Aboriginal peoples
On this subject
- Key points
- Aboriginal population
- Aboriginal population by Local Government Area
- Socioeconomic factors
- Government expenditure
- Life expectancy
- Deaths from all causes
- Causes of death
- Potentially avoidable and premature deaths
- Potentially avoidable deaths by type of cause
- Infant mortality
- Perinatal deaths and antenatal care
- Antenatal care by Health Area
- Prematurity and low birth weight
- Low birth weight by Health Area
- Hospitalisation
- Causes of hospitalisation
- Disability adjusted life years
- Ambulatory care sensitive conditions
- Ambulatory care sensitive conditions by Health Area
- Avoidable episodes of care
- Selected chronic conditions and health determinants
- Cardiovascular disease
- Diabetes
- Diabetes hospitalisations by Health Area
- Cancer incidence
- Acute respiratory infections in children
- Gastrointestinal infections in children
- Skin infections in children
- Injury and poisoning hospitalisations
- Injury and poisoning hospitalisations by Health Area
- Interpersonal violence hospitalisations
- Immunisation coverage by Health Area
- Oral health
- Pertussis in children
- Tympanoplasty and otitis media
- Risk alcohol drinking and smoking
- Smoking attributable hospitalisations
- Alcohol attributable hospitalisations
- Alcohol attributed hospitalisations by Health Area
- Alcohol attributable hospitalisations for injury
- Alcohol and other drugs treatment
- Environment: Blood lead levels in Broken Hill children
- Environment: Healthy Living Practices in Aboriginal houses
- Health-related behaviours: Opioid Treatment Program use by Aboriginality
- Rural and remote populations: Demography
- Rural and remote populations: Deaths by Aboriginality
- Rural and remote populations: Potentially avoidable deaths by Aboriginality
- Rural and remote populations: Low birth weight by Aboriginality
- Rural and remote populations: Premature babies by Aboriginality
- Rural and remote populations: Antenatal care by Aboriginality
- Communicable diseases: Influenza and pneumococcal immunisation
Introduction
The physical and social environments in which people live determine to a large degree whether they live productive lives relatively free of serious illness. This is particularly the case for Aboriginal people, who still suffer disproportionately from some of the consequences of European colonisation, in particular the impact of new infectious and chronic diseases and social dislocation. Many Aboriginal people live today in conditions of clear social and economic disadvantage. All of these things interact to contribute to poor health in many groups of Aboriginal people (ABS and AIHW, 2008).
In 2006, Aboriginal and Torres Strait Islander people comprised 2.2% of the total NSW population. The NSW Aboriginal population is 94.4% Aboriginal only, 3.4% Torres Strait Islander only, and 2.2% both Aboriginal and Torres Strait Islander. In this report all these people are referred to as Aboriginal in recognition of the fact that Aboriginal people are the original inhabitants of NSW.
Estimating the size and composition of the Aboriginal population is difficult for a range of reasons, in particular the incomplete and differential identification of Aboriginal people in administrative data collections. The Aboriginal population is generally under-identified in administrative data collections for reasons such as staff reluctance to ask about Aboriginality and Aboriginal people's reluctance to identify as Aboriginal in some circumstances.
The quality of collection of data on the level of identification of Aboriginal people in health administrative datasets in NSW varies. The ABS estimates the level of implied coverage of the Aboriginal population in deaths data by calculating deaths recorded as Aboriginal on death certificate as a percentage of expected number of deaths based on the low series of projections of Aboriginal population. Using this method, based on the 2001 population census, the level of implied coverage of the Aboginal population in NSW for the period 2002-2006 was 45% (ABS, 2008). Recently, the ABS conducted the ABS Indigenous Mortality Quality Study, which involved the linkage of 2006 census records with deaths registered for the 11-month period following the census. This estimate was calculated as deaths recorded as Aboriginal on death certificate as a percentage of deaths recorded as Aboriginal after linkage. Based on this method, the estimate of coverage of the Aboriginal population in the NSW deaths data was 76.3%. This is not as low as previously thought, but is still much lower than estimates for Queensland, South Australia, Western Australia and the Northern Territory (ABS, 2008).
