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Keywords:

  • housing;
  • Indigenous health;
  • remote communities

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

Indigenous people living in remote communities face some particular difficulties with regard to housing and its impact on their health. This paper reviews the contemporary international understanding of the relationship between housing and health, the history of settlement and housing conditions in remote Aboriginal and Torres Strait Islander communities, and some of the recent initiatives to improve housing in these communities.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

The importance of living conditions, and specifically housing, or ‘shelter’, has been recognised for centuries as a fundamental requirement for health.1,2 The nature of the benefits and risks of housing to health is diverse, and may be related to the availability of housing, the specifics of housing design and construction, the condition of the house and surrounds, and to settlement design. While many of the threats to health of poor housing are common to other disadvantaged groups, the history of colonisation and the relationship of Indigenous people to their land add to the significance of housing conditions as a determinant of health for Indigenous Australians. The vastness of the Australian continent, the relatively high proportion of Indigenous people living outside the major cities and towns, and the small size and isolation of many communities make issues of housing particularly acute in rural and remote communities.

This paper discusses some key issues for housing and health improvement in remote Aboriginal and Torres Strait Islander communities in the context of the contemporary international understanding of the relationship between housing and health.

A brief historical perspective

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

The history of colonisation, the processes of dispossession, and the creation of reserves and resettlement that occurred with the establishment of missions, cattle stations and mines is widely recognised as having had a major impact on the lifestyles and health of Australia’s Indigenous people. Dispossession and resettlement disrupted established social systems.3 Indigenous people were excluded from their familiar country, and notions of private property were forced on people who had a communal view of space and place.3 A number of writers have described the historical and ongoing importance of the connection that Indigenous Australians have with their land. Lack of recognition of Indigenous people’s property rights has led to a loss of control over their lives and living environments, and the poor health status of the Indigenous people has been described as being fundamentally related to this loss of control and subsequent social disruption.4

Housing conditions and the expected contribution to ill-health for Indigenous Australians

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

The inadequacy of housing for Indigenous Australians has been widely acknowledged.5–12‘Adequacy’ of housing includes quality of basic services, materials, facilities and infrastructure; habitability; affordability; accessibility; legal security of tenure; and location and cultural adequacy.1 Housing may affect health through both direct and indirect ways. Direct influences include the effect of the material conditions of housing on physical health and the effect of the associated social conditions on mental health and well-being. Housing has an indirect influence on health, at both the individual and neighbourhood or group level, by being an important component of general socioeconomic status and influencing access to services (Fig. 1).1 The interrelationships between these mechanisms mean that they operate together, and that they are generally associated with other negative social and economic influences.

image

Figure 1. Direct and indirect ways in which housing can affect health (adapted from Shaw1). SES, socioeconomic status.

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The health problems faced by remote communities can be broadly grouped into three interrelated categories: infectious diseases; problems resulting from social disruption and despair; and ‘lifestyle-related’ diseases resulting from poor nutrition, lack of exercise and emotional stress.13 The quality of housing impacts on all these three categories. Infectious diseases have the greatest impact on Aboriginal children and are directly related to factors such as inadequate water supplies, washing facilities, sanitation and overcrowding.

Crowding and ‘overcrowding’

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

Indigenous households tend to be larger than non-Indigenous households, with the average size of an Indigenous household being 3.5 people compared with 2.6 for Australia overall.14 In 2005, the Australian Bureau of Statistics (ABS) reported that households in Indigenous or community housing tended to be larger, with an average of 4.7 people compared with 3.4 for Indigenous home owners. ‘Overcrowding’ is defined by the ABS according to a standard that specifies the number of bedrooms required in a dwelling based on the number, age, sex and interrelationships of household members.14 Based on this standard, in 2002, 6% of Indigenous households were identified as being overcrowded. In remote areas, almost 20% of households were overcrowded compared with approximately 4% in non-remote areas. In some remote communities, the number of people per house has been reported to be as high as 33.10 The excessive number of people in a house puts strain on a range of household facilities, and can be an important contributor to the poor state of infrastructure in many dwellings, and a major limiting factor in conducting ‘healthy living practices’.9

Crowded housing conditions facilitate the spread of a number of common infectious and parasitic conditions. Recurrent and chronic infections contribute generally to poor growth and development, and exacerbations of chronic disease. Important examples of these infectious and parasitic conditions are bacterial ear infections and scabies skin infestation. These in turn can lead to hearing impairment and consequent learning difficulties, and renal and heart diseases. Tuberculosis is another disease of poverty and overcrowding15 that has largely been controlled in Australia, but which continues to occur in remote Indigenous communities.16

Crowded conditions have been associated with poorer self-reported mental and physical health.1,17 The social stress associated with overcrowding is likely to be an aggravating factor in physical and mental illness in many situations. This social stress associated with crowding is also expected to be an important contributor to high rates of domestic violence.

