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 Aboriginal and Torres Strait Islanders peoples.1 It has been prepared by the Australian Indigenous HealthInfoNet as a part of our contribution to 'closing the gap' in health between Aboriginal and Torres Strait Islander people and other Australians by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, other health professionals including Health workers, program managers, clinicians, researchers, students and the general community.
The initial sections of this Overview provide information about the context of Aboriginal and Torres Strait Islander health, Aboriginal and Torres Strait Islander 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 Aboriginal and Torres Strait Islander people. Information is provided for state and territories and for demographics such as gender and age when it is available and appropriate.
While the Overview provides a comprehensive review of key indicators across a range of health topics, it is beyond the scope 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).
There are a number of additions to this Overview. We have included a recognition statement, a note on the use of appropriate terminology that introduces our guidelines on the matter, and a statement of commitment to enhancing our strengths based approach to reporting.
We welcome your comments and feedback about the Overview.
Neil Drew, Director
Particular thanks are extended to:
- other staff of the Australian Indigenous HealthInfoNet for their assistance, support and encouragement in the preparation of this Overview.
- previous staff members of the Australian Indigenous HealthInfoNet who have contributed to earlier versions of the Overview.
- the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) for the provision of the notification data on end-stage renal disease (ESRD).
- The Department of Health for their ongoing support of the work of the HealthInfoNet.
- At 30 June 2014, the estimated Australian Indigenous population was 713,600 people.
- For 2014, it was estimated that NSW had the highest number of Indigenous people (220,902 people, 31% of the total Indigenous population).
- For 2014, it was estimated that the NT had the highest proportion of Indigenous people in its population (30% of the NT population were Indigenous).
- In 2011, around 33% of Indigenous people lived in a capital city.
- There was a 21% increase in the number of Indigenous people counted in the 2011 Census compared with the 2006 Census.
- The Indigenous population is much younger than the non-Indigenous population.
Births and pregnancy outcome
- In 2013, there were 18,368 births registered in Australia with one or both parents identified as Indigenous (6% of all births registered).
- In 2013, Indigenous mothers were younger than non-Indigenous mothers; the median age was 24.9 years for Indigenous mothers and 30.8 years for all mothers.
- In 2013, total fertility rates were 2,344 births per 1,000 for Indigenous women and 1,882 per 1,000 for all women.
- In 2012, the average birthweight of babies born to Indigenous mothers was 3,211 grams compared with 3,373 grams for babies born to non-Indigenous mothers.
- In 2012, the proportion of low birthweight babies born to Indigenous women was twice that of non-Indigenous women (11.8% compared with 6.2%).
- In 2006-2010, the age-standardised death rate for Indigenous people was 1.9 times the rate for non-Indigenous people.
- Between 1991 and 2010, there was a 33% reduction in the death rates for Indigenous people in WA, SA and the NT.
- For Indigenous people born 2010-2012, life expectancy was estimated to be 69.1 years for males and 73.7 years for females, around 10-11 years less than the estimates for non-Indigenous males and females.
- In 2008-2012, 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 2010-2012, 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 1998 to 2012, there were significant declines in infant mortality rates for Indigenous infants.
- For 2012, the leading causes of death among Indigenous people were cardiovascular disease, neoplasms (almost entirely cancers), and injury.
- In 2006-2010, for direct maternal deaths the rate ratio was almost 4 times higher for Indigenous women than for non-Indigenous women.
- In 2012-13, 4.0% of all hospitalisations were of Indigenous people.
- In 2012-13, the age-standardised separation rate for Indigenous people was 2.7 times higher than for other Australians.
- In 2012-13, the main cause of hospitalisation for Indigenous people was for care involving dialysis, responsible for 48% of Indigenous separations.
Selected health conditions
- In 2012-2013, 13% of Indigenous people reported having a long-term heart or related condition; after age-adjustment, these conditions were around 1.2 times more common for Indigenous people than for non-Indigenous people.
- In 2012, hospitalisation rates for circulatory disease were 1.6 times higher for Indigenous people than for non-Indigenous people.
- In 2012, cardiovascular disease was the leading cause of death for Indigenous people, accounting for 25% of Indigenous deaths.
- In 2012, the age-adjusted death rate for Indigenous people was 1.6 times the rate for non-Indigenous people.
- In 2005-2009, age-adjusted cancer incidence rates were slightly lower for Indigenous people than for non-Indigenous people.
- In 2004-2008, the most common cancers diagnosed among Indigenous people were lung and breast cancer.
