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Australian Indigenous HealthBulletin
 

Introduction

Preface

This Overview 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.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 current 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.

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involves the collection, collation, and analysis of a wide range of relevant information, including both published and unpublished material.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).

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:

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.

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. First, there are deficiencies in the information available for some important areas. 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 [1]. Second, the important special reports noted above tend to be selective rather than comprehensive in their coverage of the various health topics. Third, the time periods for which detailed information is available tend to vary substantially; this means that documents like this Overview need to draw on information from various time periods in attempting to compile a comprehensive picture. Fourth, important data sources, particularly major national surveys, are generally only conducted around every five years; this is inevitable, but it means that relevant information is often quite dated. Finally, changes in aspects like methodology and levels of reporting in publications pose difficulties in the analysis and synthesis of information with a time perspective.

The initial sections of this Overview 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

Key facts

Indigenous population

Births and pregnancy outcome

Indigenous mortality

Indigenous 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 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 [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 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 [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 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 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. 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 [7]. Based on this comparison, the ABS estimated that the Australia-wide level of Indigenous identification in deaths notifications in 2006-2007 was 92% [7], a level much higher than previous estimates (around 56%) [8].

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 [9]. The level of identification in hospital admissions is very variable, with the overall level unlikely to be better than for deaths [10]. 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. 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
  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 (2012) Deaths, Australia, 2011. Canberra: Australian Bureau of Statistics
  7. Australian Bureau of Statistics (2009) Experimental life tables for Aboriginal and Torres Strait Islander Australians: 2005-2007. Canberra: Australian Bureau of Statistics
  8. Australian Bureau of Statistics (2006) Deaths, Australia, 2005. Canberra: Australian Bureau of Statistics
  9. Australian Bureau of Statistics (2007) Births, Australia, 2006. Canberra: Australian Bureau of Statistics
  10. 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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    Last updated: 8 April 2013
     
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