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1. Introduction

Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

1. Introduction

The Aboriginal and Torres Strait Islander Health Performance Framework summary report provides the latest information on the health and welfare of First Nations people, compiling key findings from the Health Performance Framework (HPF) measures.

Since 2020, detailed HPF findings and data have been presented together on a dedicated website: indigenoushpf.gov.au. The website includes:

  • comprehensive national and state and territory reporting
  • supplementary data tables
  • interactive data visualisations.

The measures also include sections on research and evaluations. These provide insights into aspects of health and service delivery that are not easily captured in administrative data sets but can demonstrate characteristics of communities and services that are working well or need improvement.

Feature articles will also be progressively published on the Aboriginal and Torres Strait Islander Health Performance Framework website to further explore insights from key data and research, exploring particular topics across HPF measures. The first feature article Key factors contributing to low birthweight among Aboriginal and Torres Strait Islander babies was released in May 2022. This feature article examines birthweight among First Nations babies, with a focus on identifying factors contributing to low birthweight.

The Aboriginal and Torres Strait Islander Health Performance Framework

Starting in 2006, Aboriginal and Torres Strait Islander Health Performance Framework (HPF) reports have provided information about health outcomes, key drivers of health and the performance of the health system for First Nations people.

The HPF was designed, in consultation with First Nations stakeholder groups, to promote accountability, inform policy and research, and foster informed debate about the health of First Nations people. The HPF also provides information to support progressive improvements in national goals and targets. 

The Aboriginal and Torres Strait Islander Health Performance Framework

The HPF is made up of 68 measures across 3 levels, or tiers:

  • Tier 1: Health status and outcomes
  • Tier 2: Determinants of health
  • Tier 3: Health system performance

Each HPF measure represents a health-related concept that is explored in detail, using various indicators drawn from relevant data sources and research. It is important to note that measures in the 3 tiers are interconnected, and understanding the reasons for progress (or lack thereof) in the health status and outcomes of First Nations people (Tier 1) may often be best understood by examining relevant measures in Tier 2 (determinants of health) and Tier 3 (performance of the health system).

The HPF analyses variation within the population of First Nations people by age, geography, and other key characteristics, and provides insights through research and evaluations. The HPF also analyses trends across the measures and draws implications for further improvement. This helps identify what is working well and how to better target policy and services to meet the needs of First Nations people.

The HPF reporting process is overseen by a Steering Committee made up of First Nations representatives and other stakeholders. These include:

  • a First Nations person as Chair
  • the National Aboriginal Community Controlled Health Organisation
  • the Australian Institute of Health and Welfare
  • the National Indigenous Australians Agency
  • the Australian Government Department of Health and Aged Care
  • representatives from 2 or 3 State and Territory Governments
  • two or three non government representatives with data expertise relating to First Nations people.

The design of the HPF recognises that the health system and factors beyond the health sector contribute to health outcomes, and that achieving better health outcomes requires a whole-of-government approach, working in partnership with First Nations people (AHMAC 2006).

A key theme of Tier 3: Health system performance is the importance of culturally competent service delivery, and the need to partner with and share decision-making with First Nations people in the design of services and programs that affect them.

While there are organisations across sectors that provide culturally competent services to First Nations people, the HPF highlights the crucial role of Aboriginal Community Controlled Health Services (ACCHS). ACCHSs are operated and governed by the local community to deliver holistic, comprehensive and culturally safe primary health services (NACCHO 2022). The HPF also highlights where mainstream services are not adequately meeting the needs of First Nations people, or where there are service gaps.

The Cultural safety in health care for Indigenous Australians: monitoring framework aims to measure progress in achieving cultural safety in the Australian health system by bringing together data focusing on:

  • culturally respectful health care services
  • patient experience of health care among First Nations people
  • access to health care.

Terminology and data interpretation

The term ‘First Nations people’ is now the preferred term used by the AIHW when referring to Aboriginal and Torres Strait Islander people. Across the HPF website, ‘Indigenous Australians’ is also used. As content in the HPF website is updated, this will be progressively updated to ‘First Nations people’.

