Health checks and follow-ups for Aboriginal and Torres Strait Islander people

Long-term trends and key variation

This section presents key analyses on health checks and follow-up activity for reference.

Health checks over time

Uptake of health checks has plateaued in recent years at 25% (266,000 participants). Uptake dropped between 2020 and 2022, coinciding with the COVID-19 pandemic restrictions, reaching a low of 21% in 2021–22 (209,000 participants). Prior to the pandemic, uptake was gradually rising, peaking at 26% in 2019 (250,000 participants) (Figure 1).

Throughout this report, uptake refers to the proportion of the First Nations population who had a health check in each year. Aboriginal and Torres Strait Islander population data used for calculating uptake align with the final 2021 Census-based estimated resident populations, the 2021 Census-based “Medium series” projections and the 2021 Census-based backcast population estimates from the Australian Bureau of Statistics (ABS 2011-to-2031).

An alternative projection series, published by the ABS in 2025, includes assumptions about changes in First Nations identification over time (ABS 2011-to-2031). The “identification change series” was not used to calculate uptake in this report to maintain consistency with other AIHW analyses and due to the limited granularity of those outputs. A brief example including identification change, however, is explored in the following section.

Health checks by age and sex

Uptake of health checks is higher among older people than among younger age groups, and higher among females than among males. In 2024, 35% of First Nations people aged 50 and over had a health check, compared with 21% of people aged 15–24 (67,900 and 41,800 participants, respectively). Overall, 28% of females had a health check (144,000 participants), compared with 23% of males (122,000 participants). Among those aged 25–49, uptake was considerably higher among females (28%) than among males (20%) (45,500 and 32,000 participants, respectively) (Figure 2).

Geographic variation in uptake of health checks

Uptake of health checks varies considerably between geographic regions. In 2024, Queensland recorded the highest uptake at 31% (91,000 participants), more than double that of Victoria, which had the lowest rate at 13% (11,300 participants). Differences by remoteness were more moderate, with uptake highest in remote areas (30%) and lowest in Outer regional areas (23%) (Figure 3).

Touching on the more granular data that are available, statistical analysis at the SA4 level suggests that geographic factors explain nearly twice as much of the variation in uptake as age and sex combined. These insights are explored in more detail in the following section, comparing geographic and demographic variation.

Cumulative uptake of health checks

Looking at health check activity over multiple years gives a fuller picture of how many people are engaging with these services. A key insight from this analysis is that uptake increases relatively sharply when pooling 2 years of participants (39% in 2023–2024 up from 25% in 2024), indicating that many people get health checks less regularly than every 12 months (406,000 participants up from 266,000). Pooling participants across a 5-year period indicates that over half of the First Nations population (57%) had at least one health check by the end of 2024 (598,000 participants). Cumulative 5-year uptake is even higher among older people aged 50 and over (70% or 137,000 participants) (Figure 4).

Follow-up activity

At the end of a health check, some participants receive referrals to see allied health professionals. Others might go on to receive suggested care from a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of their GP. These are described as ‘follow-up’ services. There are dedicated MBS follow-up items specifically for First Nations people, and similar MBS items that are available to patients with a chronic condition being managed by a GP.

In this report, analyses of MBS data show the proportion of health check participants who received a follow-up service within 6 months of their health check. For completeness, analyses are available for First Nations-specific follow-up items, chronic disease management (CDM) items with a GP (which are not strictly follow-up items), follow-up items for people under chronic disease management, and the total combining all of these services. For brevity, only First Nations-specific follow-ups and the combined total are discussed in this section.

Among people who had a health check in 2024, 39% received a First Nations-specific follow-up within 6 months. When CDM-related items are included, this proportion increases to 53%, largely driven by CDM services delivered by GPs. Follow-up proportions tend to increase with age, and this pattern is stronger when CDM-related services are included. These findings highlight the broader range of targeted care accessed by First Nations people following health checks, particularly among those living with chronic conditions (Figure 5).

Note that some people who have health checks will not need follow-up services. If it were possible, excluding those individuals from the denominator could potentially increase the proportions markedly and reveal different variation (see ‘Unmet need and incomplete visibility of follow-up care’ in the Data gaps section for more information).

Community-controlled services drive health check delivery

The Aboriginal Community Controlled Health Organisation (ACCHO) sector plays a disproportionately large role in delivering health checks to First Nations people. Data from the Aboriginal and Torres Strait Islander primary health care national Key Performance Indicators (nKPIs) data collection suggest that GPs working in ACCHOs conduct approximately 44% of all health checks, despite representing only about 2.2% of full-time equivalent GPs nationally (Figure 6).

