NACCHO Aboriginal Health : Some big improvements but challenges remain says the @aihw 2018 Report : The report card is in—and here’s what we can learn

 ” There have been some big improvements in the health of Australia’s Aboriginal and Torres Strait Islander population—but challenges remain.

Life expectancy for Indigenous Australians has improved over time and with higher education attainment closely associated with better health outcomes, rising year 12 completion rates among Indigenous Australians are a positive sign.

There have also been reductions in smoking rates and alcohol use, as well as a significant improvement in child death rates.

While the improvements seen in recent years are positive, the report shows that social factors are key to making further progress—social factors such as employment, education and income are responsible for about one-third of the health gap between Indigenous and non-Indigenous Australians.

By comparison, health risk factors such as smoking and obesity account for one-fifth of the health gap.

In 2015–16, Indigenous primary health care services were delivered across nearly 370 sites, more than two-thirds of which were in Very remote (33%), Remote (13%) and Outer regional (23%) areas.”

From Executive summary see Part 1 Below

Or See Pages 305 -357 in report for more detail

Download Here

 ” Australia is generally a healthy nation but there are some key areas where we could do better, according to the latest report from the Australian Institute of Health and Welfare (AIHW).

The two-yearly report card, Australia’s health 2018, was launched today by the Hon. Greg Hunt MP, Minister for Health.”

See Part 2 Below

Download Brief aihw-aus-222.pdf

Part 1 Overview Indigenous Health

Aboriginal and Torres Strait Islander people are the Indigenous peoples of Australia. Indigenous Australians can be of Aboriginal origin, Torres Strait Islander origin, or both.

There were an estimated 787,000 Indigenous Australians in 2016—3.3% of the total Australian population, with an estimated growth in their population size of 19% since 2011.

This chapter presents information on the health status of the Indigenous population, as well as the determinants of health and access to health services that are specific to the Indigenous population.

For Indigenous Australians, good health is more than the absence of disease or illness; it is a holistic concept that includes physical, social, emotional, cultural, spiritual and ecological wellbeing, for both the individual and the community.

This concept of good health emphasises the connectedness of these factors and recognises how social and cultural determinants can affect health.

As a group, Indigenous Australians experience widespread disadvantage and health inequality. In 2014–15, Indigenous Australians were at almost half as likely as non-Indigenous Australians to rate their health as ‘fair’ or ‘poor’, and much less likely to rate their health as ‘excellent’ or ‘very good’.

Compared with non-Indigenous Australians, Indigenous Australians are 1.7 times as likely to have disability or a restrictive long-term health condition and 2.7 times as likely to experience high or very high levels of psychological distress.

The gap in life expectancy between Indigenous and non-Indigenous Australians in 2010–2012 was around 10.6 years for males and 9.5 years for females. Health inequality can start early for Indigenous people—reflected in infant and child mortality rates being generally higher in their communities.

Further, although rates have declined in recent years, Indigenous children are 2.1 times as likely as non-Indigenous children to die before the age of 5.

Indigenous children and adolescents are also far more likely than non-Indigenous children to be affected by ear infections and hearing loss. Although the proportion of Indigenous children with poor ear health and hearing loss has decreased in the last 15 years, the rate of long-term ear/hearing problems in children aged 0–14 is still almost 3 times that for non-Indigenous children (8.4% compared with 2.9%). Poor ear and hearing health can profoundly affect a child’s life, impeding cognitive development, auditory processing skills and speech and language development.

Hearing loss can lead to social isolation and problems with school attendance, which, in turn, can have life-long negative social consequences. For many Indigenous children, hearing loss and the associated aftermaths further compound many of the disadvantages already facing Indigenous Australians.

Much of the understanding of the ‘health gap’ between Indigenous and non-Indigenous Australians is based on factors generally recognised as contributing to good health, including:

  • differences in the social determinants of health—Indigenous Australians, on average, have lower levels of education, employment, income, and poorer quality housing than non-Indigenous Australians
  • differences in health risk factors—Indigenous Australians, on average, have higher rates of risk factors that can lead to adverse health outcomes, such as tobacco smoking, risky alcohol consumption and insufficient physical activity for good health
  • differences in access to appropriate health services—Indigenous Australians are more likely than non-Indigenous Australians to report greater difficulty in accessing affordable health services that are close by.

