Why is it important?:Research on housing and health shows a relationship between inadequate housing and related infrastructure and poor health outcomes (Atkinson et al. 2007). Lack of access to clean water, adequate sanitation and reliable electricity services are associated with higher rates of infectious diseases (ABS & AIHW 2008).
The right to water 'entitles everyone to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses. An adequate amount of safe water is necessary to prevent death from dehydration, to reduce the risk of water-related disease and to provide for consumption, cooking, personal and domestic hygienic requirements' (WHO 2010b). Internationally, poor water supply, sanitation and personal and domestic hygiene were estimated to account for 7% of the total burden of disease measured in the Global Burden of Disease Study (Vos et al. 2007). These determinants were second only to malnutrition as a major risk factor category. An adequate and reliable supply of water is required for washing people, food, kitchen utensils, and clothes.
A functional sewerage system prevents sewerage from contaminating drinking water, and reduces the risks of infectious diseases. Waste water in the living environment can be a source of infection leading to diarrhoea and diseases such as hepatitis (WHO 2010b).
A power supply such as electricity or gas contributes to health through improved nutrition by ensuring food is safely stored through refrigeration, and can be prepared and cooked appropriately. Aboriginal and Torres Strait Islander peoples in remote and very remote areas are more likely to live in conditions that would be considered unacceptable by general Australian standards. Problems can include overcrowding, poorly maintained buildings, high housing costs relative to income and a lack of basic environmental health infrastructure, such as adequate sanitation, water supply and appropriate housing.
Findings:In the 2006 Community Housing and Infrastructure Needs Survey (CHINS), 1,187 discrete Aboriginal and Torres Strait Islander communities were surveyed (ABS 2007). These communities had a population of 92,960 people, representing 18% of the Indigenous population. Most of these communities were in remote areas.
Just over half of these people (52%) relied on bore water as their main source of water supply. The proportion of people connected to a town water supply increased from 17% in 2001 to 30% in 2006. Interruptions to water supply of two days or more were experienced by 22% of the 366 communities in which more detailed survey questions were asked. Of the 164 communities that were not connected to a town water supply and had their drinking water tested for levels of microbiological agents, 48 had drinking water that failed water quality tests, an improvement since 2001.
Between 2001 and 2006 there was an increase in the number of communities connected to the state electricity grid or other transmitted supply (from 21% to 23%). Community generators supplied electricity for 32% of communities and 18% relied on solar or solar hybrid sources. Thirty-two communities, all but one having a population of fewer than 50 people, reported no organised electricity supply, compared with 80 communities in 2001. In 2006, interruptions to the electricity supply in the previous 12 months occurred in 246 communities (76% of the discrete Indigenous communities with a reported population of 50 or more). This was slightly lower than in 2001 and 1999. However, there was an increase in communities experiencing interruptions of more than 24 hours (13% in 2001 to 26% in 2006). In 2008, the NATSISS found that 7% of Indigenous households in remote areas and 4% in non-remote areas had major electrical problems.Top of page
The number of discrete Indigenous communities connected to a town sewerage system increased from 89 in 2001 to 121 in 2006 (10% of communities). Septic tanks remained the most commonly used sewerage disposal system (694 or 58% of communities). Approximately 22 discrete Indigenous communities did not have an organised sewerage system. A further 202 communities relied on pit toilets for their sewerage. In 2006, 142 discrete Indigenous communities (38%) reported sewerage system overflows or leakages in the previous 12 months. Of these, 82 (22%) reported up to 4 overflows/leakages and 14 (4%) reported 20 or more overflows/leakages. These were most common in discrete Indigenous communities with septic tanks with leach drains as the main sewerage system. In 22% of communities the leakages or outflows had continued for longer than 48 hours.
In the 2008 NATSISS, 25% of Indigenous households in non-remote areas had major structural problems like major cracks in walls/floors, problems with foundations, major plumbing problems, wood rot and termites. The NATSISS also found that 5% of Indigenous households had major electrical problems, ranging from 4% in major cities to 9% in very remote areas. Approximately 99% of Indigenous households reported that they had working facilities for washing people, 94% reported working facilities for washing clothes/bedding, 94% reported working facilities for preparing food and 98% reported working sewerage systems. This varied considerably by remoteness with 79% of households in very remote communities reporting working facilities for the storage and preparation of food.
Implications:Improved access to functional housing is associated with better health outcomes. An evaluation of the NSW Housing for Health Program found that 'those who received the Housing for Health intervention had a significantly reduced rate of hospital separations for infectious diseases—40% less than the hospital separation rate for the rest of the rural NSW Aboriginal population without the Housing for Health interventions'. Research evidence suggests that housing programs need to be accompanied by health promotion and environmental programs to support a reduction in the occurrence of common childhood infections (Bailie et al. 2011a; Bailie et al. 2011b).
The National Partnership Agreement on Remote Indigenous Housing has been established as a ten-year funding strategy to address overcrowding, homelessness, poor housing conditions and severe housing shortages in remote Indigenous communities. Over 10 years, the agreement will deliver construction of up to 4,200 new houses to address overcrowding and homelessness, and upgrades and repairs to around 4,800 existing houses through a program of major repairs and/or replacement. At the end of April 2012, over 1,200 new houses had been constructed and more than 4,000 houses had been refurbished under this agreement. Funding is also provided for property and tenancy management arrangements, including a program of tenant support and ongoing repairs and maintenance. Under the partnership, a municipal and essential services audit of 86 communities was undertaken in March 2010. The audit assessed levels of services and related infrastructure in remote Indigenous communities.Top of page
In addition, there are a number of complementary programs being delivered by the Commonwealth. The Municipal and Essential Services (MUNS) Program provides funding primarily for the maintenance of community power, water and sewerage services, garbage collection, internal road maintenance, dog health and control programs, and operational costs associated with the administration of organisations that provide infrastructure and municipal services in Aboriginal and Torres Strait Islander communities. Funding under this program is intended to supplement the efforts of the state, territory and local governments who have primary responsibility for providing municipal and essential services to Indigenous communities. The Army Aboriginal Community Assistance Program aims to improve primary environmental health and living conditions in remote Indigenous communities. One project per year is undertaken targeting improvements in housing, essential services such as water, power and sewerage, other community infrastructure, health and municipal services, and education, training and employability initiatives. The Torres Strait Major Infrastructure Program delivers essential and sustainable environmental health infrastructure projects in the Torres Strait and is funded on a matched basis by the Commonwealth and Qld Government. These projects relate to water supply and reticulation, sanitation and wastewater, community roads and drainage, and serviced housing lots. Previous projects have improved health outcomes in the region, with marked decreases in water and hygiene-related diseases.
Figure 84—Proportion of discrete Indigenous communities, with reported usual population of 50 or more, experiencing interruptions to electricity supply greater than 24 hours in the previous 12 months, by remoteness, 1999, 2001 and 2006
Source: AIHW analysis of the 1999, 2001 and 2006 CHINS surveysTop of page
Figure 85—Proportion of discrete Indigenous communities, with reported usual population of 50 or more, experiencing 10 or more sewerage system overflows or leakages in previous 12 months, by remoteness, 1999, 2001 and 2006
Source: AIHW analysis of the 1999, 2001 and 2006 CHINS surveysTop of page
Figure 86—Proportion of Indigenous households reporting lack of working facilities for each of the first four Healthy Living Practices, by remoteness, 2008
Source: AIHW analysis of 2008 NATSISSTop of page