New Directions with data on Aboriginal Health and Wellbeing

1. New Directions with data on Aboriginal Health and Wellbeing J Moller and B Stewart Aboriginal Health Council SA

2. Background • The Aboriginal and Torres Strait Islander population of SA is approximately 25,000 • About half of this population lives in the metropolitan area and one quarter in remote areas • The Aboriginal and Torres Strait Islander population of SA is much younger than the non Aboriginal population. In many places more than 60% of people are under 30 years of age. The median age is 21 years

3. Background • Current routinely available health indicators are Mortality and Hospital Separations focusing on principal diagnosis • The emphasis has been on comparisons between Aboriginal and non-Aboriginal measures. This masks differences between Aboriginal people living in different localities

4. Background • Mortality. • While death rates in Aboriginal and Torres Strait Islander populations are high, the total number of deaths per year are relatively few, making death an insensitive indicator of health Hospital Separations • Inpatient data counts episodes of care and not people. It is mainly focussed on older and sicker people who need complex care.

5. A comparison of hospital inpatient and population age distributions

6. What we need • Measures of health that adequately cover the Aboriginal and Torres Strait Islander people of SA. • Measures of health as well as disease • Indicators of the health of youth and adults • Longitudinal measures useful to understand early signs of health risk and to target prevention

7. The project • Sponsored by the SA Aboriginal Health Partnership and Hosted by The Aboriginal Health Council of SA • Developed a framework for better data on Aboriginal Health and Wellbeing in SA • Extracted and reprocessed existing data to illustrate how data can guide decision making.

8. Framework concepts • Use an Aboriginal perspective on health • Focus on differentials between Aboriginal people living in different localities. • Use a geography that can be common between sectors • Produce indicators that can be compared across sectors. • Provide data for local, regional and State wide decision making.

9. Data sources • Education Department data on literacy and numeracy of children • Department of Health, Hospital inpatient data from SA and NT • Courts conviction data • Correctional services data • SAPOL apprehensions for criminal offences data

10. Analytical methods • Analysis by • Indigenous Area (ABS ATSIC AIGC) • Place of usual residence • Standardised indicators comparing each area with the whole of the State Aboriginal population.

11. Analytical methods for hospital data • Analysis by • Principal diagnoses • All diagnoses • Including Hospitalisations for persons resident in SA treated in NT.

12. An example: The importance of local inequalities

13. An example: community differences in corrections

14. Amata & Ernabella Homelands & Anilalya Fregon & Indulkana Homelands Mount Woodroffe Mount Woodroffe South Australia north-east Coober Pedy (DC) West Coast Alcohol Country Ceduna (DC) Port Augusta (C) Port Augusta (C) Whyalla Riverland Mid North INSET Yorke Pt Lincoln Berri Peninsula Port Lincoln (C) See Murray Metro Bridge (RC) map Adelaide Murray Mallee Hills Adelaide Hills Adelaide Hills Standardised Morbidity Ratios (SMR) for Alcohol South East Separations for All Diagnoses Insufficient data (2*) Less than 75 (13*) 75 to 149 (11*) 150 to 299 (6*) 300 or more (2*) * number of Indigenous areas 0 50 100 200 300 400 which fall within the given range Kms N Produced by: Strategic Planning and Research Branch, Department of Health, South Australia Date: May 2005 The information and material displayed herein are an information resource only and whilst all Data Sources: ISAAC Hospital Inpatient Data Systems, 2002-03 reasonable care has been taken in its preparation, the Department of Health does not make Dept. of Health SA and Dept. of Health NT any representations or warranties as to its accuracy or otherwise. The Department of Health excludes all liability and or loss whatever its cause and to whomever arising directly or as defined by the ABS, 2001 indirectly from its use. Projection: Lamberts Conformal Conic

15. Adelaide north Standardised Morbidity Ratios (SMR) Playford (C) - Elizabeth for Alcohol Separations for All Diagnoses Insufficient data (2*) Salisbury (C) Port Adelaide Less than 75 (13*) Tea Tree Gully (C) Port Adelaide 75 to 149 (11*) Mid North 150 to 299 (6*) Enfield inner Alcohol Metro Enfield east 300 or more (2*) Woodville Murray Mallee * number of Indigenous areas in SA Adelaide (C)/Prospect (C) which fall within the given range Adelaide east Adelaide west Marion (C) Adelaide south Adelaide Hills Onkaparinga ISAAC Hospital Inpatient Data Systems, 2002-03

