Are Indigenous mortality gaps closing: how to tell, and when?

Abstract

Lags between policy and outcomes mean it is important to have good metrics and the right expectations about timelines I t is well known that the health of Australia's Aboriginal and Torres Strait Islander people is considerably poorer than that of their non-Indigenous counterparts. 1 Strategies, policies, programs and funding over many years have been targeted toward improving the health of Indigenous Australians and closing the gap in health status between Indigenous and non-Indigenous Australians. In this article, we review trends in key mortality rates for both populations and two complementary indices of the gap between them, both of which are essential to understanding progress or otherwise in closing the mortality gaps. Importantly, we also discuss the time required until the impact of policy changes can be assessed. Measures of "the gap" An understanding of changes in mortality over time requires: (i) graphing the non-Indigenous and Indigenous rates to see whether they are declining, remaining stable or increasing; (ii) showing trends in the rate difference (obtained by subtracting the non-Indigenous rate from the Indigenous rate) to indicate movement in the absolute size of the difference and the magnitude of improvement required for the gap to close; and (iii) showing trends in the rate ratio (obtained by dividing the Indigenous rate by the non-Indigenous rate) to indicate whether the relative rate of improvement in Indigenous mortality is faster than for non-Indigenous mortalitythe fundamental requirement for the "gap" to finally close. Are the gaps closing? Analysis of data from the Aboriginal and Torres Strait Islander Health Performance Framework 2014 report shows that the overall difference in death rates between Indigenous and non-Indigenous Australians during 2008 to 2012 was 389 deaths per 100 000, with a rate ratio of 1.7. 2 The Box shows rate differences and rate ratios for mortality from all causes, child mortality and infant mortality among Indigenous and non-Indigenous Australians from 1998 to 2012.

Heart disease, hospitalisation and referral: Coaching to Achieving Cardiovascular Health through cardiac rehabilitation in Queensland

“…Accurate rates of heart disease for Aboriginal and Torres Strait Islander peoples by HHS are currently not available, but it is known that morbidity and mortality rates are higher than non‐Indigenous people (1.6/1.8 times, respectively) . In NQ HHSs, hospitalisations of Aboriginal and Torres Strait Islanders are higher than Queensland overall, but remain relatively low.…”

“…Accurate rates of heart disease for Aboriginal and Torres Strait Islander peoples by HHS are currently not available, 16 but it is known that morbidity and mortality rates are higher than non-Indigenous people (1.6/1.8 times, respectively). 3,4 In NQ HHSs, hospitalisations of Aboriginal and Torres Strait Islanders are higher than Queensland overall, but remain relatively low. Given the isolation, high proportions of Aboriginal and Torres Strait Islander peoples, levels of disease, lack of accessible health services and overall poor social determinants of health, it is reasonable to assume that hospitalisation rates should be higher.…”

“…Heart disease is a major cause of death in Australia and contributes to significant illness, disability, poor quality of life and high health care costs in Australia . The gap in life expectancy has widened between Aboriginal and Torres Strait Islander and non‐Indigenous peoples from 2001 to 2015, and cardiovascular disease morbidity/mortality rates are 1.6/1.8 times greater with mortality rates in 30‐ to 39‐year age group three times greater, respectively . These rates are exacerbated by poor social determinants of health.…”

Analysing aggregate clinical data to support evaluation of the Tackling Indigenous Smoking program, 2014–16

“…24 It is likely that changes in smoking prevalence need longer periods of time and will not be realised until much later in the delivery phase; such lag time issues are well known in health program delivery. 25 Given that this study included only 3 years and the first 6 months under the revised TIS program (2016 data), the indication of higher recording of tobacco use is important for future program monitoring. Further, our results show that remote services funded through the TIS program had increased reporting rates of clients' smoking status than all other services.…”

Human rights and the borders of the human

“…There have been decades of government-led efforts to improve Indigenous health outcomes in Australia and 'reduce the gap' between Indigenous and non-Indigenous health status (Brown M 2002). Despite these efforts and welcome improvements in both Indigenous and non-Indigenous health the gap between Indigenous and non-Indigenous mortality and life expectancy rates remains obdurate and increasing (Ring et al 2016;AIHW 2017). While often cast in the language of self-determination, rights and partnership these health interventions have been (with some exceptions) largely pursued through welfare measures based on external professional assessments of Indigenous health needs.…”