This report contains detailed analyses against indicators in the Aboriginal and Torres Strait Islander Health Performance Framework (the HPF). The HPF is designed to provide the basis to monitor the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSH) and inform policy analyses, planning and program implementation. The HPF consists of 71 indicators covering three tiers—health status and outcomes, determinants of health and health systems performance (see Figure 1).

Due to data quality issues related to Indigenous identification, hospitalisations and mortality data for Indigenous Australians are reported for some jurisdictions only and this may affect the completeness of data presented in this report. Hospitalisations data are reported for New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory while mortality data are reported for New South Wales, Queensland, South Australia, Western Australia and the Northern Territory.

A summary of the key findings under each tier are outlined below.

Health status and health outcomes

Health status and outcomes (Tier 1) covers a range of health issues affecting Aboriginal and Torres Strait Islander Australian Australians. The information presented in this tier is important for tracking progress against a number of COAG closing the gap targets such as life expectancy, infant and child mortality, and all-cause mortality.

This tier contains 4 domains: health conditions (12 indicators), human function (two indicators), life expectancy and wellbeing (four indicators) and deaths (seven indicators).

Areas of improvement

Small but significant health gains have been made in a number of areas which shows positive signs towards closing the gap in health disadvantage between Indigenous and non-Indigenous or other Australians:

  • Between 2001 and 2008, there has been a slight decrease in the prevalence of ear and hearing problems among Indigenous males (18% to 11% respectively) and females (18%to 10%)
  • Over the period 2001–02 to 2007–08 there has been a significant decline in Indigenous hospitalisation rates for pneumonia (8% decline)
  • Significant closing of the gap between Indigenous and non-Indigenous infant and perinatal mortality; due to a 43% decline in infant mortality and a 34% decline in perinatal mortality between 1999 and 2008
  • Over the period 1991–2008, there was a significant decline (25% reduction) in all-cause mortality for Indigenous Australians with a 24% decline in the gap between Indigenous and non-Indigenous Australians
  • Between 1997 and 2008, there has been a 29% decline in the rate of deaths from circulatory disease, and a 23% decline in respiratory diseases death rate
  • Deaths from avoidable causes among Indigenous Australians declined significantly (20%decline) between 1997 and 2008

Areas needing further work

Despite making progress in some areas, Indigenous Australians are lagging behind in a large number of areas where further improvements need to be made to close the gap in health disadvantage:

  • Babies of Indigenous mothers are still twice as likely to be of low birthweight as babies born to non-Indigenous mothers and over the period 1991–2008 the rate difference between low birthweight babies born to Indigenous and non-Indigenous mothers has increased significantly (13% increase)
  • Indigenous hospitalisation rates for all major health conditions have increased by 21%from 2001–02 to 2007–08 with an increase of 42% in the rate difference between Indigenous and other Australians
  • Hospitalisations for diabetes among Indigenous Australians in 2007–08 was 4 times the rate of other Australians and there has been a significant increase (17%) in diabetes hospitalisations for Indigenous Australians over the period 2000–01 to 2007–08
  • The incidence rate of treated end stage renal disease (ESRD) for Indigenous Australians was around eight times the rate of non-Indigenous Australians. The number of Indigenous patients starting ESRD treatment has more than quadrupled since 1991 (from54 in 1991 to 242 in 2008) and Indigenous patients starting ESRD treatment are substantially younger compared to non-Indigenous Australians
  • Rates of gonorrhea and chlamydia have increased significantly between 1994–1996 to2006–2008 (by 61% and 199% respectively)

Determinants of health

Determinants of health (Tier 2) are reported for a range of factors and behaviours that contribute towards health status among Aboriginal and Torres Strait Islander Australians. In this tier, there are 5 domains: environmental factors (three indicators), socioeconomic factors (seven indicators), community capacity (seven indicators), health behaviours (eight indicators) and person-related factors (one indicator).

Areas of improvement

There have been improvements in several key health determinants in recent years including:

  • The proportion of Indigenous people living in overcrowded households declined from around 29% to 25% between 2001 and 2006
  • Indigenous school retention rates to Years 10, 11 and 12 have steadily increased over the last 5 years.
  • The proportion of Indigenous Australians reporting that the highest year of school completed was Year 12 has increased from 19% in 2002 to 23% in 2008
  • Rate of employment among Indigenous Australians increased between 2001 and 2008(from 44% to 54%)
  • The proportion of Aboriginal and Torres Strait Islander people who own their own home has increased slightly from 27% in 1996 to 33% in 2008
  • Hospitalisations for assault among Indigenous Australians have declined slightly over the period 2001–02 to 2007–08
  • The proportion of Indigenous Australians aged 15 years and over who are current smokers (daily or less frequently) declined from 52% in 1994 to 47% in 2008