Furthermore, crowded conditions are likely to exacerbate the range of health effects of environmental tobacco smoke – an issue of particular concern for child health given the high rates of smoking in the Indigenous adult population.14 Smoking and crowding are among a range of factors that may increase risk of house fires and the associated risk of injury and death.1

Quality of housing infrastructure

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

Much of the work on housing in remote Indigenous communities in Australia is built around the nine ‘healthy living practices’ that emerged from work in Central Australia in the mid-1980s (Box 1). Being able to carry out these practices effectively is dependent on functioning household infrastructure.8,18

Evidence on the extent of the poor state of housing infrastructure on a broad and reasonably comparable scale has only recently begun to become available.14,18,19 Surveys of Indigenous communities in the Northern Territory (NT) in 1999 showed that the amenities required for a number of the healthy living practices were functioning adequately in only 38% to 68% of surveyed houses.19 While adequate knowledge and appropriate behaviour are critical requirements for good domestic hygiene,20 the extent to which hygiene can be maintained is clearly limited by the availability of functioning infrastructure.

The effective and safe removal of human waste, and the provision of an adequate and safe water supply for washing, drinking and cooking have long been recognised as essential to health and have been key factors in improvements in health in developed countries. Five of the nine healthy living practices are to some extent dependent on water supply. Water supplies are deficient in many Indigenous communities, and many households lack adequate facilities for washing people and clothes.14,21 Sewerage infrastructure is also inadequate and is subject to frequent breakdown and leakages.21 These factors are barriers to good domestic hygiene, including hand washing with soap and toilet training of young children. Failure to dispose safely of human faeces contributes to high rates of gastroenteritis and parasitic conditions, which are in turn also important factors in malnutrition and decreased resistance to infection.

There are major structural problems in many (58 100 (35%)) households, most commonly (55%) in households in Indigenous or community housing rental programs.14 In 2001, almost one-third (32%) of permanent dwellings in discrete Indigenous communities required major repairs or replacement.22 Structural deficiencies present risk of injury and exposure to heat, cold, dust and insects. These exposures increase risks of heart, respiratory, eye and insect-borne diseases and skin infections.18 Structural deficiencies may also limit privacy, interfere with personal hygiene behaviours and increase social stresses, all of which may have a variety of consequences for health and well-being.

The lack of reliable and safe power supplies is also a barrier to good health through a number of ways – exposure to excessive cold or heat, and lack of hot water for washing, a safe fuel source for cooking, and good lighting for a range of domestic activities, including studying. Almost two-thirds of permanent dwellings in discrete Indigenous communities rely on community (58%) or domestic (2%) generators, or some form of solar power (3%).22 Community power supplies are subject to relatively frequent interruptions, and the use of power by many households is limited by lack of funds for purchasing electricity.

BOX 1: The nine ‘Healthy Living Practices’18

  • 1
    Washing people
  • 2
    Washing clothes and bedding
  • 3
    Removing waste safely
  • 4
    Improving nutrition: the ability to store, prepare and cook food
  • 5
    Reducing crowding
  • 6
    Reducing negative contact between people and animals, insects and vermin
  • 7
    Reducing dust
  • 8
    Controlling the temperature of the living environment
  • 9
    Reducing trauma

Housing tenure, housing assistance and housing affordability

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

A range of factors may contribute to an association between housing tenure and health.1,23 Owning rather than renting may confer ontological security – a sense of security, control and mastery – which in turn may have flow on effects to health and well-being.1

Home ownership provides the most secure form of housing tenure. In only 30% of Indigenous households was the house owned or being purchased by the residents (compared with 70% for all Australian households), and in only one-third of these was the home owned outright.14 There is some evidence that there has been an increase over the past decade in the percentage of Indigenous households where the home is being purchased by the residents.

