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Executive summary

Since 2006, Aboriginal and Torres Strait Islander Health Performance Framework (HPF) reports have provided information about Indigenous Australians’ health outcomes, key drivers of health and the performance of the health system. The HPF was designed, in consultation with Aboriginal and Torres Strait Islander stakeholder groups, to promote accountability, inform policy and research, and foster informed debate about Indigenous Australians’ health.

The design of the HPF recognises that the health system and factors beyond the health sector contribute to health outcomes, and that achieving better health outcomes requires a whole-of-government approach, working in partnership with Aboriginal and Torres Strait Islander people (AHMAC 2006).

Introduction

The burden of disease among Aboriginal and Torres Strait Islander people is 2.3 times that of non-Indigenous Australians. Chronic diseases—a group that includes cancer, cardiovascular diseases, mental and substance use disorders, cancer, chronic kidney disease, diabetes, vision loss, hearing loss and selected musculoskeletal, respiratory, neurological and congenital disorders—caused 64% of the disease burden among Indigenous Australians. A significant part of the disparity in health outcomes between Indigenous and non-Indigenous Australians can be explained by disparities in social determinants including education, employment and income. In many cases, Indigenous Australians also have lower access to health services than non-Indigenous Australians, for a range of reasons including barriers such as cost and a lack of accessible or culturally appropriate health services. For Indigenous Australians to have better health outcomes, improvements in the health system and determinants beyond the health sector are required.

Measures of Indigenous Australians’ health status and outcomes drawn from the 2020 Aboriginal and Torres Strait Islander HPF show mixed results over the most recent decade. While there have been improvements in some outcomes, in others progress has stalled or outcomes have become worse. For example, perinatal, infant, and child death rates for Aboriginal and Torres Strait Islander people have declined over the past 20 years, but there has been little change in the ten years to 2018. Key health determinants and risk factors also show mixed outcomes. Similarly, HPF measures of how well the health system is meeting the needs of Aboriginal and Torres Strait Islander people show varying results. These outcomes are discussed in more detail in the national summary report and in the HPF measures.

The health of Aboriginal and Torres Strait Islander people improved on a number of measures over the most recent decade. The proportion of low birthweight babies has decreased. The rate of avoidable deaths has decreased and death rates for cardiovascular disease, diabetes and kidney disease have fallen.

There have also been improvements in some social determinants of health—levels of educational attainment have increased and the proportion of Indigenous Australians living in overcrowded housing has decreased. Among Indigenous Australians, rates of smoking—a key health risk factor—continue to decline.

There have also been some improvements in the health system, such as increases in rates of attendance at antenatal care among Indigenous women. Immunisation rates for Indigenous children have increased, with the vast majority being fully immunised at 5 years. Rates of health checks and use of general practitioner (GP) management plans for chronic diseases have also increased substantially.

Other health outcomes for Indigenous Australians have not improved or have worsened over the most recent decade.

The proportion of Indigenous Australians with diabetes has not changed significantly, and rates of death from cancer and suicide among Indigenous Australians have increased.

There has been little change in the employment rate—a key social determinant of health—among Indigenous Australians. The imprisonment rate among Indigenous adults has increased over the most recent decade. The rate of obesity among Indigenous adults has increased—this is a key health risk factor.

Some areas of health system performance that have worsened for Indigenous Australians over the most recent decade include an increase in the rate of preventable hospitalisations and in the rate of people taking their own leave from hospital before completing treatment. Indigenous Australians are less likely than non-Indigenous Australians to receive a medical or surgical procedure while in hospital, and per person expenditure on prescription medicines is lower for Indigenous Australians than non-Indigenous Australians.

It is often difficult to establish the reasons behind improving or worsening health in a population, for several reasons:

  • The factors that affect health are complex and are often inter-related
  • The relationship between health and health determinants can work in both directions—while education and employment can affect people’s health, health can also affect people’s ability to participate in schooling and work
  • Health is shaped throughout life—an adult’s health is shaped by their life history, daily living conditions and health behaviours (Osborne et al. 2013).

However, the following examples illustrate how measures across the HPF tiers can provide insights into changing health outcomes:

  • the proportion of low birthweight babies has decreased, as the rate of smoking during pregnancy has decreased and the rate of antenatal care visits early in pregnancy has increased
  • deaths from cardiovascular disease have decreased along with a decreased rate of smoking and increased rates of hospital procedures related to coronary heart disease.

The following Key facts in detail section includes some additional results that are available from the full set of measures (listed at Appendix 1) at indigenoushpf.gov.au.

