Why is it important?:Transport can have a beneficial impact on health by enabling access to goods and services and achieving and maintaining social networks. It is an enabling resource that communities require to achieve desired outcomes, including safety and health. Research into the social determinants of health has found that ‘lack of access to transport is experienced disproportionately by women, children, disabled people, people from minority ethnic groups, older people and people with low socioeconomic status—especially those living in remote rural areas’ (Acheson 1998, Part 2 Section 5; Marmot 2010). The negative impacts of transport include reduced physical activity and accidents.
Aboriginal and Torres Strait Islander communities face various challenges related to transport. These challenges have a broader impact on social and economic circumstances, and specific impacts on access to health services. Limited or no public transport options significantly impact on the capacity to access health care, especially specialist services. Problems with access are particularly significant for patients with chronic illnesses where frequent attendance at specialist clinics may be required. Schemes to assist patients with travel and associated accommodation operate in the various jurisdictions. Other approaches have also been adopted such as support for specialist services flying into remote localities.
Findings:In 2008, households in non-remote areas with Aboriginal and Torres Strait Islander persons were significantly less likely than other households to have access to a working motor vehicle (50% vs 15% respectively). In remote areas 43% of households with Aboriginal and Torres Strait Islander persons had no access to motor vehicles.
In the 2008 NATSISS, an estimated 26% of Aboriginal and Torres Strait Islander adults had used public transport in the previous two weeks. Of the 215,400 adults who had not used public transport in the previous two weeks, 43% lived in an area in which there was no local public transport available. Use of public transport by Indigenous adults is lower in remote areas (13% in the last two weeks) than in non-remote areas (30%). One of the key contributing factors is the lack of availability of public transport in remote locations. Of the 65,000 Indigenous adults in remote areas who had not used public transport in the previous two weeks, 83% lived in an area where there was no public transport available.
In 2008, an estimated 8% of Indigenous people aged 18 years and over living in non-remote areas could not, or often had difficulty, getting to places needed, compared with 4% of non-Indigenous Australians in 2006. The proportion of Indigenous adults reporting these difficulties was higher in remote areas (18%) than in non-remote areas (8%).
The proportion of Aboriginal and Torres Strait Islander adults with access to a working motor vehicle was 78% overall, ranging from 70% of those aged 18–24 years to 85% of those aged 35–44 years. The rates between Aboriginal and Torres Strait Islander and other Australians were significantly different for each age group, with Aboriginal and Torres Strait Islander peoples having lower access in each instance. In 2008, a higher proportion of Aboriginal and Torres Strait Islander males than females reported having access to a motor vehicle whenever they needed it (74% compared with 69%).
In the 2008 National Aboriginal and Torres Strait Islander Health Survey, 10% of Aboriginal and Torres Strait Islander people aged 15 years and over reported transport/ distance as the reason they did not access a health care service when they needed to. Transport/distance was a bigger issue for those living in remote areas (19%) than those living in non-remote areas (7%).
Implications:While public transportation may compensate for the lack of private transport in non-remote areas, a higher proportion of Indigenous Australians in both remote and non-remote areas report having difficulty getting to places they need to go compared with other Australians.
The NSFATSIH’s Key Result Area Six identifies wider strategies that impact on health. Actions related to transport include reviewing the effectiveness, eligibility criteria and payment levels of patient-assisted travel schemes to improve equitable access to services by Aboriginal and Torres Strait Islander peoples across Australia. The National Healthcare Agreement (November 2008) commits states and territories to provide and fund patient assistance travel schemes and ensure that public patients are aware of how to access the schemes. Australian governments are currently working on the development of key policy principles and models for a nationally consistent scheme.
Patient transport services particularly designed to assist patients with chronic illnesses to access health services on a regular basis are an important aspect of health service delivery. This is particularly the case for Indigenous households where private and public transport options are often restricted. Patient transport services are provided by a broad range of services including voluntary groups, Aboriginal controlled health services, hospitals and ambulance services. However, the provision of these services varies significantly across Australia and access is not always assured.
Figure 109 – Proportion of households without access to a working motor vehicle, by Indigenous status and remoteness, 2008 (Indigenous) and 2006 (non-Indigenous)
Source: ABS analysis of 2008 NATSISS. Non-Indigenous data are from the 2006 General Social Survey
Text description of figure 109 (TXT 1KB)
Figure 110 – Difficulty with transport, by Indigenous status, and remoteness, persons aged 18 years and over, 2008 (Indigenous) and 2006 (non-Indigenous)
Source: ABS analysis of 2008 NATSISS. Non-Indigenous data from the 2006 General Social Survey
Text description of figure 110 (TXT 1KB)
Table 52 – Use of public transport, by remoteness, Indigenous persons aged 18 years and over, 2008
|Used public transport in last 2 weeks|
|Used transport but not public transport in last 2 weeks|
|Did not use any transport in last 2 weeks|
Main reason did not use public transport(a)
|Prefer to use own transport or walk|
|Costs too much/takes too long|
|No suitable services|
|Total with access to public transport in local area|
|No public transport available in local area|
* Estimate has a relative standard error between 25% and 50% and should be used with caution.
Source: ABS analysis of 2008 NATSISS.