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Australian Institute of Health and Welfare

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Access to appropriate, high-quality and timely health care throughout life is essential for improving health outcomes for Aboriginal and Torres Strait Islander people (Indigenous Australians). Some aspects of health system performance for Indigenous Australians have improved the last decade. Barriers affecting their access, however, remain, as observed in their disparities in their level of access compared with non-Indigenous Australians.

This page presents measures of health system performance for Indigenous Australians drawn from the Aboriginal and Torres Strait Islander Health Performance Framework (Indigenous HPF).

The Indigenous HPF monitors progress against 68 measures organised under 3 tiers: health status and outcomes; determinants of health; and health system performance.

The Indigenous HPF Tier 3 - Health system performance includes 22 measures organised into 6 domains relating to health system effectiveness, responsiveness, accessibility, continuity, capability, and sustainability (Table 1).

Effective, appropriate, efficient

Effective - the care, intervention or action achieves the desired outcome.

Appropriate - the care, intervention or action is relevant to the client's needs and is based on established standards.

Efficient - the desired results are achieved with the most cost effective use of resources.

Antenatal care (3.01)Immunisation (3.02)Health promotion (3.03)Early detection and early treatment (3.04)Chronic disease management (3.05)Access to hospital procedures (3.06)Selected potentially preventable hospital admissions (3.07)Cultural competency (3.08)

Responsive

The service provides respect for persons and is client oriented, including respect for dignity, confidentiality, participation in choices, promptness, quality of amenities, access to social support networks, and choice of provider.

Discharge against medical advice (3.09)Access to mental health services (3.10)Access to alcohol and drug services (3.11)Aboriginal and Torres Strait Islander people in the health workforce (3.12)Competent governance (3.13)

Accessible

Ability of people to obtain health care at the right place and right time irrespective of income, cultural background or physical location.

Access to services compared with need (3.14)Access to prescription medicines (3.15)Access to after-hours primary health care (3.16)

Continuous

The ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time.

Regular general practitioner or health service (3.17)Care planning for chronic diseases (3.18)

Capable

An individual or service's capacity to provide a health service based on skills and knowledge.

Accreditation (3.19)Aboriginal and Torres Strait Islander people training for health-related disciplines (3.20)

Sustainable

System's or organisations' capacity to provide infrastructure such as workforce, facilities and equipment, and be innovative and respond to emerging needs (research, monitoring).

Expenditure on Aboriginal and Torres Strait Islander health compared to need (3.21)Recruitment and retention of staff (3.22)

It is important, however, to remember that health outcomes are very much affected by factors outside the health system. For more information on these factors, see Determinants of health for Indigenous Australians and Indigenous health and wellbeing.

Measures of the performance of the health system for Indigenous Australians drawn from the Indigenous HPF show mixed results over the most recent decade, with improvements seen in some measures but not all.

Improvements in health system performance for Indigenous Australians over the last decade include:

increases in the number of services providing primary health care to Indigenous Australians

an increase in Indigenous women accessing antenatal care in their first trimester of pregnancy

increased immunisation rates for Indigenous children (with the vast majority being fully immunised at 5 years)

increases in the rates of Indigenous health checks and use of general practitioner (GP) management plans for chronic diseases

increased access to hospital procedures, however, Indigenous Australians are less likely than non-Indigenous Australians to receive a medical or surgical procedure (Table 2).

Notes:

1. ✔ = improved; ✘ = not improved; ≈ = little or no change.

2. Trend based on analysis of change over time for the relevant time period. These periods vary by measure. See Indigenous HPF for detail. Trends may differ from that presented in Chapter 3 'Changes in Aboriginal and Torres Strait Islander people's use of health services in the early part of the COVID-19 pandemic' in Australia's health 2022: data insights because of differing time periods and type of data presented.

Areas of health system performance that have worsened for Indigenous Australians over the most recent decade include increases in the rate of preventable hospitalisations and in the rate of people taking their own leave from hospital before completing treatment.

Barriers to accessing health services for Indigenous Australians include services not being available in their area (especially for those living in remote areas), services being too far away and they do not have transport, cost, waiting times, and the availability of culturally safe and responsive health services.

A culturally safe and responsive health system

Improving the cultural safety and cultural responsiveness of the health system can improve access to, and the quality of, health care for Indigenous Australians. A culturally safe health system is one that respects Indigenous cultural values, strengths and differences, and addresses racism and inequity. It also requires health professionals and health services to be culturally responsive, to take action to overcome racism and power imbalances and to have active engagement with Indigenous clients/patients to ensure that the system meets their needs (Coalition of Peaks 2020; Dudgeon et al. 2010; IAHA 2019).