Socioeconomic factors account for more than one-third (34%) of this health gap—household income is the largest individual contributor to the overall gap (14%), followed by employment status (12%).

Health risk factors contribute 19% of the gap—with differences in smoking rates between Indigenous and non-Indigenous Australians being the largest contributor, at 10%. While the Indigenous smoking rate has fallen substantially in recent years—from 51% in 2002 to 42% in 2014–15—it is still 2.7 times as high as that for non-Indigenous Australians.

Access to appropriate, high-quality and timely health care can help to improve health outcomes. Indigenous Australians can use mainstream or Indigenous-specific primaryhealth care services.

In 2015–16, Indigenous primary health care services were delivered across nearly 370 sites, more than two-thirds of which were in Very remote (33%), Remote (13%) and Outer regional (23%) areas.

The geographic distribution of the Indigenous population can pose substantial challenges for workforce recruitment and delivery of health services. For example, access to midwives is critical for the health of Indigenous women, who are less likely to attend antenatal care in the first trimester of pregnancy, and have higher levels of social disadvantage.

These factors contribute to the higher likelihood that babies born to Indigenous mothers will be premature, of low birthweight and/or will die before their first birthday. Looking at the supply of midwives across Australia, 15% of Indigenous women of child-bearing age live in areas likely to pose the highest challenges for supply of a midwife workforce.

This percentage is 8 times as high as that for non-Indigenous women of child-bearing age (1.8%).

Part 2 AIHW Press Release

Australia is generally a healthy nation but there are some key areas where we could do better, according to the latest report from the Australian Institute of Health and Welfare (AIHW).

The two-yearly report card, Australia’s health 2018, was launched today by the Hon. Greg Hunt MP, Minister for Health.

Download Brief aihw-aus-222.pdf

The report shows that Australia sits squarely in the best third of OECD countries when it comes to life expectancy, with girls born in 2016 likely to live 84.6 years, while boys can expect to live to 80.4 years.

Fewer of us are smoking or putting ourselves at risk from long-term alcohol use than in the past. More of our children have been immunised and we’re doing well in terms of preventing avoidable deaths.

At an individual level, we’re feeling the effects of these good results, with more than 4 in every 5 Australians grading their own health to be at least ‘good’—if not ‘very good’ or ‘excellent’.

But with a population that is living longer, we are now experiencing higher rates of chronic and age-related conditions. For example, we know that older Australians use a higher proportion of hospital and other health services and 75% of all PBS medicines were dispensed to people aged 50 and over.

And with health spending continuing to rise—reaching $170 billion in 2015–16 and outstripping population growth—we see the important role our health system plays in both prevention and treatment.

Long-term health conditions are common—often underpinned by lifestyle factors

Half of Australians have a common chronic health condition, such as diabetes, heart disease, a mental illness, or cancer. Importantly, almost a quarter of us have two or more of these conditions, often making our experiences of health and healthcare particularly complex.

Many chronic health conditions share common preventable risk factors, such as smoking, excessive alcohol consumption, and not getting enough exercise—in fact, around one-third of our nation’s ‘disease burden’ is due to preventable risk factors.

Our expanding waistlines are a notable example: about 6 in 10 adults—or 63%—are either overweight or obese, while carrying too much weight is responsible for 7% of our total disease burden.

Over the past two decades, the proportion of Australians who have a healthy body weight fell, while the proportion who are obese increased. Over the same period, the proportion who are ‘severely obese’ nearly doubled.

AIHW CEO Barry Sandison said that when it comes to obesity, it is not just a case of poor diet or exercise habits. Rather, a range of factors—biological, behavioural, social and environmental—contribute to our likelihood of becoming obese, including the walkability of our cities, rising work hours and increasingly sedentary jobs, larger portion sizes and food advertising.

‘Understanding why someone may be obese—or in good or poor health generally—is complex and it’s important to look at the raft of factors across a person’s life that may be at play,’ he said.

