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Australian Indigenous HealthBulletin
 

Concluding comments

Concluding comments

It is clear from this Overview that Indigenous people remain the least healthy sub-population in Australia. Being a 'snapshot' of the most recent indicators of health status – with limited attention to trends – the Overview doesn't, however, fully reflect the evidence that the health status of Australia's Indigenous people continues to improve slowly.

For a start, there is evidence of reductions in mortality in recent years in a number of jurisdictions.28 Age-standardised death rates for Indigenous people living in WA, SA and the NT, the only jurisdictions with adequate data quality for long-term analysis, declined by around 33% over the 20-year period 1991-2010 [1]. The gap in death rates between Indigenous and non-Indigenous people declined significantly both absolutely and relatively over that period. Much of the decline appears to have been in the first half of the 20-year period, however, as the pattern in WA, SA and the NT in 2001-2010 has been very similar to that documented for NSW, Qld, WA, SA and the NT combined, for which jurisdictions the rates declined by only 5%.

An earlier analysis of Indigenous mortality in the NT, the jurisdiction with by far the best quality data about Indigenous deaths, provides evidence of declines in death rates for some causes of death and a slowing in the increase in rates for others [2]. In the twelve-year period 1990-2001, the death rate for COPD declined significantly. The death rates for stroke and renal failure for people aged less than 50 years also declined, but not significantly. On the other hand, death rates for coronary heart disease and diabetes mellitus increased significantly in the period 1990-2001, but at lesser annual rates of change than documented for the period 1977-1989. A later analysis of deaths from acute myocardial infarction in the NT in the 13-year period 1992-2004 revealed that the increase in death rates for Indigenous people was due to a marked increase in the incidence of coronary heart disease, which had been partly moderated by an increase in survival [3].

The most recent estimates of life expectancy at birth for Indigenous people – 67.2 years for males and 72.9 years for females in 2005-2007 – are higher than previous estimates, but, as the ABS warns, the apparent improvements are likely to be due largely to revised statistical methods [4].29

Indigenous infant mortality rates for WA, SA and the NT declined significantly over the 20-year period 1991-2010 [1]. The Indigenous rate declined by 62% over that period, slightly more than the 43% decline of the rate for non-Indigenous people. The gap between Indigenous and other Australians closed significantly, both absolutely (67%) and relatively (35%).

The long-term declines in infant mortality rates have occurred despite the lack of parallel changes in the birthweights of babies born to Indigenous mothers – the mean weight of babies born in 2010 to Indigenous mothers was still around 200 grams less than the weights of babies born to non-Indigenous mothers [5]. Importantly, the proportions of LBW babies born to Indigenous mothers increased by 11% over the 19-year period 1991-2009 and the gap in proportions between babies born to Indigenous and non-Indigenous mothers widened. These long-term estimates may conceal some recent improvements, however, as analysis of births in the 10-year period 2000-2009 suggests a significant decline in the proportion of LBW babies born to Indigenous mothers [1].

In terms of specific health conditions, substantial improvements have occurred in the overall impact of many infectious diseases (partly due to immunisation programs) including:

There have also been improvements in a number of areas contributing to health status:

There is no doubt other evidence of improvement in some measures health status, and of deterioration in others. But, clearly, the gap between the health status of Indigenous people and that of other Australians is still very, very wide.

There have also been substantial improvements in the availability of information about the health of Aboriginal and Torres Strait Islander people. Such information is crucial for both policy and strategy development and for monitoring progress towards the various targets set recently as a part of the COAG commitments to 'closing the gap' in health between Indigenous and other Australians (see below) [19].

The preparation of this Overview has benefited greatly from some of these improvements, particularly the introduction of regular reporting about various aspects of Indigenous health. The first of these substantial reports was the 1997 The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples [20], produced jointly by the ABS and the AIHW. The second was the Indigenous compendium to the annual Reports on government services produced by the Steering Committee for the Review of Government Service Provision (SCRGSP), first published by the Productivity Commission in 2003 [21]. This report was complemented by a biennial report on key indicators of Indigenous disadvantage, also produced by the SCRGSP and published by the Productivity Commission (the first report was published in November 2003) [22]. These reports were followed in 2006 with the first report in the Aboriginal and Torres Strait Islander health performance framework series [23]. These reports, prepared by the Australian Health Ministers Advisory Council (AHMAC) in 2006, 2008, 2011 and 2012, are accompanied by substantial detailed analyses.

Along with these substantial reports on Indigenous health and related areas, continuing attention has been directed at improving the various data collections that feed into these and other reports. This work, overseen by the National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (NAGATSIHID), has achieved considerable progress, but the current NAGATSIHID strategic plan acknowledges the need for 'new data collections or enhancing existing collections' … 'so that a comprehensive information base is available to inform policy, practice and service delivery' ([19], p.13).

