**1. Progress**

Thompson [1] and Smith [2] have described the early history of the development of Aboriginal and Torres Strait Islander health statistics. In brief, the National Health and Medical Research Council (NHMRC) in 1955 drew attention to the fact that despite reported high levels of Indigenous morbidity and mortality in parts of Australia, precise information was not available. The first regular collection of data was commenced by the Northern Territory (NT) administration on infant mortality in 1957, but that was the only systematic collection for many years. In 1973 Commonwealth and jurisdictional Health Ministers endorsed a policy of collecting national Aboriginal health statistics. Progress was painfully slow and in the early 1980s no jurisdiction identified Aboriginal and Torres Strait Islander people in birth and death records. This is despite the 1967 constitutional changes to include Aboriginal and Torres Strait Islander people in the national population count. In 1984 the Commonwealth established a high-level taskforce on Aboriginal health statistics, but progress with implementation of its recommendations to prioritise Indigenous identifiers in vital statistics and hospital and perinatal statistics by the jurisdictions was patchy. Responsibility then passed to the newly formed Australian Institute of Health (AIH), but the funds provided for progressing the development of Indigenous health statistics were only half of those recommended arising from the National Aboriginal Health Strategy (NAHS) in 1989.

**Citation:** Ring, I.; Griffiths, K. Australian Aboriginal and Torres Strait Islander Health Information: Progress, Pitfalls, and Prospects. *Int. J.Environ. Res. Public Health* **2021**, *18*, 10274. https://doi.org/10.3390/ ijerph181910274

Academic Editor: Paul B. Tchounwou

Received: 24 August 2021 Accepted: 26 September 2021 Published: 29 September 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

There have been extensive developments in the capture of Aboriginal and Torres Strait Islander data for the purposes of national statistics in the last 60 years. Since federation, there have been a number of laws enacted for the purposes of identifying and counting Aboriginal and Torres Strait Islander people [3]. While there are departments, centres, and groups within the Australian governmen<sup>t</sup> that focus on Aboriginal and Torres Strait Islander statistics, there have been some, but limited, developments in governmen<sup>t</sup> support for Aboriginal and Torres Strait Islander oversight. Historically, it has often been individuals within governmen<sup>t</sup> who have worked with Aboriginal and Torres Strait Islander communities and individuals to support the visibility of Indigenous people in the nation.

The Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW) instituted a joint unit in Darwin in 1996. In 1997 this unit produced the first in a series of what was intended to be flagship biennial publications on the Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples [4]. Importantly, the first edition was launched in Darwin by the Governor General of Australia, Sir William Deane, who emphasised the importance of good statistics to drive good policy and action:

"This report will hopefully do much to influence all Australians, both Indigenous and non-Indigenous, to approach the question of the health and welfare of Aboriginal and Torres Strait Islander peoples, particularly children, on the basis of unprejudiced statistical facts [5]."

The joint unit was disbanded after 7 years, and ABS and AIHW followed independent paths.

#### *1.1. The Aboriginal and Torres Strait Islander Health Information Plan*

It was in this context that the Aboriginal and Torres Strait Islander Health Information Plan was prepared for the Australian Health Ministers Advisory Council (AHMAC) by ABS and AIHW in 1997 [6], appropriately subtitled ... *This time let's make it happen*, and is a convenient starting point. The subtitle is an explicit recognition of the relative failure of previous attempts to make significant progress with this important topic. As the foreword to the report says:

In 1994 the AHMAC endorsed the recommendation of the national body responsible for national health information, that the highest national priority was to:

"Work with Aboriginal and Torres Strait Islander peoples to develop a plan to improve all aspects of information about their health and health services."

Funds were provided to implement that recommendation and develop a plan.

AHMAC accepted the recommendations of the Report and instructed the National Health Information Management Group (NHIMG) to oversee the implementation. NHIMG established an implementation group including Indigenous health organisations and other agencies for this purpose.

The report described the shortcomings in the collection, processing and use of Indigenous health information, and emphasized the central role of the poor quality of Indigenous identification in current collections. The report went on to say that there was little new in its findings and recommendations and noted the lack of commitment to implement the findings of the numerous reviews that had been undertaken as the chief reason for the overall lack of progress.

Up until the publication of this report, the main source of national information had been the National Aboriginal and Torres Strait Island Survey conducted by the ABS in 1994 [7]. This was as part of the Government's response to Recommendation 49 [8] of the Royal Commission into Aboriginal Deaths in Custody, "That proposals for a special national survey covering a range of social, demographic, health and economic circumstances of the Aboriginal population with full Aboriginal participation at all levels be supported". The aim was to provide Australian governments with a "stronger information base for planning for the empowerment of Australia's Indigenous peoples and for measuring progress in meeting their objectives, aspirations and needs".

#### *1.2. National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (NAGATSIHID)*

NAGATSIHID was established "as a result of a decision by AHMAC in October 2000, to improve reporting on the health status of Indigenous Australians. It was set up as the national body to create a partnership between the Commonwealth, jurisdictions and Aboriginal and Torres Strait Islander people to improve Indigenous information in national and jurisdictional data collections" [9]. The purpose of the committee was to make strategic decisions regarding the use of governmen<sup>t</sup> held data pertaining to Aboriginal and Torres Strait Islander people and work to improve the quality and accessibility of Indigenous data and information.

