Indigenous Health
Data Systems
The current national policy framework
Professor Ian Anderson
Chair National Indigenous Health Equality Council
Presentation
•
•
•
•
Policy Context
Reporting environment
Indigenous health targets
Indigenous Health Data Systems
Policy Context
• On the 24th March 2008 Prime Minister
Kevin Rudd, the leader of the Federal
Opposition and significant leaders in the
health sector signed a pledge to
– Close the Indigenous health gap by 2030
– Close the equity gap in health service
provision by 2018
Policy Context
• Indigenous persons have a life expectancy at birth
which is 17 years less than a non-Indigenous person
• Indigenous Australians have 2.5 times the burden of
disease compared to non-Indigenous Australians
• Indigenous Australians have 5 times the burden of
disease due to diabetes
• Four and a half times the burden disease due to
cardiovascular disease
• Four times the burden of disease and disability due
to intentional injuries such as suicide or harm from
violence
Policy Context
Indigenous Health Gap
39,522 DALY’s
59%
95,967 DALY’s
Contributing Conditions
15%
6%
12%
23%
10%
9%
Vos et al
2007
10%
15%
**Non-communicable diseases
Contributing Risk Factors
17%
16%
12%
7%
4%
6%
5%
11%
Policy Context
• The policy environment is complex
– The Australian Government has committed to
providing an annual Closing the Gap report to
parliament
– CoAG Reform Council likely to have a role in
reporting on progress CoAG initiatives
– Both AHMAC and AHMC have a role in
progressing outcomes to CoAG
– National Health Indigenous Equality Council
COAG
Ministerial Council
of CommonwealthState Relations
Indigenous Reform
Economic
Participation and
Welfare Reform
Building Blocks &
Governance
Building the evidence
Optimising Service
Delivery sub-group
Protective Security,
Alcohol and
Substance Abuse
Indigenous Early
Childhood (WGIR with
PAWG and HAWG)
Health and
Ageing
Productivity
Agenda
Skills subgroup
Compact sub-group
(Dealing with SPP
Revision)
Climate
Change &
Water
Water subgroup
Infrastructure
Indigenous
sub-group
Housing
Indigenous
sub-group
Chair: Cth
Business
Regulation
and
Competition
Heads of
Treasuries
Schools
sub-group
Indigenous subgroup
Early
Childhood
sub-group
Sub -groups of Early
Childhood subgroup:
-- Data
-- Quality - Early
Years Learning
Framework
- Workforce
Adaptation
sub-group
Reform of SPP
Working Party
National Framework for
Reporting Expenditure
on Services to
Indigenous Australians
Steering Group
Policy Context
• Council of Australian Governments
– Established Working Group on Indigenous Reform
(WGIR) to develop reform proposals for improving
community safety, remote service delivery and
Indigenous economic development and active
welfare.
– WGIR, in conjunction with other Working Groups,
to report to COAG on how COAG’s broader
reform agenda will deliver an integrated strategy
on closing the gap for all Indigenous people.
Policy Context
• Health & Ageing Working Group
National Reform Proposals
– Chronic
– Acute
– Preventive
– Cancer
– Indigenous
Policy Context
• COAG Building Blocks
– Early childhood development
– Education
– Economic participation
– Health services
– Healthy homes
– Safe communities
– Governance and leadership
Policy Context
•Reform of Specific Purpose Payments
–92 SPPs to 5
–No ‘matched funding’ input controls
–High level statements of objectives,
outcomes and indicators
Policy Context
Health
KPIs
Education
KPIs
Housing
KPIs
KPIs for outcomes for Indigenous people
Complementary
Report of
Indigenous
outcomes
across all
SPPs?
