Australian Institute of Health and Welfare (2022) Cultural safety in health care for Indigenous Australians: monitoring framework, AIHW, Australian Government, accessed 27 November 2022.
Australian Institute of Health and Welfare. (2022). Cultural safety in health care for Indigenous Australians: monitoring framework. Retrieved from https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework
Cultural safety in health care for Indigenous Australians: monitoring framework. Australian Institute of Health and Welfare, 29 June 2022, https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework
Australian Institute of Health and Welfare. Cultural safety in health care for Indigenous Australians: monitoring framework [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2022 Nov. 27]. Available from: https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework
Australian Institute of Health and Welfare (AIHW) 2022, Cultural safety in health care for Indigenous Australians: monitoring framework, viewed 27 November 2022, https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework
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Improving cultural safety for Aboriginal and Torres Strait Islander health care users can improve access to, and the quality of health care. This means a health system that respects Indigenous cultural values, strengths and differences, and also addresses racism and inequity.
The Cultural safety in health care for Indigenous Australians: monitoring framework aims to measure progress in achieving cultural safety in the Australian health system. For this purpose, cultural safety is defined with reference to the experiences of Indigenous health care users, of the care they are given, their ability to access services and to raise concerns.
The cultural safety monitoring framework covers three modules:
How health care services are provided
Indigenous patients’ experience of health care
Selected measures regarding access to health care
Data are reported from a wide range of available national and state and territory level sources to provide a picture of cultural safety, though there are significant data gaps. Sources include both national administrative data collections and surveys of Indigenous health care users.
Cultural respect is achieved when the health system is a safe environment for Indigenous Australians, and where cultural differences are respected. This module reports on how health care is provided, and whether cultural respect is reflected in structures, policies and programs.
Between 2013 to 2020:
Among Indigenous-specific primary health care organisations and maternal/child health services:
The experiences of Aboriginal and Torres Strait Islander health care users, including having their cultural identity respected, is critical for assessing cultural safety. Aspects of cultural safety include good communication, respectful treatment, empowerment in decision making and the inclusion of family members.
The differences in rates of Indigenous and non-Indigenous hospital patients who choose to leave prior to commencing or completing treatment are frequently used as indirect measures of cultural safety. In relation to admitted patient hospitalisations, Indigenous Australians were discharged against medical advice for 3.9% of hospitalisations in 2018–20. Based on age standardised rates, Indigenous patients were discharged against medical advice at over 5 times the rate of non-Indigenous Australians.
Aboriginal and Torres Strait Islander people do not always have the same level of access to health services as non-Indigenous Australians. Disparities in use of health services may indicate problems with access to health services due to affordability, cultural safety, distance travelled especially in remote and very remote areas, and previous experiences of racism in health care environments for themselves, family or community members and fear of how they will be treated.
Selected measures of access to health care services for Indigenous and non-Indigenous Australians are used to monitor disparities in access.
Monitoring cultural safety and cultural respect in the health system, and the impact it has on access to appropriate health care, are limited by a lack of national and state level data. This is particularly the case in relation to reporting on the policies and practices of mainstream health services, such as primary health care services and hospitals.
There is also limited data on the experiences of Indigenous health care users. Most jurisdictions undertake surveys about patients’ experiences in public hospitals, but there is not a lot of available data on Indigenous patient experience. A high proportion of Indigenous Australians use mainstream health services, so further data developments in this area are required to allow for more comprehensive reporting across the health sector.
Additionally, the ABS Indigenous health and social surveys, for example, the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19 and the National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2014–15, are national surveys to collect cultural safety information/patient experience. Both surveys contain questions relevant to patient experience and cultural safety. However, the infrequent data collection (around 5–6 years or more) do not allow for timely update of data for the monitoring framework.
This report brings together data from a wide range of sources. All the data presented in this monitoring framework are available in Excel format under Data. The Excel tables also include all relevant footnotes, technical details and individual data sources.
Since the beginning of the COVID-19 pandemic protecting the health, safety and wellbeing of Indigenous Australians has been a key national priority. However, there has been ongoing recognition that the changes to the health system and the restrictions and lockdowns necessary to prevent the spread of COVID-19 may have affected the need for, and use of, a broad range of health services by Indigenous Australians. This update presents data, where available, spanning the COVID-19 pandemic in Australia.
Specific impacts on the data are discussed in relation to relevant measures however, the full impact of COVID-19 may become apparent in the data for other measures in future years.
Impacts of COVID-19 on data used in this report are also explored in the AIHW reports:
For data and information that relate to COVID-19, please see the AIHW’s COVID-19 resources.
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