Indigenous Health Data Systems The current national policy framework Professor Ian Anderson Chair National Indigenous H

1. Indigenous Health Data SystemsThe current national policy frameworkProfessor Ian AndersonChair National Indigenous Health Equality Council

2. Presentation • Policy Context • Reporting environment • Indigenous health targets • Indigenous Health Data Systems

3. Policy Context • On the 24th March 2008 Prime Minister Kevin Rudd, the leader of the Federal Opposition and significant leaders in the health sector signed a pledge to • Close the Indigenous health gap by 2030 • Close the equity gap in health service provision by 2018

4. Policy Context • Indigenous persons have a life expectancy at birth which is 17 years less than a non-Indigenous person • Indigenous Australians have 2.5 times the burden of disease compared to non-Indigenous Australians • Indigenous Australians have 5 times the burden of disease due to diabetes • Four and a half times the burden disease due to cardiovascular disease • Four times the burden of disease and disability due to intentional injuries such as suicide or harm from violence

5. Contributing Conditions 15% 6% 12% 23% 10% 9% 10% 15% Contributing Risk Factors 17% 16% 12% 7% 4% 6% 5% 11% Policy Context Indigenous Health Gap 95,967 DALY’s 39,522 DALY’s 59% Vos et al 2007 **Non-communicable diseases

6. Policy Context • The policy environment is complex • The Australian Government has committed to providing an annual Closing the Gap report to parliament • CoAG Reform Council likely to have a role in reporting on progress CoAG initiatives • Both AHMAC and AHMC have a role in progressing outcomes to CoAG • National Health Indigenous Equality Council

7. COAG Ministerial Council of Commonwealth-State Relations Health and Ageing Productivity Agenda Climate Change & Water Indigenous Reform Business Regulation and Competition Infrastructure Housing Compact sub-group (Dealing with SPP Revision) Economic Participation and Welfare Reform Skills sub-group Water sub-group Indigenous sub-group Indigenous sub-groupChair: Cth Heads of Treasuries Schools sub-group Building Blocks & Governance Indigenous sub-group Adaptation sub-group Reform of SPP Working Party Early Childhood sub-group Building the evidence Sub -groups of Early Childhood sub-group:-- Data-- Quality - Early Years Learning Framework- Workforce National Framework for Reporting Expenditure on Services to Indigenous Australians Steering Group Optimising Service Delivery sub-group Protective Security, Alcohol and Substance Abuse Indigenous Early Childhood (WGIR with PAWG and HAWG)

8. Policy Context • Council of Australian Governments • Established Working Group on Indigenous Reform (WGIR) to develop reform proposals for improving community safety, remote service delivery and Indigenous economic development and active welfare. • WGIR, in conjunction with other Working Groups, to report to COAG on how COAG’s broader reform agenda will deliver an integrated strategy on closing the gap for all Indigenous people.

9. Policy Context • Health & Ageing Working Group National Reform Proposals • Chronic • Acute • Preventive • Cancer • Indigenous

10. Policy Context • COAG Building Blocks • Early childhood development • Education • Economic participation • Health services • Healthy homes • Safe communities • Governance and leadership

11. Policy Context Reform of Specific Purpose Payments 92 SPPs to 5 No ‘matched funding’ input controls High level statements of objectives, outcomes and indicators

12. Health Education Housing KPIs KPIs KPIs Complementary Report of Indigenous outcomes across all SPPs? KPIs for outcomes for Indigenous people Policy Context

13. Policy Context

14. Policy Context • The National Indigenous Health Equality Council established in July 2008 • Membership drawn from the Australian Government, the Aboriginal and Torres Strait Islander community including the Aboriginal Community Controlled Health sector, and the broader health sector

15. Policy Context • NIHEC Terms of Reference: • advising on commitments made under the March 2008 Statement of Intent on achieving Indigenous health equality; • advising on the development and monitoring of health related goals and targets • developing advice to the Minister on: • strategic priorities for Aboriginal and Torres Strait Islander Health; meeting target; monitoring progress; Government & AHMAC • Health Workforce • Other

16. Policy Context • Mechanisms for the development of Indigenous health data • National Advisory Group Aboriginal Torres Strait Islander Health Information Development • National Indigenous Health Equality Council • Advisory Group for Aboriginal and Torres Strait Islander Statistics (AGATSIS).

17. Targets • COAG 20 Dec 2007: • Close the LE gap in a generation • Halve the child mortality gap in 10 years • Halve the literacy and numeracy gap • COAG 26 March 2008: • Halve the gap in employment outcomes within a decade • Halve the gap for Indigenous students in Year 12 by 2020 • In five years all Indigenous four year olds in remote Indigenous communities will have access to a quality early childhood education program.

18. Targets • History of target setting in Indigenous Health • Whitlam government national plan • NAHS interim goals and targets 1991 • 1997 National Performance Indicators • ATSIHPF • Indigenous health equality campaign

19. Targets Valid target setting requires: • Good base-line data • Good time-series data • An evidence base that establishes links between interventions to outcomes • An ability to exercise influence over the outcomes being targeted; and • Avoiding perverse incentives (eg, worsening non-Indigenous health will “close the gap”)

20. Targets • Some consideration in selection of targets • Specific • Measurable • Achievable • Realistic • Time bound

21. Target Draft Definition of Terms

22. Targets • Reporting environment • Overcoming Indigenous Disadvantage (Productivity Commission) • Aboriginal and Torres Strait Islander Health Performance Measurement Framework (AHMC/AHMAC) • Proposed Annual Report to Parliament (Australian Government) • COAG SPPs • Other – Social Justice Report, Report on Government Services, Biennial Report Aboriginal and Torres Strait Islander Health and Welfare

23. Targets • Potential relationships between reporting structures • ATSIHPF Tier One Health Status and Outcomes: CoAG Health Targets • ATSIHPF Tier One Determinants of Health (risk factors, social & environmental determinants). CoAG Building Blocks • ATSIHPF Tier One Health System Performance. CoAG Health Building Blocks

24. Data Systems • Population Data • Remote area enumeration • Life expectancy data • Indirect vs direct methods, methods development • Mortality Data (& birth data) • Data poor jurisdictions, methods, negotiations with data custodians, strategies to improve identification

25. Data Systems • Administrative data • Data poor jurisdictions, primary care data • Identification in general practice • Strategic relationships and governance