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Background

This is the fifth report against the Aboriginal and Torres Strait Islander Health Performance Framework (HPF)—see Figure 1

In this report Aboriginal and Torres Strait Islander peoples are also referred to as Indigenous Australians.

The HPF comprises three tiers:

Tier 1—Health status and outcomes

Measures the prevalence of health conditions including disease or injury, human function, life expectancy and wellbeing, and deaths.

Tier 2—Determinants of health

Measures the determinants of health including socio-economic factors, environmental factors and health behaviours

Tier 3—Health system performance

Measures health system performance including effectiveness, responsiveness, accessibility, continuity, capability and sustainability.

The HPF covers the entire health system, including Indigenous-specific services and programmes, and mainstream services. It includes performance measures across the full continuum, from inputs, processes, outputs, and intermediate outcomes to final outcomes.

Detailed Analysis

The detailed statistical analysis, including state-specific reports that underpin the analysis in this report, are available on the Australian Institute of Health and Welfare website at www.aihw.gov.au/indigenous/publications.cfm. For this report, specific citations are included where the data comes from a report/research article and all of the other data are found in the Detailed Analysis.

Data limitations

The statistics in this report are the latest available but some are several years old and therefore may not reflect the impact of recent action.

There are well-documented problems with the quality and availability of data about Aboriginal and Torres Strait Islander health. These limitations include the quality of data on all key health measures—including mortality and morbidity, uncertainty about the size and composition of the Aboriginal and Torres Strait Islander population, and a paucity of available data on other health issues such as access to health services (see the Technical Appendix for details). The following should be noted when interpreting the data analysis:

Under-identification

  • Under-identification of Aboriginal and Torres Strait Islander people is the main issue in most administrative data collections. Under-identification is a major problem in hospital and mortality data collections, particularly for some states and territories.
  • The under-identification of Aboriginal and Torres Strait Islander people in administrative data collections is due to various factors, including:
    • whether the question about Indigenous status is asked in the first instance
    • issues about consistency in the way the question is asked and recorded
    • differing responses by the person involved depending on the situation.
  • Decisions on which data to include have been based on the most recent evaluations (see the Technical Appendix). Work is underway to improve data quality. In future, some measures will have more comprehensive data available.

Coverage by jurisdictions

  • Due to the under-identification issues described above, for some data collections the analysis has been limited to jurisdictions where better data quality is known to exist. Some measures presented in this report are based on an analysis of data for selected jurisdictions only. For example, mortality data are currently only published for NSW, Qld, SA, WA and the NT.

Uncertainty in Indigenous population estimates

  • Measuring the size of the Indigenous population is not easy. The Aboriginal and Torres Strait Islander Census population estimate has varied considerably over the last two decades with a 30% increase in the estimate between 2006 and 2011. Cohort analysis from one Census to the next show that these changes are not entirely due to demographic factors such as births, deaths, migration and immigration. The population is used as the basis of rate calculations and trends have all been updated for this report based on the new 2011 Census estimates—therefore historical estimates have changed from the previous HPF report.

Inconsistencies in the Indigenous status question

  • A standard Indigenous status question has been developed and endorsed nationally (AIHW 2010d). However, the standard question and categories are still not used in data collections across all jurisdictions. For example, in the national perinatal data, Indigenous status is currently based on the mother (missing 30% of babies with an Indigenous father and non‑Indigenous mother). Data on the Indigenous status of the baby is available for reporting from the 2012 collection year.