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

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

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

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.

A comparison of hospital inpatient and population age distributions

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

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.

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.

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

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.

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

An example: The importance of local inequalities

An example: community differences in corrections

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

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

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

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

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

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

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

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

Interrelationships

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.

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

Human Capital

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 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

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.