Related research

Recent research has provided further insight into the use and impact of health checks for Aboriginal and Torres Strait Islander people.

Association between self-rated health and health checks

A study of nearly 1,800 First Nations adults in New South Wales found that people with poorer self-rated health were more likely to have had a health check than those who rated their health as excellent (adjusting for age, sex, other sociodemographic characteristics, and GP use) (Butler et al. 2022). Likewise, people with diabetes or a higher BMI were more likely to have had a health check than people without those conditions.

Barriers to participation in health checks

Several barriers to participation in health checks have been identified through interviews with patients and clinical staff. These insights are supported by broader evidence from research and policy literature relating to primary health care, preventive health care, and culturally appropriate service delivery. These include:

• Logistical barriers:
  • Limited appointment availability due to workforce shortages or intermittency, busy clinics and long waiting times (Shahid et al. 2016, AIHW 2023).
  • The long duration and complexity of health checks (Jennings et al. 2014).
  • Long travel distances to health services or preferred health services (AIHW 2023, Beks et al. 2023).
  • Difficulty accessing services at convenient times, particularly for people living in rural and remote areas, with limited transport options, with complex health conditions, or with inflexible work, education, caring and cultural commitments (AIHW 2023, Harfield et al. 2024, Nolan-Isles et al. 2021).
  • Prioritisation of acute care over preventive health services (Yadav et al. 2025).
• Psychosocial barriers:
  • Shame and fear of receiving distressing diagnoses (Shahid et al. 2016, Spurling et al. 2018).
  • Difficulty establishing trust with health professionals, particularly in clinics with high staff turnover or reliance on visiting GPs (Wilson et al. 2020, Veginadu et al. 2024).
  • Concerns about confidentiality, including fears that personal health information may be used in government reporting (Jennings et al. 2014).
  • Discomfort with lifestyle-related components, especially among Aboriginal and Torres Strait Islander health workers attending to elders, clients of the opposite sex, or individuals from different cultural backgrounds (Jennings et al. 2014).
  • Concerns that health checks are too disease-focused, not properly addressing issues like identity crises (Spurling et al. 2018).
  • Lower help-seeking behaviour among men, particularly young men, possibly influenced by social norms (Shahid et al. 2016, Terhaag et al. 2020).
  • Attitudes among some health professionals that health checks are ineffectual or that follow-up will not be delivered (Yadav et al. 2025).
  • Perceived lack of entitlement to accessing community-controlled services in a different area (Beks et al. 2023).
• Additional barriers in mainstream GP settings:
  • Low rates of routine identification of First Nations people (Bailie et al. 2014, Yadav et al. 2025).
  • Lack of awareness of the relevant MBS items (Schütze et al. 2016).
  • Negative past experiences and fear of stigmatisation (Yadav et al. 2025).
  • Affordability of services (where out-of-pocket expenses apply).

Recognising these barriers can inform efforts to improve the accessibility and effectiveness of health checks, and help ensure they remain a meaningful tool for early intervention and better health outcomes for First Nations people.

Data gaps

While this report presents a range of insights into the use of health checks by First Nations people, several important data gaps remain:

• Determinants of variation in uptake: Differences in health check uptake by region, age, and other demographics are evident, but the underlying influences are not well understood. Further insights could be gained through targeted surveys or linked data studies. More detailed exploration of factors such as provider type (ACCHO or mainstream) are of persistent interest.
• Long-term health outcomes: There is limited evidence on whether receiving a health check leads to improved long-term health outcomes. While health checks can support early identification of health needs, meaningful change depends on what follows – whether through care pathways, community-led responses, or individual choices. Evaluating the initiative’s impact over time would require longitudinal outcome data and appropriate comparison groups.
• Unmet need and incomplete visibility of follow-up care: Available data capture only follow-up services billed under specific MBS items. It is not possible to determine how many people required follow-up care but did not receive it, or to account for services delivered through other pathways. For example, follow-up care may be provided under different MBS items, in residential aged care, by practitioners who are not eligible to bill Medicare, or through private health insurance.

Addressing these gaps would support more effective policy and service planning, and help ensure that the health check initiative continues to meet the needs of First Nations communities.

Feedback relating to this report

To date, feedback on this report has been limited to requests for more detailed geographic data. In response:

• SA3-level data have been included in earlier editions and remain available.
• LGA-level data are newly added in this edition, providing more localised insights.

A feedback button is included below. Users are encouraged to share their thoughts, suggestions, or data needs to help improve future editions of this report.

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