Aboriginal and Torres Strait Islander Health Performance Framework - 2010
Why is it important?:Health promotion includes interventions designed to facilitate behavioural and environmental adaptions that will improve or protect health within social, physical, economic and political contexts. Health promotion includes lifestyle advice (e.g. smoking, alcohol and drug use, physical activity, diet), social marketing (e.g. sunscreen, safe sex), mass media campaigns (e.g. drink-driving, road safety) and public policy interventions. Health promotion also includes promoting social responsibility for health, empowering individuals, and strengthening community capacity. Currently there are limited methods for measuring the nature and level of health promotion programs and activities and their reach within Indigenous communities.
Findings:In 2006–07, total government expenditure per person on public health for selected health promotion activities was estimated to be around $26 for Indigenous persons and $11 for non-Indigenous persons, and for prevention of hazardous and harmful drug use was $30 for Indigenous persons and $7 for non-Indigenous persons. These estimates are likely to understate expenditures as health promotion is often embedded within other funding sources and programs (e.g. funding for GPs).
In 2006–07, 88% of Divisions of General Practice ran programs for Type 2 diabetes, 85% for lifescripts, 75% for health promotion, 55% for physical activity, 54% for alcohol and other drugs, 46% for nutrition, 40% for smoking and 25% for injury prevention. Around 35% of Divisions targeted Indigenous Australians in their Type 2 diabetes programs, 14% in their Lifescripts programs, 25% in their health promotion programs, 10% in physical activity programs, 11% in their alcohol and other drugs programs, 13% in nutrition programs, 8% in their smoking programs, and 5% in their injury prevention programs. It is not known how many actual GP practices or patients were reached through these programs.
Based on the BEACH survey (2004–05 to 2008–09), it is estimated that selected clinical treatments related to health promotion were provided in around 29% of GP encounters for Indigenous patients. After adjusting for age, this was slightly less than for non-Indigenous Australians. The most common of these were general (unspecified) ‘advice/education’ which was provided in an estimated 5% of GP encounters with Indigenous patients. This was followed by ‘advice/education/ treatment’ (4%) and counselling/advice related to nutrition and weight (4% of encounters for Indigenous patients, particularly for those with diabetes).
Counselling/advice related to smoking was provided in 3% of GP encounters for Indigenous patients, which was 2 times the rate for non-Indigenous patients. Counselling/advice related to alcohol was provided in around 2% of GP encounters for Indigenous patients which was also 2 times the rate for non-Indigenous patients.
In 2008–09, 94% of Aboriginal and Torres Strait Islander primary health care services offered health promotion/education programs; 82% organised influenza immunisation, 81% child immunisation, 77% women’s health programs, 76% organised pneumococcal immunisation, and 65% ran men’s health programs. Health promotion activities are also a key feature of programs run by Aboriginal and Torres Strait Islander substance use specific services.
CHINS data on health promotion programs are available for discrete Indigenous communities representing 18% of the Indigenous population, mostly in remote areas. In 2006, 67% of discrete Indigenous communities reported that 1 or more health promotion programs had been conducted, with women’s health programs reported by 58%, well babies programs by 54%, immunisation programs by 54% and men’s health programs by 52% of communities. Stop smoking programs were reported for only 26% of communities. Most programs were conducted weekly or monthly, except for trachoma control and eye health, which were most often conducted less than three-monthly.
Implications:The inter-relationships between alcohol consumption, chronic disease management and recruitment and retention of clinical staff could be explored. Accessibility of mainstream health services from both the geographic and cultural perspectives could also warrant further attention.
A range of health promotion initiatives are being implemented under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes which has a focus on preventative health and primary health care. For example, the Indigenous Chronic Disease Package (ICDP) includes evidenced-based social marketing activities to reduce the prevalence of chronic disease risk factors, and includes the development of partnerships with local Indigenous community and media organisations and a specialist Indigenous communications consultant. The ICDP also includes funding for a national network of Regional Tobacco Coordinators, Tobacco Action Workers and Healthy Lifestyle Workers (see Measure 2.18). The Tackling Smoking workforce will implement community-based smoking prevention and cessation activities tailored to local communities. Healthy Lifestyle Workers will promote improved nutrition and physical activity and will seek to reduce the lifestyle risk factors that contribute to preventable chronic disease.
The Australian Government also supports VIBE Australia to deliver health promotion products and activities, targeting young Indigenous Australians. Factors in designing effective health promotion interventions for Indigenous communities include: involving local Indigenous people in design and implementation of programs; acknowledging different drivers that motivate individuals; building effective partnerships between community members and the organisations involved; cultural understanding and mechanisms for effective feedback to individuals and families; developing trusting relationships, community ownership and support for interventions (Black 2007).
Table 61 – Expenditure for selected public health activities, by Indigenous status, 2006–07
Selected public health activities:
Expenditure per person
|Selected health promotion|
|Food standards and hygiene|
|Breast cancer screening|
|Cervical cancer screening|
|Prevention of hazardous and harmful drug use|
|Public health research|
Table 62 – Proportion of funded Aboriginal and Torres Strait Islander primary health care services that undertook selected preventative health care and screening activities, 2008–09
Preventative health care and screening activities:
% of all responding services
|Organise influenza immunisation|
|Women's health programs|
|Organise pneumococcal immunisation|
|Dietary and nutrition programs|
|Infective diseases programs/education|
|Men's health programs|
|Child growth monitoring|
|Sexually transmissable infection contact tracing|
|Physical activity programs|
|Outreach health promotion|
Figure 155 – Proportion of clinical treatments provided by GPs, age-adjusted, by Indigenous status, 2004–05 to 2008–09
Source: AIHW analysis of BEACH survey of general practice AGPSCC
Text description of figure 155 (TXT 1KB)
Figure 156 – Discrete Indigenous communities located 10 kilometres or more from a hospital: Selected health promotion programs conducted in community, 2006
Source: AIHW analysis of ABS 2006 Community Housing and Infrastructure Needs Survey (CHINS)
Text description of figure 156 (TXT 1KB)