Allied health professionals (AHPs) can play a vital role in holistic care aimed at improving physical, psychological, and social wellbeing.1 Yet despite the importance of these services, First Nations people continue to face significant barriers in accessing allied health services that form a vital component of equitable primary care.
The consequences of limited access to allied health services are far-reaching. They can exacerbate existing health conditions, hinder early intervention, and impede the overall quality of life for First Nations individuals and communities. Moreover, the absence of culturally competent care may contribute to a lack of trust in the healthcare system, perpetuating a cycle of underutilisation and diminished health outcomes.
The Closing the Gap Annual Report in 2022 finds that First Nations women, born 2015-17 are expected to live to 75.6 years, 7.8 years less than other Australian women. For First Nations men, born at the same time, the gap is wider at 8.6 years and life expectancy stands at 71.6 years.2 Chronic disease, particularly mental health, cardiovascular disease, and musculoskeletal conditions, account for 80% of the gap in life expectancy.2 Chronic conditions frequently affect First Nations Australians at a younger age.3
Recognising the urgency and importance of addressing these disparities, various initiatives have been launched at the national, state, and local levels in Australia.4 56 These efforts aim to enhance the cultural responsiveness of allied health services, strengthen workforce capacity, promote community engagement, and foster partnerships between First Nations communities and healthcare providers. While progress has been made, significant work remains to be done to ensure equitable access to allied health services for Australian First Nations people.6
This article explores the inequities faced by First Nations communities in accessing allied health services in Australia, by describing the distribution of AHPs in relation to First Nations’ communities, highlighting both the role of Aboriginal and Torres Strait Islander Health Workers (AHW) in brokering the referral and therapeutic process, and their distribution in each state.
Aboriginal and Torres Strait Islander health services address health disparities
Much of the primary care for First Nations people in Australia is managed through Aboriginal and Torres Strait Islander health services, which are usually controlled and run by First Nations people. This includes management, prevention, health promotion and treatment, and is underpinned by shared cultural values.7 This shift in service delivery from mainstream primary health care has been instrumental in improving the health of First Nations communities8 7, although the bigger picture, such as tackling social determinants of health, remains.9
There are now about 200 Aboriginal and Torres Strait Islander health services, including 144 Aboriginal Community Controlled Health Organisations (ACCHOs) which provide services in some 550 clinics10 and 52 state-run Aboriginal Community Controlled Health Services (formerly referred to as Aboriginal Medical Service (AMS).11 Some ACCHOs employ AHPs as a permanent part of their multidisciplinary teams including pharmacists, social workers, diabetes educators, and clinical psychologists.11 Other AHPs are involved via referrals through GP Management Plans and Team Care Arrangements, and it is in these relationships that Aboriginal and Torres Strait Islander health workers play a vital role.
Despite this, ACCHOs lack the capacity to provide healthcare for all First Nations communities, and mainstream health services continue to play a part in the delivery of allied health support.12
Access to allied health for First Nations people
The maps below show (in red) the percentage of First Nations people per state population in 2021.13 The alternate view (in blue) shows the provision of AHPRA-registered allied health professions per 100,000 people by state at the same time. 14 This comparison suggests that states with a higher percentage of First Nations residents have poorer access to AHPs.
Map by state – First Nations population relative to all allied health practitioners—Drag the slider to view First Nations percentage of population or the allied health practitioners per 100,000 people by state for 2021.
In 2021 the Northern Territory had the highest percentage of First Nations people (26%) and the lowest rate of AHPRA-registered AHPs (651 per 100,000 people). By contrast, the state of Victoria had the lowest proportion of First Nations people at 1%, and the second highest rate of AHPRA-registered AHPs with 802 per 100,000. Then there is Tasmania, where First Nations people made up 5.4% of the state, which was serviced by just 680 AHPs per 100,000 people.
The above snapshot illustrates that distribution is part of the disparity. This is compounded in some states by the size of the regional and remote areas. Provision of allied health services to the 32.8% of First Nations people residing in rural and remote areas is not yet adequate, and ongoing investment in accessible rural allied health services is required.6 Ideally, the allied health workforce needs to increase significantly, but recruitment to remote settings is challenging.6 10 15.