Key facts in detail

The following key facts are structured into three groups: outcomes that have improved, those where there has been no recent change, and those that worsened over time. Changes over time cannot be assessed for all measures, as trend data are not available in all cases.

Outcomes have improved for a number of measures

The proportion of low birthweight babies (excluding multiple births) born to Indigenous mothers fell from 11.3% in 2007 to 10.7% in 2017. There is a strong relationship between low birthweight and smoking during pregnancy, which has also declined (see below).

Between 2006 and 2018, the age-standardised rate of avoidable deaths among Indigenous Australians fell from 374 to 303 per 100,000. Indigenous Australians died from avoidable causes at three times the rate of non-Indigenous Australians.

Cardiovascular disease (CVD) is the second leading cause of death among Aboriginal and Torres Strait Islander people. The age-standardised death rate for CVD fell from 323 per 100,000 in 2006 to 229 per 100,000 in 2018. The decline in mortality from CVD coincided with reductions in smoking rates and an increase in hospitalisations for CVD-related procedures.

Levels of educational attainment have improved over the decade. The proportion of Indigenous Australians aged 20–24 who had a Year 12 or equivalent qualification increased from 45% in 2008 to 66% in 2018–19. The rate at which Indigenous adults completed higher education courses increased from 38 to 67 per 10,000 between 2001 and 2018–19.

There has been some improvement in the rate of youth justice supervision among Indigenous youth (decreasing from 212 to 170 per 10,000 population between 2010–11 and 2017–18). However, Indigenous Australians represented nearly half (47%) of all young people in detention in 2017–18.

In 2016, 38% of Indigenous households were home owners/buyers—an increase from 32% in 2001. The proportion of Indigenous Australians who lived in overcrowded households fell from 27% in 2004–05 to 18% in 2018–19.

Household incomes of Indigenous adults increased in real terms (that is, after adjusting for inflation) from $544 to $802 per week between 1996 and 2016. Other Australian adults experienced a weekly increase in household income from $801 to $1,096 over the same period.

The proportion of Indigenous Australians aged 15 and over who smoked daily fell from 45% in 2008 to 37% in 2018–19. The proportion of Indigenous Australians aged 15–17 who smoked fell from 22% to 13% between 2008 and 2018–19 and the proportion who had never smoked increased from 72% to 85% over the same period. The proportion of Indigenous women who smoked during pregnancy fell from 54% in 2006 to 44% in 2017.

In 2017, 99.2% of Indigenous mothers accessed antenatal care services at least once during their pregnancy. From 2012 to 2017, the proportion of Indigenous mothers who attended antenatal care in the first trimester (less than 14 weeks) increased from 51% to 63%. Mothers who attend antenatal care during pregnancy are more likely to have babies in the healthy birthweight range.

The proportion of Indigenous children aged 1 who were fully immunised increased from 82% in 2001 to 92% in 2018. The immunisation rate for Indigenous 5-year-olds increased from 77% in 2008 to 97% in 2018, which was higher than the non-Indigenous rate of 95% in 2018.

The number of health assessments for Indigenous Australians increased fourfold between 2009–10 and 2018–19, from 68 to 297 per 1,000. Health check rates increased across all age groups over this period. There was also an increase in the proportion of Indigenous women aged 50–69 who were screened for breast cancer, from 31% in 1999–00 to 37% in 2017–18.

Between 2009–10 and 2017–18, the age-standardised rate of Medicare Benefit Schedule (MBS) claims for Indigenous Australians for chronic disease management plans increased—from 55 to 125 per 1,000 for Team Care Arrangements (TCAs) and from 69 to 142 per 1,000 for GP Management Plans (GPMPs). In 2018, the rate for TCAs and GPMPs combined was 1.4 times the rate for non-Indigenous Australians (267 per 1,000 compared with 185 per 1,000).

The number of Commonwealth-funded Indigenous-specific primary health-care organisations increased from 108 in 1999–00 to 198 in 2017–18. Episodes of care delivered by these organisations increased from 1.2 million to 3.6 million and the number of health care workers in these organisations more than tripled from 2,300 to 8,200 over the same period.

In 2018–19, 92% of Indigenous Australians reported they had a usual place to go for health problems and advice, an increase from 87% in 2012–13. Those with a usual general practitioner or medical service reported higher rates of satisfaction with their health care experience than those without one.

The rate of general practitioner Medicare Items claimed by Indigenous Australians increased by 42% between 2003–04 and 2017–18. Indigenous Australians used GP services at rates that were slightly higher than those for non-Indigenous Australians (1.2 times) but do not reflect the higher level of need among Indigenous Australians.

