Australia is one of the wealthiest countries in the world, with an advanced and supportive healthcare system. Australia’s universal health insurance scheme, Medicare, began in 1984 and provides Australian citizens with the healthcare they need at low or no cost, regardless of where they live or their ability to pay.
The Socio-economic and Health Gap
While Australians have equitable access to healthcare, a substantial gap exists in the socio-economic and health status between Indigenous and non-Indigenous Australians. Indigenous Australians have been overrepresented in data on poverty, ill health and premature mortality for many years, although continued research and interventions are progressively closing the gap.
Poverty and illness are interconnected, with causal factors including intergenerational trauma from colonization, low income, high unemployment rates, educational disadvantage, limited access to healthcare due to geographical isolation and the limited availability of culturally appropriate healthcare.
The Australian government and Indigenous representatives consistently work to improve the well-being of the Indigenous Australian community.
The Poverty and Health Status of Indigenous Australians
A summary report the Australian government published in 2025 states that while there have been improvements over the past decade, Indigenous Australians continue to experience substantially higher rates of poverty and ill health compared to non-Indigenous Australians.
The Australian Institute of Health and Welfare (AIHW) states that in 2021, 35% of Indigenous Australians resided in households in the lowest 20% of the national income distribution, in contrast to 20% of non-Indigenous Australians.
Additionally, Indigenous Australians are more likely to live in highly disadvantaged geographical areas. In 2021, 30% of Indigenous people lived in the most disadvantaged areas of Australia, while only 8% of non-Indigenous Australians lived in these regions. Poverty rates are generally higher in remote and very remote regions, where incomes are often lower and employment, housing and health services are less accessible. Therefore, initiatives to increase job, housing and health service accessibility are important considerations and examples appear below under Initiatives Targeting Health and Poverty.
Regarding the health burden among Indigenous Australians, the most recent data comes from the AIHW First Nations Burden of Disease Study (2022), last updated in June 2026. The latest AIHW comparison shows that in 2022, the disease burden for Indigenous Australians was 2.1 times that of non-Indigenous Australians. Further to this, the five largest disease groups affecting Indigenous Australians included mental health and substance use disorders, cardiovascular disease, cancer and other neoplasms, as well as respiratory diseases.
The National Agreement on Closing the Gap
The National Agreement on Closing the Gap is the leading Australian government strategy to improve the socio-economic and health status of Indigenous Australians. All levels of government and Indigenous representatives established this agreement in 2020; its overarching objective is to reduce the enduring inequalities between Indigenous and non-Indigenous Australians by 2031. The agreement comprises 19 socio-economic targets that measure progress, with key domains including well-being, employment, education, housing and economic participation.
The 19 socio-economic targets rest on a foundation that strives to ensure Indigenous Australians can take part in decision-making processes related to policies, programs and services affecting their well-being. Additionally, all targets align with delivering services that are culturally responsive and ensure Indigenous communities have access to information that supports their decision-making.
Initiatives Targeting Health and Poverty
Aboriginal Community Controlled Health Services (ACCHSs) represent an excellent example of consistency with the aforementioned foundational objectives. The Australian government greatly supports ACCHSs, which Indigenous communities govern and operate to provide primary healthcare services in regional and remote areas. ACCHSs provide preventive health checks, chronic disease management, maternal and child healthcare, mental health support, medication access and health promotion programs.
Queensland Health conveys the significantly positive impact of ACCHSs in improving healthcare access and uptake. At Inala Indigenous Health Service, now renamed the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, the uptake of services grew from 12 in 1994 to more than 6,000 Indigenous consumers as of March 9, 2023. This positive trend highlights the strong likelihood of continued uptake of ACCHSs within Indigenous communities in the coming years.
