Introduction

Preface

This overview has been prepared by the Australian Indigenous HealthInfoNet as a part of our efforts to contribute 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 and the general community. ¹

The main purpose of the overview is to provide a comprehensive summary of the most recent indicators of the health of Indigenous people. It is beyond the scope of the overview to analyse trends in the various indicators, so it tends to draw attention to the health status of Australia’s Indigenous peoples. The overview doesn’t attempt to review other aspects, such as the availability and use of services (including barriers to their use) and strategies and policies related to specific health topics. Readers interested in these aspects should refer to the topic-specific reviews that are available on the HealthInfoNet’s website. It is important to acknowledge that some improvements have occurred in Indigenous health status – a brief summary of improvements is provided in the section entitled ‘Concluding comments’.

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involves the collection, collation, and analysis of a wide range of relevant information, including both published and unpublished material.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) and the Steering Committee for the Review of Government Service Provision (SCRGSP).

Very 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:

• Reports in The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples series, first produced jointly in 1997 by the ABS and the AIHW. Reports in this series were then produced jointly by the ABS and the AIHW in 1999, 2001, 2003, 2005 and 2008. The ABS produced an online version in 2010 and the AIHW an overview version in 2011
• The Indigenous compendium to the Reports on government services produced by the SCRGSP; the compendium has been published annually by the Productivity Commission since 2003
• The report on key indicators of Indigenous disadvantage, also produced by the SCRGSP and published by the Productivity Commission; the report has been published biennially since November 2003
• Reports in the Aboriginal and Torres Strait Islander health performance framework series. These reports, prepared by the AIHW for the Australian Department of Ageing in 2006, 2008 and 2011, are accompanied by substantial detailed analyses.

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.

Importantly, the overview draws also 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.

The initial sections provide information about the context of Indigenous health, Indigenous population, and various measures of population health status. Most sections about specific health conditions comprise an introduction about the condition and evidence of the current burden of the condition among Indigenous people.

It should be noted that some references in this overview to specific health conditions or groups of related health conditions follow the exact terms used by the World Health Organization (WHO) in its International Classification of Disease (ICD). These terms are usually included in quote marks preceded by ICD.

Further information about the aspects summarised in this overview are included in the corresponding sections of the HealthInfoNet’s website (www.healthinfonet.ecu.edu.au), on which updated versions of this overview will be made available.

We welcome your comments and feedback about the overview.

Neil Thomson, Director, on behalf of the HealthInfoNet team

Acknowledgements

Particular thanks are extended to:

• other staff of the Australian Indigenous HealthInfoNet for their assistance, support and encouragement in the preparation of this overview
• the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for the provision of notification data on end-stage renal disease (ESRD)
• the Office for Aboriginal and Torres Strait Islander Health (OATSIH) within the Australian Department of Health and Ageing for their ongoing support of the work of the HealthInfoNet.

Key facts

Indigenous population

• At 30 June 2011, the estimated Australian Indigenous population was 575,552.
• NSW had the highest number of Indigenous people (168,773, 29% of the total Indigenous population); the NT had the highest proportion of Indigenous people in its population (30% of NT population are Indigenous).
• In 2006, the majority of Indigenous people lived in cities and towns; around one quarter of Indigenous people lived in remote or very remote areas.
• The Indigenous population is much younger than the non-Indigenous population.

Indigenous births and pregnancy outcome

• In 2010, there were 16,129 births registered in Australia with one or both parents identified as Indigenous (4% of all births registered).
• In 2010, Indigenous mothers were younger than non-Indigenous mothers; the median age was 24.6 years for Indigenous mothers and 30.7 years for non-Indigenous mothers.
• In 2010, the total fertility rates were 2,575 births per 1,000 for Indigenous women and 1,886 births per 1,000 for all women.
• In 2008, the average birthweight of babies born to Indigenous mothers was 3,196 grams, 189 grams less than the average for babies born to non-Indigenous mothers.
• In 2008, the proportion of babies of low birthweight born to Indigenous women was twice that of babies born to non-Indigenous women (12.3% compared with 5.9%).

Indigenous mortality

• In 2004-2008, the age-standardised death rate for Indigenous people was 1.8 times the rate for non-Indigenous people.
• Between 1991 and 2008, there was a 25% reduction in the death rates of Indigenous people in WA, SA and the NT.
• For Indigenous people born 2005-2007, life expectancy was estimated to be 67.2 years for males and 72.9 years for females, around 10 years less than the estimates for non-Indigenous males and females.
• In 2006-2010, age-specific death rates were higher for Indigenous people than for non-Indigenous people across all age-groups, and were much higher in the young and middle adult years.
• For 2008-2010, the infant mortality rate was higher for Indigenous infants than for non-Indigenous infants; the rate for Indigenous infants was highest in the NT.
• From 1991 to 2008, there were significant declines in infant mortality rates for Indigenous and other infants.
• For 2004-2008, the leading causes of death among Indigenous people were cardiovascular disease, cancer, and respiratory disease.
• In 2003-2005, maternal mortality ratios were 2.7 times higher for Indigenous women than for non-Indigenous women.