Patterns of home ownership and rental vary by location. The proportion of home owners and private renters is highest in Victoria, New South Wales and Queensland, and lowest in the NT.14 In discrete Indigenous communities in the NT, dwellings are generally owned by the community, and opportunities for home ownership are limited. Correspondingly, the NT has the highest proportion of people (48%) living in Indigenous or community housing. Western and South Australia have relatively high proportions of people renting from state housing authorities. Among Indigenous households in remote areas of Australia, two-thirds (67%) are renting Indigenous or community housing (50%) or public housing (17%).14

Homelessness

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

Homeless people tend to have poor health,1 and homelessness may be regarded as being at the extreme of housing disadvantage. While health problems might predate or contribute to becoming homeless, many of the negative health impacts of poor housing referred to above can be expected to be more severe for homeless people. Furthermore, the lack of a regular place of residence may itself be a significant barrier to employment and regular access to health and social services.23

A number of recent publications have recognised that ‘home’ may have a different meaning14 and the concept of ‘homelessness’ may differ for Indigenous people compared with the general Australian population.24,25 These differences may relate to different values and beliefs, spiritual connection with the land and the transition from a traditional lifestyle. Some Indigenous people choose not to live in conventional ‘homes’ for extended periods, and may not regard themselves as ‘homeless’. Memmott et al. have described these people as ‘public place dwellers’.24 They also describe ‘spiritual homelessness’, which may not necessarily be associated with a lack of conventional housing.24 However, higher levels of mobility associated with living in remote regions and the need to access services or to attend to cultural obligations, and higher levels of poverty, lack of housing and the associated lack of access to adequate temporary accommodation mean that Indigenous people are more likely to be in emergency, temporary or no accommodation.

Rates of homelessness among Indigenous people in 2001 ranged from 92 per 10 000 in Tasmania to 344 per 10 000 in the NT. Rates for Indigenous people were between 30% and 500% higher than non-Indigenous people.26

Governance and management of Indigenous housing programs

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

There are two main forms of social housing specific to Indigenous people:

  • • 
    State-owned and managed Indigenous housing (SOMIH), which is managed by state governments with funding provided by State–Commonwealth Housing Agreements.
  • • 
    Indigenous community housing (ICH), which is managed by Indigenous community housing organisations (ICHO) with funding provided by both the states and territories and the Commonwealth.

With the abolishment of the Aboriginal and Torres Strait Islander Commission (ATSIC) and Aboriginal and Torres Strait Islander Services (ATSIS), the Department of Family and Community Services has taken over Commonwealth responsibility for Indigenous housing.27 In the states, territories and regions, multiagency Indigenous Coordination Centres (ICC) have been established, managed by the Office of Indigenous Policy Coordination (within the Department of Immigration and Multicultural and Indigenous Affairs). It is intended that the ICC will work with regional networks of representative Indigenous organisations to ensure that local needs and priorities are understood. Nationally, there are 23 regional and remote, and seven urban ICC.27 Thus, governance arrangements for Indigenous housing have been fragmented and unstable.

Initiatives to improve housing conditions in remote Indigenous communities

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

In recent decades, there have been a number of initiatives that have aimed to address the challenges of Indigenous housing. These have included:

  • • 
    High-level policy and strategy statements, for example the National Aboriginal Health Strategy of 198911 and the national housing minister’s statement on Building a Better Future: Indigenous Housing to 2010 (Box 2)28
  • • 
    Infrastructure funding programs, for example the Health Infrastructure Priorities Projects and the National Environmental Health Strategy
  • • 
    Information initiatives, for example the Northern Territory Environmental Health Survey,19 the Community Housing and Infrastructure Needs Survey,22,29 and the National Reporting Framework for Building a Better Future30
  • • 
    Building and maintenance programs, for example Fixing Houses for Better Health31 and a number of state- and territory-based programs
  • • 
    Building standards and guidelines, for example the National Indigenous Housing Guide,18 and the National Framework for the Design, Construction and Maintenance of Indigenous Housing32
  • • 
    Innovative governance and funding arrangements, for example ATSIC and the Indigenous Housing Authority of the Northern Territory33
  • • 
    Workforce programs, for example Aboriginal Environmental Health Worker and Healthy Housing Worker Programs34
  • • 
    Homemaker or home management programs designed to enhance the ability of households to maximise the social and health benefits of housing.35

The initiatives in the last area have been particularly insubstantial. Other initiatives appear to have had varying levels of success, but few of them have been formally evaluated, and the undeveloped state of housing information systems has failed to provide a clear picture of progress.

BOX 2: Desired outcomes from the new directions for Indigenous housing:28

  • Better housing: housing that meets agreed standards is appropriate to the needs of Aboriginal and Torres Strait Islander people, and contributes to their health and well-being;
  • Better housing services: services that are well managed and sustainable;
  • More housing: growth in the number of houses to address both the backlog of Indigenous housing needs and emerging needs of a growing Indigenous population;
  • Improved partnerships: ensuring that Indigenous people are fully involved in the planning, decision-making and delivery of services by governments;
  • Greater effectiveness and efficiency: ensuring that assistance is properly directed to meeting objectives, and that resources are being used to best advantage;
  • Improved performance linked to accountability: program performance reporting based on national data collection systems and good information management; and
  • Coordination of services: a ‘whole of government’ approach that ensures greater coordination of housing and housing-related services linked to improved health and well-being outcomes.

