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This Overview of the health of Indigenous people in Western Australia 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
Its preparation was undertaken as a part of the development within the HealthInfoNet web resource of a specific section devoted to the health of Indigenous Western Australians. Development of the section, the first of a planned series for all states and territories, has been enabled with the provision of separate funds from the Western Australian Department of Health’s Aboriginal Health Division. The HealthInfoNet is grateful for this support.
The main purpose of this Overview is to provide a comprehensive summary of the most recent indicators of the health of Indigenous people in WA. 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 WA’s Indigenous people. 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 web resource.
Research for this Overview involved the collection, collation, and analysis of a wide range of relevant information, including both published and unpublished material. Sources include the full range of relevant literature, including journal articles and other relevant publications, the vast majority of which are accessible via the HealthInfoNet’s Australian Indigenous HealthBibliography. This bibliography, with more than more 20,000 entries, captures all relevant journal articles, books, book chapters and reports (including the ‘grey’ literature).
As well as the relevant journal literature, the HealthInfoNet’s overviews draw on important government reports, particularly those produced by the Australian Bureau of Statistics (ABS), the Australian Institute of Health and Welfare (AIHW), the Steering Committee for the Review of Government Service Provision (SCRGSP), and reports in the Aboriginal and Torres Strait Islander health performance framework series. These reports, prepared by the Australian Health Ministers’ Advisory Council (AHMAC) in 2006, 2008, 2011 and 2012, are accompanied by substantial detailed analyses, including analyses that are specific to WA, and accessible on the AIHW website. The HealthInfoNet’s overviews also draw 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, this 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.
A number of sections include the results of our own analyses of data obtained from a variety of sources. For example, estimates of some health conditions were made using notification data provided by the Epidemiology Branch at the WA Department of Health. The section on cancer benefitted from information provided by the WA Cancer Registry.
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. 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 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, the Indigenous population in WA, 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 Diseases (ICD). These terms are usually included in quotation marks preceded by ICD.
Further information about the aspects summarised in this Overview are included in the corresponding sections of the HealthInfoNet's web resource (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 of the health of Indigenous people in Western Australia 2013.
Neil Thomson, Director, on behalf of the HealthInfoNet team
Particular thanks are extended to:
This Overview of the health of Indigenous people in Western Australia 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). 2
The assessment of the health status of Indigenous people in WA requires accurate information about the size of the population and the numbers of specific health conditions/occurrences. This information is required at state, regional, and local levels (for more information about the assessment of population health status, see ).
Nationally, 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 . 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 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 . 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 . Based on this comparison, the ABS estimated that the Australia-wide and WA levels of Indigenous identification in deaths notifications in 2006-2007 were 92% ; this level of identification is much higher than previous national estimates (around 56%) .
The AIHW conducted a study in 2011-2012 that investigated the quality of Indigenous identification in records of public hospital separations in Australia’s states and territories . This study found that 96% of Indigenous patients in WA’s public hospitals were correctly identified as such in 2011-12. The accuracy of the identification of Indigenous people varied slightly with remoteness level in WA: 100% in outer regional and very remote areas; 96% in major cities; 90% in inner regional and remote areas. A previous study estimated the completeness of Indigenous identification of WA’s hospital data to be 97% in 2007 .
The estimated coverage of Indigenous births in WA was 95% for the period 2002-2006 . In 2012, a study was undertaken comparing the consistency in determining the Indigenous status of children recorded in a large-scale survey (Western Australian Aboriginal child health survey (WAACHS)) and two administrative data sources (WA Register of Births and the WA Midwives’ Notification System) . This study found that there was substantial under-identification of Indigenous births when using only the two administrative data sources; applying an adjustment based on the linked survey data increased the estimated number of Indigenous births in WA by around 25%.
The need for information at a community level was identified in consultations undertaken for the development of the National Aboriginal and Torres Strait Islander information plan , but there are no reliable data routinely available at this level. Survey information, particularly that collected nationally by the ABS, (such as in the 2004-05 National Aboriginal and Torres Strait Islander health survey (NATSIHS) and the 2008 National Aboriginal and Torres Strait Islander social survey (NATSISS)), is valuable, but it is limited at a regional level by the relatively small number of Indigenous people surveyed. It is also difficult to compare survey findings because of differing sample sizes, methodologies, and seasonal variations in some health conditions. On the other hand, very good data about various aspects of the health of Indigenous children in WA are available from the WAACHS.
Statistics on hospitalisation provide some insights into ill-health in the population. They are, however, quite a poor reflection of the extent and patterns of treatable illness in the community because they represent only illness that is serious enough to require hospitalisation. Even then, hospital statistics relate to episodes of hospitalisation, with the result that each admission of an individual for a specific condition will be counted. This has a major impact on the numbers of admissions for aspects like renal dialysis, for which some people may be admitted many times in a year.
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.