National Summary of the 2001 and 2002
Jurisdictional Report Against the ATSI Health Performance Indicators
AIHW Catalogue No. IWH-12; Available from CanPrint
(ph: 1300 889 873); $28.00
xvii
Executive summary
This is the first national summary report on the refined
set of 56 health performance
indicators for Aboriginal and Torres Strait Islander
peoples. The indicators are designed to
provide an assessment of whether the health of
Indigenous people is improving and to
highlight problem areas that Australia’s health system
should address as high priorities.
This report, like many previous reports, draws
attention to the relatively poor quality of the
data on the health of Aboriginal and Torres Strait
Islander peoples. This means that
comprehensive comparisons between states and
territories are not yet possible. In the report,
the indicators are presented according to different
domains of the Aboriginal and Torres
Strait Islander Health Performance Framework; this
executive summary is intended to
highlight particular areas that warrant further
attention.
Areas of concern
Life expectancy at birth is significantly lower for
Aboriginal and Torres Strait Islander people
than all Australians (Indicator 5). Also, the
probability of a 20-year-old person dying before
his or her 55th birthday is 3 to 5 times higher for
Indigenous Australians than for all
Australians (Indicator 49). The proportion of births
to Indigenous mothers that are low
birthweight—a risk factor for ill health and
mortality—is twice the rate observed in the non-
Indigenous population (Indicator 28).
Chronic diseases
The major causes of early adult deaths in the
Aboriginal and Torres Strait Islander
population are chronic diseases such as diabetes and
circulatory diseases (including
rheumatic heart disease) and respiratory system
diseases. Death rates from diabetes were
between 9 and 16 times higher than the rates in the
non-Indigenous population (Indicator 55)
Death rates from circulatory system diseases in the
Indigenous population were 4 to 5 times
higher than in the non-Indigenous population
(Indicator 52). Death rates from respiratory
diseases were between 5 and 8 times higher (Indicator
54).
A large proportion of Indigenous people participate in
behaviours that place their health at
risk in the short and long term. Approximately 48% of
Indigenous adults are overweight or
obese (Indicator 31), 53% are current smokers
(Indicator 29), and 46% consumed alcohol. Of
those who consumed alcohol, 28% consumed it at risky
or high-risk levels (Indicator 30).
Injury and assaults
Across the states and territories, Indigenous people
were hospitalised for injury at between 3
and 4 times the rates of non-Indigenous people, and
died from injury at between 2 and 4
times the rates of non-Indigenous people (Indicators 42
and 53). Prominent among injuries
leading to hospitalisation or death was
assault—hospitalisations for Indigenous people were
between 14 and 24 times the rate for non-Indigenous
people, while death rates for
Indigenous people were between 5 and 13 times the rate
for non-Indigenous people
(Indicators 42 and 53). For injury resulting from
assault, just over half of Indigenous
xviii
hospitalisations were female, compared with only
one-quarter of non-Indigenous
hospitalisations.
Sexually transmitted diseases
Another area of concern is sexually transmissible
diseases (Indicator 39). Rates of infection
with chlamydia, gonococcus and syphilis in the
Indigenous population are high. Sexually
transmitted diseases are avoidable, and untreated
sexually transmitted diseases can lead to
serious complications and the continued spread of the
diseases.
Mental health, self-harm and substance use
Mortality from self-harm is 3 to 4 times higher in the
Indigenous population than in the non-
Indigenous population, and morbidity is around 3 times
higher (Indicators 53 and 42). The
rate of hospitalisation for substance use disorders
was between 6 and 10 times higher in the
Indigenous population. Hospitalisation rates for
depressive and anxiety disorders were
between 1 and 4 times the rates in the non-Indigenous
population (Indicator 46).
Health system capacity
A number of the indicators provide measures of the
current capacity of the Australian health
system to provide health promotion and primary health
care for Indigenous Australians
(Indicators 2, 4 and 20).
In relation to expenditure on health promotion
programs for Aboriginal and Torres Strait
Islander people, there was considerable variation
across states and territories. Expenditure in
2001–02 ranged from nil in Tasmania to $4.8 million in
the Northern Territory. In relation to
overall expenditure on health care, the ratio of
expenditure on Indigenous to non-Indigenous
Australians under the Medical Benefits Scheme and the
Pharmaceutical Benefits Scheme was
just 0.39 (Indicator 2). These programs are a
principal route for the delivery of primary health
care to both Indigenous and non-Indigenous
Australians. The ratio of Indigenous to non-
Indigenous expenditure for all programs funded and
administered by the Australian
Government was 0.82.
With regard to workforce capacity of Indigenous
people, in 2001, only 0.3% of doctors and
0.5% of nurses were Indigenous (Indicator 20),
although the numbers are increasing. Another
way to improve access to services is to reduce the
cultural barriers that confront Indigenous
people seeking treatment in mainstream health
services. A considerable amount of variation
exists between states and territories in the cultural
awareness training that is provided to
professional staff (Indicator 24).
Data limitations
A common problem highlighted in the report is the poor
quality of information, especially in
the identification of Indigenous people, with
Indigenous status being not recorded or
wrongly recorded in many datasets. The identification
of Indigenous people in birth and
death registrations, primary health care service
records (including general practitioners’
records) and hospital records remains a significant
data quality problem (Indicator 1). While
progress is being made, continued effort is needed in
states and territories to improve and
maintain Indigenous identification in the different
data collections.