16. Amata & Ernabella Homelands & Anilalya Fregon & Indulkana Homelands Mount Woodroffe Mount Woodroffe South Australia north-east Coober Pedy (DC) West Coast Mental Health Country Ceduna (DC) Port Augusta (C) Port Augusta (C) Whyalla Riverland Mid North INSET Yorke Pt Lincoln Berri Peninsula Port Lincoln (C) See Murray Metro Bridge (RC) map Adelaide Murray Mallee Hills Adelaide Hills Adelaide Hills Standardised Morbidity Ratios (SMR) for Mental Health South East Separations for All Diagnoses Insufficient data (0*) Less than 75 (12*) 75 to 149 (16*) 150 to 299 (5*) 300 or more (1*) * number of Indigenous areas 0 50 100 200 300 400 which fall within the given range Kms N

17. Adelaide north Standardised Morbidity Ratios (SMR) Playford (C) - Elizabeth for Mental Health Separations for All Diagnoses Insufficient data (0*) Salisbury (C) Port Adelaide Less than 75 (12*) Tea Tree Gully (C) Port Adelaide 75 to 149 (16*) Mid North 150 to 299 (5*) Enfield inner Enfield east 300 or more (1*) Woodville Murray Mallee * number of Indigenous areas in SA Mental Health Metro Adelaide (C)/Prospect (C) which fall within the given range Adelaide east Adelaide west Marion (C) Adelaide south Adelaide Hills Onkaparinga

18. Amata & Ernabella Homelands & Anilalya Fregon & Indulkana Homelands Mount Woodroffe Mount Woodroffe South Australia north-east Coober Pedy (DC) West Coast Tobacco Country Ceduna (DC) Port Augusta (C) Port Augusta (C) Whyalla Riverland Mid North INSET Yorke Pt Lincoln Berri Peninsula Port Lincoln (C) See Murray Metro Bridge (RC) map Adelaide Murray Mallee Hills Adelaide Hills Adelaide Hills Standardised Morbidity Ratios (SMR) for Tobacco Use South East Separations for All Diagnoses Insufficient data (1*) Less than 75 (17*) 75 to 149 (10*) 150 to 299 (6*) 300 or more (0*) * number of Indigenous areas 0 50 100 200 300 400 which fall within the given range Kms N

19. Adelaide north Standardised Morbidity Ratios (SMR) Playford (C) - Elizabeth for Tobacco Use Separations for All Diagnoses Insufficient data (1*) Salisbury (C) Port Adelaide Less than 75 (17*) Tea Tree Gully (C) Port Adelaide 75 to 149 (10*) Mid North 150 to 299 (6*) Enfield inner Enfield east 300 or more (0*) Woodville Murray Mallee * number of Indigenous areas in SA Tobacco Metro Adelaide (C)/Prospect (C) which fall within the given range Adelaide east Adelaide west Marion (C) Adelaide south Adelaide Hills Onkaparinga

20. Amata & Ernabella Homelands & Anilalya Fregon & Indulkana Homelands Mount Woodroffe Mount Woodroffe South Australia north-east Coober Pedy (DC) West Coast Substance use country Ceduna (DC) Port Augusta (C) Port Augusta (C) Whyalla Riverland Mid North INSET Yorke Pt Lincoln Berri Peninsula Port Lincoln (C) See Murray Metro Bridge (RC) map Adelaide Murray Mallee Hills Adelaide Hills Adelaide Hills Standardised Morbidity Ratios (SMR) for Substance Use South East Separations for All Diagnoses Insufficient data (7*) Less than 75 (14*) 75 to 149 (8*) 150 to 299 (5*) 300 or more (0*) * number of Indigenous areas which fall within the given range

21. An example of cross sectoral analysis • A comparison of the geographic distribution of the comparative frequency of • Alcohol related hospital inpatient episodes • Mental health inpatient episodes and • Assault data from corrections and police apprehensions

22. Interrelationships

23. Major findings • The prevalence in communities of Alcohol related disease and a wide range of assault measures and mental health prevalence are highly correlated. • The prevalence in communities of Mental health diagnoses is more strongly associated with assaults to police than the prevalence of alcohol related disease.

24. Major findings • Alcohol related disease and Mental Health diagnoses appear to be taken into account in choice of justice response. • Community violence is strongly associated with the level of alcohol related disease. • Patterns of Violence toward police suggest the need for earlier mental health intervention services and better police training in dealing with persons with mental health problems

25. Human Capital

26. Access to data • The Aboriginal Health Council has produced a CD with detailed analyses including hospital data down to ICD10 Code for principal and all diagnoses ben.stewart@ahcsa.org.au • The South Australian Aboriginal Health Partnership is about to release a regional indicators publication which packages and maps summary data of key indicators by Indigenous Area rob.obrien@health.sa.gov.au

27. The role of health researchers • Extend the range of well documented health indicators • Develop ways of analysing the data which take into account the small population and further explore local differentials and their causes.