Guest Column with Jane Freemantle

November 10 / 49

Associate Professor Jane Freemantle is an ARC Fellow in the Centre for Health and Society, the Melbourne School of Population Health.  She is a nationally and internationally recognised expert in Indigenous child health and the use of linked total population data bases to describe and monitor Indigenous child health outcomes.

Are we there yet? How will we know when we have ‘closed the gap’ in the disparities between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander child health outcomes?

Measuring and monitoring the rates and cause/s of morbidity and mortality for Aboriginal and Torres Strait Islander children and their access to care is made possible through the identification of Indigenous status (or ethnicity) in data such as birth, hospital and death collections/registries, health surveys and population census.  To enable reporting on Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander populations and to analyse comparisons between the two, these data are disaggregated according to identification in the Indigenous status variable in health data sets.

Health data disaggregated by Indigenous status provide an evidence base for the development of health policy and programs, the evaluation of services and interventions, and monitoring of public expenditure.  At a local level, these data enable assessment of the cultural-appropriateness and responsiveness of health services to the needs of their clients. These data can be a valuable tool for communities in advocating for policy change and monitoring political accountability.  Analysis of expenditure per capita, disaggregated by Indigenous status also provides a basis from which to assess the human right to equal opportunity to good health.

More specifically, infant and early childhood mortality statistics are important indicators of a population’s health and an accurate picture of mortality informs a moral society of its social progress at a national and/or community level.  This is particularly valid given that causes of infant and childhood mortality such as infections are potentially preventable.  Others, such as low birth weight or preterm birth can be partially prevented with good health care and antenatal interventions. Studies of the trends in mortality and related statistics demonstrate the changing health status of the population.

However, a statistical approach to measuring population-level child health outcomes has its limitations due to issues of accuracy and completeness of identification of Indigenous status in birth information. Issues are generally due to a combination of differential classification of Indigenous persons, the changing propensity to identify ones Indigenous status, and/or inconsistencies in the routine asking of the question by staff. Under-registration of Aboriginal and Torres Strait Islander births and deaths, remoteness and accessibility issues for many Aboriginal and Torres Strait Islander communities,  the role of self-identification and classification  of ‘Indigenousness’ and the history of institutionalised discrimination against Indigenous peoples by settler populations also result in disjointed and incomplete data.

In order to achieve the targets identified under local and national reporting agreements, we must be able to describe and monitor Aboriginal and Torres Strait Islander child health outcomes.  This requires complete, accurate, reliable, and valid ethnicity data.  However, despite wide acknowledgments of the significant disparities in the provision of healthcare and resulting health inequalities between Aboriginal and Torres Strait Islander and non- Aboriginal and Torres Strait Islander children, specific data describing Indigenous children are lacking.

Until very recently, in Australia, it was estimated that only 59 per cent of Aboriginal and Torres Strait Islander children (0-14 years) were included in national infant and childhood mortality statistics due to incomplete and inaccurate identification  in some states and territories. This being the case, the ability to measure progress in achieving improvements in Indigenous infant and child mortality are significantly compromised at best and at worst completely impossible.  All too often in the past we have seen the effect of policies that reflect the principle of ‘no data, no problem, no change’.

The ‘Close the Gap’ catch cry as it relates to Aboriginal and Torres Strait Islander infant and child mortality is being proclaimed in many Aboriginal and Torres Strait Islander communities, along the corridors of industry, and in the offices of Australian federal, state and territory governments. However, in order to measure the progress in closing this gap, accurate and complete data describing Aboriginal and Torres Strait Islander populations must be established. 

Closer to home, in Victoria, the paucity of baseline data that accurately describes Aboriginal and Torres Strait Islander births has been recognised and is being addressed through the Victorian Aboriginal Child Mortality Study (www.vacms.net.au).  This novel study, funded by an ARC Discovery grant and supported by the Victorian Department of Health is being led by researchers in Onemda, Melbourne School of Population Health, in collaboration with the Victorian Community Controlled Health Organisation, and other government partners. 

The project will link Victorian statutory and administrative databases that include total population information to provide more accurate and complete data that describe Aboriginal and Torres Strait Islander births during a 20-year period, and deaths of Victorian born children from birth to 18 years of age.

Without accurate Indigenous  identification, we are less able to accurately describe or monitor trends in Victorian Aboriginal and Torres Strait Islander births, deaths and child health outcomes, or importantly accurately identify avoidable morbidity/mortality amenable to intervention in this population. Inaccurate and incomplete data only provide part of the picture; we need to ‘know the unknown’. 

Without these data we cannot accurately measure progress toward Council of Australian Governments (COAG) goals or the Victorian Indigenous Affairs Framework change indicators. Neither are we able to strategically introduce initiatives consistent with human rights, rights that ensure that Aboriginal and Torres Strait Islander children enjoy the highest attainable standard of health and equal access to quality care.  Most importantly, we cannot answer the question: ‘are we there yet?’

The author acknowledges Bree Heffernan, Research Assistant, Centre for Health and Society, in the preparation of this paper.

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