Shelter WA and National Shelter have appointed PwC's Indigenous Consulting Pty Limited to review housing policy and programs over the last twenty five years and their intersection with health policy, and to recommend housing policy solutions that will deliver better health outcomes for Indigenous people.
Aboriginal Health and Housing
The World Health Organisation has identified that the social conditions in which people are born, live and work is the single most important determinant of good health or ill health.
As factors that affect health, social determinants can be seen as ‘causes of the causes’, that is, as the foundational determinants which influence other health determinants. Safe, affordable and secure housing is associated with better health, which in turn impacts on people’s participation in work, education and the community. It also effects parenting and social and familial relationships.(1)
There is a well-developed literature linking poor quality housing to poor health, including respiratory illness,(2) mental health, cardiovascular disease,(3) and a number of communicable diseases, such as chronic ear infections (e.g otitis media), eye infections (e.g. trachoma), skin conditions (e.g. crusted scabies), gastroenteritis, and respiratory infections. Overcrowding has been identified as a risk factor for pneumococcal disease. Housing conditions have been shown in a large number of studies to exacerbate family violence and mental health issues. Importantly, although Australia has relatively good housing quality overall, a high proportion of Indigenous people have very poor housing conditions.(4)
Housing affects health and wellbeing directly or indirectly through several pathways. These pathways include physical, chemical, biological, economic and social factors. Housing can impact health at the time of exposure, or effects may be delayed until later in life.(5 & 6)
Research has shown that improved housing conditions can reduce health system costs and improve participation in education and employment. One study in New South Wales showed that improved Indigenous housing was linked with a 40 per cent reduction in hospital separations for infectious diseases and reductions in chronic diseases.(7)
The effects of housing on Indigenous health can vary across geographies, climatic regions and housing and land tenure. Variation is also noted among settlements in urban, township, remote and homeland contexts, with poor housing being a particularly acute issue in remote townships.(8) The literature consistently demonstrates that housing programs need to be carefully tailored to the local climate, and that what works in one type of settlement, such as urban region, may not work in another.(9)
Analysis has shown that due to the size of the housing backlog, the poor state of many existing houses and the level of overcrowding, that four key factors need to be addressed in unison to achieve healthy housing in the remote Aboriginal community context:
• all existing housing stock be maintained in good condition;
• overcrowding be incrementally reduced by continuing to provide additional housing;
• appropriate, acceptable programs that are intensive and ongoing be provided to help improve standards of personal, domestic and environmental hygiene; and
• multifactorial tenant support programs be set up to deal with underlying social and other issues.(10 & 11)
Also, the critical role of Indigenous control in improving housing outcomes and Indigenous health has been well documented.(12)
The Australian Government’s agenda to close the gap on Indigenous disadvantage is driven by three imperatives:
• to overcome decades of underinvestment in services and infrastructure;
• to encourage and support personal responsibility as the foundation for healthy, functional families and communities; and
• to build new understanding and respect between Indigenous and non-Indigenous Australians.(13)
The policy approach includes the identification of seven key “building blocks” to address specific areas of Indigenous disadvantage - early childhood, schooling, healthy homes, safe communities, economic participation, and governance and leadership.
The 2018 Closing the Gap Report highlighted the lack of progress in Indigenous affairs since the apology to the Stolen Generations a decade ago. Although not a specific target, safe, appropriate and affordable housing is acknowledged to be a fundamental building block for improving the well-being of Aboriginal people and closing the gap on many of the target indicators.
This project is being governed by a Project Governance group comprised of:
• NATSIHA - National Aboriginal and Torres Strait Islander Housing Authority, Ivan Simon
• National Shelter – Executive Officer, Adrian Pisarski o National Shelter is a non-government peak organisation that aims to improve housing access, affordability, appropriateness, safety and security for people on low incomes. Since 1976, National Shelter has worked towards this goal by influencing government policy and action, and by raising public awareness about housing issues.
• Shelter WA – Chief Executive Officer, Michelle Mackenzie o Shelter WA is the peak body for social and affordable housing and ending homelessness in Western Australia. It is part of the National Shelter network of state and territory based Shelter associations.
