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1.17 Perceived health status

Why is it important?

Self-assessed health status provides a measure of the overall level of a population's health based on individuals' personal perceptions of their own health. Health is recognised as having physical, mental, social and spiritual components. Therefore, the measurement of health must go beyond quantifying levels of morbidity and mortality. Part of this broader approach to measuring health is to ask people to assess the state of their own health. Self-assessed health status is dependent on an individual's awareness and expectations regarding their health. It is influenced by various factors, including access to health services and health information, the extent to which health conditions have been diagnosed, and level of education (Delpierre et al. 2009). Social constructs of health also influence this assessment, such as the culturally distinct view of health and wellbeing held by Aboriginal and Torres Strait Islander peoples, the existing level of health within a community and judgments concerning the person's own health compared with others in their community. Self-assessed health status correlates with measures of health, such as reported long-term health conditions, recent health-related actions, and the presence of disability. However, there are some inconsistencies in how Aboriginal and Torres Strait Islander people report their health status, particularly those for whom English is not their main language. Many Aboriginal and Torres Strait Islander people have rated their health as good or excellent despite significant health problems. Self-assessed health status is a useful measure of overall health status, but is not an objective measure and needs to be interpreted with some caution.

Findings

Based on responses from the 2012–13 Health Survey, 39% of Aboriginal and Torres Strait Islander peoples aged 15 years and over reported their health as being very good or excellent, 37% reported their health as being good, and 24% reported their health as being poor or fair. There has been a decline in the proportion of the population rating their health as excellent/very good between 2004–05 and 2012–13 (43% and 39% respectively). Older people were less likely than younger people to report very good or excellent health: 54% in the 15–24 years age group compared with 20% in the 55 years and over age group. Indigenous females were less likely than Indigenous males to report their health as being very good or excellent (37% compared with 42%). Aboriginal and Torres Strait Islander peoples were less likely than non-Indigenous Australians to report very good or excellent health, and the difference between the two populations was greatest in the older age groups. After adjusting for differences in the age structure of the two populations, Aboriginal and Torres Strait Islander peoples were twice as likely as non-Indigenous Australians to report their health as fair or poor.

The proportion of Aboriginal and Torres Strait Islander peoples reporting fair or poor health was highest in NSW, Victoria, and Tasmania (27% for the three jurisdictions), and lowest in the NT (18%). Indigenous Australians aged 15 years and over living in remote/very remote areas were less likely to report their health as being fair or poor (20%) compared with those in non-remote Australia (25%). Despite these results there is evidence that a number of health conditions such as circulatory disease (see measure 1.05) and kidney disease (see measure 1.10) and risk factors such as smoking (see measure 2.15) are worse in remote areas. Interpretation of the question will be influenced by the person's view of 'health' and whether the concept is perceived holistically to include social, culture, emotional and spiritual wellbeing or as a biomedical concept linked to the absence of disease and incapacity (NAHWSP 1989; Vass et al. 2011). It can also be influenced by how an individual assesses their own health relative to other people around them.

Nationally Aboriginal and Torres Strait Islander people reporting the presence of long-term health conditions are more likely to report their health as fair or poor. The proportion of Aboriginal and Torres Strait Islander peoples reporting fair or poor health increases with the number of health conditions reported. A similar pattern can be observed for non-Indigenous Australians.

In 2012–13, 46% of Indigenous Australians in the highest household income quintiles reported very good/ excellent health status, compared with 32% of those in the lowest quintile. Approximately 49% of those who had completed Year 12 reported good/ excellent health status, compared with 29% of those who had completed Year 9 or below. Note: this analysis does not control for age. Based on responses from the 2008 Social Survey, having excellent or very good self-assessed health status is associated with feeling safe, feeling able to have a say with family or friends and within the community, having contact with family or friends outside the household at least once a week, having friends to confide in, no community problems reported and agreeing that most people can be trusted (see measure 1.13).

Implications

Aboriginal and Torres Strait Islander people rate their own general health as poorer than that of other Australians across all adult age groups, particularly in the middle age groups. The differences between the two populations are large, which is consistent with other measures of overall health status. Self-assessed health is one of very few measures of overall health status that are currently available for Aboriginal and Torres Strait Islander peoples throughout the country. Those living in very remote areas are more likely to rate their health as good and less likely to rate it as fair/ poor than other places in Australia. This could be related to definitions of 'health' (holistic or biomedical), the role of connections to family, community, land, sea and spirit and also how an individual assesses their own health relative to other people around them. There is a similar challenge to develop valid measures for comparing international variations in perceptions of health and health-related experiences (Murray et al. 2003; Salomon et al. 2003). On some measures such as the prevalence of end stage kidney disease there is a worsening of health by remoteness (see measure 1.10).

Figure 1.17-1 Self-assessed health status (age-standardised) by Indigenous status, persons aged 15 years and over, 2012–13
chart showing Self-assessed health status (age standardised)

Figure 1.17.1 shows the age-standardised proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians who report their self-assessed health status as very good or excellent; good; or poor or fair. Data is presented for persons aged 15 years and over. Refer to the findings section of this measure for a description of key results found in this figure.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 1.17-2 Self-assessed health status by Indigenous status and age group, persons aged 15 years and over, 2012–13
chart showing Self-assessed health status

Figure 1.17.2 shows the proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians who report their self-assessed health status as very good or excellent; good; or poor or fair. Data is presented separately for the following age groups: 15-24 years; 25-34 years; 35-44 years; 45-54 years; and 55 years and over. Refer to the findings section of this measure for a description of key results found in this figure.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 1.17-3 Self-assessed health status, Indigenous Australians aged 15 years and over, by remoteness, 2012–13
chart showing Self-assessed health status

Figure 1.17-3 shows the proportion of Aboriginal and Torres Strait Islander peoples aged 15 years and over who report their self-assessed health status as very good or excellent; good; or poor or fair. Data is presented separately for major cities; inner regional areas; outer regional areas; remote areas; and very remote areas. Refer to the findings section of this measure for a description of key results found in this figure.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 1.17-4 Self-assessed health status (age-standardised) by Indigenous status and number of long-term health conditions, 2012–13
chart showing self-assessed health status (age-standardised)

Figure 1.17-4 shows the proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 15 years an over who report their self-assessed health status as very good or excellent; good; or poor or fair. Data is presented separately for respondents with no long-term health conditions; 1 long-term health condition; 2 long-term health conditions; and 3 or more long-term health conditions. Refer to the findings section of this measure for a description of key results found in this figure.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 1.17-5 Self-assessed health status, Indigenous Australians aged 15 years and over, by state/territory, 2012–13
chart showing self-assessed health status

Figure 1.17-5 shows the proportion of Aboriginal and Torres Strait Islander peoples reporting fair or poor health in 2012–13 was highest in NSW, Victoria, and Tasmania (27% for the three jurisdictions), and lowest in the NT and the ACT (18% and 21% respectively).

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 1.17-6 Self-assessed health status, Indigenous Australians aged 15 years and over, 2004–05, 2008 and 2012–13
chart showing Self-assessed health status

Figure 1.17-6 shows there has been a decline in the proportion of the Aboriginal and Torres Strait Islander peoples aged 15 years and over rating their health as excellent/very good between 2004–05 and 2012–13 (43% and 39% respectively).

Source: ABS and AIHW analysis of 2012–13 AATSIHS