Policy Context
Policy Context
• The National Indigenous Health
Equality Council established in July
2008
– Membership drawn from the Australian
Government, the Aboriginal and Torres
Strait Islander community including the
Aboriginal Community Controlled Health
sector, and the broader health sector
Policy Context
• NIHEC Terms of Reference:
– advising on commitments made under the March
2008 Statement of Intent on achieving Indigenous
health equality;
– advising on the development and monitoring of
health related goals and targets
– developing advice to the Minister on:
• strategic priorities for Aboriginal and Torres
Strait Islander Health; meeting target;
monitoring progress; Government & AHMAC
– Health Workforce
– Other
Policy Context
• Mechanisms for the development of
Indigenous health data
– National Advisory Group Aboriginal Torres
Strait Islander Health Information
Development
– National Indigenous Health Equality
Council
– Advisory Group for Aboriginal and Torres
Strait Islander Statistics (AGATSIS).
Targets
• COAG 20 Dec 2007:
– Close the LE gap in a generation
– Halve the child mortality gap in 10 years
– Halve the literacy and numeracy gap
• COAG 26 March 2008:
– Halve the gap in employment outcomes within a decade
– Halve the gap for Indigenous students in Year 12 by 2020
– In five years all Indigenous four year olds in remote
Indigenous communities will have access to a quality early
childhood education program.
Targets
• History of target setting in Indigenous
Health
– Whitlam government national plan
– NAHS interim goals and targets 1991
– 1997 National Performance Indicators
– ATSIHPF
– Indigenous health equality campaign
Targets
Valid target setting requires:
• Good base-line data
• Good time-series data
• An evidence base that establishes links
between interventions to outcomes
• An ability to exercise influence over the
outcomes being targeted; and
• Avoiding perverse incentives (eg, worsening
non-Indigenous health will “close the gap”)
Targets
• Some consideration in selection of
targets
– Specific
– Measurable
– Achievable
– Realistic
– Time bound
Target Draft Definition of Terms
Term
Definition
Draft
Headline indicators
The precise measure of the outcome target
Life expectancy estimates,
released five yearly by ABS
Proxy indicators
An annual indicator to be used where the
headline indicator is only available in the 5
yearly Census.
Death rate by jurisdiction, age and
gender.
Interim targets
Goals or milestones to aim for over time, ie,
at regular intervals between now and the
target year.
The gap in life expectancy at 5, 10,
15, 20, 25 years
Trajectory
The line or path to be taken to reach the
target
To be determined. This could be a
straight line from now to 25 years.
Progress indicators
Key indicators of the most significant
factors which provide the best measure of
progress, ie, based on evidence that they
reflect the delivery chain or provide a line of
sight between what we do and changes in
the headline indicator.
Access to primary health care.
Changes in leading causes of
mortality such as smoking rates,
prevalence of overweight and
obesity. Early detection and
treatment rates.
Chronic disease management.
Priority progress indicators
A small set of progress indicators selected
for inclusion in the annual report on
progress.
To be determined.
Contributing factors
Factors which are known to influence the
outcomes (ie, the targets). The progress
indicators are measures of some of these
factors.
Education. Employment status,
Income.
Targets
• Reporting environment
– Overcoming Indigenous Disadvantage
(Productivity Commission)
– Aboriginal and Torres Strait Islander Health
Performance Measurement Framework
(AHMC/AHMAC)
– Proposed Annual Report to Parliament (Australian
Government)
– COAG SPPs
– Other – Social Justice Report, Report on
Government Services, Biennial Report Aboriginal
and Torres Strait Islander Health and Welfare
Targets
• Potential relationships between
reporting structures
– ATSIHPF Tier One Health Status and Outcomes: CoAG
Health Targets
– ATSIHPF Tier One Determinants of Health (risk factors,
social & environmental determinants). CoAG Building Blocks
– ATSIHPF Tier One Health System Performance. CoAG
Health Building Blocks
Data Systems
• Population Data
– Remote area enumeration
• Life expectancy data
– Indirect vs direct methods, methods development
• Mortality Data (& birth data)
– Data poor jurisdictions, methods, negotiations with
data custodians, strategies to improve
identification
Data Systems
• Administrative data
– Data poor jurisdictions, primary care data
– Identification in general practice
• Strategic relationships and governance