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Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

Aboriginal and Torres Strait Islander Health Performance Framework - Summary report
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Suggested citation:
Australian Institute of Health and Welfare 2024. Aboriginal and Torres Strait Islander Health Performance Framework: summary report March 2024. Canberra: AIHW. Accessed [insert date].
This report summarises the latest information health outcomes, health system performance and the broader determinants of health for Aboriginal and Torres Strait Islander (First Nations) people, drawing from the Health Performance Framework (HPF) measures. A pdf copy of the web report is available for download below (version released on 21 March 2024). Please check the online version for any available updates.
Download Report (4.9 MB)

This release incorporates updates from the following measures: 1.01 Birthweight, 1.06 Acute rheumatic fever and rheumatic heart disease, 1.12 HIV, hepatitis and sexually transmissible infections, 1.20 Infant and child mortality, 1.21 Perinatal mortality, 2.11 Contact with the criminal justice system, 2.12 Child protection, 2.21 Health behaviours during pregnancy, 3.01 Antenatal care, 3.06 Access to hospital procedures, 3.07 Selected potentially preventable hospital admissions, 3.09 Self-discharge from hospital.


In 2018, the burden of disease among Aboriginal and Torres Strait Islander (First Nations) people was 2.3 times that of non-Indigenous Australians. Among First Nations people, mental and substance use disorders were the leading contributor to disease burden (24%).

Measures of health status (Tier 1), determinants of health (Tier 2), and health system performance (Tier 3) drawn from the Aboriginal and Torres Strait Islander Health Performance Framework (HPF) show mixed results. It is important to note that measures in the 3 tiers are interconnected, and understanding the reasons for progress (or lack thereof) in the health status and outcomes of First Nations people may often be best understood by examining relevant measures in determinants of health and health system performance.

AIHW analysis of ABS health survey data for 2017–19 showed that an estimated 35% of the total health gap between First Nations people and non-Indigenous Australians was explained by social determinants (e.g. employment, income, education, housing), and a further 30% by selected health risk factors (e.g. smoking). Around 35% of the gap was unexplained, reflecting factors that could not be included in the analysis. For example, these factors may include access to affordable and culturally appropriate health care services, connection to Country and language, and effects of structural disadvantage and racism.

First Nations people are often found to have relatively poorer access to health services than non-Indigenous Australians in relation to need, for a range of reasons, including barriers such as availability, cost and a lack of culturally appropriate health services. The HPF measures have a particular focus on differences by remoteness, given that in general, First Nations people living in rural and remote areas are more likely to live with, and die prematurely from, a disease or injury. 

The HPF highlights that enhanced health services and continued improvement in, and access to, comprehensive, culturally appropriate and safe primary health care services are needed to support improvements in the health and reduce the burden of disease among First Nations people.

For First Nations people, self-determination and empowerment, cultural identity, family and kinship, Country and caring for Country, knowledge and beliefs, language and participation in cultural activities and access to traditional lands are also key determinants of health and wellbeing.

The HPF shows improvements in some aspects of First Nations people’s health and social determinants, while other aspects have either not improved or worsened.

Across the HPF measures, in the last decade or so, there have been improvements in health-related measures such as smoking (including during pregnancy), attendance at antenatal care, immunisation, health assessments, chronic disease management, early detection and early treatment, deaths from cardiovascular and kidney diseases, and self-discharge from hospital. Social determinants such as Year 12 attainment, employment and home ownership, and youth detention have also improved.

However, there has been little or no progress in some measures, while some others have worsened. For example, measures such as birthweight, infant and child mortality, perinatal mortality, diabetes mortality, avoidable mortality and potentially preventable hospitalisations have shown little or no progress; while measures of suicide, death from cancer, female hospitalisation for assault, children in out-of-home care, and adult imprisonments have all worsened.