Canberra; ABS.
Australian Bureau of Statistics. 2006. Births, Australia 2005. Cat. No. 3301.0. Canberra: ABS.
Australian Institute of Health and Welfare. 1998. Nursing and midwifery workforce 1995. Canberra: AIHW.
Australian Institute of Health and Welfare. 2008, Rural, regional and remote health Indicators of health status and determinants of health. Canberra: AIHW.
Australian Institute of Health and Welfare. 2008a. Nursing and midwifery workforce 2005. Canberra: AIHW.
Taylor J. 2002. Population futures in the Australian desert, 2001-2016. CAEPR Discussion Paper 231. Canberra: Centre for Aboriginal Economic Policy Research.
TOM BOLTON IS A RESEARCH ASSOCIATE WITH THE HEALTH ECONOMICS AND POLICY GROUP. IN THE SCHOOL OF NURSING AND MIDWIFERY DIVISION OF HEALTH SCIENCES AT THE UNIVERSITY OF SOUTH AUSTRALIA