Language and health issues
Background
Australia has always been a diverse country, with over 500 Indigenous language
groups in existence prior to European settlement in the 1700s. This diversity has
continued to be enhanced by the continuing influx of people from all over the world
brought about by various factors such as convict transportation, gold rushes,
industry demand (eg mining, sheep, pearling), gender imbalances, wars, upheavals
and humanitarian crises1.
Aboriginal people
The 2006 Census indicates that there are 58,726 Aboriginal and Torres Strait
Islanders living in WA. This figure accounts for 3% of the State’s population.
Aboriginal communities, each with their distinct culture, language, customs and
traditions, live in the metropolitan as well as the rural and remote areas of Western
Australia.
English is not the first language for many Aboriginal people. English could be their
second, third or fourth language. Various kinds of English, called Aboriginal English,
are spoken by Aboriginal people throughout Western Australia. These language
varieties are dialects of English but often are linked with traditional Aboriginal
languages.
Research has shown that because Aboriginal people speak some English, it is often
incorrectly assumed by health or justice service providers that there would be
effective communication and understanding in situations involving complex
concepts and information. The Aboriginal Legal Service claims that 1 in 5 Aboriginal
people living in remote areas have difficulty understanding, or being understood by
service providers.
Aboriginal people are among the most disadvantaged in Australian society. The
Overcoming Indigenous disadvantage in Western Australia Report (Department of
Indigenous Affairs, 2005), indicates the following:2
 Life expectancy of Indigenous persons was about 15-20 years less than that of
non-Indigenous persons.
 An estimated 39% of the Indigenous population aged 15 years and over had a
disability or long term health condition.
1
National Health and Medical Research Council (2006). Cultural Competency in Health: A guide for
policy, partnerships and participation. Commonwealth of Australia.
2
Department of Indigenous Affairs, Overcoming Indigenous Disadvantage, WA Report 2005.
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Perinatal deaths were three times more prevalent among births to Indigenous
mothers than non-Indigenous mothers. There has been little consistent
improvements in the mortality rates for Indigenous babies in the last decade.
The hospital separation rate in Western Australia for Indigenous children aged
0-3 is four times higher than that of non-Indigenous children and the highest
rates are found in remote regions.
Indigenous Australians have significantly higher rates of mortality than other
Australians.
The Scoping Study on Indigenous Interpreting Service conducted by the Equal
Opportunity Commission (July 2007) has found that Aboriginal people are either not
accessing available services or are accessing them in an ad hoc manner. It also
found that some agencies are not able to provide culturally appropriate services and
do not cater to the needs of Indigenous people.
The Australian Institute of Health and Welfare reported that:3
 Indigenous Australians were considerably more likely to suffer a heart attack
and die from it, regardless of whether or not they were admitted to hospital
 Where they were admitted to hospital, they were less likely than other
Australians to receive some medical investigations or common lifesaving
procedures
 Indigenous people had three times the rate of major coronary events such as
heart attacks compared with other Australians
 When admitted to hospital for coronary heart disease, Indigenous Australians
had, as compared to other Australians:
 More than twice the chance of dying in hospital.
 A 40% lower rate of being investigated by angiography.
 A 40 % lower rate of coronary angioplasty or stent procedures.
 A 20 % lower rate of coronary bypass surgery.
Migrants and refugees
The cultural diversity of Australia, and Western Australia, has been and continues to
be enhanced by the influx of people from all over the world. This influx has been
brought about by various factors such as:
 convict transportation
 gold rushes
 industry demand (for example mining, sheep, pearling)
 gender imbalances
 wars
 upheavals
 humanitarian crises.1
At the time of the 2011 Census, WA had the highest proportion of overseas born
population in Australia, with 32.8 per cent of its population born overseas.2
3
Mathur, S. et al (2006) Aboriginal and Torres Strait Islander people with coronary heart disease.
Australian Institute of Health and Welfare. Canberra.
2
The top 10 countries of birth were:
1. United Kingdom
2. New Zealand
3. South Africa
4. India
5. Malaysia
6. Italy
7. Phillipines
8. China
9. Ireland
10. Singapore.
In the same year, 15 per cent of Western Australians spoke a language other than
English at home, using as many as 270 different languages.
