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2.1 Strategic Change Indicators of Social Inclusion

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The Australian Government’s vision of a socially inclusive society is one in which all Australians feel valued and have the opportunity to participate fully in the life of our society. Achieving this vision means that all Australians will have the resources, opportunities and capability to learn, work, engage in the community and have a voice.

Measurement and reporting strategies will provide a focus on outcomes and what works. From 2011 Australian Government departments are held accountable for their progress on social inclusion through reporting on strategic change indicators of social inclusion relevant to their portfolio in their annual reports. Strategic change indicators are short-term progress measures of potential progress in relevant areas of Government policy and service delivery.

The Minister for Health and Ageing has approved seven social change indicators for the department and these are reported below. They aim to report on health risk factors for social inclusion and the outputs of Government health and ageing programs designed to improve inclusion outcomes.

While these performance indicators cover important aspects of social inclusion, there are a number of limitations for measuring progress. For example, it is unclear whether it would be an increase or a decrease in mental health treatment rates that would be desirable (Council of Australian Governments Reform Council (CRC), 2010).

The following indicators are reported by socio-economic status using Socio-Economic Indexes for Areas (SEIFA) and remoteness, where data are available. SEIFA Quintiles assign those persons resident in the most disadvantaged areas to Quintile 1 and those in the least disadvantaged areas to Quintile 5. Not all data for the social change indicators can be expressed in the same categories.

Indicators

Mortality Rate

Mortality rate is a summary measure of the overall health status of a population. Improvements rely not just on access to health services but on a range of factors including living conditions, and economic and social circumstances. This indicator will measure progress towards the Council of Australian Governments (COAG) target to close the life expectancy gap between Indigenous and other Australians within a generation.

Mortality rate (by Indigenous status), 2008
All Australians	Indigenous Australians
Aged standardised rate per 100,000 population
602.5	1,497.6

Source: CRC 2011/ABS (unpublished) Causes of Death, Australia 2008.
1. SEIFA and remoteness data not available.

Infant/Young Child Mortality Rate

Infant and young child (0-4 years) mortality rate is an important indicator of the health of pregnant women, newborns and children. Halving the gap in mortality rates for Indigenous children under five within a decade (that is, by 2018) is one of the COAG targets to reduce disadvantage among Indigenous Australians.

Infant/young child (0-4) years mortality rate (by Indigenous status), 2005-09
All Australians	Indigenous Australians
Rate per 100,000 population
105.9	234.7

Source: CRC 2011/ABS (unpublished) Causes of Death, Australia 2008; ABS (unpublished) Births, Australia; ABS (unpublished) Estimated Resident Population; ABS (2009) Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021.
1. See source publication for notes.
2. SEIFA and remoteness data not available.

Obesity

Obesity is a major risk factor for multiple chronic diseases which in turn are major causes of disability. There is a clear socio-economic gradient in obesity and its causes are exacerbated by social disadvantage and remoteness.

Obesity rate (by Indigenous status, SEIFA and remoteness), Australia, 2007-08
All Australians	Indigenous Australians	Index of disadvantage		Remoteness of Residence
Total rate	Total rate	Quintile 1	Quintile 5	Major Cities	Remote
24.7%	33.6%	32.5%	18.6%	22.5%	35.0%

Source: CRC 2010/ABS (unpublished) National Health Survey, 2007-08.
1. See source publication for notes.
2. Data are for adults and children.
3. Data for very remote not available.
4. No new data available for 2009-10.

Smoking

Smoking is a major risk factor for multiple chronic diseases and is thus a major cause of disability. There is a clear socio-economic gradient in smoking and, as for obesity above, its causes are exacerbated by social disadvantage and remoteness.

Daily smoking rate (by Indigenous status, SEIFA and remoteness), Australia, 2007-08
All Australians	Indigenous Australians	Index of disadvantage		Remoteness of Residence
Total rate	Total rate	Quintile 1	Quintile 5	Major Cities	Remote
19.1%	44.8%	28.7%	11.2%	17.6%	27.3%

Source: CRC 2010/ABS (unpublished) National Health Survey, 2007-08.
1. See source publication for notes.
2. Data are for adults.
3. Data for very remote is unavailable.
4. No new data available for 2009-10.

People Deferring Recommended Treatment

Deferring recommended treatment increases the chances that a medical condition will deteriorate. Social disadvantage contributes to treatment deferral, particularly in relation to purchasing medications.