In most of the data presented, ‘First Nations people’ refers to people who have identified themselves or have been identified by a representative (for example, their parent or guardian), as being of Aboriginal and/or Torres Strait Islander origin. For a few data collections, such as those associated with government grants and payments, information on acceptance of a person as being of Aboriginal and Torres Strait Islander origin by their community may also be required. See also Glossary.

Note that references to ‘First Nations people’ on this website refer to First Nations people in Australia only. Where data are compared with those for indigenous people internationally, for clarity, ‘Aboriginal and Torres Strait Islander people’ will be used.

The HPF draws on data from various sources, and the reference period reported varies between topic areas. Some data are restricted to states and territories where information on Indigenous status is considered of sufficient quality; this is indicated in relevant sections.  

Improvements in data quality and changes in Indigenous identification in several important data sets have a major bearing on the interpretation of the findings and can impact the interpretation of changes in outcomes. This is particularly important for mortality data, the Census, and the population estimates derived from the Census that form the denominators for many of the statistics across data sets.

See also Additional information. 

Closing the Gap

Information from  HPF reporting has been used, in part, to monitor progress towards improving health and wellbeing outcomes for First Nations people outlined in the National Agreement on Closing the Gap (the National Agreement). 

In July 2020, the National Agreement on Closing the Gap was developed in partnership between Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations (the Coalition of Peaks). The National Agreement has been built around four Priority Reforms that will change the way governments work with First Nations people. These reforms outline obligations for governments to work in partnership; share decision making; build the community-controlled sector; transform government organisations; and provide shared access to regional level data.

This agreement provides a framework to address the entrenched inequality faced by First Nations people so that their life outcomes are equal to all Australians.

The National Agreement on Closing the Gap, July 2020

Closing the Gap is a government framework aiming to reduce disadvantage among First Nations people. In 2008, the Australian government first agreed to targets to ‘close the gap’ between First Nations people and non-Indigenous Australians in life expectancy, child mortality, education and employment. With 4 of the 7 targets expiring unmet, a new approach was needed.

The National Agreement is a marked shift in the approach to the Closing the Gap framework. The agreement represents the culmination of a significant amount of work by the Joint Council on Closing the Gap in partnership between all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations.

This was the first time an agreement designed to improve life outcomes for First Nations people had been developed with First Nations people. The agreement was launched on 30 July 2020 by former Prime Minister Scott Morrison, Minister for Indigenous Australians Ken Wyatt, and Pat Turner, the convenor of the Coalition of Peaks – a representative body of more than 50 First Nations community controlled peak organisations that have come together to partner with Australian governments on closing the gap.

The National Agreement is available at Closing the Gap. The Agreement has been built around four Priority Reforms:

  • Priority reform 1 – Formal partnerships and shared decision making.
  • Priority reform 2 – Building the community-controlled sector.
  • Priority reform 3 – Transforming government organisations.
  • Priority reform 4 – Shared access to data and information at a regional level.

The Agreement also includes 17 socioeconomic outcomes and targets – see Table 1.1.

The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 (the Health Plan), provides a strong overarching policy framework for First Nations health and wellbeing and is the first national health plan to address the health targets and priority reforms of the National Agreement (Department of Health and Aged Care 2021b). Data relevant to some of these targets are presented within this summary report. Assessment of progress against the targets by the Productivity Commission is available from the Closing the Gap Information Repository.

As reporting on the National Agreement targets and the Health Plan progresses, the HPF will need to adapt. This might mean changing existing measures or adding other measures into the future.

Table 1.1. National Agreement on Closing the Gap – socioeconomic outcomes and targets

Outcome

Target

1 Aboriginal and Torres Strait Islander people enjoy long and healthy lives.

Close the Gap in life expectancy within a generation, by 2031.

2 Aboriginal and Torres Strait Islander children are born healthy and strong.

By 2031, increase the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to 91 per cent.

3 Aboriginal and Torres Strait Islander children are engaged in high quality, culturally appropriate early childhood education in their early years.

By 2025, increase the proportion of Aboriginal and Torres Strait Islander children enrolled in Year Before Fulltime Schooling (YBFS) early childhood education to 95 per cent.

4 Aboriginal and Torres Strait Islander children thrive in their early years.

By 2031, increase the proportion of Aboriginal and Torres Strait Islander children assessed as developmentally on track in all five domains of the Australian Early Development Census (AEDC) to 55 per cent.

