Aboriginal Health Data for Our Region. Newcastle/Hunter Aboriginal Partnership Forum Planning Day July 2017

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1 Aboriginal Health Data for Our Region Newcastle/Hunter Aboriginal Partnership Forum Planning Day July 2017

2 Aboriginal Health Needs Assessment Aimed to identify local health priorities for action, and inform and guide our activities in achieving better health outcomes for Aboriginal communities across the region.

3 Aboriginal Health Needs Assessment A range of publicly available quantitative data was collated, along with general practice and workforce data held internally. Key data sources: Australian Bureau of Statistics Australian Childhood Immunisation Register Australian Government Department of Human Services Australian Health Ministers Advisory Council Australian Indigenous HealthInfoNet Australian Institute of Health and Welfare Cancer Institute NSW Centre for Epidemiology and Evidence Public Health Information Development Unit

4 Aboriginal Health Needs Assessment PEN CAT Data As at 31 st July 2016, 117 General Practices had submitted data using the online PAT CAT data tool, providing aggregated data for almost 1,000,000 patients across the region. This represented one quarter of general practices and did not include any Aboriginal Medical Services. Just under 4% of all data submitted was for patients identified as Aboriginal and/or Torres Strait Islander. For Aboriginal and Torres Strait Islander patients, practice data submissions were evenly spread between major cities (50%) and inner regional areas (38%), with the remainder (12%) from outer regional and remote areas.

5 Aboriginal Health Needs Assessment Interviewed stakeholders from across the region between July and September This information was integrated with quantitative data to supplement, support and build a deeper understanding of health needs and issues. Stakeholder groups represented included: Aboriginal consumers and communities; Aboriginal Medical Services; General Practitioners and other general practice staff; private health providers; non-government organisations; and local, state and commonwealth government organisations. Conducted a literature review examining the experience of health service access for Aboriginal people.

6 Demographics

7 Age Distribution Percentage of the local Aboriginal population within each age group Note the young age profile, with the greatest proportions aged 24 years and younger Age Groups (%), Aboriginal Persons, 2016 ERP Region Lake Macquarie LGA Maitland LGA Newcastle LGA HNECC NSW Australia

8 Age Distribution Number of Aboriginal people in each age group in the Lake Macquarie, Maitland and Newcastle LGAs. Age Groups (numbers), Aboriginal Persons, 2016 ERP LGA Total Lake Macquarie 1, ,734 Maitland ,521 Newcastle ,593

9 General Practice Data Data extracted from PATCAT clinical data aggregation tool (25 July 2017) Includes only General Practices submitting data in Lake Macquarie, Maitland and Newcastle LGAs 60 out of a total 150 practices Data restricted to active patients (those seen 3 or more times within the last 3 years as per RACGP definition) Total active patients at 25 July ,928 Total Aboriginal or Torres Strait Islander patients 8,437 Total Non-Indigenous patients 195,974 Total patients where Indigenous status was not recorded 50,517

10 General Practice Data

11 Socioeconomic Disadvantage There is strong evidence that socioeconomic disadvantage directly correlates with poor health, higher incidence of risky health behaviours and reduced access to health care services. Stakeholders have identified that socioeconomic disadvantage is contributing to poorer health outcomes for Aboriginal people across the region.

12 IRSEO values closer to 100 = most socioeconomically disadvantaged IRSEO values closer to 0 = least socioeconomically disadvantaged Newcastle (15), Maitland (28) and Lake Macquarie (28) have lower IRSEO values, so are among the least socioeconomic disadvantaged LGAs in our region, and are less disadvantaged than the averages for NSW (41) and Australia (46).

13 Life Expectancy Life expectancy for the Aboriginal population is around 10 years less than the non-indigenous population due to higher rates of fertility and deaths occurring at younger ages The increased prevalence of health risk factors and chronic illness contributes substantially to the shorter life expectancy

14 Chronic Disease

15 Chronic Disease Aboriginal people experience higher rates of chronic disease. In , in the HNECC PHN region, 73% of Aboriginal people reported having a long-term health condition, with 21.2% having one condition and 51.9% having two or more conditions Of particular concern to stakeholders are diabetes, cancer and kidney disease

16 Chronic Disease Based on PAT CAT data extracted , in Lake Macquarie, Maitland and Newcastle LGAs, higher proportions of Aboriginal patients had COPD, asthma, mental health, anxiety and depression compared to non- Indigenous patients. Note: COPD and Mental Health figures include patients diagnosed with these diseases as well as patients whose profile indicates they have these diseases although it was not recorded in their medical record.