Areas needing further work

  • Indigenous children are twice as likely as non-Indigenous children to live in households with daily smokers (65% vs 32% in 2007–08)
  • Proportions of Indigenous students in Years 3, 5, 7 and 9 achieving reading, writing and numeracy benchmarks are lower compared to non-Indigenous children
  • In 2008, approximately 49% of Indigenous Australian adults were in the lowest quintile of equivalised gross weekly household income compared with 20% of non-Indigenous Australians. Only 4.9% of Indigenous Australians were in the highest quintile of equivalised gross weekly household income compared with 22% of non-Indigenous Australians
  • While Indigenous Australians are less likely than non-Indigenous Australians to consume alcohol, of those who do consume alcohol, around 55% consumed it at long-term risky or high risk levels
  • An estimated 23% of Indigenous Australians reported substance use in the last 12months, and 43% reported ever using a substance
  • The rate of Indigenous imprisonment has increased by 11% since 2007Aboriginal and Torres Strait Islander mothers smoked during pregnancy at around three times the rate of non-Indigenous mothers
  • The level of sedentary physical activity for Indigenous Australians has increased between 2001 and 2004–05 from 37% to 47%
  • Approximately 5% of Indigenous children did not usually eat fruit and 4% did not usually eat vegetables while a further 33% reported consuming one serve or less of fruit per day and 27% reported having one serve or less of vegetables per day
  • Approximately 60% of Indigenous adults were overweight or obese in 2004–05, which is an increase from 1995 and 2001. Indigenous Australians are nearly twice as likely to be obese as non-Indigenous Australians.

Health system performance

Health system performance (Tier 3) reports on the performance of the health system including population health, primary health care and secondary/tertiary care services. The indicators selected for this publication are drawn from these sectors, and are intended to cover six domains of performance: effectiveness, appropriateness and efficiency of health services (seven indicators), responsiveness of health services to Aboriginal and Torres Strait Islander communities and individuals (four indicators), accessibility of services (three indicators), capability (two indicators) and sustainability (two indicators). Measures included in this tier encompass those dealing with a range of programs and service types including child and maternal health, early detection and chronic disease management, continuous care, assess to secondary/tertiary care, the health workforce and expenditure.

Areas of improvement

  • In 2007, 97% of Indigenous mothers attended at least one antenatal care session during pregnancy
  • Indigenous primary health-care services that provide management of chronic disease have increased by 20% between 2001–02 and 2008–09
  • A high proportion of Aboriginal Health Services (91%) provide care planning for people with chronic diseases
  • While Aboriginal and Torres Strait Islander people are more likely than other Australians to be discharged from hospital against medical advice, the gap between Indigenous and other Australians in the rate of discharge against medical advice has reduced from 19 times the rate of other Australians in 2001–02 to 16 times the rate in 2007–08
  • The number of Indigenous people in health related occupations have increased by 64% between 1996 and 2006
  • Between 2004–05 and 2008, the proportion of Indigenous Australians reporting problems accessing health care has decreased from 42% to 30%
  • A large proportion of Indigenous Australians report that they usually go to the same GP or medical service (91%)
  • Between 2001 and 2008, the number and rate of Indigenous students who have both enrolled and completed undergraduate health-related courses have shown a slight increase. The proportion of Indigenous students enrolled in VET sector health-related courses has also increased between 2003 and 2007 (from around 4% to 6%)

Areas needing further work

Gaps remain in health system performance and access to services for Aboriginal and Torres Strait Islander people.

  • Rates of immunisation remain lower among Indigenous children, compared with other children, at ages 1, 2 and 5
  • Participation in the BreastScreen program by Indigenous women aged 50–69 years was markedly lower than the national rate for all females in that age group (36% compared with 55%)
  • Although Indigenous Australians were more likely to be hospitalised than other Australians, they were less likely to undergo a procedure once admitted to hospital. While there has been a significant increase in hospital procedure rates for Indigenous Australians, only 59% of Indigenous hospitalisations had a procedure recorded,compared with 81% of hospitalisations for other Australians during the period July 2006 to June 2008
  • Indigenous persons were almost six times as likely as other persons to discharge themselves from hospital against medical advice
  • Between 2001–02 and 2007–08 there has been a significant increase in the ambulatory care sensitive conditions hospitalisations for Indigenous Australians, particularly for potentially preventable chronic conditions including diabetes. The gap between Indigenous and non-Indigenous hospitalisations for preventable chronic conditions has widened over this period by an average increase of 27% per year
  • In 2005–06, there were around twice as many contacts with community mental healthcare services for Aboriginal and Torres Strait Islander people as for other people
  • On a per person basis, average health expenditure for Indigenous people was $5,568.50,which was 31% higher than the expenditure for non-Indigenous Australians ($4,247.00).Much of the expenditure was on four areas: community health services, patient transport, public health and public hospitals. However, the average health expenditure on services provided outside of public hospitals for Indigenous Australians was half that of non-Indigenous Australians.