Apart from English, the most common languages spoken at home were:
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Mandarin
Cantonese
Italian
Indian and South Asian
Vietnamese
Phillippine languages
Arabic
Indonesian
German
Spanish.
In 2011–12, Australia’s Humanitarian Program offered 13 750 new places, with
6000 places for refugees offshore and 7750 places for onshore protection and the
Special Humanitarian program. Of these, 2099 came to Western Australia under the
Humanitarian Program.3
In 2012–13, Australia’s humanitarian program was increased to 20 000 places, with
12 000 places for refugees offshore and 8000 places for onshore protection and the
Special Humanitarian Program (SHP).4
The 10 major countries of birth and languages spoken, for humanitarian entrants
settling in Western Australia from January 2007 to January 2011 were:
Burma – Burmese, Chin dialects, Karen dialects
Afghanistan – Dari (Afghan Farsi), Pashto, Farsi, Hazaraghi
Sudan – Arabic, English, Dinka, Nuer, Acholi
Thailand (of Burmese heritage living in Thai refugee camps) – languages the
same as Burma.
5. Iraq – Arabic, Kurdish, Armenian, Azerbaijani, Farsi
6. Democratic Republic of the Congo – French, Lingala, Kituba, Tshiluba,
Kiswahili, Akan, Bemba
1.
2.
3.
4.
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7. Liberia – English, Bassa, Kpelle, Klao
8. Ethiopia – Amharic, Arabic, English, Oromo, Tigrinya, Gamo
9. Iran – Farsi, Arabic, Kurdish, Turkmen
10. Sri Lanka – Sinhalese, Tamil, English.5
In 2006, the Department of Immigration and Citizenship identified 3 groups as most
in need of assistance to settle successfully in their new country:
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humanitarian entrants
family stream migrants with low levels of English proficiency
dependents of skilled migrants with low English proficiency who have settled
in regional areas.
Western Australia has also been the recipient of an increasing number of skilled
workers who have been sponsored by business employers and the Australian
Government to fill the skills shortage brought about by the mining boom.
In 2011-12, WA received 25 557 Skill Stream placements with many coming from
non-English speaking countries like India and the Philippines. There were also
many from English speaking countries such as the United Kingdom, South Africa
and Ireland).6 These migrants first enter on a provisional visa for 2 to 4 years. After
that period they may apply for permanent residency.
Mortality and hospitalisation
In 2005 – 2007, the mortality rate for persons born overseas was 7 per cent below
that for persons born in Australia, with marked variations by country of birth, for
example:
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People born in:
o Vietnam had 41 per cent lower mortality rate;
o Phillippines, 40 per cent lower mortality rate;
o China, 35 per cent lower mortality rate
o Malaysia, 33 per cent lower mortality rate.7
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People born in New Zealand and Poland had similar rates of mortality to
Australian-born people, while those born in the United Kingdom and Ireland
were slightly higher.
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Immigrants born in the Netherlands, United Kingdom and Ireland
experienced higher rates of lung cancer (which may reflect a higher level of
smoking).
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Higher diabetes mortality rates were present among immigrant groups from:
o Germany
4
o
o
o
o
o
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Greece
India
Italy
Lebanon
Poland.
Females born in Asia had higher rates of hospitalisation for cervical cancer –
women born in these regions also report lower rates of regular Pap smear
testing.
Language issues
Strong evidence suggests that people who speak a language other than English at
home participate less in health services than those who speak English at home.
References
1. National Health and Medical Research Council, 2006. Cultural Competency
in Health: A guide for policy, partnerships and participation. Commonwealth
of Australia.
2. Department of Immigration and Border Protection, 2013. State and Territory
migration summary report. Commonwealth of Australia.
3. Department of Immigration and Citizenship, 2013. Australia’s offshore
Humanitarian Program 2011 – 2012. Commonwealth of Australia.
4. Department of Immigration and Citizenship, 2013. Australia’s offshore
Humanitarian Program 2012-13. Commonwealth of Australia.