Housing and health research

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

Recent reviews of the literature highlight that the quality of evidence linking housing to health effects is generally poor.1,2,36 Few intervention studies, and even fewer with designs adequate to control for confounding, have been completed. Methodological difficulties and political obstacles are the reasons cited for these deficiencies.36

It is increasingly recognised that broad generalisations about the links between deprivation and health are of limited value in informing social policy decisions, and there is an associated need for more and better research in this area.1,23,36,37 Evidence of the effectiveness and cost-effectiveness of interventions is important, and in many sectors there is increasing commitment to using good evidence to inform policy decisions.

The methodological limitations of the research to date make it difficult to specify the nature or size of potential health gains of improved housing, and to determine priorities for intervention. The differences between remote Indigenous communities and the social and physical environment in which most research has been conducted limit the relevance of the findings of these studies to the Indigenous Australian context and to many other settings where poor housing is a barrier to good health.

Ongoing elucidation and documentation of the relationship between policy and neighbourhood differences should contribute to a much needed debate on priorities and strategies for health promotion and disease prevention.38 Housing policy and practice in the Indigenous Australian context could benefit from a stronger local research and evaluation base.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References

There have been some significant efforts made to improve the housing situation in Indigenous communities, but these appear to have suffered from fragmentation and instability. There is some evidence of a longer-term more strategic approach being taken through the Building Better Futures initiative. However, the undeveloped state of information systems will continue to limit the understanding of the extent to which housing programs can and are achieving their objectives. While housing has been the focus of some attention, there is clearly a need for dynamic political leadership and an increase in resources and capacity at local levels.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. A brief historical perspective
  5. Housing conditions and the expected contribution to ill-health for Indigenous Australians
  6. Crowding and ‘overcrowding’
  7. Quality of housing infrastructure
  8. Housing tenure, housing assistance and housing affordability
  9. Homelessness
  10. Governance and management of Indigenous housing programs
  11. Initiatives to improve housing conditions in remote Indigenous communities
  12. Housing and health research
  13. Conclusion
  14. Acknowledgements
  15. References
  • 1
    Shaw M. Housing and public health. Annual Review of Public Health 2004; 25: 122.
  • 2
    Hood E. Dwelling disparities: how poor housing leads to poor health. Environmental Health Perspectives 2005; 113: A311A317.
  • 3
    Troy P. Foreword. In: ReadP, ed. Settlement: A History of Australian Indigenous Housing. Canberra: Aboriginal Studies Press, 2000; vvi.
  • 4
    Trudgen RI. Why Warriors Lie Down and Die. Darwin: Aboriginal Resource and Development Services, 2000.
  • 5
    Dodson M. More than bricks and mortar: the implications of housing assistance reform for Aboriginal and Torres Strait Islander peoples. Shelter – NHA 1996; 12: 714.
  • 6
    Heppell M. Aboriginal housing a forlorn future. Shelter – NHA 1977; 4: 36.
  • 7
    Marra Worra Worra Aboriginal Corporation. A Regional Approach to Delivery of Housing and Essential Services to Aboriginal Communities in the Kimberley: Submission to the Government of Western Australia, the Commonwealth Government, and ATSIC Concerning Policies and Practices, and ‘Regional Service Agreements’ as a Pilot Project in the Kimberley. Fitzroy Crossing: Marra Worra Worra Aboriginal Corporation, 1995.
  • 8
    Nganampa Health Council, South Australian Health Commission, Aboriginal Health Organisation of SA. Report of Uwankara Palyanyku Kanyintjaku: An Environmental and Public Health Review within the Anangu Pitjantjatjara Lands. Adelaide: Nganampa Health Council, 1987.
  • 9
    Pholeros P, Rainow S, Torzillo P. Housing for Health: Towards a Healthy Living Environment for Aboriginal Australia. Newport Beach: Healthabitat, 1993.
  • 10
    Johnston E. Royal Commission into Aboriginal Deaths in Custody. Canberra: AGPS, 1991.
  • 11
