**1. Introduction**

People with disability have the right to enjoy the highest attainable standard of health without discrimination on the basis of disability, as affirmed in Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) [1]. This right is not currently being realised. In Australia, as in other countries across the globe, people with disability experience poorer health outcomes than people without disability [2–6]. At population level, disability-related health disparities are caused in large part by avoidable disadvantage, and not primarily by underlying impairment [7]. As such, governments have a duty to act to reduce these health disparities.

Population statistical data have a crucial role to play in identifying and understanding disability-related inequalities, informing more effective policy interventions, evaluating interventions, and holding key actors to account. Numerous international and Australian reports have highlighted the need for population-level statistical data that can be disaggregated by disability, and the importance of using such data for monitoring and regularly reporting on disability-related inequalities [6,8–10]. In Australia, the current policy context has generated a high level of interest in disability data. Key features of this context include the National Disability Insurance Scheme (which reached full rollout in July 2020), the

**Citation:** Fortune, N.; Madden, R.H.; Clifton, S. Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps. *Int. J. Environ. Res. Public Health* **2021**, *18*, 11705. https:// doi.org/10.3390/ijerph182111705

Academic Editor: Paul B. Tchounwou

Received: 7 September 2021 Accepted: 6 November 2021 Published: 8 November 2021

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ongoing Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, and the development of a new national disability strategy to guide Australian disability policy for the coming decade.

In the context of health systems and health data, disability has traditionally been treated as an outcome [11]. This is powerfully illustrated by the Global Burden of Disease study: an international epidemiological study that produces estimates of the fatal and non-fatal 'burden' attributable to specific diseases and risk factors using the Disability Adjusted Life Year (DALY) metric [12,13]. Considering health inequalities experienced by people with disability requires a wholly different perspective. It means viewing disability as akin to a demographic factor by which health data may be disaggregated [11]. However, the concept of disability is inextricably linked to and defined with reference to health. Thus, use of statistical data to investigate disability-related health inequalities presents complexities that require interrogation.

Statistical classifications provide standard structures for collecting, organising and analysing data [14]. The use of standard statistical classifications as a basis for developing data collections promotes data consistency, so that data from different sources may be compared and potentially used together to generate new information and boost the value of existing data resources. The World Health Organization's (WHO) Family of International Classifications is a suite of classifications designed to provide internationally consistent information on different aspects of health and the healthcare system [15]. The three core members of the WHO-FIC are the International Classification of Diseases (ICD), the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Health Interventions (ICHI) (currently in development). The ICF has been broadly adopted as the international standard framework and classification for organising and documenting information about functioning and disability [16], and has been used in Australia to underpin the development of disability-related data items in population surveys and administrative data collections [17].

In this paper, we describe how people with disability are identified in key Australian data sources, review available statistical data on health and health service use for people with disability, and outline priorities and considerations to guide efforts to fill data gaps and improve the evidence base.