The AIHW conducted a national validation survey of patients in hospitals in 2007 to provide comparative data for the first time on the level of underestimation of Aboriginal people in hospital data. The results showed that the estimated level of enumeration in hospital admitted patient data in NSW was 88%. However, this varied by geographic area: Major cities = 81%; Inner regional areas = 89%; Outer regional areas = 95%; and Remote and very remote areas = 100% (AIHW, 2007). Before this survey, the level of enumeration was thought to be much lower at 67%, although this figure was not obtained from a validation survey. The coverage of the Aboriginal population in cancer incidence data from the NSW Central Cancer Registry is likely to be similar to that of NSW hospitals, as the data on Aboriginality are derived mainly from hospital notifications to the Registry, although there are no separate estimates of enumeration for this dataset.
Estimates of the level of enumeration of Aboriginal babies are calculated regularly for the NSW Midwives Data Collection though the linking of MDC births to births data from the NSW Registry of Births, Deaths and Marriage using capture-recapture methods. The data on Aboriginality of babies in the NSW MDC is based on the Aboriginality of the mother only. The most recent estimates are for 2004 data, which showed an overall coverage of 69%. Coverage varied by health area from the lowest coverage in Sydney South West AHS at 44% to the highest in Greater Western AHS at 91% (Centre for Epidemiology and Research, 2007).
Underenumeration can introduce bias in the study results if it is systematic. There is evidence of bias based on place of residence in hospital and MDC data; however, it is also likely to be true for deaths and cancer data. Efforts are currently being made by the ABS and AIHW, in partnership with state and territory authorities such as NSW Health and the NSW Registry of Births, Deaths and Marriages, and the Aboriginal community, to improve the quality and completeness of Aboriginal identification in health data collections. The linkage of data from various health administarative datasets has the potential to improve 'identification' of Aboriginal records for statistical purposes.
In this report, records that were not positively identified as Aboriginal were counted as non-Aboriginal. The resulting calculations of rates of deaths, illness and disease in Aboriginal populations must therefore be treated with caution. The Aboriginal population is relatively young, with a median age of 21 years, compared with 36 years for the non-Aboriginal population. As age is closely related to health, care should be taken when comparing information for these two populations.
NSW Health is committed to working in partnership with Aboriginal people and other government agencies to improve the health outcomes for Aboriginal people. Two Ways Together, the NSW Aboriginal Affairs Plan 2003-2012 (NSW Department of Aboriginal Affairs, 2004), adopts a whole-of-government approach to improve the lives of Aboriginal people in seven priority areas. The areas were identified in consultation with the Aboriginal communities of NSW. They are health, education, economic development, justice, families and young people, culture and heritage, and housing and infrastructure.
The NSW State Plan includes several health-specific priorities relevant to Aboriginal people, in addition to a specific priority regarding improved health and education outcomes for Aboriginal people. These are:
- Improved health through reduced obesity, smoking, illicit drug use and risky drinking,
- Improved outcomes in mental health, and
- Embedding the principle of prevention and early intervention into government service delivery in NSW.
The Housing for Health Program aims to assess, repair or replace health hardware so that houses are safe and the occupants have the ability to carry out healthy living practices. It has been delivered to Aboriginal communities in NSW since 1998, through the Aboriginal Communities Development Program. Between 2002-03 and 2006-07, a total of 871 houses in Aboriginal communities were included in the Housing for Health program, benefiting 3,270 people (Department of Aboriginal Affairs, 2007).
