The Link Between Primary Health Care and Health Outcomes for Aboriginal and Torres Strait Islander Australians

2. Health systems and health status

This review explores the evidence both domestically and internationally as to whether access to high quality primary health care is essential to enhancing Indigenous health status.

Page last updated: June 2008

This report attempts to examine the health outcomes that can be attributed to the provision of primary health care in Aboriginal and Torres Strait Islander communities. However, strictly speaking, there are two prior questions.

First, is there evidence that health systems in general improve the health of populations?

And if so, second, is there evidence about the extent to which primary health care services contribute to such improvements?

These questions are necessary to set the foundations upon which the inquiry into Indigenous health and primary health care is Australia can be built. After all, if there is no strong international evidence to support the contention that primary health care (or indeed, health care systems as a whole) improve population health, it would be unwarranted to expect the evidence to show such a pattern in Aboriginal and Torres Strait Islander communities.

Therefore, the purpose of this chapter is to stand back and look in the broadest manner possible at the relationship between the provision of health care and the health of populations.

In doing so, we will be looking at some of the substantial literature that looks at this relationship. We will be using the ‘hardest’ measures of health status, that is, mortality rates and / or life expectancy. This is not because these measures are necessarily the best indication of the health of a population – they have their limitations – but as the most rigorous measure available we assume that changes in health systems or society that produce changes in mortality and life expectancy of populations are changing their health in a significant way.

We will also briefly examine a number of subsidiary questions, such whether overall national health system spending is related to health, and the relationship between the number of health care providers (and in particular primary health care providers) and the health of populations.

We will also introduce in this Chapter the important concept of ‘avoidable’ mortality as well as briefly examining the critical issue of the social determinants of health.