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

This is the fourth report against the Aboriginal and Torres Strait Islander Health Performance Framework (HPF). In 2011, the framework was reviewed and revised. This report is based on the revised framework (see Figure 1). Details of changes to the framework are provided in Appendix 1.

The HPF comprises three tiers:

Tier 1—Health status and outcomes

Measures the prevalence of health conditions including disease or injury, human function, life expectancy and wellbeing, and deaths.

Tier 2—Determinants of health

Measures the determinants of health including socioeconomic factors, environmental factors and health behaviours.

An important feature of the HPF is that it recognises sustainable health gain will require not only an efficient, effective and equitable health system, but also timely contributions from other sectors. The HPF tracks changes in key measures outside of the health sector to provide a better context for interpreting changes in health outcomes and to provide a basis for constructive intersectoral dialogue.

Tier 3—Health system performance

Measures health system performance including effectiveness, responsiveness, accessibility, continuity, capability and sustainability.

The HPF covers the entire health system, including Indigenous-specific services and programs, and mainstream services. It includes performance measures across the full continuum, from inputs, processes, outputs, and intermediate outcomes to final outcomes. This enables short- to medium-term measures of progress to be included, and accommodates the different stages of development of services and systems. The statistics in this report are the latest available but some are several years old and therefore may not reflect the impact of recent action.

Monitoring the performance of health services and governments in their stewardship role is critical. In doing this, attention should be given to assessing not only the level of access to appropriate care but the personal experiences of Aboriginal and Torres Strait Islander peoples as active partners in managing their health.
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Reporting against the HPF is designed to:Promote accountability
  • The HPF measures government achievement against commitments to improve the health of Aboriginal and Torres Strait Islander peoples.
Inform policy
  • The HPF informs the development of policy in Aboriginal and Torres Strait Islander health and in whole of government action on the determinants of health.
Inform research
  • The HPF provides a valuable tool for those involved in research relating to Aboriginal and Torres Strait Islander health.
Foster informed debate
  • The HPF is a key resource to support and encourage informed public debate around Aboriginal and Torres Strait Islander health.

Structure of this report

  • The report is structured according to the revised framework presented in Figure 1.
  • An overview of existing national strategies and policies are included in the introductory section of this report.
  • The main body of the report includes data and policy analysis for each tier of the framework incorporating analyses of each of the 68 measures. It contains:
    • a discussion of why the measure is important
    • a presentation of the results relating to the measure, and
    • an outline of the implications of the findings for policy development/action.
  • The material presented on each measure is succinct, and in some cases only touches on the major features of complex issues. Additional data analyses supplementing this report are available on the Australian Institute of Health and Welfare website.

Data limitations

There are well-documented problems with the quality and availability of data about Aboriginal and Torres Strait Islander health. These limitations include the quality of data on all key health measures—including mortality and morbidity, uncertainty about the size and composition of the Aboriginal and Torres Strait Islander population, and a paucity of available data on other health issues such as access to health services (see Technical Appendix for details). The following should be noted when interpreting the data analysis:


  • Under-identification of Aboriginal and Torres Strait Islander people is the main issue in most administrative data collections. Under-identification is a major problem in hospital and mortality data collections, particularly for some states and territories.
  • The under-identification of Aboriginal and Torres Strait Islander people in administrative data collections is due to various factors. These include:
    • whether the question about Indigenous status is asked in the first instance
    • issues about consistency in the way the question is asked and recorded, and
    • differing responses by the person involved depending on the situation.
  • Decisions on which data to include have been based on the most recent evaluations (see Technical Appendix). Work is underway to improve data quality. In future, some measures will have more comprehensive data available.

Coverage by jurisdictions

  • Due to the under-identification issues described above, for some data collections the analysis has been limited to jurisdictions where better data quality is known to exist. For the current period of reporting, some measures presented in this report are based on an analysis of data for selected jurisdictions only. For example, mortality data are currently only published for NSW, Qld, SA, WA and the NT. Longer-term mortality trends (i.e., from 1991) are limited to SA, WA and the NT, as these jurisdictions have been shown to have adequate coverage for these earlier years. However, most jurisdictions now have at least a decade of mortality data that are considered adequate for analysis. Note: WA mortality data in the years 2007, 2008 and 2009 have recently been revised. This has resulted in revisions to data previously published in the HPF.Top of page

Uncertainty in Indigenous population estimates

  • Measuring the size of the Indigenous population is not easy. The Aboriginal and Torres Strait Islander Census count has varied considerably over the last two decades. Cohort analysis from one Census to the next show that these changes are not entirely due to demographic factors such as births, deaths, migration and immigration. The estimates of the population projections and backcast estimates are based on a series of informed assumptions around life expectancy. The population is used as the basis of rate calculations and trends and this uncertainty affects many of the statistics in this report including analysis of progress.