The NSW Aboriginal Maternal and Infant Health Strategy has been implemented to improve access to culturally appropriate maternity services for Aboriginal mothers. This Strategy has been successful in addressing issues which cause under-utilisation of maternity services by Aboriginal women, such as inappropriate and inaccessible maternal health services and lack of long-term targeted Aboriginal maternal health programs (NSW Department of Health, 2003).
The program Chronic Care for Aboriginal People focuses on an integrated approach to diabetes, heart disease, stroke, hypertension and kidney disease, because of the shared risk conditions and common approaches needed to prevent and manage these conditions in Aboriginal communities. The NSW Aboriginal Chronic Conditions Area Health Service Standards, released in 2005, emphasise a primary health care approach, foster coordinated service delivery across the continuum of care, and promote multidisciplinary care (NSW Health, 2005).
The NSW Aboriginal Mental Health and Well Being Policy 2006-2010 is a framework to guide NSW Health and NSW Area Mental Health Services in providing culturally sensitive and appropriate mental health and social and emotional well being services to the Aboriginal community (NSW Department of Health, 2007).
Aboriginal Medical Services (AMSs) play a vital role in regard to Aboriginal health services in NSW. An AMS is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care. Aboriginal communities operate 46 AMSs in NSW, ranging from large multifunctional services to small services which rely on Aboriginal health workers.
This chapter presents a selection of health and health-related indicators based on a range of administrative data sources, performance indicators for specific program areas and self-reported survey data. Additional indicators of Aboriginal health, including indicators relating to oral health, vaccine-preventable diseases, drug and alcohol treatment services and Aboriginal prison inmates, are included in the electronic version of this report.
In 1996-97 a change in coding practice for Aboriginal status in hospital morbidity data resulted in a disproportionately large number of hospital separations being attributed to Aboriginal people, and the artefact is evident in some of the health indicators reported in this chapter. The methods used for analysing and presenting death and hospitalisation data are described in more detail in the Methods section.
For more information
Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, 2008. ABS Cat. No. 4704.0. AIHW Cat. No. IHW 21. Canberra: ABS, 2008. Available at www.abs.gov.au/AUSSTATS/abs@.nsf/mf/4704.0
NSW Department of Aboriginal Affairs. Two ways together report on indicators 2007. Sydney: Department of Aboriginal Affairs, 2007.
NSW Department of Health Working Party on Ear Disease in Aboriginal Children. Guidelines on the prevention and control of otitis media and its sequelae in Aboriginal children. Med J Aust 1996; 164: S1-S17.
NSW Health. NSW Aboriginal Maternal and Infant Health Strategy. Evaluation final report 2005. Sydney: NSW Health, 2006.
Vos T, Barker B, Stanley L, Lopez A. The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane: University of Queensland, 2007.
Australian Bureau of Statistics. Causes of Death, Australia 2006. Catalogue no. 3303.0. Canberra: ABS, 2008. Available at www.abs.gov.au/ausstats/abs@.nsf/0/2093DA6935DB138FCA2568A9001393C9
Australian Bureau of Statistics. Information paper: Census data enhancement - Indigenous mortality quality study. ABS Cat. No. 4723.0. Canberra: ABS, 2008. Available at www.abs.gov.au/AUSSTATS/abs@.nsf/mf/4723.0
Statistical Information Management Committee. Out-of-session Agenda item paper number 4/2007. Canberra: AIHW, 2007.
Print version
Although this page can be printed directly from your Web browser, a higher quality version of this page is available as an Acrobat PDF file which can be printed or viewed on screen using free software.
Copyright notice
This work is copyright NSW Department of Health, 2006. It may be reproduced in whole or in part, subject to the inclusion of an acknowledgement of the source. Commercial usage or sale is prohibited.
Suggested citation
Population Health Division. The health of the people of New South Wales - Report of the Chief Health Officer. Sydney: NSW Department of Health. Available at: www.health.nsw.gov.au/publichealth/chorep/. Accessed (insert date of access).
Produced by
Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.
Last updated on 15 December 2008