Barriers to equitable access
The majority of First Nations people live in major cities and inner regional Australia (66.2% or 538,138 people in 2021).13 In general, access to AHPs is better in urban centres.14 In the SA4 area19, Brisbane Inner City, for example, there were 2,025 AHPRA-registered AHPs per 100,000 people in 2021.14 This area included some 4,000 First Nations people (1% of the population). However, the physical proximity of allied health services may not translate into equitable access for First Nations people, as the cost of allied health services, lack of transport, and concerns around culturally appropriate service, may present barriers.16
Aboriginal and Torres Strait Islander health practitioners (AHPRA-registered since 2012) can play a crucial role in supporting First Nations community members to access appropriate allied health care. The importance of building these reciprocal relationships is acknowledged by many allied health professionals as an important step toward improving health outcomes.17
The importance of culturally safe primary health care: the role of Aboriginal Health Workers
By enhancing cultural competence, Aboriginal and Torres Strait Islander health workers and health practitioners are likely to benefit health outcomes for First Nations people in their communities. Their presence is associated with improving attendance at screening clinics and prevention programs, enhancing referrals, and maintaining integration with other health professionals.11 10 Nationally in 2021, there were 659 Aboriginal and Torres Strait Islander health practitioners which made up 0.34% of the 195,216 AHPs.14
The role is multifaceted and includes practical actions to mitigate some of the realities of the social determinants of health, like arranging transport, improving health literacy, and enhancing communication between First Nations clients and AHPs, few of whom identify as First Nations people themselves.11 In 2020, 0.8% of psychologists, 0.7% of physiotherapists and 0.6% of osteopaths identified as Aboriginal and/or Torres Strait Islander.14 For the majority of AHPs the biomedical model is the normative approach to health, and special training may be required to understand the alternative knowledge systems informing First Nations peoples’ more holistic understanding of health and healing.15
The chart below compares the location of Aboriginal and Torres Strait Islander health practitioners with the percentage of First Nations people at the State level. In general, the rate of Aboriginal and Torres Strait Islander health practitioners per 100,000 increases as the First Nations percentage of the population increases. The Northern Territory is an outlier again, but this time, because it had the highest ratio of Aboriginal and Torres Strait Islander health practitioners, at 63 per 100,000, followed, a long way behind, by Western Australia with just under 5 practitioners per 100,000.
First Nations Australians percentage of population compared to Aboriginal and Torres Strait Islander health practitioners per 100,000 by State for 2021—Tap or hover on points for more information. The size of the points indicates relative total population. Note the non-linear scales of the charts.
The next chart shows the same comparison at smaller areas (Statistical Area 3 – SA3)18 and reveals significant differences within states and that many SA3 areas have no practitioners. In Western Australia in 2021, for example, there were fourteen SA3 areas with no Aboriginal and Torres Strait Islander health practitioners, while the area with the highest percentage of First Nations people (41.1%), Kimberley, had 82 practitioners per 100,000.
First Nations Australians percentage of population compared to Aboriginal and Torres Strait Islander health practitioners per 100,000 by Statistical Area 3 (SA3) coloured by State for 2021. Click or tap the Legend entries to control which data are displayed.
In 2021, 382,397 (53%) First Nations people lived in an SA3 with no Aboriginal and Torres Strait Islander Health Practitioners; roughly two-thirds of Queensland SA3 areas had no Aboriginal and Torres Strait Islander practitioners. In most of these, First Nations people made up less than 10% of the population. An exception was the SA3 area Outback North Queensland which had no practitioners, although 27% of the residents were First Nations people. The area with the best provision was Far North where First Nations people made up 51% of the residents, relative to 71 practitioners per 100,000.
For the 47% of First Nations people living in SA3s with Aboriginal and Torres State Islander practitioners, the number of practitioners tends to be higher in locations with higher First Nations populations.
Conclusion
Aboriginal and Torres Strait Islander health services, including Aboriginal Community Controlled Health Organisations (ACCHOs) and state-run Aboriginal Medical Services (AMS) (also referred to as Aboriginal Community Controlled Health Services), have improved healthcare accessibility in the communities they serve, but there are still many acute challenges to be addressed. One of these is the provision of allied health services for First Nations communities; allied health-integrated primary healthcare teams are more likely to improve health outcomes and prevent hospitalisation and chronic illness.
As this article illustrates, there are large inequities in the distribution of allied health practitioners. First Nations people have a disproportionately high burden of illness compared to other Australians, while lacking access to those services that have the potential to improve outcomes. Aboriginal and Torres Strait Islander health practitioners are a catalyst for positive change in health outcomes, and while there is a general trend for their provision to reflect the proportion of First Nations people living in the area, their distribution is extremely varied within states, leaving large parts of the community without this crucial support. By brokering referrals and promoting trust, this workforce provides a bridge to other allied health professions for First Nations peoples.
Benchmarking the distribution of AHPRA allied health professions, and Aboriginal and Torres State Islander practitioners, in relation to the proportion of First Nations people has revealed reciprocal trends. Workforce planning to improve access in poorly served areas identified in each state has the potential to improve equity of access and bring lasting benefits to First Nation people by improving their health and wellbeing.
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Appendix
Methods
Total and First Nations population data was sourced from the ABS 2021 Census and the number of AHPRA Health practitioners was sourced from the Department of Health and Aged Care National Health Workforce Data Tool. ‘All allied health practitioners’ was defined as all AHPRA-registered professions except for medical practitioners, nurses, and midwives.
Definitions
SA3 and SA4 are Statistical areas defined by the Australian Bureau of Statistics.
SA3 – These areas have roughly 20,000 to 130,000 people and are often based around regional towns and cities or clusters of related suburbs around urban commercial and transport hubs within the metropolitan areas.
SA4 – These are larger areas with populations of over 100,000. Regional SA4s tend to have 100,000 to 300,000 people, while in metropolitan areas SA4s include larger populations between 300,000 and 500,000 people.
Style guide
Aboriginal and/or Torres Strait Islander Australians are respectfully termed First Nations people here and their cultural and historical diversity is acknowledged.
