Aboriginal and Torres Strait Islander Health Performance Framework - 2010
Why is it important?:Avoidable and preventable mortality refers to deaths from conditions that are considered avoidable given timely and effective health care (including disease prevention and population health initiatives) (Page et al. 2006). Avoidable deaths have been used in various studies to measure the quality, effectiveness and/or accessibility of the health system, although deaths from most conditions are influenced by a range of factors in addition to health system performance, including the underlying prevalence of conditions in the community, environmental and socioeconomic factors and health behaviours. Avoidable mortality includes conditions that are significantly attributable to factors outside the health system such as socioeconomic factors, environmental factors, lifestyle factors and legal issues.
Causes of avoidable mortality can be sub-divided into ‘preventable’ conditions for which there are effective means to prevent the condition occurring (e.g. conditions caused by smoking) and ‘amenable’ conditions for which death may be averted even after the condition has developed through early detection and effective treatment (e.g. cervical cancer).
Potentially avoidable deaths can sometimes be further assigned to categories reflecting whether they could be avoided through primary interventions (prevention), secondary (early intervention) and tertiary interventions (medical treatment) (National Health Performance Committee 2004).
Findings:In the period 2004–08, there were 6,443 deaths of Aboriginal and Torres Strait Islander people aged 0–74 years from avoidable causes in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined. This represented 72% of deaths of Indigenous Australians aged 0–74 years in these five jurisdictions and 59% of deaths in all age groups. In contrast, deaths from avoidable causes for non-Indigenous people represented 67% of deaths of other Australians aged 0–74 years in these five jurisdictions and 23% of all deaths for non-Indigenous Australians.
Amenable mortality accounted for 2,498 Indigenous deaths in the five jurisdictions, or 28% of deaths of Indigenous Australians aged 0–74 years. For non-Indigenous Australians aged 0–74 years, amenable mortality accounted for 27% of deaths.
After adjusting for differences in age structure, Aboriginal and Torres Strait Islander peoples died from all avoidable causes at 4 times the rate of non-Indigenous Australians. The avoidable mortality rate of Aboriginal and Torres Strait Islander peoples was higher than that of non-Indigenous Australians in all age groups, and particularly high (4–5 times that of other Australians) in the middle adult age groups (25–64 years).
Reliable data on time-trends in avoidable mortality is available since 1991 for Western Australia, South Australia and the Northern Territory. There was a significant decline in the avoidable mortality rate for Aboriginal and Torres Strait Islander peoples in the period 1991 to 1996 in these jurisdictions combined. This decline continued in the period 1997 to 2008, when the trend in rates has been a decline of 20% for Indigenous Australians. The difference in rates between Indigenous and other Australians has narrowed significantly over this period.
The most common conditions or events causing avoidable mortality were ischaemic heart disease (19%), cancer (17%, in particular lung cancer), diabetes (10%) and suicide (8%). Mortality rates for Indigenous Australians aged 0–74 years for these conditions were significantly higher than non-Indigenous Australians: 4 times higher for ischaemic heart disease, 2 times higher for cancer, 13 times higher for diabetes and 2 times higher for suicide. Although not causing such a high proportion of avoidable deaths, several other conditions or events caused a high relative excess of avoidable deaths for Aboriginal and Torres Strait Islander peoples compared with non-Indigenous Australians including: rheumatic and other valvular heart disease (17 times as high); nephritis and nephrosis (11 times as high); violence (9 times as high); alcohol-related disease (7 times as high); and selected invasive bacterial and protozoal infections (avoidable mortality rate 6 times as high as for non-Indigenous Australians).
In terms of the number of potentially avoidable deaths, the greatest opportunities to reduce mortality for Indigenous Australians relate to primary prevention. However, there are also significant opportunities in terms of secondary and tertiary interventions.
Implications:Avoidable mortality presents a similar picture to that seen in other mortality measures: death rates for Aboriginal and Torres Strait Islander peoples are declining and the gap is closing. Chronic diseases and injury are the conditions causing the greatest proportion of excess deaths for Aboriginal and Torres Strait Islander peoples, and these conditions are amenable to both prevention and treatment. While all conditions causing excess deaths among Aboriginal and Torres Strait Islander peoples are important and need to be reduced, chronic conditions and injury are the conditions for which the greatest reductions in excess mortality could be achieved.
The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes comprises a package of health reforms that include a focus on preventive health and primary health care. Through this agreement a range of initiatives are being implemented which address prevention, early detection and management of chronic disease.
Figure 65 – Age-standardised mortality rates for avoidable causes of death, Indigenous and other Australians aged 0–74 years, WA, SA, NT, 1991–2008
Source: AIHW analysis of National Mortality Database
Text description of figure 65 (TXT 1KB)
Figure 66 – Avoidable mortality (by subcategory) and unavoidable mortality, by Indigenous status, persons aged 0–74 years, NSW, Qld, WA, SA and NT, 2002–2008
Source: AIHW analysis of National Mortality Database
Text description of figure 66 (TXT 1KB)
Table 37 – Avoidable mortality, by cause of death and Indigenous status, persons aged 0–74 years, NSW, Qld, WA, SA and NT, 2004–2008
Cause of death
Age standardised rate per 100,000
|Ischaemic heart disease|
|Road traffic injuries|
|Alcohol related disease|
|Nephritis and nephrosis|
|Complications of perinatal period|
|Rheumatic and other|
|Total avoidable deaths|
|Total deaths people 0-74 years|
Source: AIHW and ABS analysis of National Mortality Database