Tackling the ‘why’ of poor health

Mr Sandison said that through data, we are able to better understand how a diverse array of social and other factors contribute to our health.

For example, the report shows a clear connection between socioeconomic position and health—compared with people living in Australia’s highest socioeconomic areas, those in the lowest group are almost 3 times as likely to smoke or have diabetes and twice as likely to die of potentially avoidable causes.

Those in the lowest group are also more likely to have cost barriers preventing them from accessing health services—more than twice as likely to avoid seeing a dentist or filling a prescription due to the cost.

The impact of socioeconomic position on health can also be thought of in terms of disease burden, with those in the lowest socioeconomic group experiencing disease burden 1.5 times higher than those in the highest group.

Mr Sandison noted a similar pattern was seen among people living in remote areas, while certain groups—such as veterans—experience higher rates of mental health conditions such as depression. LGBTI Australians, people with a disability, prisoners and people of cultural and linguistically diverse backgrounds also experience specific health challenges.

As well as social factors, our natural environment is connected to our health and wellbeing—with air and water quality, exposure to extreme weather, and other events such as bushfires and drought all playing a role.

‘There is more to learn about the connections between health and the natural world—and in turn, the interplay between these and other risk factors,’ Mr Sandison said.

Employment and income key factors in improving Indigenous health

The value of data and looking forward

Mr Sandison noted that in a digital age, there is enormous potential to fill data gaps through new sources of health information.

‘Health data is collected for a variety of reasons—in hospitals, at our GP and through the prescriptions we receive, while new sources of information are emerging, such as through the Australian Government’s My Health Record.’

Despite the breadth of health and welfare information available, there are gaps in our knowledge and opportunities to make better use of existing data.

By bringing together data, we can gain important insights into people’s pathways through the health system and experiences of their own health, such as the relationship between different chronic conditions and the services and treatments yielding the greatest improvements in health outcomes and quality of life.

‘With a structured, strategic approach to health information and leadership from agencies like the AIHW, Australia’s health data assets can be built and improved to fill gaps in our knowledge and understanding—to drive better health outcomes for all Australians,’ Mr Sandison said.

Media coverage

Indigenous Australians are more than twice as likely to die before their fifth birthday than non-Indigenous Australians.

Australia’s Health 2018, a report released by the Australian Institute of Health and Welfare today , says Indigenous Australians have a shorter life expectancy than non-indigenous Australians and are at least twice as likely to rate their health as fair or poor.

On average, indigenous Australians have lower levels of education, employment and income and poorer quality housing than non-indigenous Australians.

However there have been improvements in child mortality rates, smoking rates and drinking rates for those over the age of 15.

Factors in the health gap include higher rates of smoking and risky alcohol consumption, less exercise, a greater risk of high blood pressure and difficulty accessing affordable health services.

The report states that if indigenous adults were to have the same household income, employment rates, hours worked and smoking rate as non-indigenous Australians, the health gap would be reduced by more than a third.

Levels of health vary within the indigenous population, with those employed in 2014-15 less likely to smoke and use illicit substances and more likely to have an adequate daily fruit intake.

IMPROVEMENTS IN INDIGENOUS HEALTH

– Child mortality rates (zero to four) decreased from 217 deaths per 100,000 in 1998 to 140 deaths per 100,000 in 2016

– Between 2005-2007 and 2010-2012, the gap in life expectancy at birth between indigenous and non-indigenous Australians decreased from 11.4 to 10.6 years for males and 9.6 to 9.5 years for females

– Smoking rates declined from 51 per cent in 2002 to 42 per cent in 2014-15, concentrated in non-remote areas.

– In 2014-15, 17 per cent of indigenous Australians aged between 15-17 smoked, compared to 30 per cent in 1994

INDIGENOUS HEALTH COMPARED TO NON-INDIGENOUS HEALTH

– 2.1 times as likely to die before their fifth birthday

– 2.7 times as likely to experience high or very high levels of psychological distress

(Source: Australia’s Health 2018, Australian Institute of Health and Welfare

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