What made NAGATSIHID different from other committees was: "(i) the level of representation from the governments (chaired by an AHMAC member); (ii) it had a majority Aboriginal and Torres Strait Islander membership with representatives from a wide range of key stakeholders in Aboriginal and Torres Strait Islander health such as the community controlled sector, academia and the governmen<sup>t</sup> sector with decision making made through an Aboriginal and Torres Strait Islander quorum; (iii) it provided a unique example of an effective working partnership between governmen<sup>t</sup> agencies, Aboriginal and Torres Strait Islander people and organisations to advance the development and use of data and information on the health of Indigenous Australians; (iv) having a majority of Indigenous people on NAGATSIHID gave the agencies some confidence that the decisions by AHMAC (through NAGATSIHID) reflect the views of Indigenous people and their representative bodies; and (v) it is recognised internationally and has been responsible for many of the significant changes in Aboriginal and Torres Strait Islander health statistics and data" [9].

The main role of NAGATSIHID was "to provide broad strategic advice to AHMAC, and in particular was responsible for:


NAGATSIHID was abolished in 2019, without notice to its members. While there are a number of advisory committees within governmen<sup>t</sup> agencies [11,12] to support decisionmaking regarding Aboriginal and Torres Strait Islander data by those individual agencies, there has been no replacement to the principal committee.

#### *1.3. Development of National Surveys*

In 2001, the National Health Survey was enhanced with a supplementary sample of Indigenous people of sufficient size to produce national estimates for Indigenous people. The supplementary sample was part funded by the Commonwealth and the jurisdictions, and became the first national Indigenous health survey. This was followed by a larger supplementary Indigenous sample in 2004 to provide both national and jurisdictional estimates, and thereafter, was conducted every 6 years [13].

Even though a national biomedical risk factor survey had been conducted for the Australian administration in Papua New Guinea in the late 1960s [14], it was not until 2012–2013 that a parallel survey was conducted in Australia, and was made possible by additional funding provided by the Australian Government Department of Health and the National Heart Foundation of Australia. This national survey included two Indigenous components, a National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey and a National Aboriginal and Torres Strait Islander Health Measures Survey [15].

#### *1.4. ABS and AIHW Publications*

Currently, the ABS has a range of publications concerning Aboriginal and Torres Strait Islander peoples, based largely on the census and the extensive ABS survey program [13] covering health surveys; population estimates and projections; life tables; understanding the increase in census counts; Torres Strait Islander people characteristics; Aboriginal and Torres Strait Islander women; smoking trends; education, etc.

The AIHW regularly produces a wide variety of publications on Indigenous health and welfare topics. Recent topics include: the Health Performance Framework; acute rheumatic fever and rheumatic heart disease; Indigenous injury deaths; Indigenous specific primary health care datasets: The Online Services Report and the national Key Performance Indicators; Northern Territory remote Aboriginal investment: oral health program; better cardiac care measures for Aboriginal and Torres Strait Islander people; cultural safety in health care for Indigenous Australians; hearing health outreach services for Aboriginal and Torres Strait Islander children in the Northern Territory; aged care; disability support; Indigenous community safety; Indigenous education and skills; Indigenous employment; Indigenous housing; Indigenous income and finance; understanding Indigenous welfare and wellbeing; Indigenous eye health; Indigenous mental health and suicide prevention clearinghouse, etc.

#### *1.5. The Overcoming Indigenous Disadvantage (OID) Report*

The Council of Australian Governments (COAG) commissioned the OID [16] report in 2002, and nominated two core objectives for the report:


As the 2020 report [17] says, "This edition of the report seeks to identify the significant strengths of, and sources of wellbeing for, Aboriginal and Torres Strait Islander people— and to illustrate the nature of the disadvantage they experience, focusing on the key structural and systemic barriers that contribute to this disadvantage. The framework of indicators focuses on some of the factors that contributed to their wellbeing or that cause the disadvantage they experience, these factors were selected based on evidence, logic and where experience suggests that targeted policies will have the greatest impact. The indicators are supplemented by additional research on structural and systemic barriers that contribute to, or maintain, the disadvantage experienced by Aboriginal and Torres Strait Islander people, and where governments may have a role in removing barriers."

#### *1.6. The Aboriginal and Torres Strait Islander Health Performance Framework*

The purpose of this report is said to be that "The Aboriginal and Torres Strait Islander Health Performance Framework (HPF) monitors progress in Aboriginal and Torres Strait Islander health outcomes, health system performance and the broader determinants of health (such as employment, education and safety). The HPF is a comprehensive source of evidence designed to inform policy, planning, program development and research.

Beginning in 2006, HPF reports have been released every 2–3 years. The HPF includes data analysis drawn from over 60 data collections, findings from research and evaluations, and analysis of implications of the evidence for government, health services and the research sector.

The HPF consists of 68 measures across three domains (Tiers): Tier 1—Health status and outcomes; Tier 2—Determinants of health; Tier 3—Health system performance" [18].
