People born in Australia from English-speaking backgrounds are more likely to suffer from chronic health conditions than the country's migrant population, according to a new government report.
The Australian Institute of Health and Welfare (AIHW) analysed new data collected from the 2021 Census to build a more complete picture of the health of 7 million people living in Australia who were born overseas.
For the first time, it was able to access information on the prevalence of 10 chronic conditions by country of birth, time since arrival, and language.
"We have been able to look at the prevalence of these chronic conditions at a really granular level," AIHW spokeswoman Clare Sparke told the ABC.
"So we can see where some groups may be worse or better off than others, rather than just comparing populations born overseas to Australian-born people."
The AIHW found what has been referred to as the "healthy migrant effect".
On average, migrants who come to Australia have lower rates of long-term health conditions.
The report also revealed the longer they lived in Australia, the chances of chronic illness increased.
Tim Senior, a GP and medical advisor for the Royal Australian College of General Practitioners (RACGP) Aboriginal and Torres Strait Islander health, said the report provoked many questions.
"There's a lot in there that makes me think, 'I wonder what the reason for that is?'"
Differences between countries
Ms Sparke said although the report found people born in Australia were more likely to suffer from chronic conditions, the general findings can "mask the story" for some groups.
There are specific long-term illnesses that are more common among certain demographics of culturally and linguistically diverse (CALD) Australians.
"Many people arrive in Australia through our skilled migration scheme where there's strict eligibility criteria and often people are highly educated," Ms Sparke said.
"So on average, those migrants appear to be healthier than the Australian population."
But many Australians who arrived through the humanitarian stream may experience worse health outcomes, she added.
People born in Australia and migrants from other English-speaking countries and Europe were generally more likely to suffer from arthritis, asthma, cancer, lung conditions and mental health conditions, the report found.
For Australians born in some overseas countries — particularly from regions such as Polynesia, South Asia and the Middle East — there were higher rates of dementia, heart disease, stroke, diabetes and kidney disease.
Ms Sparke said most of the conditions were cardiovascular diseases and a lot of people would be living with multimorbidity, meaning they had more than one of those conditions.
"So it's not a surprise that they're sort of all clustered together," she said.
China and Nepal rank lowest in chronic disease prevalence
The report found 36 per cent of people born in Australia had at least one long-term health condition.
Looking at the 20 most common overseas countries of birth, people from Iraq had the highest prevalence — at 29 per cent — among the main non-English-speaking countries.
Lebanon followed with 26 per cent, then Sri Lanka with 25 per cent.
Ms Sparke said chronic conditions could be affected by a number of factors such as education, lifestyle, and biomedical factors like genetics.
"So it's really tricky to tease out those exact reasons why there's differences," she said.
"For each different group, those broad areas will affect them differently."
The social situation someone grew up in, in their country of birth, or a traumatic migrant journey, can also affect long-term chronic health conditions, Dr Senior said.
At the other end of the spectrum, China and Nepal had the lowest rates of one or more long-term health conditions.
Both reported 15 per cent, followed by South Korea with 16 per cent.
Cultural and lifestyle influences
The occurrence of chronic health conditions increased the longer a migrant had been in Australia, across all conditions and for most countries of birth, the report found, even after controlling for age.
However, for recent arrivals from Iraq, multiple conditions — including dementia, heart disease and kidney disease — were more common.
"Indicators like the length of time migrants have been in Australia can give a picture of how familiar they are with Australian society and health practices," Ms Sparke said.
"It is also useful to explore how the social characteristics of migrants change with length of time spent in Australia."
Migrants may adapt a new culture's health habits such as changing diets, but there are still unanswered questions around why exactly that increase happens, Ms Sparke said.
According to an AIHW 2018 study, about 38 per cent of the burden of disease in the country could have been prevented by reducing exposure to all the modifiable risk factors.
These included tobacco and alcohol use, weight, and high blood pressure.
Dr Senior said where and how people lived and settled in Australia could play a role.
There are reports about the difference in health for people who live in remote parts of Australia, but there are also circumstances that will affect the health of those who live in major cities, he said.
For instance, access to green spaces, health services, and adequate housing.
"People from different communities settle in different parts of our cities and different parts of Australia, which can have consequences on the food that they have available or what is affordable," Dr Senior said.
Overcrowded housing can also have an effect on chronic diseases, he added.
Languages show potential progress
The report analysed data for the 6 million people who in the census reported speaking a language other than English.
For people who arrived more recently — within 10 years before the 2021 census — there was little difference in the occurrence of many long-term health conditions for people with low or high English proficiency.
"Except for asthma, which was more common among people with high English proficiency," Ms Sparke said.
Dr Senior said it may be indicative of the success of both communities and health services that have attempted to overcome language barriers.
There are also many doctors and health professionals these days who speak a language other than English, he added.
For main languages used at home, the findings were consistent with those for country of birth.
For instance, people who spoke Tongan or Māori had the highest rates of diabetes and kidney disease, Ms Sparke said.
A lower English proficiency among people who spoke Arabic was also linked to higher rates of long-term health conditions.
Important 'flags' and lessons
Dr Senior said the report revealed important insights and a level of detail that would be beneficial for health providers and policymakers.
"One of the most important things for us is about knowing our own local communities well," he said.
"[The report] leads us into this really more nuanced understanding of cultural differences and understanding of what it means to provide appropriate care for those different communities."
He said there is a lot to dig into further, with the findings raising a lot of "flags".
"They're saying, 'hey, there's something interesting going on here that we don't quite understand'."
Ms Sparke said the dataset had provided an opportunity to "drill down to all these different groups".
It will help direct funding and services to communities where a particular cultural background may need more kidney services, dementia services, or planning in aged care.
"It's not all based on what people's idea of an Australian is, but it takes into account all these multiple cultural backgrounds," Dr Senior said.
Given the complexity of the data, it will be important to engage with the migrant communities to refine those actions, he added.
"Working with, say, Chinese communities about what their health needs are, and the reasons for what we're seeing … we can provide more individualised management to our communities."
