This report presents analysis of ongoing Aboriginal and Torres Strait Islander health-related data collections of the Australian Institute of Health and Welfare to 1992. In addition, information was derived from a variety of different data sources to generate a comprehensive picture of the health status of Aboriginal and Torres Strait Islander peoples. The report was prepared to inform the National Aboriginal Health Strategy Evaluation Committee on the current state of Aboriginal and Torres Strait Islander health and provide it with an analysis of trends in mortality over 1985-92.

Significant differences were found between the mortality, morbidity and disability experiences of Aboriginal and non-Aboriginal populations. Differences exist both in the types of diseases and disabilities as well as in their magnitude. The time-series analysis suggested that health differentials between non-Aboriginal and Aboriginal Australians have increased in recent years.

Aboriginal death rates greatly exceed the corresponding total Australian rates at all ages. While there has been a steady decline in non-Aboriginal age­standardised death rates over 1985-92, limited reduction in these rates was noted for Aboriginal and Torres Strait Islander peoples. These differences are reflected in the expectation of life at birth which for an Aboriginal boy is between 16 and 18 years shorter than his non-Aboriginal counterpart; the gap is slightly wider for an Aboriginal girl.

The growing impact of non-communicable diseases-particularly cardiovascular disease and diabetes-without much decline in infectious­ disease mortality is a phenomenon peculiar to Aboriginals. With adult prevalence rates exceeding 30% in some communities and age-standardised mortality more than seven times that of the non-Aboriginal rate, diabetes is now one of the major health concerns among Aboriginal and Torres Strait Islander peoples. Preventable communicable diseases also continue to contribute disproportionately to high Aboriginal and Torres Strait Islander mortality. Although there has been some reduction in mortality from these diseases lately, a clear diminution in the impact of communicable diseases is not yet in sight.

For Aboriginal and Torres Strait Islander males, the hospital admission rate for the year 1991-92 was 60% higher than that expected from the indirectly age­ standardised rate for non-Aboriginal males. The hospitalisation rate for Aboriginal and Torres Strait Islander females, which also included admissions for childbirth, was 50% higher than the corresponding indirectly age­ standardised rate for non-Aboriginal females. The hospitalisation data included in the analysis were limited to New South Wales and South Australia on account of poor identification of indigenous peoples in hospital separations of other States and Territories.

No national or state-level data are available on disability and handicap in Aboriginal and Torres Strait islander peoples. A recent survey in the Taree area of New South Wales has revealed that one out of every four Aboriginal persons suffers from one or more disabilities. A significant proportion of those surveyed were also found to be handicapped by their disability. Although the results obtained from a localised survey can not be generalised to the whole indigenous community, the rate ratios for the Taree Aboriginals are indicative of the extent of disability and handicap that may be prevalent particularly in view of the high prevalence of debilitating and chronic diseases in Aboriginal and Torres Strait Islander peoples.

Identification of indigenous peoples in health-related collections is poorly validated and almost certainly inadequate. Substantial under-identification of births, deaths and hospitalisation of Aboriginal and Torres Strait Islander peoples is likely, with resulting underestimation of rates of health events. To generate reliable statistics, this problem needs to be addressed by agencies responsible for the collection of vital statistical and health data.

The state of Aboriginal health may be worse than that documented here because of the above-mentioned difficulties. Considerable caution is therefore necessary when interpreting the findings presented in this report.