Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012


The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

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Aboriginal Community Controlled Health Service (ACCHS)

Community control is a process which allows the local Aboriginal community to be involved in its affairs in accordance with whatever protocols or procedures are determined by the community.

Aboriginal community control has its origins in Aboriginal peoples' right to self-determination. This includes the right to be involved in health service delivery and decision making according to protocols or procedures determined by Aboriginal communities based on the Aboriginal holistic definition of health.

An ACCHS is:
  • an incorporated Aboriginal organisation
  • initiated by a local Aboriginal community
  • based in a local Aboriginal community
  • governed by an Aboriginal body which is elected by the local Aboriginal community
  • delivering a holistic and culturally appropriate health service to the community which controls it.
Source: National Aboriginal Community Controlled Health Organisation (NACCHO)

Acute rheumatic fever (ARF)

ARF is a disease caused by an auto-immune reaction to a bacterial infection with Group A streptococcus. ARF is a short illness, but can result in permanent damage to the heart—rheumatic heart disease (RHD). A person who has had ARF once is susceptible to repeated episodes, which can increase the risk of RHD. Following an initial diagnosis of RHD, patients require long-term treatment, including long-term antibiotic treatment to avoid infections that may damage the heart (Steer et al. 2009).


The formal process, using registration procedures, under which a person is accepted by a hospital or an area or district health service facility as an inpatient.

Age-adjusted rate

See Age-standardised rate.

Age-specific rate

Rate for a specified age group. Both numerator and denominator refer to the same age group. Top of page

Age-Standardised rate

Rate adjusted to take account of differences in age composition when rates for different populations are compared. The direct method of standardisation is used for the HPF. To calculate age-standardised rates using the direct method:

SR = (SUM (ri * Pi))/SUM Pi

  • SR is the age-standardised rate for the population being studied
  • ri is the age-group specific rate for age group i in the population being studied
  • Pi is the population for age group i in the standard population.
Also called age-adjusted rate.

Ambulatory mental health service

A specialised mental health service that provides services to people who are not currently admitted to a mental health or residential service. Services are delivered by health professionals with specialist mental health qualifications or training, as well as community-based crisis assessment and treatment teams, mental health outpatient clinics, and home based treatment services.

Antenatal care

Includes recording medical history, assessment of individual needs, advice and guidance on pregnancy and delivery, screening tests, education on self-care during pregnancy, identification of conditions detrimental to health during pregnancy, first-line management and referral if necessary (WHO Health Services Coverage Statistics

Antepartum haemorrhage

An antepartum haemorrhage (APH) is bleeding from the vagina after 20 weeks of pregnancy and before the birth of the baby. The common causes of bleeding include: cervical ectropion (when the cells on the surface of the cervix change in pregnancy, the tissue is more likely to bleed), vaginal infection, placental edge bleed (when the lower-half of the uterus begins to stretch and grow, the edge of the placenta can separate from the wall of the uterus), placenta praevia (when the placenta covers all or part of the cervix) or placental abruption (when the placenta detaches from the uterus). The latter two conditions can lead to death of the foetus and/or mother.


A disturbed rhythm of the heart beat—too fast (tachycardia), too slow (bradycardia) or irregular.Top of page

At-risk communities (regarding trachoma)

The National Trachoma Surveillance and Reporting Unit analysed jurisdictional trachoma screening and management data for 2010 by region, with five regions in the NT, six in SA and four in WA. Jurisdictional authorities designated 243 remote Aboriginal communities in these regions as being at-risk of endemic trachoma in 2010.

Australian Standard Geographical Classification—Remoteness Area (ASGC-RA)

ASGC-RA is a geographic classification system that was developed in 2001 by the ABS as a statistical geography structure to classify data from Census Collection Districts (CDs) into broad geographical categories, called Remoteness Areas (RAs). The RA categories are defined in terms of 'remoteness'—the physical distance of a location from the nearest Urban Centre (based on population size). Remoteness is calculated using the road distance to the nearest Urban Centre (access to goods and services) for five categories:
  • RA1—Major Cities of Australia
  • RA2—Inner Regional Australia
  • RA3—Outer Regional Australia
  • RA4—Remote Australia
  • RA5—Very Remote Australia (see also RRMA categorisation). Top of page

Australian 2001 standard population

The 2001 Australian population has been used as the standard population for calculation of directly age-standardised rates.

Avoidable mortality

Refers to deaths from certain conditions that are considered avoidable given timely and effective health care. Avoidable mortality measures premature deaths (for those aged 0-74 years) for specific conditions defined internationally and nationally as potentially avoidable given access to effective health care.