Apart from the governance group, the following key stakeholders have been identified for this project. It must be noted this is not comprehensive and will be identified in a more detailed Stakeholder engagement plan.
• National Aboriginal Community Controlled Health Organisation
• Expert Reference Panel for Indigenous Environmental Health (ERPATSIEH)
• Federal Department of Health
• Department of Prime Minister and Cabinet
• Australian Housing and Urban Research Institute
• Australian Institute of Health and Welfare
The Project and Project Deliverables
A review and analysis on the health and housing continuum in reference to:
- Indigenous housing costs;
- Availability, affordability and suitability across Australia;
- Access a range of Commonwealth, State and territory and other housing initiatives; and
- Information on policy changes required to reform the current housing asset base/housing estate.
- An update on this project is provided at the World Indigenous Housing Conference, 20-24 May 2019 on the Gold Coast.
- A presentation or workshop on this project at the Australian Housing and Urban Research Institute (AHURI) Biennale National Housing Conference 28-30 August (Darwin).
This project is supported by the Federal Department of Health through the Indigenous Australians’ Health Program.
1 AIHW, 2016; Australian Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: Viewed 30 January 2019,
2 Bonnefoy, X., Braubach, M., Krapavickaite, D., Ormand, D., & Zurlyte, I. (2003). Housing conditions and self-reported health status. Journal of Housing and the Built Environment, 18, 329–352. doi:10.1023/b:joho.0000005757.37088.a9
3 Clinch, P. J., & Healy, J. D. (2000). Housing standards and excess winter mortality. Journal of Epidemiology & Community Health, 54, 719–720. doi:10.1136/jech.54.9.719
4 Emma Baker, Laurence H. Lester, Rebecca Bentley & Andrew Beer (2016) Poor housing quality: Prevalence and health effects, Journal of Prevention & Intervention in the Community, 44:4, 219-232
5 AIHW 2011a. Health and the environment: a compilation of evidence. Cat. no. PHE 136. Canberra: AIHW. Viewed 11 October 2013, <http://www.aihw.gov.au/publication-detail/?id=10737418534.
6 Bailie R 2007. Chapter 10: Housing. In: Carson B, Dunbar T, Chenhall RD & Bailie R (eds). Social determinants of Indigenous health. Sydney: Allen & Unwin
7 AEHU (Aboriginal Environmental Health Unit, NSW Department of Health) 2010. Closing the gap: 10 years of Housing for Health in NSW: an evaluation of a healthy housing intervention. Sydney: NSW Health.
8 National Shelter 2011. Indigenous Housing Round Table report. Australia: National Shelter
9 Hulse K, Jacobs K, Arthurson K & Spinney A 2011. At home and in place? The role of housing in social inclusion. AHURI final report no. 177. Melbourne: AHURI.
10 Bailie RS, McDonald EL, Stevens M, et al. Evaluation of an Australian Indigenous housing programme: community level impact on crowding, infrastructure function and hygiene. J Epidemiology Community Health 2011; 65: 432-437
11 Services and Indigenous Affairs. National Indigenous Housing Guide. Improving the living environment for safety, health and sustainability. http://www.fahcsia.gov.au/sa/indigenous/progserv/housing/Documents/default.htm
12 Campbell, M.A. et al. Contribution of the Aboriginal Community-Controlled Health Services to Improving Aboriginal Health: an Evidence Review, Australian Health Review (http://www.publish.csiro.au/ahr [6 March 2017]).
13 Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. Closing the Gap — Prime Minister’s report 2011. http://www.fahcsia.gov.au/sa/indigenous/pubs/closing_the_gap/2011_ctg_pm_report/Pages/default.aspx (accessed Nov 2011)
14 Pholeros, P. Rainow, S. Torzillo, P. ISBN 0646173340 (paperback).1993
16 The Indigenous Australians Health Program aims to contribute to closing the gap in life expectancy within a generation and to halve the gap in mortality rates for Indigenous children under five within a decade.