This is the third report against the Aboriginal and Torres Strait Islander Health Performance Framework (HPF). The framework was based on the National Health Performance Framework (NHPC 2001), and its measures developed through an extensive consultative process managed originally by the former AHMAC Standing Committee on Aboriginal and Torres Strait Islander Health (SCATSIH 2006).

The HPF report continues to play an important role in documenting the health of Aboriginal and Torres Strait Islander peoples and how well the health system performs for this population. In particular, this report aims to:

  • Provide a quantitative account of the current state of play and progress in relation to health status and outcomes, determinants of health, and health system performance.
  • Present information on policy implications.
  • Articulate the relationships between determinants of health, health behaviours and health outcomes.
  • Summarise the overall findings and implications for Aboriginal and Torres Strait Islander peoples and governments.
An important feature of the HPF is that it recognises sustainable health gain will require not only an efficient, effective and equitable health system, but also timely contributions from other sectors. Any measure of health performance in relation to Aboriginal and Torres Strait Islander peoples must take account of the particular health and social issues that are likely to affect Indigenous Australians to a greater or different degree than other Australians. The HPF tracks changes in key measures outside of the health sector to provide a better context for interpreting changes in health outcomes and to provide a basis for constructive intersectoral dialogue.

Performance monitoring of the stewardship role of governments in their efforts to improve Aboriginal and Torres Strait Islander health is critical. In doing this, attention should be given to assessing not only the levels of access to appropriate care but the experiences of Aboriginal and Torres Strait Islander peoples in receiving care. Attention must also be given to the social and policy context of Aboriginal and Torres Strait Islander health and the complex relationships between determinants of health, the health system and health outcomes.
Reporting against the HPF is designed to:

Promote accountability

  • The HPF measures government achievement against commitments to improve Aboriginal and Torres Strait Islander health.

Inform policy

  • The HPF informs the development of policy in Aboriginal and Torres Strait Islander health and in whole of government action on the determinants of health.

Inform research

  • The HPF provides a valuable tool for those involved in research relating to Aboriginal and Torres Strait Islander health.

Foster informed debate

  • The HPF is a key resource for informed public debate around Aboriginal and Torres Strait Islander health.
The HPF covers the entire health system, including Indigenous-specific services and programs, and mainstream services. It includes performance measures across the full continuum from inputs, processes, outputs, and intermediate outcomes to final outcomes. This enables short to medium-term measures of progress to be included, and accommodates the different stages of development of services and systems. The statistics in this report are the latest available but are sometimes a few years old and therefore may not reflect the impact of recent action.

Structure of this report

  • The report is structured according to the framework presented in Figure 1.
  • Introductory analysis includes key messages that have emerged through the analysis of new data and consultations with stakeholders, drawing out the major linkages between the three tiers of the HPF.
  • An overview of existing national strategies and policies is also included in the introductory section of the report.
  • The main body of the report is data and policy analysis for each tier of the framework incorporating:
    • Analysis of each of the 71 measures.
    • Discussion of why the measure is important.
    • Presentation of the results relating to the measure.
    • An outline of the implications of the findings for policy development/action.
  • The material presented on each measure is succinct, and in some cases only touches on the major features of complex issues. Additional data analyses supplementing this report are available on the Australian Institute of Health and Welfare website at www.aihw.gov.au/indigenous/publications.cfm.

Data Limitations

There are well-documented problems with the quality and availability of data about Aboriginal and Torres Strait Islander health issues. These limitations include the quality of data on all key health measures— including mortality and morbidity, uncertainty about the size and composition of the Indigenous population, and a paucity of available data on other health issues such as access to health services (see Technical Appendix). The following should be noted when interpreting the data analysis:

Under-identification:

  • Under-identification of Aboriginal and Torres Strait Islander people is the main issue in most administrative data collections. Under-identification is a major problem in hospital morbidity and mortality data collections, particularly for some states and territories. In the primary care setting, only a minority of GPs have effective routine Indigenous identification processes in place. Therefore, any Indigenous data generated through GPs are currently problematic.
  • Under-identification of Aboriginal and Torres Strait Islander people in administrative data collections is due to various factors, for example, whether the Indigenous status question is asked in the first instance, consistency in the way the question is asked, and differing responses by the person involved depending on the situation. Decisions on which data to include have been based on the most recent evaluations (see the Technical Appendix). Work is underway to improve data quality. In future, more comprehensive data will be available for some measures.