Body Mass Index (BMI)

Used to assess overweight and obesity levels. BMI is calculated as follows: BMI = weight (kg) / height (m)˛

The normal range of BMI is between 18.5 and 25.
  • Underweight: BMI below 18.5
  • Normal weight: BMI from 18.5 to 24.9
  • Overweight: BMI from 25.0 to 29.9
  • Obese: BMI of 30.0 and over
The BMI cut-off points are derived from mainly European populations and can vary for other groups, including Aboriginal and Torres Strait Islander peoples.


Clouding of the lens in the eye that affects vision. The most common type of cataract is associated with ageing. Other causes of cataract include:Top of page
  • Smoking
  • Sunlight exposure
  • Diabetes
  • Arthritis
  • Short-sightedness
  • Some blood pressure lowering medications

Cerebrovascular disease

Disease of the blood vessels, especially the arteries that supply the brain. It is usually caused by hardening of the arteries (atherosclerosis) and can lead to a stroke.


A sexually transmissible infection (STI) that can affect women and men. Chlamydia is caused by the bacterium Chlamydia trachomatis. If left untreated, chlamydia can cause pelvic inflammatory disease in women, which can lead to chronic pain and infertility.

Chronic obstructive pulmonary disease (COPD)

COPD is a serious long-term lung disease that mainly affects older people and is often difficult to distinguish from asthma. It is characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.

Circulatory disease

Any disease of the circulatory system, namely the heart (cardio) or blood vessels (vascular). Includes heart attack, angina, stroke and peripheral vascular disease. Also known as cardiovascular disease. Top of page

Closing the Gap

A commitment made by Australian governments in 2008 to improve the lives of Aboriginal and Torres Strait Islander Australians.

The Council of Australian Governments (COAG) agreed to six specific targets and timelines to reduce disadvantage among Indigenous Australians. These targets acknowledge the importance of reducing the gap in health outcomes and improving the social determinants of health. They are:
  • To close the life-expectancy gap within a generation
  • To halve the gap in mortality rates for Indigenous children under five within a decade
  • To ensure access to early childhood education for all Indigenous four years olds in remote communities within five years
  • To halve the gap in reading, writing and numeracy achievements for children within a decade
  • To halve the gap in Indigenous Year 12 (or equivalent) attainment rates by 2020
  • To halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade.

Congenital malformations

Physical or anatomical abnormalities present in a baby at birth. Examples include heart defects, spina bifida, limb defects, cleft lip and palate, and Down syndrome. Congenital malformations can be genetic or caused by environmental factors (such as alcohol), or be of unknown origin

Coronary heart disease

Coronary heart disease, also known as ischaemic heart disease, is the most common form of heart disease. There are two major clinical forms—heart attack (often known as acute myocardial infarction) and angina.

Crude rate

An estimate of the proportion of a population that experiences an outcome during a specified period. It is calculated by dividing the number of people with an outcome in a specified period by the defined population during that period.Top of page

Crude death rate

An estimate of the proportion of a population that dies in a specified period. It is calculated by dividing the number of deaths in a specified period by the defined population during that period.

Decayed, missing, or filled teeth scores

Oral health outcomes are usually measured in terms of the number of decayed, missing or filled baby or deciduous (dmft) and adult or permanent (DMFT) teeth. The dmft score measures decay experience in deciduous teeth, and the DMFT score measures decay experience in permanent teeth.

Diabetes mellitus

A chronic condition marked by high levels of glucose in the blood. This condition is caused by the inability to produce insulin (a hormone produced by the pancreas to control blood glucose levels), or the insulin produced becomes less effective, or both. The three main types are Type 1, Type 2 and gestational diabetes.
  • Type 1 diabetes, an auto-immune condition, is marked by the inability to produce any insulin and those affected need insulin replacement for survival. Type 1 diabetes is rare among Indigenous Australians.
  • Type 2 diabetes (non-insulin dependent) is the most common form of diabetes. Those with Type 2 diabetes produce insulin but may not produce enough or cannot use it effectively. There is a high prevalence of Type 2 diabetes among Indigenous Australians, who tend to develop it earlier than other Australians and die from the disease at younger ages.
  • Gestational diabetes occurs during pregnancy and usually disappears after birth.

Diabetic retinopathy

Diabetic retinopathy occurs when the tiny blood vessels inside the retina at the back of the eye are damaged as a result of diabetes. This can seriously affect vision and in some cases may even cause blindness. Top of page


A medical procedure for the filtering and removal of waste products from the bloodstream. Dialysis is used to remove urea, uric acid and creatinine (a chemical waste molecule that is generated from muscle metabolism) in cases of chronic end-stage renal disease. Two main types are:
  • haemodialysis—blood flows out of the body into a machine that filters out the waste products and returns the cleansed blood back into the body.
  • peritoneal dialysis—fluid is injected into the peritoneal cavity and wastes are filtered through the peritoneum, the thin membrane that surrounds the abdominal organs.

