Health and wellbeing of First Nations people
For many First Nations people, good health is more than the absence of disease or illness – it is a holistic concept that includes physical, social, emotional, cultural, spiritual and ecological wellbeing, for both the individual and the community.
When interpreting health and welfare data about First Nations people, it is particularly important to understand historical factors. Colonisation and subsequent discriminatory government policies have had a devastating impact on First Nations communities and culture. Ongoing entrenched disadvantage, political exclusion, intergenerational trauma and institutional racism can all have a negative impact on the health and welfare outcomes of First Nations people.
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Determinants of health
The many interrelated factors that influence our health are known collectively as determinants of health.
Social determinants of health include factors such as early childhood development, education attainment, employment outcomes, income, housing, aged care, social inclusion/ non-discrimination, family and sexual violence, contact with the child protection and criminal justice systems, and access to culturally competent health care. These factors can act to strengthen or undermine the health of individuals and communities.
Australian Institute of Health and Welfare (AIHW) flagship reports, Australia's health and Australia's welfare, include a focus on social determinants of health data and trends for First Nations people. This analysis highlights the significance of cultural determinants of health and wellbeing for First Nations people, with cultural identity and participation in cultural activities recognised as protective factors that can positively influence outcomes.
A comprehensive and current view of determinants of health for First Nations people is provided in AIHW reporting based on the Aboriginal and Torres Strait Islander Health Performance Framework, in addition to analysis of health systems performance and health outcomes. AIHW reports are also prepared on determinants of health topics for the Australian population, including behaviours and risk factors such as smoking and alcohol consumption. As part of these products, data and information about First Nations Australians are included where possible.
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Access to health care and health system reporting
Access to culturally competent primary and secondary health care is an important factor influencing the health and wellbeing of First Nations people and communities.
The AIHW reports on organisations providing First Nations-specific primary health care services and key indicators using the Online Service Reports (OSR) and national Key Performance Indicators (nKPI) data collections, and works with service providers to improve the quality and usefulness of their data to support better outcomes for their clients.
The AIHW also uses modelling and spatial analysis to explore how access to a range of health services, for example General Practitioners (GP) and breast screening, varies geographically for First Nations people. In addition, the AIHW reports on how the use of Medicare-funded health checks and follow-ups for First Nations people varies over time and geographically.
Improving cultural safety for Aboriginal and Torres Strait Islander health care users across the health system can improve access to, and the quality of, health care. The Cultural safety in health care for Indigenous Australians monitoring framework measures progress in this area.
Reporting and data on health conditions
The AIHW reports on a range of health conditions, providing information on the health and welfare status of First Nations people today and over time. This includes dedicated reports focused on health conditions and diseases that disproportionately affect First Nations Australians.
Eye health and ear and hearing health are some of the most common long-term health conditions First Nations people experience. Most of this blindness, vision impairment, chronic ear disease and hearing loss is preventable or can be treated. AIHW reports monitor changes in ear and hearing health and eye health over time and access to and use of health services.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable conditions associated with social disadvantage, inadequate housing and lack of access to timely primary health care. Over 90% of ARF notifications and over 80% of RHD diagnoses in Australia each year are in First Nations people. The AIHW’s National RHD Data Collection collates information on people with ARF and RHD from registers operating in New South Wales, Queensland, South Australia, Western Australia and the Northern Territory, and reports annually on these data.
Other AIHW reporting focuses on a range of chronic and other health conditions, including kidney disease, diabetes, chronic obstructive pulmonary and cardiovascular disease, asthma, cancer, arthritis and mental health. AIHW also undertakes analysis on health issues relevant to particular population groups, such as mothers and babies and older people. Sometimes these products are focused solely on First Nations health and population groups. However, even where reporting covers the Australian population as a whole, data and information on First Nations Australians are included where possible.
Understanding and measuring health and wellbeing
Many measures can be used to describe and assess the health experiences of First Nations people. Common summary measures include:
- Burden of disease analysis is a way of combining information about various diseases and injuries in a way that is comparable. It considers the impact of living with diseases as well as dying from them. In 2018, First Nations people experienced overall burden at 2.3 times the rate of non-Indigenous Australians, after accounting for differences due to age and sex.
- Social and emotional wellbeing (SEWB) is the foundation of physical and mental health for First Nations people. It takes a holistic view of health as it recognises that connection to land, sea, culture and spirituality all influence wellbeing. Social, historical and political factors can also affect wellbeing. For more information and data see the Indigenous Mental Health and Suicide Prevention Clearinghouse and the Health and wellbeing of First Nations people.
- Indicator-based reporting across social determinant and health topic areas.
National Agreement on Closing the Gap
The 2020 National Agreement on Closing the Gap (National Agreement) was developed in partnership between Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations.
The National Agreement acknowledges the ongoing strength and resilience of First Nations people and is underpinned by the belief that when First Nations people have a genuine say in the design and delivery of policies, programs and services that affect them, better life outcomes are achieved. It also recognises that structural change in the way governments work with Aboriginal and Torres Strait Islander people is needed to overcome the inequality experienced by First Nations people.
At the centre of the National Agreement are 4 Priority Reforms to change the way governments work with Aboriginal and Torres Strait Islander people and communities. These are:
- Formal partnerships and shared decision-making
- Build the community-controlled sector
- Transforming government organisations
- Shared access to data and information at a regional level.
The National Agreement also includes 19 national targets across socio-economic areas that have an impact on life outcomes for First Nations people. Progress against these targets is monitored by the Productivity Commission.
Building on its extensive experience reporting on the health and welfare of First Nations people, the AIHW is contributing its data collections and analysis to help track progress against targets outlined in the National Agreement.
The AIHW is also working with First Nations organisations and other government agencies to help achieve the 4 Closing the Gap Priority Reforms, particularly Priority Reform 4 focused on shared access to data and information at a regional level. This includes the development of community data portals under the Community Data Project, that will enable participating communities to access locally relevant data and statistics to inform planning and decision-making.
Better access to high-quality health and welfare data for communities
Several AIHW flagship websites and projects also aim to improve First Nations communities’ access to information and align with the objectives of the National Agreement.
The Regional Insights for Indigenous Communities (RIFIC) website brings together a wide range of data and statistics about First Nations Australians and their health and wellbeing in one place. Users can tailor their searches to find the regional statistics that are most relevant to their communities, or other locations of interest, and compare them to statistics about other regions, states and territories, or Australia.
Improving the quality, reliability and timeliness of data is another important way to ensure relevant information is available at the local level. To increase the completeness and reliability of information about First Nations people, the AIHW continues to identify where data gaps exist and options to fill these gaps, as well as assess and improve First Nations identification in a variety of ways.