Between 2004–05 and 2016–17, the proportion of Indigenous Australians who received a hospital procedure increased from 53% to 64%. However, Indigenous hospital patients were less likely to undergo a medical or surgical procedure than non-Indigenous Australians (64% compared to 81% in the period July 2015 to June 2017).

However, there has been little or no recent change for some measures

The crude death rate for Indigenous Australians in 2014–2018 was 418 per 100,000. Between 1998 and 2018, the age-standardised death rate for Indigenous Australians decreased significantly by 32%. However, most of the decline occurred between 1998 and 2006 (a 27% decrease) and there was a slower rate of decline from 2006 to 2018 (by 10%).There was no change in rates of death from respiratory disease or injuries between 2006 and 2018.

Perinatal death rates among Indigenous Australians declined over the past 20 years, but most of this decline was for the period 1998 to 2007 and there has been little or no change in the 10-year period to 2018. In 2008, the perinatal death rate was 9.7 per 1,000 births, compared with 9.0 per 1,000 births in 2018.

In 2018–19, 31% of Indigenous adults reported high or very high levels of psychological distress, not significantly different from 2014–15 (33%). A higher proportion of those who had been removed from families or had relatives removed from families had high or very high levels of psychological distress (38%) compared to those who were not removed from their families (26%).

The employment rate for Indigenous Australians remained unchanged between 2008 and 2018–19 (48% and 49%, respectively).

Some measures have worsened

Cancer is currently the leading cause of death among Indigenous Australians. Between 2006 and 2018, the age-standardised death rate from cancer among Indigenous Australians increased from 205 to 235 per 100,000. A decrease in the cancer death rate among non-Indigenous Australians occurred over the same period, leading to a widening of the gap. Indigenous Australians have lower cancer screening rates and are more likely to be diagnosed with cancer at more advanced stages resulting in lower cancer survival rates.

In 2014–2018, the suicide rate for Indigenous Australians was 24 per 100,000. There was an increase (49%) in suicide rates for Indigenous Australians between 2006 and 2018 from 18 to 24 per 100,000 with the highest rate of suicide being among those aged 35–39. From 2004–05 to 2016–17, the rate of hospitalisation due to intentional self-harm increased by 120% for Indigenous females (from 2.2 to 4.5 per 1,000) and increased by 81% for Indigenous males (from 1.6 to 3.3 per 1,000).

Between 2004–05 and 2016–17, the age-standardised rate of Indigenous Australians hospitalised after an assault increased from 4.2 to 6.9 per 1,000 population for females and from 1.6 to 2.4 per 1,000 population for males. In the period July 2015 to June 2017, the hospitalisation assault rate (age-standardised) was highest in Remote areas (25 per 1,000 population).

There was an increase of 61% in the imprisonment rate for Indigenous adults (from 1,337 to 2,088 per 100,000) between 2006 and 2019, compared with an increase of 36% for non-Indigenous adults (from 132 to 173 per 100,000) (age-standardised). In 2019, Aboriginal and Torres Strait Islander adults were imprisoned at twelve times the rate of non-Indigenous Australian adults (age-standardised).

The age-standardised rate of Medicare claims for specialist care among Indigenous Australians did not change significantly between 2009–10 (252 per 1,000) and 2017–18 (236 per 1,000). Rates for Indigenous Australians were lower than those for non-Indigenous Australians across all remoteness areas, with the largest difference in Very remote areas (70% lower).

In the two-year period July 2015 to June 2017, 15% of all hospitalisations (excluding dialysis) of Indigenous Australians were potentially preventable. Between 2010–11 and 2016–17, the potentially preventable hospitalisation rate for chronic conditions among Indigenous Australians increased from 30 to 34 per 1,000 population (age-standardised). The age-standardised rate of potentially preventable hospitalisations for Indigenous Australians with acute conditions also increased, from 24 per 1,000 in 2010–11 to 29 per 1,000 in 2016–17.

The age-standardised rate at which Indigenous Australians took their own leave from hospital increased from 11 per 1,000 population in 2004–05 to 16 per 1,000 population in 2016–17.

More details about the selected findings are found within the HPF measures.

 Key facts by tier

These findings are based on analysis of change over time for the relevant time period.