Ectopic pregnancy

Ectopic pregnancy is a pregnancy that develops outside the uterus, usually in one of the fallopian tubes. In almost all cases, the embryo dies as the developing placenta can't access a rich blood supply and the fallopian tube is not large enough to support the growing embryo. Implantation can also occur in the cervix, ovaries, and abdomen, but this is rare.

End-stage renal disease

Chronic irreversible renal failure. The most severe form of chronic kidney disease where kidney function deteriorates so much that dialysis or kidney transplantation is required to survive.

Equivalised gross household income

In measuring and comparing income, equivalised gross household income adjusts for various factors, such as the number of people living in a household, particularly children and other dependants.

Foetal alcohol spectrum disorders.

Conditions that may result from foetal exposure to alcohol during pregnancy. Disorders include foetal alcohol syndrome, alcohol-related neurodevelopmental disorder and alcohol-related birth defects. These disorders include antenatal and postnatal growth retardation, specific facial dysmorphology and functional abnormalities of the central nervous system.


Glaucoma is a common form of eye disease that often runs in families. It affects the optic nerve connecting the eye to the brain. Glaucoma is usually caused by high intraocular pressure as a result of a blockage in the eye's drainage system, which can lead to irreversible vision loss and blindness. Early detection and treatment can prevent vision loss in most cases.Top of page


Gonorrhoea is a common sexually transmissible infection that affects men and women. Gonorrhoea is caused by bacteria known as Neisseria gonorrhoea. It usually affects the genital area, although the throat or anus may also be involved. It can cause pelvic inflammatory disease and infertility in women. Gonorrhoea can be treated with antibiotics.

GP Super Clinics

In 2009, the Australian Government committed to improve the quality and accessibility of primary health care services by supporting the establishment of GP Super Clinics. GP Super Clinics are a key element in building a stronger national primary health care system with a greater focus on health promotion and illness prevention as well as better coordination between GPs and allied health services, community health and other state and territory funded services (for more information, see GP Super Clinics).


A process used to treat kidney failure. A machine is connected to the patient's bloodstream and then filters the blood externally to the body, removing water, excess substances and waste from the blood as well as regulating the levels of circulating chemicals. In doing this the machine takes on the role normally played by the kidneys (see also dialysis).

Health and Hospitals Fund 2011 Regional Priority Round

The Health and Hospitals Fund is a funding pool which was established on 1 January 2009 by the Australian Government as part of its broader nation-building infrastructure program. Its objectives, while not replacing state and territory efforts, are to invest in major health infrastructure programs that will make significant progress towards achieving the Commonwealth's health reform targets; and to make strategic investments in the health system that will underpin major improvements in efficiency, access or outcomes of health care.

Four funding rounds of the Health and Hospitals Fund have been conducted. The fourth round was the 2011 Regional Priority Round where 76 projects were allocated funding through the 2012–13 Budget. Top of page

High blood triglycerides

Triglycerides make up about 95 per cent of all dietary fats. In many cases, regular overeating leading to obesity causes a person to have raised triglycerides, which are linked with an increased risk of health conditions including diabetes and heart disease. High triglyceride levels in the blood are also known as hypertriglyceridemia.

Hospital separation or hospitalisation

See Separation.

Hypertension/hypertensive disease

High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg—a systolic pressure above 140 with a diastolic pressure above 90.

Illicit drugs

Illicit drugs include illegal drugs (amphetamine, cocaine, marijuana, heroin, hallucinogens), pharmaceuticals when used for non-medical purposes (pain-killers, sleeping pills) and other substances used inappropriately (inhalants such as petrol or glue).


The rate at which new events or cases occur during a certain period of time. Top of page

Indigenous deaths identification rate

Almost all deaths in Australia are registered. However, the Indigenous status of the deceased may not be recorded correctly or reported. This means that the identification of Indigenous Australians in deaths data is incomplete. The number of deaths registered as Indigenous may therefore be an underestimate of deaths occurring among the Aboriginal and Torres Strait Islander population (ABS 1997). As a result, the observed differences between Indigenous and non-Indigenous mortality are underestimates of the true differences.

Infant death

The death of a child before its first birthday.

