Indigenous health framework generates mixed results

The Australian Institute of Health and Welfare (AIHW) has released the Aboriginal and Torres Strait Islander Health Performance Framework 2020 (HPF) — finding mixed results for the 68 measures investigated.

The HPF examines health status and outcomes among Aboriginal and Torres Strait Islander people, including life expectancy, leading causes of illness and death, mental health, social and emotional wellbeing, and community functioning.

Across three tiers — health status and outcomes, determinants of health, and health system performance — improvements were observed in some areas, whereas no change or worsening was reported when monitoring progress in the performance measures.

Determinants of health are the environmental and socioeconomic conditions that can affect health, which include education, employment, income, housing, child protection, justice, culture and access to traditional land, and health risk factors including smoking, diet and exercise.

“Determinants of health are key drivers of health outcomes in a population,” said AIHW spokesperson Dr Fadwa Al-Yaman.

“For Indigenous Australians to have considerably better health outcomes, improvements in determinants beyond the health sector are also required.

“Despite improvements, significant differences in outcomes exist between Aboriginal and Torres Strait Islander people and non-Indigenous Australians across a range of measures.”

Many areas of concern highlighted in the framework are the focus of new targets in the National Agreement on Closing the Gap, signed by the Coalition of Peaks and all Australian governments in mid-2020.

Improved outcomes

Improvements in health outcomes for Aboriginal and Torres Strait Islander people have been observed in several areas, including reductions in avoidable deaths and cardiovascular disease.

Between 2006 and 2018, the rate of avoidable deaths fell from 374 to 303 per 100,000 deaths. Despite this, Indigenous Australians still died from preventable causes at three times the rate of non-Indigenous Australians.

Similarly, between 2006 and 2018, deaths from cardiovascular disease among Aboriginal and Torres Strait Islander people fell from 323 per 100,000 to 229 in 2018. This improvement coincided with a reduction in smoking and an increase in the uptake of cardiovascular disease-related procedures.

“In good news for Indigenous young people, 85% aged 15–17 reported that they had never smoked, compared to 72% in 2008,” Dr. Al-Yaman said.

“Overall, the rate of daily smoking among Indigenous Australians aged 15 years and over declined from 45% in 2008 to 37% in 2018–19.”

Levels of educational attainment have also improved, with the proportion of Aboriginal and Torres Strait Islander people aged 20–24 who had a Year 12 or equivalent qualification increasing from 45% in 2008 to 66% in 2018–19.

Immunisation rates for Indigenous children have increased, with the vast majority being fully immunised at one, two and five years. The proportion of Indigenous mothers who attended antenatal care during the first trimester of pregnancy increased from 51% to 63% (between 2012 and 2017), with 99% attending at least one antenatal visit.

The number of Indigenous-specific primary healthcare organisations increased from 108 in 1999–2000 to 198 in 2017–18. Episodes of care also increased from 1.3 to 3.6 million, and the number of healthcare workers increased from 2300 to 8200 over this period.

Areas of concern: no change or worsening of outcomes

Following improvements in the early 2000s, progress in a number of health outcomes stalled. These include perinatal mortality, infant and child mortality, and mortality from respiratory diseases.

Three in 10 Aboriginal and Torres Strait Islander people who needed health care in 2018–19 did not seek it — the same proportion as in 2012–13. Barriers included cost and health services being unavailable, far away or with long waiting times.

The employment rate for Indigenous Australians aged 15–64 remained unchanged between 2008 and 2018–19 (48% and 49%, respectively).

In 2018–19, 31% of Indigenous adults reported high/very high levels of psychological distress, not significantly different from 2014–15 (33%).

Between 2006 and 2018, there was a 49% increase in the suicide rate (from 18 to 24 per 100,000). The hospitalisation rate for intentional self-harm increased by 120% for Indigenous females and 81% for Indigenous males.

The rate of Aboriginal and Torres Strait Islander children in out-of-home care increased from 35 to 54 per 1000 (between 30 June 2009 and 30 June 2018). The imprisonment rate of Aboriginal and Torres Strait Islander adults increased from 1337 per 100,000 in 2006 to 2088 in 2019, a 61% increase and currently 12 times the rate among non-Indigenous Australians.

“The design of the HPF recognises that the health system and factors beyond the health sector contribute to health outcomes, and that achieving better health outcomes requires a whole-of-government approach, working in partnership with Aboriginal and Torres Strait Islander people,” Dr Al-Yaman said.

Image credit: ©stock.adobe.com/au/Hope