Aboriginal and Torres Strait Islander adolescent and youth health and wellbeing
This inaugural report on the health and wellbeing of Aboriginal and Torres Strait Islander adolescents and young people is important to understand how Australia’s young Indigenous people are faring, provides an opportunity to celebrate successes and identifies areas where support is needed.
We released 3 products on this topic: comprehensive, short in-brief, and state and territory specific reports. The Hon. Ken Wyatt, AM, MP, launched the report at the National Aboriginal Community Controlled Health Organisation (NACCHO) Members’ Conference on 31 October 2018.
The report contained some ‘good news’ stories. In 2014–15, the majority (63%) of young Indigenous people aged 10–24 rated their health as either ‘excellent’ or ‘very good’. Three in 4 (76%) Indigenous youth aged 15–24 reported being happy all or most of the time. Between 2006 and 2016, the percentage of young Indigenous Australians aged 20–24 attaining year 12 or equivalent increased from 47% to 65%.
The report also noted areas of concern. In 2011, the leading contributors to the disease burden for Indigenous Australians aged 10–24 were suicide and self-inflicted injuries (13%) and anxiety disorders (8%). In 2014–15, about 1 in 3 (33%) Indigenous Australians aged 15–24 reported experiencing high to very high levels of psychological distress in the previous month. Despite an increase in the percentage of Indigenous young people who had never smoked (56% in 2014–15 compared with 44% in 2002), 3 in 10 smoked daily.
The report received significant coverage on social media, and by media outlets such as the Sydney Morning Herald, Koori Mail, the NACCHO and the Royal Australian College of General Practitioners. Dr Fadwa Al-Yaman, Head of the AIHW’s Indigenous and Maternal Health Group, discussed the report findings in a radio interview with the Central Australian Aboriginal Media Association. The authoring team at the AIHW presented findings from the report at the 2018 Youth Health Conference.
During the period between approximately 1910 and 1970, thousands of Aboriginal and Torres Strait Islander children were removed from their families as part of government policies across Australia. These individuals are now referred to as the Stolen Generations. Their forced removal and subsequent disconnection from Indigenous culture and land have had widespread negative impacts on their wellbeing and that of their families.
As part of a larger Action Plan for Healing project, The Healing Foundation commissioned us to undertake a demographic analysis and needs assessment aimed at identifying the size, characteristics and needs of the Stolen Generations and their descendants.
We released 3 reports on this work during 2018–19:
Aboriginal and Torres Strait Islander Stolen Generations and descendants: numbers, demographic characteristics and selected outcomes—downloaded more than 2,500 times since its release in August 2018, as well as numerous hard copies distributed by The Healing Foundation
Aboriginal and Torres Strait Islander Stolen Generations aged 50 and over—almost 800 downloads since its release in November
Children living in households with members of the Stolen Generations—downloaded 360 times since its release in June.
The reports found that almost 21,000 (in 2014–15) surviving Stolen Generation members and their families were a particularly disadvantaged group within the Indigenous population, faring worse on a range of measures, including income, education, general health, and experiences of discrimination, imprisonment and violence.
The Healing Foundation used these results to inform reports to government, submissions to inquiries and policy position papers.
According to The Healing Foundation:
The evidence paints a picture of complex needs and disproportionate disadvantage for the Stolen Generations who suffered profound childhood trauma when they were forcibly removed from their homes, isolated from their families and cultures and often institutionalised, abused and assaulted.
The reports also demonstrate that the negative impact of past atrocities is affecting later generations, creating an escalating cycle of disadvantage in the form of Intergenerational Trauma. The data supports what Stolen Generations survivors have been saying for many years—that unresolved and Intergenerational Trauma is the underlying cause of many of the social and health issues affecting Aboriginal and Torres Strait Islander communities today.
Every 2 years, we collect information about social housing tenants, the homes they live in and their housing experiences and satisfaction through the National Social Housing Survey. In 2018–19, for the first time, we used regression analysis to analyse relationships between multiple variables and an outcome, to better understand differences in satisfaction between populations.
Findings from the National Social Housing Survey 2018 show that tenant satisfaction is closely coupled to the condition of the home, with satisfaction falling significantly as structural problems increase. This relationship holds after accounting for a wide range of geographical, demographic and housing-related factors. Other factors that relate to satisfaction, independently of others, include access to 7 basic household facilities and time spent living in social housing.
Importantly, the results shed light on the lower satisfaction rates observed for certain populations, such as Indigenous households. This is best explained by variation in dwelling conditions between Indigenous and other households, as well as time in social housing and household living arrangements.
Improving the evidence base on family, domestic and sexual violence
The Family, domestic and sexual violence in Australia: continuing the national story 2019 report is the second in the series on this topic. The report filled known information gaps by bringing together over 20 data sources to report on types of violence, with a particular focus on vulnerable populations (Figure 2.4).
It provided information to develop policies and services for preventing and responding to family, domestic and sexual violence. The report’s extensive media coverage, including over 100 print, television and radio mentions, demonstrated the value of our role in the national discussion on family, domestic and sexual violence. Responses received from members of the public also show growing interest in our work, and the relevance of robust national data to the wellbeing of Australians.