17 Diabetes In , in Australia, 4.7% of Aboriginal adults were at a high risk of developing diabetes Aboriginal adults are 1.8 times as likely to be at a high risk of diabetes than non-indigenous adults Aboriginal people are hospitalised for diabetes at 4 times the rate for non-indigenous people. In NSW in 2015, 17.2% of Aboriginal adults aged 16 years+ had diabetes or high blood glucose, more than two times the non-indigenous rate (8.5%) Health professionals in our region have identified diabetes as a health need for Aboriginal people

18 Chronic Kidney Disease (CKD) In , the rate of treated end stage kidney disease was over 6 times higher for Aboriginal people In , 45% of hospitalisations of Aboriginal people were due to CKD, with 99% of these being for dialysis, the leading cause of hospitalisation among Aboriginal people Over this period, Aboriginal people were 10 times as likely to be hospitalised for CKD as non-indigenous people Health professionals in our region have identified kidney disease as a health need for Aboriginal people

19 Cancer and Smoking

20 Cancer Aboriginal communities have a higher incidence of cancer than non- Indigenous communities (461 per 100,000 compared with 434 per 100,000) Aboriginal people are more likely to die from cancer than non- Indigenous people (252 per 100,000 compared with 172 per 100,000) Lung cancer is the most commonly diagnosed cancer for Aboriginal people followed by breast cancer for females, than colorectal cancer and prostate cancer Cervical cancer occurs in Aboriginal women at 4 times the rate of non- Indigenous women Health professionals in our region have identified cancer as a health need for Aboriginal people.

21 Breast Screening In , the breast screening participation rate for all women aged years in the HNECC region was 57.5% (NSW: 51.6%). Breast screening participation rates for Aboriginal women were lower, at 52% for the HNECC region (NSW: 40.2%). The participation rates for Newcastle (51.8%: N=313), Lake Macquarie (57.7%: N=390) and Maitland (61.5%: N=171) were higher than the NSW rate.

22 Cervical and Bowel Screening General practice data indicates that Aboriginal women across the HNECC region are approximately 40% less likely than non-indigenous women to participate in cervical screening Data on participation in Bowel Screening by Aboriginal people is of poor quality, however the participation rates for the total population aged years are low, in 2015: Lake Macquarie 41% Maitland 37% Newcastle 37.5% HNECC 38.1%

23 Smoking In the HNECC region in , 36.7% of Aboriginal people aged 15 years+ smoked daily In NSW in 2015, 34.9% of Aboriginal adults aged 16 years and over were current smokers at more than two and a half times the non-indigenous rate (12.9%) Current smoking by Aboriginality, persons aged 16 years and over, NSW 2015, (Centre for Epidemiology and Evidence, NSW Ministry of Health). Smoking has been identified by health professionals in HNECC region as an area of need for Aboriginal people

24 Smoking Attributable Hospitalisations From to , the rate of smoking attributable hospitalisations in NSW increased for Aboriginal people and decreased for non- Indigenous people, increasing the rate difference between the two populations from to 912 per 100,000. Rates of smoking attributable hospitalisations by Aboriginality and sex, NSW to , (Centre for Epidemiology and Evidence, NSW Ministry of Health).

25 Alcohol and Other Drug Misuse

26 Alcohol and Other Drug Misuse Alcohol and other drug misuse have been identified by health professionals from across the HNECC region as particular area of need for Aboriginal people

27 Drug and Alcohol Misuse Based on PAT CAT data extracted this week, Aboriginal patients of general practices in Lake Macquarie, Maitland and Newcastle LGAs were more likely to smoke daily and report drug misuse, but less likely to misuse alcohol when compared to non-indigenous patients.

