Improving the health of multicultural Australians

The Multicultural Network will be made up of eight consumers and eight carers who come from all states and territories, and from a variety of cultural backgrounds.

Drawing on their personal experience, they will advise the Federal Government on how to improve health and wellbeing in multicultural communities. That includes explaining the challenges those communities face in getting the right healthcare, and how to overcome those challenges.

Low vaccination in culturally and linguistically diverse (CALD) communities shows how urgent it is to listen to those communities and ensure the health system responds to their needs. The Federal Government should urgently seek the Multicultural Network’s advice on this issue, before vaccination in CALD communities falls even further.

Recent Grattan Institute analysis has shown that too many older Australians are missing out on vaccines that could keep them healthy, out of hospital, and even keep them alive. And some groups are far more likely to miss out than others.

The biggest risk of missing out is being part of CALD group. This has a bigger impact than being poor or living in a rural area. And the impact persists even when age, wealth, health, access to GP care, and a wide range of other factors are taken into account.

Our analysis shows that older people who speak a language other than English at home (including people who speak an Indigenous language) are between about five percent and 15 percent less likely to be up to date with their flu, COVID, shingles, and pneumococcal vaccinations, depending on the vaccine.

Older people who were born overseas are between about five percent and 25 percent less likely to be vaccinated for COVID, depending which region they were born in.

The consequences have been deadly. By mid-2023, people born in south-eastern Europe or the Middle East were less than a third as likely be vaccinated for COVID, and more than twice as likely to die from it.

Why is this happening? Much of the problem seems to lie with our health system.

In Australia, more than 400 languages other than English are spoken. The flu vaccination rate for older people who speak any one of these languages at home is low, compared with the rate for people who speak English at home.

Some language groups are missing out more than others. But the fact that almost all of them are doing worse, and typically a lot worse, shows that this is a systemic problem.

And it isn’t just about language barriers either. People who speak English well, but speak another language at home, are also missing out.

Once again, they have lower rates of flu vaccination, and again that applies to nearly every language group. This suggests that simply being in a cultural minority comes with barriers to getting care.

Our governments don’t collect the right data to be sure how far the problem goes.

There is no clear definition of cultural and linguistic diversity, and often only one measure – whether place of birth, language spoken at home, or the ambiguous “ancestry” – is used. Australia also continues to exclude race in data collection, despite its importance in how people experience health and healthcare.

The Federation of Ethnic Communities’ Councils of Australia (FECCA), the national peak body for CALD groups, has called for a wide range of changes.

They include the Australian Bureau of Statistics reviewing its standards for measuring CALD status, and Australian governments adding measures of cultural, ethnic and linguistic diversity to administrative datasets.

But even the data that governments have today suggest the problem goes well beyond vaccination.

CALD groups are missing out on other types of preventative care, such as cancer screening. Almost half of women who speak English had breast cancer screening in 2020-21, compared to a little over one third (37 percent) of non-English speaking women. There is a similar pattern for bowel cancer screening.

There are many reasons that CALD groups might be missing out on care.

They can include low health literacy or knowledge of the health system, or greater susceptibility to misinformation. Lack of cultural awareness and cultural diversity among healthcare providers can also play a role, as can lack of input into health policy and models of care.

These reasons vary across communities and geography, which is why it is so important to hear from the communities themselves, including through the new Multicultural Network.

But whatever is causing the disparities, governments should be accountable for learning about the problems and then making sure they are solved.

Many successful initiatives show that it can be done, as do the successes of Aboriginal Community-Controlled Health Organisations, which empower communities to design the type of services they need and also enable accountability to communities

Turning these lessons into practice should be at the heart of the health system, with detailed public reporting on gaps in access to care, dedicated funding, and national targets to drive progress.

Vaccination is a good place to start because not only is the situation bad, it’s getting worse.

Going into this winter, the COVID vaccination gap between older people from CALD backgrounds and other Australians was getting bigger, and was worse than at any time since vaccines were widely available.

The national vaccination strategy that is currently being developed should commit to reporting on gaps like these, and it should require continual progress to reduce them.

The next big national funding deal on health, the National Health Reform Agreement, is currently being negotiated.

An independent review of the last agreement recommended a new framework to measure how the health system is performing.

The framework should chart a course to filing gaps in cultural diversity data.

It should measure gaps between different cultural groups in health risks and access to primary, specialist, and hospital care, and enshrine responsibility for reducing them.

Data can’t tell us what’s going wrong. It will take advice from the Multicultural Network and many other community groups and individuals to do that.

But once those voices are heard, governments must be accountable for acting on their advice, and for getting results. By bringing together lived experience and accountability for outcomes, Australia can build a health system that works for every cultural group.