5. Data accessed from the Department of Immigration and Citizenship
settlement database.Accessed 2013.
6. Department of Immigration and Border Protection, 2013. Migration to
Australia’s states and territories 2011-12. Commonwealth of Australia.
7. Australian Institute of Health and Welfare, 2010. Australia’s Health.
Commonwealth of Australia.
Language and health issues for new and emerging
communities
Humanitarian entrants may bring with them particular health concerns.
Mental health
Poor mental health is one of the biggest health issues for humanitarian entrants.
They may experience a wide range of mental and emotional health problems,
including:
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depression and anxiety
grief and guilt
somatic disorders
attachment and relationship difficulties
loss of a sense of hope, meaning and purpose to life
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loss of identity and a diminished sense of belonging
post-traumatic stress disorder symptoms
cultural adjustment and intergenerational issues.
Key issues relating to poor mental health are associated with exposure to traumatic
experiences in the course of the refugee experience. These issues may persist long
after arrival in a safe country, and may also be exacerbated by stresses in the
period of resettlement.
The psychological effect of trauma may not be evident in the early settlement period
when humanitarian entrants are dealing with immediate needs such as
accommodation and securing income.
Some migrants and new arrivals are unaware of or are reluctant to access
counselling and mental health services due to stigma.
Other health issues
Other health issues experienced by humanitarian entrants can include:
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under-immunisation
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poor perinatal health
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a variety of intestinal parasites
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nutritional deficiencies
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poor dental health, which may be a result of:
o poor nutrition
o lack of fluoridated water
o poor dental hygiene
o limited dental care
o torture
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infectious and communicable diseases such as hepatitis B, tuberculosis,
malaria and AIDS/HIV
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chronic diseases (often not diagnosed or inadequately managed). 1,2,
People from culturally and linguistically diverse backgrounds experience similar
challenges to other Australians in accessing health care services including:
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limited availability of general practitioners, dentists, psychiatrists, other
specialist health professionals (particularly bulk-billing providers)
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shortage of hospital beds.
New migrants experience additional difficulties due to:
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language and cultural barriers
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general lack of awareness of what services are available
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unfamiliarity of health professionals on how to provide services for these
clients.
References
1. In NSW, humanitarian settlers are presenting to health services with a range of
complex health problems never previously encountered. (NSW Community
Relations Report 2006)
2. Department of Health Victoria. Victorian refugee health and wellbeing action
plan. Current and Future Initiatives 2005 -2008
Language and health issues for people who are deaf or hard
of hearing
The Australian Bureau of Statistics estimates that approximately 1 in 10 Australians
directly experience some degree of hearing impairment.1
The Australian Deaf signing population estimates that residents who use Australian
Sign Language (Auslan) as their primary language range from 6,500 to 15,000. 2
People who are deaf may use a number of communication methods depending on
whether they are communicating with another person who is deaf or a hearing
person.
The Report on Supply and Demand for Auslan Interpreters found that people who
are deaf preferred to use Auslan when communicating with other deaf people and
written English when communicating with hearing people.3
Other communication methods used by people who are deaf include:
 mobile telephone SMS
 telephone typewriter (TTY)
 on-line communication
 lip reading
 signed English.
Auslan is a complex language, is not comparable to other languages and does not
have a written form. The inclusion of Auslan as a recognised language of people
who are deaf or hard of hearing adds to the number of people who require
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interpreting and translating assistance within Government departments and
agencies.4
There are about 1,200 Auslan users in Western Australia. As deafness may be a
lifetime condition, interpreting may be required throughout the life span whereas
non-English speaking people will usually develop some English language skills.
Significant numbers of Aboriginal people as well as migrants and refugees also
suffer from deafness. They may not be familiar with Auslan and may use other
methods to communicate with other people.
References
1. Australian Bureau of Statistics, National Health Survey 2004/05, Canberra
2. Johnston, T.W. in Report on Supply and Demand for Auslan Interpreters,
Department for Families, Community Services and Indigenous Affairs
3. Department of Families, Housing, Community Services and Indigenous Affairs
Auslan was officially recognised as a language by the Australian Federal
Government in 1987.
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