28 Alcohol Consumption Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW : 32.7% of Aboriginal adults and 31.6% of non-indigenous adults had never drunk alcohol 33.5% of Aboriginal adults and 25.2% of non-indigenous adults drank alcohol less than weekly 26.6% of Aboriginal adults and 35.7% of non-indigenous adults drank weekly 7.2% Aboriginal adults and 7.5% of non- Indigenous adults drank daily

29 Alcohol Consumption In NSW in 2016, 31.7% of Aboriginal adults and 27.7% of non-indigenous adults drank alcohol at levels which posed an immediate risk to health Centre for Epidemiology and Evidence, NSW Ministry of Health.

30 Alcohol Attributable Injury Hospitalisations Centre for Epidemiology and Evidence, NSW Ministry of Health From to , the rate of alcohol attributable injury hospitalisations in NSW increased in the Aboriginal population from to per 100,000. This increased the rate difference/ gap between Aboriginal people and non-indigenous people from to per 100,000.

31 Methamphetamine Hospitalisations Centre for Epidemiology and Evidence, NSW Ministry of Health In NSW, in , Aboriginal people aged 16 years+ accounted for 14% of all people with methamphetamine-related hospitalisations. The rate of hospitalisations for Aboriginal people (431.9 per 100,000) was almost six times that of non-indigenous people (72.8 per 100,000).

32 Social and Emotional Wellbeing Warrgi Djarii (South Taree) Dance Group

33 Social and Emotional Wellbeing Mental ill-health, including complex and enduring mental illness, grief and loss, and youth mental health have been identified by health professionals across the HNECC region as a particular area of need for Aboriginal people. There is a need for greater integration between mental health and drug and alcohol services, for more flexibility in treatment approaches, and for an increased emphasis on culturally appropriate mental health treatment. There is concern amongst health professionals that the physical health needs of Aboriginal people experiencing mental illness, particularly severe and complex mental illness, are being overlooked. Health professionals have identified a need for youth programs, including leadership and mentoring, for Aboriginal people in the HNECC region.

34 Social and Emotional Wellbeing Proportion of people experiencing psychological distress by Aboriginality, persons aged 16 years and over, NSW 2003 to 2015 (Centre for Epidemiology and Evidence, NSW Ministry of Health). In NSW in 2015, 21.7% of Aboriginal people aged 16 years and over reported experiencing psychological distress, almost twice that of non-indigenous people (11.6%). This proportion has varied over time since 2003 for Aboriginal people, whilst that of non- Indigenous people has remained relatively stable.

35 Social and Emotional Wellbeing NSW, : 10.7% of Aboriginal people and 7% of non-indigenous people aged 16 years and over+ reported high levels of psychological distress 8.1% of Aboriginal people and 3.7% of non-indigenous people aged 16 years and over reported very high levels of psychological distress Centre for Epidemiology and Evidence, NSW Ministry of Health

36 Intentional self-harm hospitalisations NSW, : The rate of intentional selfharm hospitalisations for Aboriginal females aged years was per 100,000 and per 100,000 for males. Centre for Epidemiology and Evidence, NSW Ministry of Health The hospitalisation rate for non-indigenous females aged years was per 100,000 and per 100,000 for males.

37 Intentional self-harm hospitalisations NSW to : Rates of intentional self-harm hospitalisations for young Aboriginal people has increased since , particularly for females which has increased from to per 100,000. Centre for Epidemiology and Evidence, NSW Ministry of Health

38 Suicide Data provided by the National Coronial Information System indicated that between 2000 and 2013 in the HNECC region, there were 1,337 deaths recorded as intentional self-harm fatalities. Of these, 38 (2.8%) were deaths of Aboriginal people, and 135 (10.1%) were deaths where Indigenous status was recorded as unlikely to be known (NCIS, 2016).

39 Suicide NSW : The rate of suicide amongst males was 22.3 per 100,000 for Aboriginal people and 14.5 per 100,000 for non- Indigenous people. The rate of suicide for females was 6.3 per 100,000 for Aboriginal people and 4.8 per 100,000 for non- Indigenous people. Centre for Epidemiology and Evidence, NSW Ministry of Health

40 Suicide NSW : The suicide rate amongst year olds was 15.3 per 100,000 for Aboriginal people and 8.1 per 100,000 for non- Indigenous people. Centre for Epidemiology and Evidence, NSW Ministry of Health

41 Child and Family Health Health professionals in the HNECC region have identified maternal health as an area of concern for Aboriginal people, and have highlighted a need for improved coordination of prenatal care between services.