Invasive pneumococcal disease

A more serious form of pneumococcal disease, an infection caused by the Streptococcus pneumoniae bacterium. It occurs inside a major organ or in the blood and can result in pneumonia, sepsis, middle-ear infection (otitis media), or bacterial meningitis. Top of page

Ischaemic heart disease

Ischaemic heart disease, or myocardial ischaemia, is a disease characterised by reduced blood supply (ischaemia) of the heart muscle, usually due to coronary artery disease. See also coronary heart disease.

Kessler Psychological Distress Scale (K10)

A measure of psychological distress in people aged 16 years and over. K10 is a 10‑item questionnaire that measures the level of psychological distress in the most recent 4-week period. At both the population and individual level, the K10 measure is a brief and accurate screening scale for psychological distress.

Life expectancy

The average number of years of life remaining to a person at a particular age. Life expectancy at birth is an estimate of the average length of time (in years) a person can expect to live, assuming that the currently prevailing rates of death for each age group will remain the same for the lifetime of that person.

Live birth

The birth of a child who after delivery, breathes or shows any other evidence of life, such as a heartbeat. For calculation of perinatal death rates only infants weighing at least 400 grams at birth or, where birth weight is unknown, of at least 20 weeks gestation are included.

Low birthweight babies

Infants born weighing less than 2500g.Top of page

Mastoid process

The mastoid process—a bony protrusion located behind the ear in the lower part of the skulls—contains mastoid cells (small air-filled cavities) that communicate with the middle ear. Infection of the mastoid process can lead to hearing loss and other complications.

Medicare Locals

Primary health care organisations established as part of the National Health Reform to coordinate primary health care delivery and address local health needs and service gaps. Their purpose is to drive improvements in primary health care and ensure that services are better tailored to meet the needs of local communities.

Meningococcal disease

Meningococcal disease describes infections caused by the bacterium Neisseria meningitidis (meningococci bacteria). These bacteria can cause meningitis (an inflammatory response to an infection of the membranes covering the brain and spinal cord) and sepsis (an infection in the bloodstream). Meningitis can lead to deafness, epilepsy, cognitive defects and death. Sepsis can lead to organ dysfunction or failure and death.

Multivariate analysis

A set of statistical techniques used to analyse data with more than one variable.

Myocardial infarction

Myocardial infarction or acute myocardial infarction, commonly used to refer to a heart attack, but more correctly refers only to those heart attacks that have caused some death of heart muscle. Top of page


Myopia or near-sightedness is a type of refractive error of the eye, in which the eye does not focus light correctly. This makes distant objects appear blurred.

Myringotomy procedures

Incision in eardrum to relieve pressure caused by excessive build-up of fluid.

National Indigenous Reform Agreement (NIRA)

The NIRA is an agreement between the Commonwealth and state and territory Governments which provides the framework for Closing the Gap in Indigenous disadvantage. It sets out the objectives, outcomes, outputs, performance indicators and performance benchmarks agreed by COAG.

Neonatal death

Death within 28 days of birth of any child who, after delivery, breathed or showed any other evidence of life, such as a heartbeat.


An abnormal ('neo', new) growth of tissue. Can be 'benign' (not a cancer) or 'malignant' (a cancer). Same as a tumour. Top of page


Nephritis is an inflammation of the kidneys. It is often caused by toxins, infections, and auto-immune diseases.


Nephrosis is a condition of the kidneys. It is usually caused by diseases that damage the kidneys' filtering system, allowing a protein called albumin to be filtered out into the urine (albuminuria). Symptoms include protein in the urine, high triglyceride levels, high cholesterol levels, low blood protein levels, and swelling.

Non-ambulatory care

Care provided to a patient, whose condition requires admission to hospital or other inpatient facility.


In this report, notifications are cases of communicable diseases reported by general practitioners, hospitals and pathology laboratories to the relevant authorities.

Otitis media

Middle ear infection. In severe or untreated cases, otitis media can lead to hearing loss.

Overweight and Obesity

Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. See also Body Mass Index (BMI). Top of page

Patient assistance travel schemes (PATS)

The PATS is funded by states and territories to assist residents to access a range of essential specialist medical/surgical services where services are not available locally, from within the state or territory or from a visiting service. PATS provides assistance with travel, and if applicable, accommodation costs to residents who are required to travel more than 100–200kms (dependent on state/territory) to the nearest specialist medical treatment.

Perinatal death

A foetal death (death of a foetus at 20 or more weeks of gestation, or at least 400 grams birthweight) or neonatal death within 28 days of birth. See also live birth and neonatal death.

Post-Enumeration Survey (PES)

The PES aims to measure the net census undercount and is conducted three weeks after census night. It collects information about where people were on census night and their characteristics. The PES provides information on the population and dwelling characteristics of the net undercount in the Census of Population and Housing.