A project on opioid harm was conducted in parallel with the CIHI with joint release and a co-authored chapter comparing the 2 countries. It brings together information from a range of data sources to tell the national story of opioid use and its harmful effects. All opioids-including codeine- can be addictive and their use can result in dependence, accidental overdose, hospitalisation or death.
The rising use of opioids and its associated harms are issues of great public health interest, both within Australia and internationally. Australia has the eighth highest opioid consumption of 167 countries and territories based on defined daily doses per capita per day.
A key theme emerging from the Opioid harm in Australia: and comparisons between Australia and Canada report is that pharmaceutical opioids contribute more to opioid harm than illicit opioids. Rates of opioid deaths nearly doubled in the 10 years to 2016, and opioid poisoning hospitalisations in Australia also increased. In 2016, pharmaceutical opioids were involved in more opioid deaths and opioid poisoning hospitalisations than heroin.
In Australia in 2016–17, 3.1 million people had 1 or more prescriptions dispensed for opioids—most commonly for oxycodone. Based on the National Drug Strategy Household Survey, in 2016 it was estimated that more than 1 in 10 people aged 14 and over had used any type of opioid for illicit or non-medical purposes in their lifetime—the most common being in the category of Pain- killers/analgesics and pharmaceutical opioids.
Men aged 35–44 experienced some of the highest rates of opioid harm. In 2016–17, they had the highest rate of opioid deaths; the highest rates of emergency department presentations for opioid poisoning and opioid dependence; and the highest rates of hospitalisations with a principal diagnosis of opioid poisoning or opioid dependence.
In both Australia and Canada, the greatest volume of harm treated in hospitals came from side effects from opioid use. The age distribution for people hospitalised for this reason was similar in Australia and Canada, with rates of hospitalisation rising with increasing age, reflecting the rates of prescription opioids in both countries.
The report received 99 mentions. The findings have been presented at an international conference, to the Department of Health and other agencies, and have contributed to OECD work on opioid harm internationally.
Estimating the burden of disease and disease expenditure
The Australian Burden of Disease Study (ABDS) 2015 provided estimates of disease burden for 216 diseases and injuries and 38 modifiable risk factors, with comparable data for 2011 and 2003. It also provided detailed analyses for both changes in disease burden and the burden attributable to risk factors between 2003 and 2015. The ABDS suite of products comprised 3 reports (detailed, summary and methods) and interactive data visualisations for disease burden and burden due to risk factors.
The study found that:
in 2015, Australians lost 4.8 million years of healthy life due to living with illness (50.4% of total burden) and dying prematurely (49.6%)
chronic diseases, such as cancer, cardiovascular diseases and musculoskeletal conditions, contributed the most burden
38% of the burden could have been prevented by eliminating exposure to risk factors such as tobacco use, overweight and obesity, and dietary risks.
The findings of the disease expenditure in Australia study were released in conjunction with the ABDS reports and included expenditure according to ABDS disease groups and conditions:
The musculoskeletal disorders group had the highest estimated expenditure, costing $12.5 billion. The next highest expenditure groups were cardiovascular diseases ($10.4 billion), injuries ($8.9 billion) and mental and substance use disorders ($8.9 billion)
For males, the highest cost group was cardiovascular diseases ($5.7 billion) followed by musculoskeletal disorders ($5.5 billion)
For females, the highest cost group was reproductive and maternal conditions ($6.9 billion) followed by musculoskeletal disorders ($6.7 billion).
These products, funded by the Department of Health, were launched on 13 June at the Public Health Association of Australia’s Public Health Prevention Conference in Melbourne. Presentations by AIHW staff were well received, with great interest in the online interactive data as well as immediate uptake for editorials and the media. The Department of Health has funded us to undertake another edition of the ABDS for the year 2018.
Australia’s 3 national cancer screening programs (BreastScreen Australia, National Cervical Screening Program and National Bowel Cancer Screening Program) aim to reduce deaths and illness due to cancer by actively recruiting and screening target populations for early detection or prevention of disease in individuals.
Analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia is the first report using extensive data linkage to examine whether participation in national cancer screening programs reduces the risk of death from the respective cancers.
The report showed that the majority of women diagnosed with cervical cancer between 2002 and 2012 were women who had never screened, or had not done so for some time.
Additionally, people who were diagnosed through the screening programs were more likely to survive than those who were diagnosed another way (for example, experienced symptoms and went to their doctor). Compared with those who were diagnosed during 2002–2012 with a breast, cervical or bowel cancer outside of the screening programs:
women with screen-detected breast cancers were 42% less likely to die from breast cancer by 2015
women with screen-detected cervical cancers were 87% less likely to die from cervical cancer by 2015
people with a screen-detected bowel cancer were 40% less likely to die from bowel cancer by 2015.
The screening behaviour of women across these 3 programs was also investigated. Women who already participated in 1 screening program were more likely to participate in other programs for which they were eligible, suggesting that if barriers to participation in 1 screening program can be removed, there is potential to improve participation across other programs.
