An estimated 1 in 6 people in Australia (17.7% or 4.4 million people) had disability in 2018, including about 1.4 million people (5.7% of the population) with severe or profound disability (ABS 2019a) (see Defining disability). Disability and health have a complex relationship—long-term health conditions might cause disability, and disability can contribute to health problems. The nature and extent of a person’s disability can also influence their health experiences. For example, it may limit their access to, and participation in, social and physical activities.

In general, people with disability report poorer general health and higher levels of psychological distress than people without disability. They also have higher rates of some modifiable health risk factors and behaviours, such as poor diet and tobacco smoking, than people without disability.

This page looks at the health of people with disability, the risks to their health, and their experiences of health care.

Measuring disability

There are many different concepts and measures of disability, making comparisons across different data sources challenging. The AIHW promotes measures based on the International Classification of Functioning, Disability and Health (WHO 2001), which underpins the disability categories used here.

The data used in this analysis are primarily from the Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers (SDAC) 2018 and National Health Survey (NHS) 2017⁠–⁠18. 

These survey data are supplemented with administrative data from the National Disability Insurance Scheme (NDIS) and Disability Support Pension (DSP). At 30 June 2019, almost 300,000 people with disabilities had joined the NDIS (NDIA 2019a). 

The Disability Support Pension is available to Australians who meet eligibility criteria and have reduced capacity to work because of their disability (DSS 2015). At 30 June 2019, around 746,000 people received the DSP (AIHW 2019).

 

Defining disability

This page groups people with disability as people:

  • with severe or profound core activity limitation—unable to do, or always or sometimes needs help with, a core activity (self-care, mobility and communication); this is referred to in this analysis as ‘with severe or profound disability’
  • without severe or profound core activity limitation—has a mild or moderate core activity limitation, or has restriction in schooling or employment; this is referred to in this analysis as ‘with other forms of disability’.

To identify disability, the SDAC asks participants if they have at least 1 of a list of limitations, restrictions or impairments, which has lasted, or is likely to last, for at least 6 months and that restricts everyday activities (ABS 2019a). The NHS asks similar questions but with less detail (ABS 2019b).

Unlike the SDAC, the NHS does not report on people living in institutional settings, such as aged care facilities (ABS 2019b). To avoid under-representing disability among certain groups, this page focuses on people who live in households, except where specified.

Profile of people with disability

The disability population is diverse. It encompasses people with varying types and severities of disability across all parts of Australian society. Knowing how many Australians have disability, and their characteristics, can help us to plan and provide the supports, services and communities that enable people with disability to participate fully in everyday life.

The estimated number of people with disability in Australia has increased to 4.4 million in 2018 (up from 4.0 million in 2009). The prevalence rate has decreased over this period (18.5% of the population in 2009 down to 17.7% in 2018) (ABS 2019a).

Overall, the likelihood of experiencing disability increases with age for both males and females. This means the longer people live, the more likely they are to experience some form of disability. For example, only 3.7% of children aged 0⁠–⁠4 had disability, whereas 85% of adults aged 90 and over had disability in 2018 (ABS 2019a). More information on the prevalence of disability is described in the AIHW report People with disability in Australia

Health status

In the 2017⁠–⁠18 NHS, adults with disability were more likely to rate their general health as ‘fair or poor’ (42%) than ‘very good or excellent’ (24%). Adults without disability were around 2.7 times as likely to assess their health as ‘very good or excellent’ in 2017⁠–⁠18 as adults with disability (65% compared with 24%). This is especially the case for adults with severe or profound disability (13%), where adults without disability were 5 times as likely to assess their health as ‘very good or excellent’, and adults with other forms of disability (27%) were twice as likely (ABS 2019c) (Figure 1). 

Among adults with disability, those aged 65 and over were almost as likely as those aged 18⁠–⁠64 to rate their health as ‘very good or excellent’ in 2017⁠–⁠18 (24% compared with 25%). Among adults with severe or profound disability, those aged 65 and over were less likely than those aged 18⁠–⁠64 to rate their health as ‘very good or excellent’ in 2017⁠–⁠18 (10% compared with 16%) (ABS 2019c) (Figure 1).

The National Disability Insurance Agency (NDIA) collects information from participants in the NDIS. At 30 June 2019, 68% of participants aged 15⁠–⁠24, and 46% of participants aged 25 and over, rated their health as ‘good’, ‘very good’ or ‘excellent’ (NDIA 2019a).

