Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Life expectancy and wellbeing—1.17 Perceived health status

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Self-assessed health status provides a measure of the overall level of a population's health based on individuals' personal perceptions of their own health. Health is recognised as having physical, mental, social and spiritual components. Therefore, the measurement of health must go beyond quantifying levels of morbidity and mortality. Part of this broader approach to measuring health is to ask people to assess the state of their own health.

Self-assessed health status is dependent on an individual's awareness and expectations regarding their health. It is influenced by various factors, including access to health services and health information, the extent to which health conditions have been diagnosed, and level of education (Delpierre et al. 2009). Social constructs of health also influence this assessment, such as the culturally distinct view of health and wellbeing held by Aboriginal and Torres Strait Islander peoples, the existing level of health within a community and judgments concerning the person's own health compared with others in their community.

Self-assessed health status correlates with measures of health, such as reported long-term health conditions, recent health-related actions, and the presence of disability. However, there are some inconsistencies in how Aboriginal and Torres Strait Islander people report their health status, particularly those for whom English is not their main language. Many Aboriginal and Torres Strait Islander people have rated their health as good or excellent despite significant health problems. Self-assessed health status is a useful measure of overall health status, but is not an objective measure and needs to be interpreted with some caution.

Findings:

In the 2008 NATSISS, 44% of Aboriginal and Torres Strait Islander peoples aged 15 years and over reported their health as being very good or excellent, 34% reported their health as being good, and 22% reported their health as being poor or fair. These proportions have remained fairly stable since 2002. Older people were less likely than younger people to report very good or excellent health: 58% in the 15–24 years age group compared with 22% in the 55 years and over age group. Indigenous females were less likely than Indigenous males to report their health as being very good or excellent (41% compared with 47%).

Aboriginal and Torres Strait Islander peoples were less likely than non-Indigenous Australians to report very good or excellent health, and the difference between the two populations was greatest in the older age groups. After adjusting for differences in the age structure of the two populations, Aboriginal and Torres Strait Islander peoples were twice as likely as non-Indigenous Australians to report their health as fair or poor.

The proportion of Aboriginal and Torres Strait Islander peoples reporting fair or poor health was highest in SA and NSW (27% and 26% respectively), and lowest in the NT, Qld and the ACT (18%, 20% and 20% respectively).

Indigenous Australians (of all ages) living in remote areas were less likely to report their health as being fair or poor (30%) compared to those in non-remote Australia (24%). Biddle (2011) found that this result held after controlling for whether or not the person speaks a language other than English at home, suggesting that language differences in interpreting the question were not important. This supports the findings in Rowley et al. (2008) that living in remote communities can have a protective effect on health (see measure 2.14).

Aboriginal and Torres Strait Islander people reporting the presence of long-term health conditions are more likely to report their health as fair or poor. The proportion of Aboriginal and Torres Strait Islander peoples reporting fair or poor health increases with the number of health conditions reported. A similar pattern can be observed for non-Indigenous Australians.

Poorer perceived health status is associated with a range of determinants of health (see discussion in Executive Summary). For example, of Indigenous Australians reporting fair or poor health status, 62% were in the lowest income quintile compared with 3% in the highest quintile, 10% were unemployed compared with 35% who were employed and 47% had completed year 9 or below compared with 14% who had completed Year 12.

Having excellent or very good self-assessed health status is associated with feeling safe, feeling able to have a say with family or friends and within the community, having contact with family or friends outside the household at least once a week, having friends to confide in, no community problems reported and agreeing that most people can be trusted (see measure 1.13).

Implications:

Top of pageAboriginal and Torres Strait Islander people rate their own general health as poorer than that of other Australians across all adult age groups, although the disparities are narrower in the younger age groups. The differences between the two populations are large, which is consistent with other measures of overall health status.

Self-assessed health is one of very few measures of overall health status that are currently available for Aboriginal and Torres Strait Islander peoples throughout the country. The relative consistency of self-assessed health across all jurisdictions and across urban, rural and remote areas suggests that there may not be large variations in overall health status for Indigenous Australians across the country. This would be consistent with some other measures for which national data are available, such as low birthweight (see measure 1.01). However, other measures such as the prevalence of end stage renal disease indicate that there are very large differences in disease incidence between jurisdictions and across remoteness categories (see measure 1.09).

How an individual Aboriginal or Torres Strait Islander person assesses their own health status may also be influenced by how they perceive their health relative to other people, including other Aboriginal and Torres Strait Islander people, around them. There is a similar challenge to develop valid measures for comparing international variations in perceptions of health and health-related experiences (Murray et al. 2003; Salomon et al. 2003). Further research would be valuable to identify the specific issues impacting on perceived health for Aboriginal and Torres Strait Islander peoples.
Figure 59—Self-assessed health status (age-standardised proportion) by Indigenous status, persons aged 15 years and over, 2008
Figure 59—Self-assessed health status (age-standardised proportion) by Indigenous status, persons aged 15 years and over, 2008
Source: ABS and AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey
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Figure 60—Self-assessed health status by Indigenous status and age group, persons aged 15 years and over, 2008
Figure 60—Self-assessed health status by Indigenous status and age group, persons aged 15 years and over, 2008
Source: ABS and AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey
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Figure 61—Self-assessed health status, Indigenous Australians aged 15 years and over, by remoteness, 2008
Figure 61—Self-assessed health status, Indigenous Australians aged 15 years and over, by remoteness, 2008
Source: ABS and AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey
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Figure 62—Self-assessed health status by Indigenous status and number of long-term health conditions, age‑standardised, Australia 2004–05
Figure 62—Self-assessed health status by Indigenous status and number of long-term health conditions, age‑standardised, Australia 2004–05
Source: ABS and AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey
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