42 Smoking During Pregnancy In 2015, in Hunter New England LHD, 44.5% of Aboriginal mothers and 12.2% of non-indigenous mothers smoked during pregnancy. The averages for NSW were 45% and 7.4%. Centre for Epidemiology and Evidence, NSW Ministry of Health.

43 Smoking During Pregnancy and Low Birth Weight Babies Region % Low Birth Weight Babies Born to Aboriginal Mothers % Aboriginal Mothers Smoking During Pregnancy Lake Macquarie Indigenous Area Maitland Indigenous Area Newcastle Indigenous Area NSW Australia PHIDU, 2017.

44 Antenatal Visits In Hunter New England LHD in 2015, 68.3% of Aboriginal mothers and 80.6% of non- Indigenous mothers attended their first antenatal visit before 14 weeks gestation. The NSW averages were 55.6% and 64.7%. Centre for Epidemiology and Evidence, NSW Ministry of Health

45 Antenatal Visits The proportion of Aboriginal mothers in Hunter New England LHD who had their first antenatal visit prior to 14 weeks has increased from 50% in 2001 to 68.3% in Centre for Epidemiology and Evidence, NSW Ministry of Health.

46 Childhood Immunisation Percentage of Aboriginal Children Fully Immunised Region 1 year 2 years 5 years Newcastle & Lake Macquarie SA Hunter Valley (excluding Newcastle) SA HNECC PHN Australia AIHW, 2017.

47 Childhood Immunisation Based on PATCAT data extracted this week, Lake Macquarie, Maitland and Newcastle LGAs had lower childhood immunisation rates for Aboriginal patients compared to non- Indigenous patients. Note: Childhood immunisation rates reflect the National KPI for immunisation, ie numbers of children aged 1, 2, and 5 who had essential immunisations at last birthday.

48 Perinatal Mortality In NSW in 2015, the perinatal mortality rate for Aboriginal babies was 10.7 per 1,000 births compared to 8.0 per 1,000 births for non- Indigenous babies. Centre for Epidemiology and Evidence, NSW Ministry of Health.

49 Infant Mortality The Aboriginal infant mortality rate in NSW has decreased from 11.8 deaths per 1,000 live births in to 4.4 deaths per 1,000 live births in Centre for Epidemiology and Evidence, NSW Ministry of Health

50 Access to Services

51 Access to Services A key factor to the disproportionate burden of disease experienced by Aboriginal people is reduced access to services. In 2012, 18% of Aboriginal people in NSW aged 16 years and over reported having difficulty accessing health care. GPs in the HNECC region have asked for more education on the services available for their Aboriginal patients. Stakeholders across the region have identified a need for increased disease prevention and health promotion and education activities for Aboriginal people.

52 Access to Services Barriers identified by stakeholders as reducing health service access for Aboriginal people in the HNECC region: Transport Cost Low motivation Competing family and work commitments Low levels of health literacy

53 Access to Services Barriers identified by health professionals as reducing mental health service access for Aboriginal people in the HNECC region: Competing family and cultural priorities A lack of Aboriginal staff or staff of the appropriate gender A history of service mistrust and disengagement Limited awareness of services Doubts related to confidentiality Concerns that the service may not be culturally sensitive

54 Access to Services Stakeholders identified these factors as contributing to poorer health outcomes for Aboriginal people in our region: reduced compliance; poor attendance at appointments; not bringing or not having a Medicare card; the inability to effect the social determinants within the primary care setting; patient discomfort in waiting rooms and consulting rooms; difficulty contacting transient community members; limited support navigating the health system; misunderstandings between clients and health professionals; a lack of Aboriginal Health Workers; difficulty for health professionals in remaining aware of the different services and programs available to their patients; and case complexity.

55 Access to Services Aboriginal community members from across the HNECC region suggest that a great health service is one that provides a holistic health care program, and one that provides support for social issues as well as health conditions There is a need for increased integration, flexibility and cultural appropriateness of mental health and drug and alcohol services. There is fragmented care and lack of integration and coordination of health services for Aboriginal people Health professionals and Aboriginal community members have highlighted a need more holistic care for Aboriginal people taking into consideration mental health, physical health, disability, and social issues

56

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