Indigenous hospitalisation

• In 2009-10, around 3.9% of all hospitalisations were of Indigenous people.
• In 2009-10, the age-standardised separation rate for Indigenous people was 2.4 times higher than that for other people.
• In 2009-10, the main cause of hospitalisation for Indigenous people was ICD ‘factors influencing health status and contact with health services’ (around 48% of hospital separations), followed by injury (7.4% of hospital separations).

Selected health conditions

Cardiovascular disease

• In 2004-2005, 12% of Indigenous people reported having a long-term heart or related condition; after age-adjustment, these conditions were around 1.3 times more common for Indigenous people than for non-Indigenous people.
• In 2008-09, Indigenous people were hospitalised for cardiovascular disease at 1.9 times the rate of non-Indigenous people.
• In 2004-2008, cardiovascular diseases were the leading cause of death among Indigenous people, accounting for 27% of Indigenous deaths.

Cancer

• In 2003-2007, the age-adjusted cancer incidence rates were lower for Indigenous people than for non-Indigenous people.
• In 2003-2007, most common cancers diagnosed among Indigenous people were lung and breast cancer.
• In 2004-2008, death rates for cancer were higher for Indigenous people than for non-Indigenous people (1.2 times higher for males and 1.5 times higher for females).

Diabetes

• In 2004-2005, after age-adjustment, Indigenous people were 3.4 times more likely than non-Indigenous people to report having some form of diabetes.
• In 2006-2008, after age-adjustment, hospitalisation rates for diabetes among Indigenous males and females were 3.4 and 5.0 times the rates of other males and females.
• In 2004-2005, Indigenous people died from diabetes at almost seven times the rate of other Australians.

Social and emotional wellbeing

• In 2008, 79% of Indigenous people aged 18 years and over experienced at least one significant stressor in the previous 12 months; the comparable figure for the total population was 62% in 2010.
• In 2008, after age-adjustment, Indigenous people were more than two-and-a-half times as likely as non-Indigenous people to feel high or very high levels of psychological distress.
• In 2008-09, after age-adjustment, Indigenous people were hospitalised for ICD ‘mental and behavioural disorders’ at almost twice the rate of non-Indigenous people.
• In 2005-2009, Indigenous people died from intentional self-harm at 2.5 times the rate of non-Indigenous people.

Kidney health

• In 2009-10, care involving dialysis was the most common reason for hospitalisation among Indigenous people; Indigenous people were hospitalised at 11 times the rate of other people.
• In 2007-2009, after age-adjustment, the notification rate of end-stage renal disease was almost 10 times higher for Indigenous people than for non-Indigenous people.
• In 2004-2008, the age-standardised death rate from kidney disease was 5.1 times higher for Indigenous people than for non-Indigenous people.

Injury

• In 2009-10, Indigenous people were hospitalised for injuries at almost twice the rate of other people.
• In 2004-2008, injury was the third most common cause of death among Indigenous people, accounting for 15% of Indigenous deaths.

Respiratory disease

• In 2004-2005, 27% of Indigenous people reported having a respiratory condition, with 15% having asthma; after age-adjustment, the levels of respiratory disease were similar for Indigenous and non-Indigenous people.
• In 2006-2008, the age-standardised hospitalisation rates for respiratory disease were 2.6 times higher for Indigenous people than for other people.
• In 2004-2008, the age-standardised death rate for respiratory diseases was 2.3 times higher for Indigenous people than for non-Indigenous people.

Eye health

• In 2004-2005, eye and sight problems were reported by 30% of Indigenous people.
• In 2008, the rate of blindness for Indigenous adults was 6.2 times higher than for non-Indigenous adults.

Ear health

• The level of ear disease and hearing loss among Indigenous people remained higher than that of the general population, particularly among children and young adults.

Oral health

• In 2000-2003, Indigenous children had more caries in their deciduous and permanent teeth than did non-Indigenous children, and higher levels of gingivitis.
• In 2004-2006, periodontal diseases and caries were more prevalent among Indigenous adults than among non-Indigenous adults.

Disability

• In 2008, after age-adjustment, Indigenous people were more than twice as likely as non-Indigenous people to have a profound/core activity restriction.