    National Aboriginal Health Strategy Working Party. A National Aboriginal Health Strategy. Canberra: Australian Government Printing Service, 1989.
  • 12
    Jones R. The housing needs of Indigenous Australians 1991. Canberra: Centre for Aboriginal Economic Policy Research, ANU, 1994.
  • 13
    Menzies School of Health Research. Environmental Health Handbook: A Practice Manual for Remote Communities. Darwin: Menzies School of Health Research, 2000.
  • 14
    Australian Bureau of Statistics, Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. 4704.0. Canberra: Australian Bureau of Statistics, 2005.
  • 15
    Acevedo-Garcia D. Residential segregation and the epidemiology of infectious diseases. Social Science and Medicine 2000; 51: 11431161.
  • 16
    Wallace T, Williams M, Krause V. Results of contact tracing following transmission of Mycobacterium tuberculosis in an urban itinerant Aboriginal population in Australia. The Northern Territory Disease Control Bulletin 2005; 12: 1622.
  • 17
    Waters A. Do Housing Conditions Impact on Health Inequalities between Australia’s Rich and Poor. Canberra: AHURI, 2001.
  • 18
    Department of Family and Community Services. National Indigenous Housing Guide. 2nd edn. Canberra: Department of Family and Community Services, 2003.
  • 19
    Bailie RS, Runcie MJ. Household infrastructure in aboriginal communities and the implications for health improvement. Medical Journal of Australia 2001; 175: 363366.
  • 20
    EHP, UNICEF/WES, USAID, World Bank/WSP, WSSCC. The Hygiene Improvement Framework: A Comprehensive Approach for Preventing Childhood Diarrhea. Washington, DC: US Agency for International Development, 2004.
  • 21
    Bailie RS, Carson BE, McDonald EL. Water supply and sanitation in remote indigenous communities – priorities for health development. Australian and New Zealand Journal of Public Health 2004; 28: 409414.
  • 22
    Australian Bureau of Statistics. Housing and Infrastructure in Aboriginal and Torres Strait Islander Communities: Australia 2001. 4710.0 edn. Canberra: Australian Bureau of Statistics, 2002.
  • 23
    Phibbs P, Young P. Housing Assistance and Non-Shelter Outcomes. Sydney: AHURI, 2005.
  • 24
    Memmott P, Long S, Chambers C, Spring F. Categories of Indigenous ‘Homeless’ People and Good Practice Responses to Their Needs. Melbourne: Australian Housing and Urban Research Institute, 2003.
  • 25
    Keys Young. Homelessness in the Aboriginal and Torres Strait Islander Context and its Possible Implications for the Supported Accommodation Assistance Program. Canberra: Department of Family and Community Services, 1998.
  • 26
    Chamberlain C, Mackenzie D. Australian Census Analytic Program Counting the Homeless. Canberra: Australian Bureau of Statistics, 2003.
  • 27
    Office of Indigenous Policy Coordination. New Arrangements in Indigenous Affairs. Canberra: Office of Indigenous Policy Coordination, 2004.
  • 28
    HMAC Standing Committee on Indigenous Housing. Building a Better Future: Indigenous Housing to 2010. Sydney: NSW Aboriginal Housing Office for HMAC, 2001.
  • 29
    Australian Bureau of Statistics. Housing and Infrastructure in Aboriginal and Torres Strait Islander Communities: Australia 1999. McLennanW, ed. 4710.0 edn. Canberra: Australian Bureau of Statistics, 2000.
  • 30
    Australian Institute of Health and Welfare. National Reporting Framework For Indigenous Housing. Canberra: Aboriginal and Torres Strait Islander Health and Welfare Unit, 2004.
  • 31
    Pholeros P. Housing for health and fixing houses for better health. Environmental Health 2002; 2: 34.
  • 32
    Commonwealth SaTHMWGoIH. National Framework for the Design, Construction and Maintenance of Indigenous Housing. Canberra: Commonwealth Department of Family and Community Services, 1999.
  • 33
    Indigenous Housing Authority of the Northern Territory. Minimum Standards for Housing Management. Darwin: Indigenous Housing Authority of the Northern Territory, 1998.
  • 34
    enHealth Council. National review of indigenous environmental health workers. Discussion Paper. Canberra: Department of Health and Ageing, 2004.
  • 35
    Cairnduff S, Guthridge S. Exploring Indigenous Home Management Programs in the Northern Territory. Darwin: Cooperative Research Centre for Aboriginal and Tropical Health, 2001.
  • 36
    Thomson H, Petticrew M, Morrison D. Health effects of housing improvement: systematic review of intervention studies. British Medical Journal 2001; 323: 187190.
  • 37
    Australian Housing and Urban Research Institute. AHURI Research Agenda 2004. Melbourne: AHURI, 2003.
  • 38
    Diez Roux AV. Investigating neighborhood and area effects on health. American Journal of Public Health 2001; 91: 17831789.