Culturally Safe and Appropriate Healthcare Initiatives
The United Nations reports that culturally safe and appropriate healthcare initiatives are instrumental in serving the unique needs of Indigenous people. Culturally competent healthcare providers play an instrumental role in alleviating the distrust many Indigenous Australians hold toward mainstream healthcare services. Distrust largely results from historical experiences and is a foremost barrier to Indigenous people seeking healthcare.
Expanding culturally responsive healthcare is also intended to improve adherence to healthcare recommendations among Indigenous consumers. Uptake of healthcare is important, although maintaining adherence to health advice is understood to be the most critical factor in reducing the disease burden among Indigenous Australians.
In terms of alleviating poverty, the Barang Regional Alliance (BRA) is an initiative affiliated with Closing the Gap outcomes. The BRA seeks to reduce disadvantage and improve social, economic and health outcomes for Indigenous people in New South Wales, Australia. The BRA’s mission is to help create a future where Indigenous and non-Indigenous Australians enjoy equal health and socio-economic standards. The BRA delivers a youth empowerment program, known in Indigenous language as gili-dhi muru (Lighting the Path). The overarching goal of this program is to help young Indigenous people develop leadership skills, confidence and recognize education pathways that improve their future employment opportunities.
Poverty and Health: Progress in Closing the Gap
Since the formal introduction of the National Agreement on Closing the Gap in 2020, Indigenous Australians have seen improved outcomes in domains pertinent to health and poverty, including higher rates of healthy birthweights, enhanced access to ACCHSs, improvements in life expectancy, greater access to preventive health programs and improved employment outcomes.
In 2023, the Australian Productivity Commission reported that 88.9% of Indigenous babies were born at a healthy birthweight — nearly unchanged from 88.8% in 2017. The Commission’s own assessment shows no measurable progress toward the 2031 goal of birthweight equality with non-Indigenous babies, whose healthy birthweight rate stood at 93.9% over the same period.
Healthy birthweight is an extremely important target, associated with lower infant mortality, better childhood development and improved health outcomes in later life stages.
Data from the AIHW preceding 2020 usefully demonstrates positive progress in reducing the disease burden for Indigenous people over a 15-year period. Between 2003 and 2018, the total burden of disease among Indigenous Australians fell by approximately 15%.
This indicates strong progress, which is expected to accelerate as the National Agreement on Closing the Gap introduces its 19 targets.
Measuring Poverty
Poverty is a complex issue with various contributing factors, Australia’s National Agreement on Closing the Gap cannot measure poverty reduction through one standalone target. Instead, several socio-economic targets track poverty, all strongly linked to poverty and economic well-being, including economic participation, housing and employment.
For the purpose of this article, progress on increasing employment rates will be the focus, as the AIHW reports that increasing employment rates is a critical factor in reducing poverty rates.
The Australian Institute of Health and Welfare states that the employment rate for Indigenous Australians aged 25 to 64 rose from 51% in 2016 to 55.7% in 2021, narrowing the gap with non-Indigenous Australians from 24.7 to 22.0 percentage points.
Positively, employment is one of the strongest performing Closing the Gap targets and is on track to reach the 2031 goal of 62%. More Indigenous people are participating in the workforce, with the support of organizations such as BRA, mentioned above. Increasing the employment rate among Indigenous Australians carries positive outcomes, increasing household income and reducing economic disadvantage.
Summary
In summary, Indigenous Australians have experienced enduring high rates of poverty and illness compared to non-Indigenous Australians. Progress on key health indicators, such as the 15% reduction in disease burden between 2003 and 2018, demonstrates that sustained investment can produce meaningful change, though targets such as healthy birthweight show the work is far from complete. ACCHSs and organizations such as the BRA stand out as community-led organizations working to improve employment and the health status of Indigenous Australians. With the five years remaining until the Closing the Gap targets are due, continued and strengthened efforts will be essential to close the remaining gaps.
– Alexandra Nash
Alexandra is based in Belfast, County Antrim, UK and focuses on Global Health for The Borgen Project.
Photo: Flickr