Inconsistencies in the Indigenous status question

  • A standard Indigenous status question has been developed and endorsed nationally (AIHW 2010h). However, the standard question and categories are still not used in data collections across all jurisdictions. For example, in the national perinatal data, Indigenous status is currently based on the mother (missing 30% of babies with an Indigenous father and non-Indigenous mother). A question on the Indigenous status of the baby is currently being incorporated into the data collection.
Data quality limitations remain a significant impediment to fully understanding the health of Aboriginal and Torres Strait Islander peoples and the performance of the health system. One significant initiative is the introduction of the Voluntary Indigenous Identifier (VII) in the Medicare database in 2002. Since then participation has gradually increased. By 1 May 2012, 339,310 people (59% of the total estimated Indigenous population) had identified with Medicare as being Aboriginal, Torres Strait Islander, or both. From 2010, the VII data have been considered to be of sufficient quality to use as the basis for calculating statistics about Indigenous Australians' use of Medicare.

Demographic context

The preliminary estimate resident Aboriginal and Torres Strait Islander population of Australia as at 30 June 2011 was approximately 670,000 people (ABS 2012).

Overall, Indigenous Australians represent 3% of the Australian population, although this proportion varied from region to region. It ranged from 30% of the population of the Northern Territory to 0.9% of the population of Victoria.

When the data are analysed as a proportion of the Indigenous population, the results show that 31% of all Aboriginal and Torres Strait Islander peoples lived in NSW, 28% lived in Qld, 13% in WA and 10% in the NT.
Figure 10—Aboriginal and Torres Strait Islander population by state and territory, 2011 (preliminary)

Figure 10—Map of Australia showing Aboriginal and Torres Strait Islander population by state and territory, 2011 (preliminary) Longer description is in text previous to image and in table following.Top of page
In 2006, around 75% of Indigenous Australians lived in regional and metropolitan areas. While only 15% of Indigenous Australians lived in very remote areas, they made up a large proportion of Australians living in very remote areas (48%) (see Table 2). Note: 2011 Census estimates are not yet available by remoteness.

The age structure of the Aboriginal and Torres Strait Islander population is significantly younger than the non-Indigenous population (see Figure 11) which means that service delivery must be adequately resourced for children and young people, as well as developed and delivered in culturally competent ways. The younger age structure also represents a tremendous opportunity. With well-designed and competently delivered antenatal care and early childhood programs, along with effective interventions helping young adults to adopt healthy lives, there is an opportunity to temper the emergence of chronic illnesses and their devastating consequences in this group of younger people. While it is vital that the focus is on ensuring improvement of health for Aboriginal and Torres Strait Islander peoples across their life course, it is important to take account of demographic composition in planning for resource requirements and service delivery for Aboriginal and Torres Strait Islander peoples.
Table 1—Preliminary estimated resident population by jurisdiction and Indigenous status, 2011
Number of Indigenous population by jurisdiction populationIndigenous population % by jurisdiction(a)Number of total population by jurisdiction(b)Indigenous population as % of jurisdiction population
New South Wales
South Australia
Western Australia
Northern Territory
Australian Capital Territory
(a) See figure 10 (above)Top of page
(b) Indigenous plus non-Indigenous
Source: Preliminary ABS population estimates based on the 2011 Census (ABS 2012)
Table 2—Estimated resident population by remoteness area and Indigenous status, 2006
Number of Indigenous AustraliansIndigenous as % of total populationIndigenous as % of total Indigenous population
Major cities
Outer regional
Inner regional
Very remote
Source: AIHW analysis of ABS population estimates based on 2006 Census
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Figure 11—Age distribution of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, by Indigenous status and sex, 2011 (preliminary)
Figure 11—Age distribution of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, by Indigenous status and sex, 2011 (preliminary)—Males & Females
Source: Preliminary ABS population estimates based on the 2011 Census (ABS 2012)
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