Mental health

Mental health conditions can be both a cause and an effect of disability, and often involve activity limitations and participation restrictions beyond the ‘core’ areas of communication, mobility and self-care—for example, in personal relationships.

Four in 10 (42%) people with severe or profound core activity limitation, and 33% of people with other forms of disability, self-reported anxiety-related problems in the 2017⁠–⁠18 NHS. This compares with 12% of people without disability (ABS 2019d).

An estimated 36% of people with severe or profound disability self-reported that they had mood (affective) disorders such as depression, compared with 32% of people with other forms of disability, and 8.7% of people without disability (ABS 2019d).

Self-reported psychological distress is an important indication of the overall mental health of a population. Higher levels of psychological distress indicate that a person may have, or is at risk of developing, mental health issues. Adults with disability are more likely (32%) to experience high or very high levels of psychological distress than adults without disability (8.0%). This is particularly true for adults with severe or profound disability (40%) (ABS 2019c) (Figure 1).

Among adults with disability, those aged 65 and over were less likely than those aged 18⁠–⁠64 to experience very high levels of psychological distress in 2017⁠–⁠18 (5.4% compared with 17%). This is also true among adults with severe or profound disability, with those aged 65 and over less likely than those aged 18⁠–⁠64 to experience very high levels of psychological distress in 2017⁠–⁠18 (11% compared with 25%) (ABS 2019c) (Figure 1). See Mental health for more information.
 

This graph shows that people with disability are less likely than those without disability to report their general health as excellent or very good (24% verses 65%), and their psychological distress level as low (42% verses 70%). This trend is true regardless of age. 

Main conditions of people with disability

Australians with disability most commonly report a physical disorder (77%) as their main condition. Musculoskeletal disorders were the most commonly reported (30%) physical disorders, and include conditions such as arthritis and related disorders (13%), and back problems (13%) (ABS 2019a).

Mental or behavioural disorders, while less common, were reported by almost one-quarter (23%) of people with disability as their main condition. The most common mental or behavioural disorders were psychoses and mood disorders (7.5%), and intellectual and development disorders (6.5%) (ABS 2019a).

Health risk factors

People with disability generally have higher rates of some modifiable health risk factors and behaviours than people without disability. But there can be particular challenges for people with disability in modifying some risk factors, for example, where extra assistance is needed to achieve a physically active lifestyle, or where medication increases appetite or affects drinking behaviours.

In 2017–18, compared with people without disability, people with disability were:

  • more likely to report an insufficient level of physical activity in the last week (72% with disability compared with 52% without disability, for people aged 15 and over)
  • more likely to report that they smoked daily (18% compared with 12%, for people aged 15 and over)
  • more likely to be overweight or obese (72% compared with 55%, for people aged 2 and over)
  • more likely to report eating insufficient serves of fruit and vegetables per day (47% compared with 41%, for people aged 2 and over)
  • less likely to report risky alcohol consumption in the last week (14% compared with 16%, for people aged 15 and over) (Figure 2).

People aged 65 and over with disability were less likely than younger people with disability to report they smoked daily (8.2% compared with 25% for those aged 18–64) but more likely to be overweight or obese (79% compared with 73% for those aged 18–64) (ABS 2019c).

In June 2018, 17% of NDIS participants aged 25–64 were current smokers (NDIA 2019b).
 

This graph shows that people with disability are more likely than those without disability to have higher health risks for the factors: Physical activity (72% verses 52%), smoking (18% verses 12%), body weight (72% verses 55%) and diet (47% verses 41%), but are also less likely to have a higher health risk in alcohol consumption (14% verses 16%). This trend is true regardless of age.

Health care

People with disability generally use health services—such as general practitioners (GPs), medical specialists and hospital emergency departments—more than people without disability. At June 2018, 29% of NDIS participants aged 15–24 had been to hospital in the last 12 months (NDIA 2019b), compared with 7.9% of all Australians in this age group (ABS 2019e). Of those NDIS participants aged 15–24 who went to hospital, 52% had multiple visits (NDIA 2019b), compared with 22% of all Australians aged 15–24 (ABS 2019e).

In 2018, 60% of Australians with disability needed assistance with at least 1 activity of daily life. Of these, the most common form of assistance needed was with health care (30%). Among people with a profound limitation (around 610,000 people), 73% most needed assistance with health care. Of the people with disability needing assistance with health care, 55% received formal assistance and 49% received informal assistance (ABS 2019a).