Proportion of people deferring recommended treatment due to financial barriers (by SEIFA), 2009
Financial barriers to use of service
General Practitioners		Specialists		Medications
6.3%		10.5%		9.7%
Index of disadvantage
Quintile 1	Quintile 5	Quintile 1	Quintile 5	Quintile 1	Quintile 5
6.7%	5.0%	8.7%	8.0%	12.8%	6.4%

Source: CRC 2011/ABS (unpublished) Patient Experience Survey 2009.
1. See source publication for notes.
2. Data are for persons aged 15 years and over.
3. Data are not available for Indigenous Australians.
4. Data are not available for all remoteness categories.

Aboriginal and Torres Strait Islander Peoples Experiencing Financial Barriers to Treatment

Approximately 40% of Indigenous Australians are in the bottom 20% of equivalised household incomes. Deferring medical treatment increases the risk of further deterioration.

The data source for this indicator is the National Aboriginal and Torres Strait Islander Health Survey, with the most recent data dating from 2004-05. These survey results have not been used for current reporting purposes.

Potentially Preventable Hospitalisations

Preventable hospitalisations can indicate that illness and treatment are poorly controlled and therefore more likely to impact on a person’s ability to participate in work and social life. Social disadvantage and remoteness are strongly associated with avoidable hospitalisations.

Rate of selected potentially preventable hospitalisations (by Indigenous status, SEIFA and remoteness, Australia, 2008-09

Indigenous Australians Other Australians Index of disadvantage Remoteness of Residence

Aged standardised rate per 100,000 population
Total Total Quintile 1 Quintile 5 Major Cities Very Remote

14,563.6 2,955.8 3,806.9 2,254.4 2,843.9 6,927.9

Rate of selected potentially preventable hospitalisations (by Indigenous status, SEIFA and remoteness, Australia, 2008-09
Indigenous Australians	Other Australians	Index of disadvantage	Remoteness of Residence
Aged standardised rate per 100,000 population
Total	Total	Quintile 1	Quintile 5	Major Cities	Very Remote
14,563.6	2,955.8	3,806.9	2,254.4	2,843.9	6,927.9

Source: CRC 2011/AIHW (unpublished) National Hospital Morbidity Database; ABS (unpublished) Estimated Resident Population; ABS (2009) Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991
to 2021.
1. See source publication for notes.

Treatment Rates for Mental Illness

Increasing numbers of people receiving treatment for mental illness may indicate improved or better targeted access to services, or it may indicate higher rates of mental illness. However, the issue of unmet need has been prominent since the 1997 ABS National Survey of Mental Health and Wellbeing indicated that the majority of adults and younger persons affected by a mental disorder do not receive treatment. The Government’s 2010-11 Budget initiatives aim to build the capacity of the mental health care system so that Australians with, or at risk of developing, mental illness receive treatment. Improving mental health contributes towards engaging socially and participating in work.

Treatment rates for mental illness – Proportion of people receiving clinical mental health services, 2008-09 (Aged standardised rate)">Treatment rates for mental illness – Proportion of people receiving clinical mental health services, 2008-09 (Aged standardised rate)
State and Territory Community Mental Health Services				Private Hospitals
1.6%				0.1%
Commonwealth funded Medicare services by type of service
Total services	Psychiatrists	Clinical Psychologists	General Practitioners	Other Allied Health
5.7%	1.3%	0.8%	4.3%	1.7%

Source: CRC 2011/State and Territory (unpublished) community mental health care data; Private Mental Health Alliance (unpublished) Centralised Data Management Service data; DoHA (unpublished) Medicare data; ABS (unpublished) Estimated Resident Population 2008.
1. See source publication for notes.

References

Department of the Prime Minister and Cabinet (2010), A Stronger, Fairer Australia: National Statement on Social Inclusion, accessed 27 June 2011, http://www.socialinclusion.gov.au/sites/www.socialinclusion.gov.au/files/publications/pdf/brochure_stronger_fairer_australia.pdf.

COAG Reform Council (2011), National Healthcare Agreement: Performance report for 2009-10, Volume 2 Performance data, COAG Reform Council, Sydney, accessed 27 June 2011,
www.coagreformcouncil.gov.au/reports/docs/nha_09-10/nha_09-10_vol2.pdf.

COAG Reform Council (2010), National Healthcare Agreement: Baseline performance report for 2008-90, Volume 2 Performance data, COAG Reform Council, Sydney, accessed 27 June 2011,
www.coagreformcouncil.gov.au/reports/docs/healthcare_agreement_report_2008-09_vol2_sec1.pdf

Social Inclusion Board (2010), Social Inclusion in Australia: How Australia is faring, Canberra, accessed 27 June 2011,
http://www.socialinclusion.gov.au/sites/www.socialinclusion.gov.au/files/publications/pdf/SI_HowAusIsFaring.pdf

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