- In 2012-13, age-standardised hospitalisation rates for cancer were lower for Indigenous people than for non-Indigenous people.
- In 2012, the age-standardised death rate for cancer for Indigenous people was 1.5 times higher than for non-Indigenous people.
- In 2012-2013, 8% of Indigenous people reported having diabetes; after age-adjustment, Indigenous people were 3.3 times more likely to report having some form of diabetes than were non-Indigenous people.
- In 2013-14, age-adjusted hospitalisation rates for diabetes for Indigenous males and females were 3 and 5 times the rates for other males and females.
- In 2012, Indigenous people died from diabetes at 7 times the rate of non-Indigenous people.
Social and emotional wellbeing
- In 2012-13, 69% of Indigenous adults experienced at least one significant stressor in the previous 12 months.
- In 2012-13, after age-adjustment, Indigenous people were 2.7 times as likely as non-Indigenous people to feel high or very high levels of psychological distress.
- In 2008, 90% of Indigenous people reported feeling happy either some, most, or all of the time.
- In 2011-12, after age-adjustment, Indigenous people were hospitalised for ICD 'Mental and behavioural disorders' at 2.1 times the rate for non-Indigenous people.
- In 2012-13, there were 16,393 hospital separations with a principal diagnosis of ICD ‘Mental and behavioural disorders’ identified as Indigenous.
- In 2012, the death rate for ICD 'Intentional self-harm' (suicide) for Indigenous people was 2.0 times the rate reported for non-Indigenous people.
- In 2009-2013, after age-adjustment, the notification rate of end stage renal disease was 6.2 times higher for Indigenous people than for non-Indigenous people.
- In 2012-13, care involving dialysis was the most common reason for hospitalisation among Indigenous people.
- In 2008-2012, the age-standardised death rate from kidney disease was 2.6 times higher for Indigenous people than for non-Indigenous people.
- In 2012-13, after age-adjustment, Indigenous people were hospitalised for injury at nearly twice the rate for other Australians.
- In 2012-13, the hospitalisation rate for assault was 34 times higher for Indigenous women than for other women.
- In 2012, injury was the third most common cause of death among Indigenous people, accounting for 15% of Indigenous deaths.
- In 2012-2013, 31% of Indigenous people reported having a respiratory condition. After age-adjustment, the level of respiratory disease was 1.2 times higher for Indigenous than non-Indigenous people.
- In 2012-2013, 18% of Indigenous people reported having asthma.
- In 2012-13, after age-adjustment, rates for Indigenous people were 4.4 times higher for chronic obstructive pulmonary disease, 3.3 times higher for influenza and pneumonia, 1.8 times higher for asthma, 1.8 times higher for acute upper respiratory infections and 1.4 times higher for whooping cough, than for their non-Indigenous counterparts.
- In 2012, after age-adjustment, the death rate for respiratory disease for Indigenous people was 2.2 times that for non-Indigenous people.
- In 2012-2013, eye and sight problems were reported by 33% of Indigenous people.
- In 2008, the rate of low vision for Indigenous adults aged 40 years and older was 2.8 times higher than for their non-Indigenous counterparts.
- In 2008, the rate of blindness for Indigenous adults aged 40 years and older was 6.2 times higher than for their non-Indigenous counterparts.
Ear health and hearing
- In 2012-2013, ear/hearing problems were reported by 12% of Indigenous people.
- In 2012-13, the hospitalisation rate for ear/hearing problems for Indigenous children aged 0-3 years was 0.8 times lower the rate for non-Indigenous children and the rate for Indigenous children aged 4-14 years was 1.6 times higher than the rate for non-Indigenous children.
- In 2007-2008 in NSW, SA, Tas and the NT, Indigenous children had more dental problems than non-Indigenous children.
- In 2004-2006, caries and periodontal diseases were more prevalent among Indigenous adults than among non-Indigenous adults.
- In 2008, after age-adjustment, Indigenous people were 2.2 times as likely as non-Indigenous people to have a profound/core activity restriction.
- In 2006-2010, after age-adjustment, the notification rate for tuberculosis was 12.5 times higher for Indigenous people than for Australian-born non-Indigenous people.
- In 2011-2013, the crude notification rate for hepatitis B was 5 times higher for Indigenous people than non-Indigenous people.
- In 2011-2013, the crude notification rate for hepatitis C for Indigenous people was 3.7 times higher for Indigenous people than for non-Indigenous people.
- In 2007-2010, notification rates for Haemophilus influenza type b were 12.9 times higher for Indigenous people than for non-Indigenous people.
