Aboriginal and Torres Strait Islander people’s preferences for, use of, and access to primary health care 2025

Data sources

Data in this report are sourced from 3 Australian Bureau of Statistics’ (ABS) National Aboriginal and Torres Strait Islander Health Surveys (NATSIHS) – 2012–13, 2018–19 and 2022–23.

2012–13 NATSIHS

The 2012–13 NATSIHS was a key component of the broader Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). Conducted from April 2012 to February 2013, it involved over 9,000 Aboriginal and Torres Strait Islander people of all ages from nearly 5,400 dwellings, with results weighted to represent an estimated Aboriginal and Torres Strait Islander population of 638,000 across Australia (ABS 2013a, b). The survey focused on the health status of Aboriginal and Torres Strait Islander people, and health-related aspects of their lives, including:

• long-term health conditions
• consultations with health professionals
• days away from work
• medication use
• smoking
• alcohol consumption
• substance use
• usual fruit and vegetable intake
• exercise and physical measurements (ABS 2013a, b).

2018–19 NATSIHS

The 2018–19 cycle retained the core structure of the previous survey cycle while introducing several new data items and refining existing measures to better reflect contemporary health priorities and community needs of Aboriginal and Torres Strait Islander people. It collected information on several topics for the first time, including:

• mental health conditions
• consumption of sugar sweetened and diet drinks
• experiences of harm
• hearing tests.

The 2018–19 NATSIHS was conducted from July 2018 to April 2019, involving over 10,500 Aboriginal and Torres Strait Islander people from about 6,400 private dwellings, with results weighted to represent an estimated Aboriginal and Torres Strait Islander population of 814,000 across Australia (ABS 2018–19, AIHW 2025).

2022–23 NATSIHS

The 2022–23 NATSIHS was a key component of the broader Intergenerational Health and Mental Health Study (IHMHS). While retaining the core structure of the 2018–19 cycle, the survey introduced new questions reflecting evolving health priorities and feedback from Aboriginal and Torres Strait Islander communities. These included items on

• food security
• unpaid care responsibilities
• cultural safety,
• use of health services for mental health and
• personal use of the internet.

The 2022–23 NATSIHS was conducted from August 2022 to March 2024, as the COVID response was winding down and during the lead up to, the day of and the aftermath of the First Nations Voice referendum in October 2023. The survey involved around 7,800 Aboriginal and Torres Strait Islander people from around 4,900 households, with results weighted to represent an estimated Aboriginal and Torres Strait Islander population of 994,000 across Australia (ABS 2024). The number of Aboriginal and Torres Strait Islander households was not large enough to support estimates of suitable quality for the Australian Capital Territory being published separately, so state and territory data from this survey exclude data from the Australian Capital Territory. These households are included in national estimates.

Primary health care variables

The conceptual framework and literature review in AIHW (2024) highlighted the multi-faceted nature of primary health care use (and non-use). Twelve different primary health care variables were selected from the NATSIHS survey for the descriptive analysis in this and the previous report. These ranged from a respondent’s preferences and the availability of health services in their local area, to their usual source of health care/continuity of health care, recency of health use (GPs and dentists, experiences with the health-care system, and the level of unmet need for GP and dental services in the last 12 months).

The focus on timing of service use and unmet need in these analyses is for GPs and dentists as there are population-wide best practice guidelines around seeing a GP (such as at least once a year for a health check) and seeing a dentist (at least once a year for cleaning/a check-up).

Ten of the variables are available nationally (Table 9), while 2 of the variables were asked only of those in non-remote areas (Table 10).

Because of small numbers, only high-level data are presented on these outcomes. Whether there were differences by usual source of health care was also examined and results presented where there were differences.

Independent variables

Four domains (or sets of variables) were selected from the NATSIHS surveys as the core independent variables (Table 11):

• demographic/location factors (for example, age, sex, remoteness, state/territory, Socio-Economic Indexes for Areas (SEIFA))
• socioeconomic/social capital (for example, equivalised income, financial stress, education, employment status)
• cultural factors/experiences of unfair treatment (for example, language spoken at home, cultural identification, experiences of racism/discrimination)
• health status/disability (for example, perceived health status, presence of particular conditions such as diabetes or mental health conditions, comorbidities).

1. All people aged 15 and over.
2. People aged 18 and over who were physically present at the time of the interview.
3. People aged 15 and over who were physically present at the time of the interview. At the national level, the setting in which the unfair treatment took place and an additional variable (whether the respondent avoided certain situations because of past experiences of racism/discrimination) were also looked at. Because of small numbers, only the experienced/didn’t experience unfair treatment variable is included in the descriptive analyses because of small numbers in the sub-categories.
4. K5 = Kessler Psychological Distress Scale.

Comparisons across survey cycles

Looking at data across survey cycles allows a comprehensive understanding of changes over time, helping to identify persistent challenges, emerging issues, and areas of progress in primary health care for Aboriginal and Torres Strait Islander people. However, it is important to understand that each NATSIHS is an individual cross-sectional survey and that these are not longitudinal data (Table 12). It is also important to note that while each cycle of the NATSIHS maintains core elements for comparability, methodological refinements have been introduced over time to enhance data quality, relevance, and coverage. For these reasons, care needs to be taken when interpreting changes between surveys.

Source: ABS 2013a, 2013b, 2019, 2024.

Modelling preference and use of an AMS/CC

A series of multivariate logistic regression models on those aged 18 and over was run to look at the impact of variables from all 4 domains (plus local availability) on preference for an AMS/CC compared with all other service types and on the use of an AMS/CC by those who preferred an AMS/CC and had one as their usual source of health care:

• model 1 includes demographic and location variables only
• model 2 is model 1 + socioeconomic status/social capital + cultural/unfair treatment
• model 3 is model 2 + health status/disability
• model 4 is model 3 + GP services in local area by type.

The results (odds ratios) from the 4 models are presented in the accompanying Data tables. Odds ratios over 1 indicate a higher likelihood relative to the omitted category, while odds ratios under 1 indicate a lower likelihood, holding all other variables constant.

Confidence intervals

Proportions from the 2012–13, 2018–19, and 2022–23 NATSIHS presented in this report are accompanied by 95% confidence intervals (CIs). A 95% CI provides a range within which the true population value is expected to lie with 95% certainty, accounting for sampling variability. Wider intervals indicate greater uncertainty, while narrower intervals suggest more precise estimates.

When comparing proportions across survey years or population groups, a conservative approach can be used in which differences are considered statistically significant if the 95% confidence intervals did not overlap. While non-overlapping CIs generally indicate statistical significance, overlapping CIs do not necessarily imply that a difference is not significant. To confirm statistical significance, formal hypothesis testing (in this case a z-test) was therefore performed.

Rounding

All numbers presented in the text are rounded, according to the following rules:

• numbers over 100,000 and under one million are rounded to the nearest multiple of 1,000
• numbers between 1,000 and 100,000 are rounded to the nearest multiple of 100
• numbers between 500 and 999 are rounded to the nearest multiple of 10
• numbers between 100 and 499 are rounded to the nearest multiple of 5
• numbers between 0 and 99 are rounded to the nearest whole number.

Numbers in tables are rounded to the nearest 100.

Percentages in the text are rounded to the nearest whole number for values 10 and over and to 1 decimal place for values less than 10. Percentages in tables and figures are rounded to 1 decimal place.

Components may not add to total because of rounding.

Abbreviations

Symbols