Coverage by jurisdictions:

  • Due to the under-identification issues described above, for some data collections data analysis has been limited to jurisdictions with known better quality data. For current period reporting some measures presented in this report are based on analysis of data for selected jurisdictions only (e.g. mortality data are currently only published for NSW, Qld, SA, WA and the NT). Longer-term mortality trends (i.e. from 1991) are limited to South Australia, Western Australia and the Northern Territory, as these jurisdictions have been shown to have adequate coverage for these earlier years. However, most jurisdictions now have at least a decade of mortality data that is considered adequate.

Inconsistencies in the Indigenous status question:

  • A standard wording for Aboriginal and Torres Strait Islander identification has been developed and endorsed nationally. However, the standard question and categories are not used in data collections across all jurisdictions. For example, in the national perinatal data, Indigenous status is based on the mother. This means that babies with an Aboriginal and/or Torres Strait Islander father and a non-Indigenous mother are not systematically identified as Indigenous (approximately 30% of Indigenous babies).
The absence of quality data from a variety of sources remains a significant impediment to a full understanding of the health of Aboriginal and Torres Strait Islander Australians and the performance of health services. One significant initiative is the introduction of the Voluntary Indigenous Identifier (VII) in the Medicare database in 2002. Participation has gradually increased since then. By 1 November 2010, 289,350 people (51.4% of the total estimated Indigenous population) had identified with Medicare as Aboriginal, Torres Strait Islander, or both. From 2010, the VII data has been considered to be of sufficient quality to use as the basis for calculating statistics about Indigenous Australians’ use of Medicare and the PBS. This report is among the first to use VII data.

Demographic Context

Aboriginal and Torres Strait Islander people experience diverse determinants of health which inform priorities in planning, resourcing and evaluating policies and programs designed to address health inequities. Key demographic statistics important in the context of setting priorities include jurisdictional data, remoteness and age distribution. In 2010, it was estimated there were 563,101 Aboriginal and Torres Strait Islander people in Australia. Overall, Indigenous Australians represent 2.6% of the Australian population, although this proportion ranges from 30% of the population of the Northern Territory to 0.7% of the population of Victoria. Around 29% of Aboriginal and Torres Strait Islander people live in New South Wales, 29% live in Queensland, 14% in Western Australia and 12% in the Northern Territory.

Around 75% of Indigenous Australians live in regional and metropolitan areas. While only 15% of Indigenous Australians live in very remote areas they make up a large proportion of Australians living in very remote areas (48%) (see Table 2).

The significantly younger age structure of the Aboriginal and Torres Strait Islander population (see Figure 2) presents implications for service delivery to be adequately resourced for children and young people, as well as developed and delivered in culturally sensitive ways. The younger age structure also represents a tremendous opportunity. With well designed and delivered antenatal care and early childhood programs, along with effective interventions helping young adults to adopt healthy behaviours, there is an opportunity to temper the emergence of chronic illnesses and their devastating consequences in this group of younger people. While it is vital that there is focus on ensuring improvement of health for Aboriginal and Torres Strait Islander peoples across their life course, it is important to take account of demographic composition in planning for resource requirements and service delivery for Aboriginal and Torres Strait Islander peoples.

Table 1 – Estimated resident population by state/territoryand Indigenous status, 2010

Number of Indigenous AustraliansIndig. as % of total populationIndig. as % of total Indig. population
New South Wales
165,306
2.3
29.4
Victoria
36,761
0.7
6.5
Queensland
160,632
3.6
28.5
South Australia
30,403
1.9
5.4
Western Australia
76,271
3.4
13.5
Tasmania
20,106
4.0
3.6
Northern Territory
68,661
30.2
12.2
Australian Capital Territory
4,711
1.3
0.8
Australia
563,101
2.6
100.0
Source: AIHW analysis of ABS population estimates based on 2006 Census

Table 2 – Estimated resident population by remoteness area and Indigenous status, 2006

Number of Indigenous AustraliansIndig. as % of total populationIndig. as % of total Indig. population
Major cities 165,804 1.2 32.1
Outer regional 110,643 2.7 21.4
Inner regional 113,280 5.8 21.9
Remote 47,852 15.2 9.3
Very remote 79,464 48.0 15.4
Australia 517,043 2.5 100.0
Source: AIHW analysis of ABS population estimates based on 2006 Census

Figure 2 – Age distribution of Australian population, by Indigenous status and sex, 2010


Figure 2 – Age distribution of Australian population, by Indigenous status and sex, 2010
Source: AIHW analysis of ABS population estimates based on 2006 Census
Text description of figure 2 (TXT 1 KB)

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