- In 2011, the age-standardised rate of invasive pneumococcal disease was 8 times higher for Indigenous people than for other Australians.
- In 2007-2010, the age-standardised notification rate of meningococcal disease was 2.7 times higher for Indigenous people than for other Australians; the rate for Indigenous children aged 0-4 years was 3.8 times higher than for their non-Indigenous counterparts.
- In 2013, Indigenous people had higher crude notification rates for gonorrhoea, syphilis and chlamydia than non-Indigenous people.
- In 2013, age-standardised rates of human immunodeficiency virus (HIV) diagnosis were 1.3 times higher for Indigenous than non-Indigenous people.
- In some remote communities, more than 70% of young children had scabies and pyoderma.
Factors contributing to Indigenous health
- In 2012-2013, less than one half of Indigenous people reported eating an adequate amount of fruit (42%) and only one-in-twenty ate enough vegetables (5%) on a daily basis.
- In 2012-13, 46% of Indigenous adults met the target of 30 minutes of moderate intensity physical activity on most days.
- In 2012-2013, after age-adjustment, 62% of Indigenous people in non-remote areas reported that they were physically inactive, a similar level to that of non-Indigenous people.
- In 2012-2013, 66% of Indigenous adults were classified as overweight or obese; after age-adjustment, the level of obesity/overweight was 1.2 times higher for Indigenous people than for non-Indigenous people.
- In 2013, 93% of Indigenous children aged 5 years were fully immunised against the recommended vaccine-preventable diseases.
- In 2010, breastfeeding initiation levels were similar among Indigenous and non-Indigenous mothers (87% and 90% respectively).
- In 2012-13, 44% of Indigenous adults were current smokers; after age-adjustment, this proportion was 2.5 times higher than the proportion among non-Indigenous adults.
- Between 2002 and 2013, there has been a decline in the number of cigarettes smoked daily among Indigenous people.
- In 2011, 50% of Indigenous mothers reported smoking during pregnancy.
- In 2012-13, 23% of Indigenous adults abstained from alcohol; this level was 1.6 times higher than among the non-Indigenous population.
- In 2012-2013, after age-adjustment, lifetime drinking risk was similar for both the Indigenous and non-Indigenous population. In 2008-10, after age-adjustment, Indigenous males were hospitalised at 5 times and Indigenous females at 4 times the rates of their non-Indigenous counterparts for a principal diagnosis related to alcohol use.
- In 2006-2010, the age-standardised death rates for alcohol-related deaths for Indigenous males and females were 5 and 8 times higher respectively, than those for their non-counterparts.
Illicit drug use
- In 2012-13, 22% of Indigenous adults reported that they had used an illicit substance in the previous 12 months.
- In 2005-2009, the rate of drug-induced deaths was 1.5 times higher for Indigenous people than for non-Indigenous people.
This Overview of Australian Indigenous health status provides a comprehensive summary of the most recent indicators of the health of Aboriginal and Torres Strait Islander people in Australia (states and territories are: New South Wales (NSW), Victoria (Vic), Queensland (Qld), Western Australia (WA), South Australia (SA), Tasmania (Tas), The Australian Capital Territory (ACT) and The Northern Territory (NT)). It draws largely on previously published information, some of which has been re-analysed to provide clearer comparisons between Aboriginal and Torres Strait Islander peoples 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. It is often difficult to determine whether original sources that use the term ‘Indigenous' are referring to Aboriginal people only, Torres Strait Islander people only or to both groups. In these instances the terms from the original source are used.
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:
- The Overcoming Indigenous disadvantage reports, 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 with substantial detailed analyses, prepared by AHMAC since 2006.
- 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 health and welfare of Australia's Aboriginal and Torres Strait Islander peoples series, produced by the ABS and the AIHW. The ABS produced an online version in 2010, some sections of which have been updated, and the AIHW produced an overview version in 2011.
In addition to 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' (, p.13).
This Overview draws 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 relies 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 Indigenous2 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 ).
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 . Despite these efforts, doubts remain about the extent to which official estimates reflect the actual size of the Indigenous population .
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 persistent 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 .
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 . 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 NT had the highest rate of consistent reporting (95%) and 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 . 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 .
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:
- 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 2014 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 .
- The important special reports noted above tend to be selective rather than comprehensive in their coverage of the various health topics.
- 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.
- 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.
- Changes in aspects like methodology and levels of reporting in publications pose difficulties in the analysis and synthesis of information with a time perspective.
- See Box 1 for terminology
- 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. See Box 1 for a more detailed explanation regarding the appropriate use of terminology.