Potentially avoidable hospital admissions

See selected potentially avoidable hospital admissions

Preterm labour

Preterm labour is defined as birth before 37 completed weeks of gestation.


The rate at which existing events or cases are found at a given point or in a period of time. Top of page

Primary health care

Primary health care usually is the first point of contact a person encounters with the health care system. In mainstream health throughout Australia primary health care is normally provided by general practitioners, community health nurses, pharmacists, environmental health officers etc., although the term usually means medical care. Primary health care may be provided through an ACCHS or satellite clinic (from Aboriginal Health and Medical Research Council of NSW 1999).

Refractive error

A refractive error, or refraction error, is an error in the focusing of light by the eye and a frequent reason for blurred vision. It may lead to visual impairment.

Respiratory disease

Respiratory disease includes conditions affecting the respiratory system—which includes the lungs and airways—such as asthma, COPD and pneumonia (see also COPD).

Rheumatic heart disease (RHD)

RHD may develop after illness with rheumatic fever, usually during childhood. Rheumatic fever can cause damage to various structures of the heart including the valves, lining or muscle and this damage is known as RHD (see also acute rheumatic fever).

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease. In rheumatoid arthritis, the immune system attacks the body's own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints causing pain in the joints and inflammation throughout the body.


Globally, rotavirus is the most common cause of severe gastroenteritis in early childhood. Almost all children in Australia have been infected by the time they reach five years of age.

Secondary health care

Secondary health care refers to particular services provided by hospitals, such as acute care, as well as services provided by specialists. Top of page

Selected potentially avoidable hospital admissions

Selected potentially preventable hospital admissions refers to admissions to hospital that are considered sensitive to the effectiveness, timeliness and adequacy of non‑hospital care. This includes conditions for which hospitalisation could potentially be avoided through effective preventive measures or early diagnosis and treatment (Page et al. 2007). Selected potentially preventable conditions are usually grouped into three categories:
  • vaccine-preventable conditions—including invasive pneumococcal disease, influenza, tetanus, measles, mumps, rubella, pertussis, and polio;
  • potentially preventable acute conditions—including dehydration/gastroenteritis, kidney infection, perforated ulcer, cellulitis, pelvic inflammatory disease, dental conditions, and ear, nose and throat infections; and
  • potentially preventable chronic conditions—including diabetes, asthma, angina, hypertension, congestive heart failure, and chronic obstructive pulmonary disease.


The formal process whereby an in-patient leaves a hospital or other healthcare facility after completing an episode of care. For example, a discharge to home, discharge to another hospital, nursing home, other care facility, or death. The hospital separation rate is the average number of hospital separations per 1000 population.

Statistically significant

An indication from a statistical test that an observed difference or association may be significant or 'real' because it is unlikely to be due just to chance. A statistical result is usually said to be 'significant' if it would occur by chance less than once in 20 times. 

Substantiated child protection notifications

A child protection notification is substantiated where it is concluded that the child has been, is being, or is likely to be, abused, neglected or otherwise harmed.

Sudden infant death syndrome (SIDS)

The sudden and unexpected death of a baby with no known illness, typically affecting sleeping infants between the ages of 2 weeks to 6 months.


Syphilis is a sexually transmissible infection caused by a bacterium called Treponema pallidum. It can affect both men and women. Syphilis is transmitted through close skin-to-skin contact and is highly contagious when the syphilis sore (chancre) or rash is present. If untreated, syphilis can damage the internal organs, such as heart and brain and can result in death. Top of page

Tertiary health care

Tertiary health care refers to highly specialised or complex services provided by specialists or allied health professionals in a hospital or primary health care setting, such as cancer treatment and complex surgery.


Trachoma is an eye infection that can result in scarring, in-turned eyelashes and blindness. Australia is the only developed country where trachoma is still endemic and it is found almost exclusively in remote and very remote Aboriginal and Torres Strait Islander populations. Trachoma is associated with living in an arid environment (including the impact of dust); lack of access to clean water for hand and face washing; overcrowding and low socioeconomic status (Taylor 2008).


Trichiasis involves the misdirection of eyelashes toward the eyeball, causing irritation and, if untreated, corneal scarring and vision loss. The misdirected lashes may be diffuse across the entire lid or in a small segmental distribution.


A surgical intervention to reconstruct a perforated eardrum.

Unemployment rate

The number of unemployed people expressed as a proportion of the labour force (i.e., employed and unemployed).

Vocational Education and Training (VET) load pass rate

The VET load pass rate is a ratio of hours of supervision in assessable modules or units that students have completed to the hours of supervision in assessable modules or units that students have either completed, failed or withdrawn from.
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