5 Aboriginal and Torres Strait Islander students achieve their full learning potential.

By 2031, increase the proportion of Aboriginal and Torres Strait Islander people (age 20–24) attaining Year 12 or equivalent qualification to 96 per cent.

6 Aboriginal and Torres Strait Islander students reach their full potential through further education pathways.

By 2031, increase the proportion of Aboriginal and Torres Strait Islander people aged 25–34 years who have completed a tertiary qualification (Certificate III and above) to 70 per cent.

7 Aboriginal and Torres Strait Islander youth are engaged in employment or education.

By 2031, increase the proportion of Aboriginal and Torres Strait Islander youth (15–24 years) who are in employment, education or training to 67 per cent.

8 Strong economic participation and development of Aboriginal and Torres Strait Islander people and communities.

By 2031, increase the proportion of Aboriginal and Torres Strait Islander people aged 25–64 who are employed to 62 per cent.

9 Aboriginal and Torres Strait Islander people secure appropriate, affordable housing that is aligned with their priorities and need.

A: By 2031, increase the proportion of Aboriginal and Torres Strait Islander people living in appropriately sized (not overcrowded) housing to 88 per cent.

B: By 2031, all Aboriginal and Torres Strait Islander households:

i. within discrete Aboriginal and Torres Strait Islander communities receive essential services that meet or exceed the relevant jurisdictional standard;

ii. in or near to a town receive essential services that meet or exceed the same standard as applies generally within the town (including if the household might be classified for other purposes as a part of a discrete settlement such as a ‘town camp’ or ‘town based reserve’).

10 Aboriginal and Torres Strait Islander adults are not overrepresented in the criminal justice system.

By 2031, reduce the rate of Aboriginal and Torres Strait Islander adults held in incarceration by at least 15 per cent.

11 Aboriginal and Torres Strait Islander young people are not overrepresented in the criminal justice system.

By 2031, reduce the rate of Aboriginal and Torres Strait Islander young people (10–17 years) in detention by at least 30 per cent.

12 Aboriginal and Torres Strait Islander children are not overrepresented in the child protection system.

By 2031, reduce the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of-home care by 45 per cent.

13 Aboriginal and Torres Strait Islander families and households are safe.

By 2031, the rate of all forms of family violence and abuse against Aboriginal and Torres Strait Islander women and children is reduced by at least 50%, as progress towards zero.

14 Aboriginal and Torres Strait Islander people enjoy high levels of social and emotional wellbeing.

Significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero.

15 Aboriginal and Torres Strait Islander people maintain a distinctive cultural, spiritual, physical and economic relationship with their land and waters.

A. By 2030, a 15 per cent increase in Australia’s landmass subject to Aboriginal and Torres Strait Islander people’s legal rights or interests.

B. By 2030, a 15 per cent increase in areas covered by Aboriginal and Torres Strait Islander people’s legal rights or interests in the sea.

16 Aboriginal and Torres Strait Islander cultures and languages are strong, supported and flourishing.

By 2031, there is a sustained increase in number and strength of Aboriginal and Torres Strait Islander languages being spoken.

17 Aboriginal and Torres Strait Islander people have access to information and services enabling participation in informed decision-making regarding their own lives.

By 2026, Aboriginal and Torres Strait Islander people have equal levels of digital inclusion.

Structure of this report

  • Section 1 ‘Introduction’ presents the background to, and purpose of, the HPF.
  • Section 2 ‘Demographic and social context’ presents an overview of the broader social and policy context to the health of First Nations people.
  • Section 3 ‘How First Nations people are faring’ presents a summary of key findings from the 2023 Aboriginal and Torres Strait Islander HPF.
  • Section 4 ‘Tier 1 – Health status and outcomes’ presents key findings from Tier 1 of the HPF.
  • Section 5 ‘Tier 2 – Determinants of health’ presents key findings from Tier 2 of the HPF.
  • Section 6 ‘Tier 3 – Health system performance’ presents key findings from Tier 3 of the HPF.
  • Section 7 ‘Additional information’ provides information about where to find more detailed data and related information (such as data source information).
  • Section 8 ‘References’ provides a list of references used in the Summary report.
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