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Introduction

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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 Aboriginal and Torres Strait Islanders people. It has been prepared by Australian Indigenous HealthInfoNet staff as part of our contribution to supporting those who work in the Aboriginal and Torres Strait Islander health sector. The Overview is a key element of the HealthInfoNet commitment to authentic and engaged knowledge development and exchange.

The initial sections of this Overview provide information about the context of Aboriginal and Torres Strait Islander health, 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 sex 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). For more information on accessing and using the HealthInfoNet resource please view our instructional videos accessible from the web resource and also located on You Tube at www.youtube.com/channel/UCftVbk_1fVQz2i_9TyQ1E2Q.

As part of our ongoing commitment to the use of appropriate terminology regarding Aboriginal and Torres Strait Islander people, we have changed the title of the Overview to make it consistent with the HealthInfoNet guidelines on the appropriate use of terminology (www.healthinfonet.ecu.edu.au/key-resources/bibliography?lid=30201).

The key to successful knowledge exchange and transfer is authentic partnership in the development of materials so we welcome your comments and feedback about the Overview of Aboriginal and Torres Strait Islander health status 2015.

Also in this issue we pay tribute to Professor Neil Thomson the founder and Foundation Director of the HealthInfoNet who passed away on the 24 January, 2016.

Neil Drew, Director on behalf of the HealthInfoNet team

Acknowledgements

Particular thanks are extended to:

Artwork

Bibdjool Artwork by Donna Lei Rioli

Bibdjool

Donna Lei Rioli - a Western Australian Indigenous artist - was commissioned by the HealthlnfoNet to create a logo incorporating a gecko, chosen as it is one of a few animals that are found across the great diversity of Australia.

Donna is a Tiwi/Nyoongar woman who is dedicated to the heritage and culture of the Tiwi people on her father's side, Maurice Rioli, and the Nyoongar people on her mother's side, Robyn Collard. Donna enjoys painting because it enables her to express her Tiwi and Nyoongar heritage and she combines the two in a unique way.

Donna interpreted the brief with great awareness and conveyed an integrated work that focuses symbolically on the pathway through life. This is very relevant to the work and focus of the Australian Indigenous HealthlnfoNet in contributing to improving the health and wellbeing of Aboriginal and Torres Strait Islander Australians.

 

Dedication to Professor Neil Thomson

Neil Thomson

The 2015 Overview of Aboriginal and Torres Strait Islander health status is dedicated to founding Director of the Australian Indigenous HealthInfoNet, Professor Neil Thomson who passed away in January 2016. Neil was responsible for the first Overview in 1999 which was originally called a Summary. The Overview continues today as an authoritative, comprehensive annual summary of the most recent indicators of the health of Aboriginal and Torres Strait Islander people. It is an important part of the Australian Indigenous HealthInfoNet’s contributions to closing the gap in health between Aboriginal and Torres Strait Islander and other Australians and draws on the most up-to-date, authoritative sources and undertakes some original analyses.

Neil had a long involvement in Aboriginal and Torres Strait Islander health combined with tertiary training in medicine, mathematics, anthropology and public health and clinical medical practice including positions in the Kimberley region of WA. His special interests were in the transfer/translation of research and other information to inform policy-making, planning and service delivery and in 1997 he established the Australian Indigenous HealthInfoNet. This dedication is an acknowledgement of Neil’s substantial and tireless contribution over his working career to improving health outcomes of Aboriginal and Torres Strait Islander people, of which the Overview remains a hallmark publication.

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 Aboriginal and Torres Strait Islander health

Nutrition

Physical activity

Bodyweight

Immunisation

Breastfeeding

Tobacco use

Alcohol use

Illicit drug use

Introduction

This Overview of Australian Aboriginal and Torres Strait Islander 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 people 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 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 health and related areas:

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 NAGATSIHID strategic plan 2011-2015 acknowledged 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' ([2], 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, for example, the Australian Aboriginal and Torres Strait Islander health 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 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 Aboriginal and Torres Strait Islander health information

The assessment of Aboriginal and Torres Strait Islander people’s 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.

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 Aboriginal and Torres Strait Islander 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 Aboriginal and Torres Strait Islander 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 persistent problem, however, is the extent to which Aboriginal and Torres Strait Islander 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 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 [7]. The level of identification in hospital admissions is variable, but overall it has been estimated that 88% of Aboriginal and Torres Strait Islander patients were correctly identified in Australian public hospital admission records in 2011-12 [8].

The levels of Aboriginal and Torres Strait Islander people’s 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 health status. The differences between Aboriginal and Torres Strait Islander people 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 Aboriginal and Torres Strait Islander people, there is substantial scope for further improvement. For example:

References

  1. Australian Institute of Health and Welfare (2015) The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Canberra: Australian Institute of Health and Welfare
  2. 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
  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 (2014) Cancer in Australia: an overview 2014. Canberra: Australian Institute of Health and Welfare
 
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