With this powerful evidence on the effectiveness of the programs, consumers can better understand the benefits of taking part in cancer screening, while policymakers can look for opportunities to expand the programs to reach more people and save more lives.
National Integrated Health Services Information Analysis Asset
The first version of the National Integrated Health Services Information Analysis Asset (NIHSI AA) has been built. It contains de-identified data from 2010–11 to 2016–17 on admitted patient care services (in all public and, where available, private hospitals), emergency department services and outpatient services in public hospitals for the participating states (New South Wales, Victoria, South Australia and Tasmania). It also includes national data for the same period from the MBS, PBS and Repatriation Pharmaceutical Benefits Scheme as well as residential aged care data and National Deaths Index data. It contains data from almost 12 billion recorded events, which makes it potentially the largest health data linkage exercise ever conducted in Australia and represents the most comprehensive health data asset created.
The NIHSI AA will be managed under the AIHW’s custodianship and will be available in mid-2019 to selected analysts in those state health authorities whose hospital data are included in the initial release, the Department of Health and the AIHW.
Work will continue on development of governance arrangements for access to the asset by jurisdictional and other users into the future, and incorporation of hospital data from other states and territories. Additional years of data across all component collections will be added in annual updates.
Estimates of female genital mutilation/cutting
Towards estimating the prevalence of female genital mutilation/cutting in Australia was commissioned by the Department of Social Services (DSS) to support its work on this complex and sensitive subject.
Female genital mutilation/cutting (FGM/C) is a collective term for a range of procedures involving partial or total removal of the external female genitalia, or other injury to female genital organs for non-medical reasons. FGM/C is most commonly performed on girls before the age of 15, and is associated with a range of social and cultural factors. In Australia, it is illegal to perform FGM/C, and Australian governments view FGM/C as an abuse of human rights, children’s rights and a complex form of violence against women.
The report estimates that about 53,000 women and girls living in Australia in 2017 but born elsewhere may have undergone FGM/C. This estimate was calculated by combining available international FGM/C prevalence rates by country with Australian migration data. Although the methodology has several limitations, it provides an indication of the extent to which FGM/C may be relevant in Australia.
Relatively little is known about the health-care needs and health service utilisation patterns of the girls and women in Australia who have undergone FGM/C. Better understanding of FGM/C in Australia is important, particularly because of the:
likelihood of high prevalence rates in some communities and the potential for the rate to rise due to migration trends
potential impact on a female’s physical, reproductive and psychological health throughout her life
complexity and intersectional nature of FGM/C in Australia (that is, discrimination or disadvantage stemming from multiple roots; for example, age, sex, race and social class).
A further report, A discussion of female genital mutilation/cutting data in Australia, will be released in 2019–20 and will identify and discuss what relevant data sources exist in Australia, the potential service contexts in which data are (or could be) captured, and what steps might be taken to improve the collection of data. It will include analyses from the National Hospital Morbidity Database on admitted patients where FGM/C was recorded as relevant to the patient’s care (primarily episodes of care related to childbirth) for the 3-year period 2015–16 to 2017–18.
The health of Australia’s prisoners
We have been reporting on the health of people in Australia’s prisons since 2009, and Australia is unique in having such a long- running and comprehensive data collection. For the latest report, information was gathered from 62 prisons across Australia (except New South Wales). Data were collected from 803 people entering prison, and 335 who were due to be released in the following 4 weeks. They were asked about their cultural and family background, education, employment, living arrangements, and mental and physical health. Key findings from the report are presented in Figure 2.6.
Information was also collected on 8,000 people who visited the prison health clinic, and on another 8,000 who received medications while in prison. The health of Australia’s prisoners 2018 is a comprehensive view of the health, wellbeing and social factors that affect people before, during and after their time in prison.
A profile of Australia’s veterans 2018, released in partnership with the Department of Veterans' Affairs, is the first comprehensive report on Australian veterans’ health and welfare.
Veterans of the Australian Defence Force (ADF) are an important group for health and welfare monitoring. The unique nature of military service means their needs and outcomes can differ from those of the general population.
The report explores the ‘veteran-centred model' (Figure 2.7)—comprising 7 domains and based on the AIHW’s Person-centred model—to understand the factors that influence veterans' health and welfare.
Information from 30 diverse data sources has been compiled to build a profile of the whole veteran population, including information on veterans' families. The report also identifies opportunities to fill gaps in our understanding of veterans’ health and welfare, particularly in the domains of housing, income and finance, and justice and safety.
The report found that ADF members are generally much healthier than the general population and various cohorts of veterans have lower all-cause mortality than the general population. Encouragingly, in 2014–15, 78% of people who had served in the ADF rated their health as excellent, very good or good. However, veterans may be at greater risk of developing some cancers, and affective disorders, and the age-adjusted suicide rate for former serving men is higher than for all Australian men.
The report has been well received by the Department of Veterans' Affairs. An article on the report published in the VetAffairs newsletter on 8 April 2019 stated:
The report … will serve as a benchmark, building the foundation for future work to address gaps in the understanding of veterans’ health and welfare, and inform research and policy development to benefit veterans and their families.