Some people with disability experience difficulties in accessing health services, such as unacceptable or lengthy waiting times, cost, inaccessibility of buildings, and discrimination by health professionals. They may also experience issues caused by lack of communication between different health professionals who treat them.

Of people with disability in 2018, 12% avoided medical facilities because of their disability in the last 12 months (ABS 2019a). Difficulty accessing health care can vary with the extent or severity of disability (Table 1).

Table 1: Difficulties in accessing health services in last 12 months, by disability severity, 2018

 

With severe or profound disability (%)

With other forms of disability (%)

Had difficulty accessing medical facilities(a, b)

12.8

9.2

Experienced unfair treatment or discrimination from health staff (c)

8.9

2.0

Delayed or did not see a GP when needed, because of the cost(d)

6.0

8.4

Saw a GP but waited longer than they felt was acceptable to get an appointment(c)

26.8

23.5

Did not see a medical specialist when needed, because of the cost(d)

5.0

4.3

Saw a medical specialist but waited longer than they felt was acceptable to get an appointment(c)

38.3

29.2

Delayed or did not see a dental professional when needed, because of the cost(d)

21.5

29.8

On a public dental waiting list and still waiting to receive public dental care(d)

28.4

32.5

Delayed or did not go to hospital when needed, because of the cost(d)

5.1

2.4*

Experienced issues caused by lack of communication among different health professionals when seeing 3 or more for the same condition(d)

24.3

18.8

(a) People who need assistance or have difficulty with communication or mobility because of disability

(b) People aged 5–64

(c) People aged 15–64 who had a personal interview

(d) People aged under 65

* Estimate has a relative standard error of 25–50% and should be used with caution.

Source: ABS 2019f.

As the patient experience information in the SDAC is collected only from people with disability and their carers, it is not possible to make direct comparisons with people without disability. Information from the ABS Patient Experience Survey 2018–19 (ABS 2019e) provides a general population comparison. It suggests that people with disability are more likely to face barriers such as cost when accessing some types of health services. For example, 21% of people with disability aged 15–64, who delayed seeing or did not see a GP when needed in the last 12 months, did so because of cost (ABS 2019f), compared with 16% of all Australians aged 15–64 (ABS 2019e).

Of the participants in the NDIS, at 30 June 2019, 69% of those aged 15–24 and 66% of those aged 25 and over did not report any difficulties accessing health services (NDIA 2019a). For participants aged 25 and over who had experienced some difficulty, the most common reason for those was access issues (10%), followed by attitudes and/or expertise of health professionals (6%). Participants aged 15–24 from regional and remote locations were less likely than those in major cities to have a regular doctor and more likely to have difficulty accessing health services (NDIA 2019b).

The establishment of a National Disability Data Asset, announced on 6 September 2019 by the Australian Data and Digital Council, will provide further insights into the experiences of people with disability when accessing health services. The asset, being piloted in 2020, will link data from multiple service sectors including health, such as visits to hospitals, GPs and specialists.

Where do I go for more information?

For more information on the health of people with disability, see:

Visit Disability for more on this topic.

References

ABS (Australian Bureau of Statistics) 2019a. Disability, Ageing and Carers, Australia: summary of findings, 2018. ABS cat. no. 4430.0. Canberra: ABS.

ABS 2019b. National Health Survey: users’ guide 2017–18. ABS cat. no. 4363.0. Canberra: ABS.

ABS 2019c. Microdata: National Health Survey, 2017–18, main unit record file. ABS cat. no. 4324.0.55.001. Finding based on AIHW analysis of ABS microdata. Canberra: ABS.

ABS 2019d. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. AIHW analysis of ABS TableBuilder. Canberra: ABS.

ABS 2019e. Patient Experiences in Australia: summary of findings, 2018–19. ABS cat. no. 4839.0. Canberra: ABS.

ABS 2019f. Microdata: Disability, Ageing and Carers, Australia, 2018. ABS cat. no. 4430.0.30.002. AIHW analysis of ABS TableBuilder. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2019. People with disability in Australia. Cat. no. DIS 72. Canberra: AIHW.

DSS (Department of Social Services) 2015. Social Security Guide. Canberra: DSS.

NDIA (National Disability Insurance Agency) 2019a. COAG Disability Reform Council, quarterly report, 30 June 2019. Canberra: NDIA.

NDIA 2019b. NDIS participant outcomes 30 June 2018. Canberra: NDIA.

WHO (World Health Organization) 2001. International Classification of Functioning, Disability and Health. Geneva: WHO.