Despite the important advances that have been made in recent years in both the extent and quality of information about the health of Indigenous people, it will be very obvious to readers of this version of the Overview that there is substantial scope for further improvement.

For a start, the identification of Indigenous people in most of the various health and related data collections is still far from complete. Few of the collections have good national coverage of Indigenous people, and, for many health issues, good information is only available for a minority of jurisdictions and/or is quite dated. Probably the best example is cancer, the second most common cause of death among Indigenous people. The AIHW's recent Cancer in Australia: an overview 2012 is a welcome addition, but, as that report acknowledges, national data on cancer incidence and mortality among Indigenous people are not available and Indigenous-specific information about screening is only collected for breast cancer and not for cervical and bowel cancer [24]. Readers of this Overview will recognise many other areas where there is a need for substantial enhancements.

In view of the commitments made in December 2007 by all Australian governments, through the COAG,30 to 'closing the gap' in disadvantage between Indigenous and other Australians [25], the need for reliable, up-to-date, comprehensive information about the health of Indigenous people is more important than ever. The 'closing the gap' commitments were stimulated by the Social justice report 2005, which highlighted the vast gap between the health of Indigenous and other Australians and called on Australian governments to commit to achieving Indigenous health equality within 25 years [26].31

Following the release of the report, 40 of Australia's leading Indigenous and non-Indigenous health peak bodies and human rights organisations joined forces to launch a campaign to 'close the gap' on health inequality [27]. In December 2006, the coalition published an open letter to the Prime Minister, the State Premiers and Territory Chief Ministers, parliamentarians and the Australian public calling for an end to Indigenous health inequality. The 'close the gap' campaign was launched in April 2007.

The Indigenous Health Summit, held in March 2008, concluded with the Prime Minister issuing, on behalf of the Australian Government and the Indigenous peoples of Australia, a statement of intent 'to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030' ([28], p.1).

In March 2008, the Prime Minister also announced establishment of the National Indigenous Health Equality Council,32 which 'advises the [Australian Government's] Minister for Health and Ageing… on the achievement of equitable and sustainable health outcomes for Aboriginal and Torres Strait Islander peoples' ([29], p.546).

Reflecting the increased attention directed to Indigenous reform, it is now a standing item on all COAG meetings. As a part of its deliberations about 'closing the gap', COAG has agreed on a number of specific targets for reducing Indigenous disadvantage in the areas of education, early childhood development, health and employment. The targets are to [30]:

In addressing these targets, COAG, through the Australian and state and territory governments, allocated $4.6 billion over four years across early childhood development, health, housing, economic participation, and remote service delivery. COAG also achieved a number of supportive commitments by the corporate and community sectors [30].

This is the first time that such a high level of commitments has been made by the Australian, state and territory governments and others, raising the possibility of substantial reductions in the health and other disadvantages experienced by Indigenous people.

As encouraging as these commitments are, achievement of substantial improvements in the health and wellbeing of Indigenous people will depend largely on the effective implementation of comprehensive strategies and policies that address the complexity of the factors underlying the disadvantages experienced by Indigenous people.

Importantly, effective, integrated comprehensive strategies and policies will need to be sustained for a long period of time, as improvements to the extent set in the various targets will not occur in the short-term. The timeframes for the 'closing the gap' targets suggest there is some awareness by governments of the enormity of the challenge, but the real test will be to sustain the commitments through changing political and economic cycles.

