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Australian Indigenous HealthBulletin
 

Introduction

Preface

The main purpose of the Overview is to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Indigenous people1. It has been prepared by the Australian Indigenous HealthInfoNet as a part of our contributions to 'closing the gap' in health between Indigenous people and other Australians by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers, students and the general community.

The initial sections of this Overview provide information about the context of Indigenous health, Indigenous population, and various measures of population health status. Most of the subsequent sections about specific health conditions comprise an introduction about the condition and evidence of the current burden of the condition among Indigenous people. Where available and appropriate; information is provided for each state and territory and for demographics such as gender and age.

While it provides a comprehensive review of key indicators across a range of health topics, it is beyond the scope of the Overview to provide detailed information on other aspects, such as the availability and use of services (including barriers to their use) and strategies and policies related to specific health topics. Interested readers should refer to the topic-specific reviews that are available on the HealthInfoNet's website. Additional, more in depth, information about the topics summarised in this Overview is included in the corresponding sections of the HealthInfoNet's website (www.healthinfonet.ecu.edu.au ).

We welcome your comments and feedback about the Overview.

Neil Drew, Director, on behalf of the HealthInfoNet team

Acknowledgements

Particular thanks are extended to:

Key facts

Population

Births and pregnancy outcome

Mortality

Hospitalisation

Selected health conditions

Cardiovascular disease

Cancer

Diabetes

Social and emotional wellbeing

Kidney health

Injury

Respiratory disease

Eye health

Ear health and hearing

Oral health

Disability

Communicable diseases

Factors contributing to Indigenous health

Nutrition

Physical activity

Bodyweight

Immunisation

Breastfeeding

Tobacco use

Alcohol use

Illicit drug use

Introduction

This Overview of Australian Indigenous health status draws largely on previously published information, some of which has been re-analysed to provide clearer comparisons between Indigenous and non-Indigenous people (for more details of statistics and methods, readers should refer to the original sources). Very little information is available separately for Australian Aboriginal people and Torres Strait Islander people.

Sources of information

Research for the Overview involves the collection, collation, and analysis of a wide range of relevant information, including both published and unpublished material. Sources include government reports, particularly those produced by the Australian Bureau of Statistics (ABS), the Australian Institute of Health and Welfare (AIHW), the Australian Health Ministers’ Advisory Council (AHMAC), and the Steering Committee for the Review of Government Service Provision (SCRGSP). Important additions to the regular ABS and AIHW publications are four series of special reports that bring together key information about Indigenous disadvantages in health and related areas:

Along with these substantial reports, 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' ([1], p.13).

This Overview draws heavily on information from the main administrative data collections (such as the birth and death registration systems and the hospital inpatient collections) and national surveys. Information from these sources has been published mainly in government reports, particularly those produced by the ABS, the AIHW, and the SCRGSP. It also draws on a wide variety of other information sources, including registers for specific diseases and other conditions, regional and local surveys, and numerous epidemiological and other studies examining particular diseases, conditions, and health determinants. Information from these sources is disseminated mainly through journals and similar periodicals, or in special reports (such as the annual reports of the Kirby Institute and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)).

A number of sections include the results of our own analyses of data obtained from a variety of sources. For example, estimates of the age-adjusted incidence of end-stage renal disease were made using notification data provided by ANZDATA. Similarly, information about a number of communicable diseases was derived from data published by the Kirby Institute.

Limitations of the sources of Indigenous health information

The assessment of Indigenous health status requires accurate information about the size of the population and the numbers of specific health conditions/occurrences. This information is required at national, regional, and local levels (for more information about the assessment of population health status, see [2]).

There have been improvements in recent years - both in estimates of the Indigenous population (the denominator for calculation of rates) and in the availability of data for a number of health conditions/occurrences (the numerators for calculating rates) - but there is still some uncertainty in most areas.

In relation to population estimates, the ABS has made considerable efforts in recent decades to achieve accurate counts of the Indigenous population in the five-yearly Australian censuses [3][4]. Despite these efforts, doubts remain about the extent to which official estimates reflect the actual size of the Indigenous population [3][5].

The ABS has also worked for many years with the AIHW and state and territory authorities to improve the accuracy of Indigenous status in a number of health-related collections, including birth and death registrations, hospital administrative data, and the maternal/perinatal collection. Some attention has also been directed to the data collections related to communicable diseases, cancer, and to a number of other disease-specific collections.

A persisting problem, however, is the extent to which Indigenous people are correctly identified in the various health-related data collections. In death registrations, for example, not all Indigenous deaths are correctly identified as such, with some identified as non-Indigenous [6]. Estimating the proportions of deaths identified correctly is not simple, so it is difficult to estimate the actual number of Indigenous deaths occurring and the corresponding rates. The ABS uses estimates of the proportions of registered deaths correctly identified as Indigenous in preparing its life tables, the source of life expectancy figures.

The Indigenous mortality project involved linking death registrations with 2011 Census records with the aim to assess the consistency of Indigenous status across the two datasets [6]. It was estimated that the Australia-wide rate of Indigenous identification in deaths notifications was 62%. For the jurisdictions for which results could be reported, the Northern Territory (NT) had the highest rate of consistent reporting (95%) and Victoria (Vic) had the lowest rate (29%). In relation to age-groups, the lowest rate of consistent identification was for people over the age of 70 years. Consistent identification of Indigenous status for both the Census and death registrations was lowest in major cities (44%) and highest in remote areas (92%).

The ABS has estimated that the proportion of Indigenous births identified correctly was 96% in 2002-2006, a significant improvement over the level for previous years [7].

The level of identification in hospital admissions is variable, but overall it has been estimated that 88% of Indigenous patients were correctly identified in Australian public hospital admission records in 2011-12 [8].

The levels of Indigenous identification in many of the other health-related data collections are generally so incomplete as to preclude reasonably accurate estimates. With these uncertainties, there must be some doubt about the precision of the various estimates of Indigenous health status. The differences between Indigenous and non-Indigenous people in the levels of most of these estimates are so great, however, that the slight imprecision in some estimates is of little practical importance.

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, there is substantial scope for further improvement. For example:

References

  1. 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
  2. Thomson N (2003) The need for Indigenous health information. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 1-24
  3. Biddle N (2012) CAEPR Indigenous population project 2011 census papers: population and age structure. Canberra: Centre for Aboriginal Economic Policy Research
  4. Australian Bureau of Statistics (2012) Census of population and housing - counts of Aboriginal and Torres Strait Islander Australians, 2011. Canberra: Australian Bureau of Statistics
  5. Taylor J, Biddle N (2008) Locations of Indigenous population change: what can we say?. Canberra: Centre for Aboriginal Economic Policy Research
  6. Australian Bureau of Statistics (2013) Information paper: death registrations to census linkage project - key findings for Aboriginal and Torres Strait Islander peoples, 2011-2012. Retrieved 15 November 2013 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0.55.005?OpenDocument
  7. Australian Bureau of Statistics (2007) Births, Australia, 2006. Canberra: Australian Bureau of Statistics
  8. Australian Institute of Health and Welfare (2013) Indigenous identification in hospital separations data: quality report. Canberra: Australian Institute of Health and Welfare
  9. 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

Endnotes

  1. The term ‘Indigenous’ is used in this Overview to refer generally to the two Indigenous populations of Australia - Australian Aboriginal people and Torres Strait Islander people.
 

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    Last updated: 8 July 2014
     
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