Improving

Health status and outcomes

Start date

End date

Low birthweight (Measure 1.01)

2007

2017

Decrease in the proportion of low birthweight live born babies born to Indigenous mothers (excluding multiple births) (%)a

11.3

10.7

Circulatory (cardiovascular) disease (Measure 1.05)

2006

2018

Decrease in the age-standardised rate of deaths from cardiovascular disease among Indigenous Australians (per 100,000 population)b

323

229

Diabetes (Measure 1.09)

2006

2018

Decrease in the age-standardised rate of deaths from diabetes among Indigenous Australians (per 100,000 population)b

93

72

Kidney disease (Measure 1.10)

2006

2018

Decrease in the age-standardised rate of deaths from kidney disease among Indigenous Australians (per 100,000 population)b

45

20

Avoidable and preventable deaths (Measure 1.24)

2006

2018

Decrease in the age-standardised rate of avoidable deaths among Indigenous Australians (per 100,000 population)b

374

303

Determinants of health

Start date

End date

Housing (Measure 2.01)

2004–05

2018–19

Decrease in the proportion of Indigenous Australians living in overcrowded housing (%)

27

18

Education outcomes for young people (Measure 2.05)

2008

2018–19

Increase in the proportion of Indigenous Australians aged 20–24 who had a Year 12 or equivalent qualification (%)

45

66

Tobacco use (Measure 2.15)

2008

2018–19

Increase in the proportion of Indigenous Australians aged 15–17 who had never smoked (%)

72

85

Health system performance

Start date

End date

Antenatal care (Measure 3.01)

2012

2017

Increase in the age-standardised proportion of Indigenous women accessing antenatal care in first trimester of pregnancy (%)

51

63

Immunisation (Measure 3.02)

2008

2018

Increase in the proportion of Indigenous children fully immunised at age 5 (%)

77

97

Early detection and early treatment (Measure 3.04)

2009–10

2018–19

Increase in the rate of health checks for Aboriginal and Torres Strait Islander people (per 1,000 population)

68

297

Chronic disease management (Measure 3.05)

2009–10

2017–18

Increase in the age-standardised rate of claims for GP management plans for chronic disease (per 1,000 population)

69

142

a Data from New South Wales, Victoria, Queensland, Western Australia, South Australia, and the Northern Territory combined.

b Data from New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory combined.

 These findings are based on analysis of change over time for the relevant time period.

 Not improving

Health status and outcomes

Start date

End date

Cancer (Measure 1.08)

2006

2018

Increase in the age-standardised rate of deaths from cancer among Indigenous Australians (per 100,000 population)a

205

235

Diabetes (Measure 1.09)

2012–13

2018–19

No significant change in the prevalence of self-reported diabetes among Indigenous adults (%)

7.7

7.9

Social and emotional wellbeing (Measure 1.18)

2006

2018

Increase in the age-standardised suicide rate among Indigenous Australians (per 100,000 population)a

18

24

Infant and child mortality (Measure 1.20)

2008

2018

No significant change in the rate of child deaths (aged 0–4) for Indigenous Australians (per 100,000 population)b

160

147

Perinatal mortality (Measure 1.21)

2008

2018

No significant change in the rate of perinatal deaths (stillbirths and infant deaths within 28 days following birth) for Indigenous Australians (per 1,000 births)a

9.7

9.0

Determinants of health

Start date

End date

Employment (Measure 2.07)

2008

2018–19

No significant change in the employment-to-population ratec among Indigenous Australians aged 15–64 (%)

48

49

Contact with the criminal justice system (Measure 2.11)

2006

2019

Increase in the age-standardised imprisonment rate of Indigenous Australians (per 100,000 population)

1,337

2,088

Overweight and obesity (Measure 2.22)

2012–13

2018–19

Increase in the proportion of Indigenous Australians aged 15 and over who are overweight or obese (%)

66

71

Health system performance

Start date

End date

Selected potentially preventable hospital admissions (Measure 3.07)

2013–14

2016–17

Increase in the age-standardised rate of potentially preventable hospitalisations among Indigenous Australians (per 1,000 population)

63

70

Discharge against medical advice (Measure 3.09)

2004–05

2016–17

Increase in the age-standardised rate at which Indigenous hospital patients leave hospital without completing treatment (per 1,000 population)d

11

16

Access to services compared with need (Measure 3.14)

2012–13

2018–19

No change in the proportion of Indigenous Australians who needed to go to a health provider in the previous 12 months but didn’t (%)

30

30

a Data from New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory combined.

b Data from New South Wales, Western Australia, South Australia, and the Northern Territory combined.

c Excludes employment through the Community Development Employment Projects Scheme.

d Data from New South Wales, Victoria, Queensland, Western Australia, South Australia, and the Northern Territory combined.

 For more information on these key facts and their broader context please refer to the Measures section.