References

  1. Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
  2. Thomas DP, Condon JR, Anderson IP, Li SQ, Halpin S, Cunningham J, Guthridge SL (2006) Long-term trends in Indigenous deaths from chronic diseases in the Northern Territory: a foot on the brake, a foot on the accelerator. Medical Journal of Australia; 185(3): 145-149
  3. You J, Condon JR, Zhao Y, Guthridge S (2009) Incidence and survival after acute myocardial infarction in Indigenous and non-Indigenous people in the Northern Territory, 1992–2004. Medical Journal of Australia; 190(6): 298-302
  4. Australian Bureau of Statistics (2009) Experimental life tables for Aboriginal and Torres Strait Islander Australians: 2005-2007. Canberra: Australian Bureau of Statistics
  5. Li Z, Zeki R, Hilder L, Sullivan EA (2012) Australia's mothers and babies 2010. Canberra: Australian Institute of Health and Welfare
  6. Australian Indigenous HealthInfoNet (2005) Review of respiratory disease among Indigenous peoples. Retrieved from http://www.healthinfonet.ecu.edu.au/chronic-conditions/respiratory/reviews/our-review
  7. Roche PW, Krause V, Cook H, Barralet J, Coleman D, Sweeny A, Fielding J, Giele C, Gilmour R, Holland R, Kampen R, Brown M, Gilbert L, Hogg G, Murphy D (2008) Invasive pneumococcal disease in Australia, 2006. Communicable Diseases Intelligence; 32(1): 18-30
  8. Taylor HR, National Indigenous Eye Health Survey Team (2009) National Indigenous eye health survey: minum barreng (tracking eyes): full report. Melbourne: Indigenous Eye Health Unit, The University of Melbourne
  9. Menzies R, Turnour C, Chiu C, McIntyre P (2008) Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 2003 to 2006. Canberra: Department of Health and Ageing
  10. Penny M, Thomson N (1987) A preliminary analysis of Aboriginal tuberculosis, 1984. Aboriginal Health Information Bulletin; 8: 15-18
  11. Barry C, Konstantinos A, National Tuberculosis Advisory Committee (2009) Tuberculosis notifications in Australia, 2007. Communicable Diseases Intelligence; 33(3): 1-12
  12. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare
  13. Steering Committee for the Review of Government Service Provision (2011) Overcoming Indigenous disadvantage: key indicators 2011. Canberra: Productivity Commission, Australia
  14. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
  15. Australian Bureau of Statistics (2010) National Aboriginal and Torres Strait Islander social survey, 2008: Table 10. Indigenous persons aged 15 years and over, by age groups by sex [data cube]. Retrieved from http://abs.gov.au/AUSSTATS/SUBSCRIBER.NSF/log?openagent&4714.0_aust_010_2008.xls&4714.0&Data%20Cubes&6959208EE47E867DCA25770B0016F56D&0&2008&21.04.2010&Previous
  16. Thomas DP (2012) Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008. Medical Journal of Australia; 197(9): 503-506
  17. Australian Bureau of Statistics (2012) Census of population and housing: characteristics of Aboriginal and Torres Strait Islander Australians, 2011. Canberra: Australian Bureau of Statistics
  18. Australian Bureau of Statistics (2011) Schools, Australia, 2010. Canberra: Australian Bureau of Statistics
  19. National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (2011) National Advisory Group on Aboriginal and Torres Strait Islander Health Information strategic plan 2011-2015. Canberra: Australian Institute of Health and Welfare
  20. Australian Bureau of Statistics, Australian Institute of Health and Welfare (1997) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples. Canberra: A joint program of the Australian Bureau of Statistics and the Australian Institute of Health and Welfare
  21. Steering Committee for the Review of Commonwealth Service Provision (2003) Report on Government services 2003: Indigenous compendium. Melbourne: Productivity Commission
  22. Steering Committee for the Review of Commonwealth Service Provision (2003) Overcoming Indigenous disadvantage: key indicators 2003 report. Canberra: Productivity Commission
  23. Australian Health Ministers’ Advisory Council (2006) Aboriginal and Torres Strait Islander health performance framework: 2006 report. Canberra: Department of Health and Ageing
  24. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries (2012) Cancer in Australia: an overview 2012. Canberra: Australian Institute of Health and Welfare
  25. Council of Australian Governments (2009) National Indigenous reform agreement (closing the gap). Canberra: Council of Australian Governments
  26. Aboriginal and Torres Strait Islander Social Justice Commissioner (2005) Social justice report 2005. Sydney: Human Rights & Equal Opportunity Commission
  27. Calma T (2009) Close the gap campaign for Aboriginal and Torres Strait Islander health equality by 2030: a community guide. Canberra: Australian Human Rights Commission
  28. Australian Government (2008) Statement of intent. Paper presented at the Indigenous Health Equality Summit: Close the Gap. 20 March 2008, Canberra
  29. Anderson I (2009) Close the Gap: National Indigenous Health Equality Council. Medical Journal of Australia; 190(10): 546
  30. Department of Families Housing Community Services and Indigenous Affairs (2009) Closing the gap on Indigenous disadvantage: the challenge for Australia. Canberra: Commonwealth of Australia

Endnotes

28. Reflecting the uncertainty and probable variation in the levels of under-identification of Indigenous status, some caution should be exercised in assessing trends in death rates.

29. A variety of techniques has been developed by demographers to estimate life expectancy in instances where registration of deaths is incomplete. This is effectively the case with Indigenous deaths: even though very few Indigenous deaths will not be registered, many Indigenous deaths are not correctly identified as such.

30. COAG is 'the peak intergovernmental forum in Australia, comprising the Prime Minister, State Premiers, Territory Chief Ministers and the President of the Australian Local Government Association (ALGA)'.

31. The Social justice report is an annual report of the Australian Human Rights Commission's Aboriginal and Torres Strait Islander Social Justice Commissioner.

32. The Council was re-named National Aboriginal and Torres Strait Islander Health Equality Council in August 2011.

 

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