Communicable diseases

• In 2003-2007, the age-standardised incidence rate of tuberculosis was 14.8 times higher for Indigenous people than for non-Indigenous people.
• In 2008-2010, the crude hepatitis B and C notification rates were 2.2 and 5.1 times higher for Indigenous people than for non-Indigenous people.
• In 2003-2006, the age-standardised notification rate for Haemophilus influenza type b was 8.8 times higher for Indigenous people than for non-Indigenous people.
• In 2006-2008, the age-standardised rate of invasive pneumococcal disease was 7.3 times higher for Indigenous people than for other Australians.
• In 2003-2006, the age-standardised notification rate of meningococcal disease was 2.7 times higher for Indigenous people than for non-Indigenous people.
• In 2008-2010, sexually transmissible infections were more common among Indigenous people than among non-Indigenous people; gonorrhoea notifications were 50 times higher.
• In 2010, the rate of human immunodeficiency virus (HIV) infection was similar for Indigenous and non-Indigenous people.
• In some remote Indigenous communities, more than 70% of young children had scabies and pyoderma.

Factors contributing to Indigenous health

Nutrition

• In 2004-2005, the majority of Indigenous people reported eating fruit (86%) and vegetables (95%) on a daily basis.
• In 2004-2005, 13% of Indigenous people reported having no usual daily fruit intake (compared with 7% of non-Indigenous people), and 5% reported no usual daily vegetable intake (compared with 1% of non-Indigenous people).

Physical activity

• In 2004-2005, after age-adjustment, 51% of Indigenous people in non-remote areas reported low or very low levels of physical activity, compared with 33% of non-Indigenous people.

Bodyweight

• In 2004-2005, after age-adjustment, the level of obesity/overweight was 1.2 times higher for Indigenous people than for non-Indigenous people.

Immunisation

• In 2004-2005, 88% of Indigenous children 0-6 years in non-remote areas were fully immunised against the recommended vaccine-preventable diseases.

Breastfeeding

• In 2004-2005, 84% of Indigenous mothers reported having breastfed their children.

Tobacco smoking

• In 2010, after age-adjustment, daily smoking was 2.2 times more common among Indigenous people than among non-Indigenous people (38% compared with 18%).

Alcohol use

• In 2008, 35% of Indigenous people aged 15 years or older abstained from alcohol, a level of abstinence more than 2.5 times that of the Australian population aged 15 years or older in 2007-08.
• In 2004-2005, 8% of Indigenous people aged 18 years or older consumed alcohol at a ‘high risk’ level, compared with 6% of their non-Indigenous counterparts.
• In 2006-2008, Indigenous people were hospitalised for a diagnosis related to alcohol use at a rate 4.2 times that of non-Indigenous people.
• In 2004-2008, the death rate from alcohol-related causes was 6.3 times higher for Indigenous people than for non-Indigenous people.

Illicit drug use

• In 2008, Indigenous people aged 15 years or older were 1.6 times more likely than non-Indigenous people aged 14 years or older to have used an illicit substance in the previous 12 months.

Introduction

This overview of Australian Indigenous health 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 Islanders, but, wherever possible, separate information has been provided.

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 [1]).

There have been some 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 calculation rates) – but there is still some uncertainty in most areas.

In relation to population estimates, the Australian Bureau of Statistics (ABS) has made considerable efforts in recent decades to achieve accurate counts of the Indigenous population in the five-yearly Australian censuses [2]. Despite these efforts, doubts remain about the extent to which official estimates reflect the actual size of the Indigenous population [3].

The ABS has also worked for many years with the Australian Institute of Health and Welfare (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 been directed also 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 [4]. 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. Details of these estimates are not available for recent years. However, it is likely that they are in line with the ABS’s assessment of the completeness of recording of Indigenous deaths in 2006-2007, which was based on a comparison of deaths in those years with Indigenous status reported in the 2006 census [5]. Based on this comparison, the ABS estimated that the Australia-wide level of Indigenous identification in deaths notifications in 2006-2007 was 92% [5], a level much higher than previous estimates (around 56%) [6].

The proportion 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 very variable, with the overall level unlikely to be better than for deaths [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.

References

1. 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
2. Australian Bureau of Statistics (2007) Population distribution, Aboriginal and Torres Strait Islander Australians, 2006. Canberra: Australian Bureau of Statistics
3. Taylor J, Biddle N (2008) Locations of Indigenous population change: what can we say?. Canberra: Centre for Aboriginal Economic Policy Research
4. Australian Bureau of Statistics (2011) Deaths, Australia, 2010. Canberra: Australian Bureau of Statistics
5. Australian Bureau of Statistics (2009) Experimental life tables for Aboriginal and Torres Strait Islander Australians: 2005-2007. Canberra: Australian Bureau of Statistics
6. Australian Bureau of Statistics (2006) Deaths, Australia, 2005. Canberra: Australian Bureau of Statistics
7. Australian Bureau of Statistics (2007) Births, Australia, 2006. Canberra: Australian Bureau of Statistics
8. Australian Institute of Health and Welfare (2009) Australian hospital statistics 2007-08. Canberra: Australian Institute of Health and Welfare

Endnote

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 Islanders.

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