To measure progress in achieving cultural safety in the Australian health system, the AIHW has developed the Cultural safety in health care for Indigenous Australians: monitoring framework. For the purposes of this framework, cultural safety is defined with reference to the experiences of Indigenous health care users, of the care they are given, and their ability to access services and to raise concerns.

Lockdowns, other restrictions and changes to the health system as a result of COVID-19 affected the need for, access to, and use of a broad range of health services by Indigenous Australians. For more information, see 'Chapter 3 Changes in Aboriginal and Torres Strait Islander people's use of health services in the early part of the COVID-19 pandemic' in Australia's health 2022: data insights, 'Chapter 1 The impact of a new disease: COVID-19 during 2020, 2021 and into 2022' in Australia's health 2022: data insights, and Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections: impact of COVID-19.

For detailed information on the performance of the health system for Indigenous Australians, see the AIHW's and the National Indigenous Australians Agency's (NIAA's) Aboriginal and Torres Strait Islander Health Performance Framework and linked reports.

For more information on Indigenous Australians' use of health services, see also:

References

AIHW (Australian Institute of Health and Welfare) (2021) Cultural safety in health care for Indigenous Australians: monitoring framework, AIHW, Australian Government, accessed 4 April 2022.

AIHW (2022a) Aboriginal and Torres Strait Islander Health Performance Framework, AIHW, Australian Government, accessed 4 April 2022.

AIHW (2022b) Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections, AIHW, Australian Government, accessed 4 April 2022.

Coalition of Peaks (2020) National Agreement on Closing the Gap,Australian Government, accessed 4 April 2022.

Dudgeon P, Walker R, Scrine C, Shepherd CCJ, Calma T and Ring IT (2014) Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people, AIHW and Australian Institute of Family Studies (AIFS), Australian Government, Closing the Gap Clearinghouse, accessed 4 April 2022.

Dudgeon P, Wright M and Coffin J (2010) 'Talking it and walking it: cultural competence', Journal of Australian Indigenous Issues, 13:29-44.

IAHA (Indigenous Allied Health Australia) (2019) Cultural responsiveness in action: an IAHA Framework, IAHA, accessed 4 April 2022.

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Indigenous Australians and the health system - Australian Institute of Health and Welfare

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Access to appropriate, high-quality and timely health care throughout life is essential for improving health outcomes for Aboriginal and Torres Strait Islander people (Indigenous Australians). Some aspects of health system performance for Indigenous Australians have improved the last decade. Barriers affecting their access, however, remain, as observed in their disparities in their level of access compared with non-Indigenous Australians.

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First Nations mothers are more likely to die during childbirth. More First Nations midwives could close this gap

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First Nations women and their newborns are considered high risk due to fatality rates and access to care. Research shows First Nations-led culturally safe healthcare could prevent further deaths.

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Case study: Aboriginal and Torres Strait Islander families & health inequities

The Djarra family are a proud Aboriginal family living in a regional town in Queensland. They are strongly connected to Country, culture, and community, but face ongoing challenges related to health and wellbeing.

The eldest child, Sarah, has asthma but finds it difficult to regularly access specialist healthcare because the nearest hospital with respiratory services is two hours away. Her grandmother, Aunty June, also has type 2 diabetes and relies on regular medication, but she sometimes struggles to afford prescriptions.

While the local Aboriginal Medical Service provides excellent culturally safe care, the service is often underfunded and stretched. The family sometimes feels frustrated that mainstream health systems don’t always respect their cultural values, such as including extended family in health decisions.

Despite these challenges, the family draws strength from their Elders, community networks, and cultural practices, which provide support, identity, and resilience.

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Discuss these questions in your group.

How does limited access to healthcare services affect families like the Djarra family?

In what ways does culture act as a source of strength and resilience for Aboriginal and Torres Strait Islander families?

How do systemic issues (e.g. funding, cultural safety in healthcare) contribute to inequities?

What role can governments and communities play in improving outcomes for Aboriginal and Torres Strait Islander families?

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Introduction

On March 19, 2014 a "mystery" hemorrhagic fever outbreak occurred in Liberia and Sierra Leone. This outbreak was later confirmed to be Ebola, a disease first discovered in what is now the Democratic Republic of Congo. The 2014-2016 outbreak sickened more than 28,000 people and left more than 11,000 dead (CDC 2020).

For the people in West Africa, the outbreak was personally tragic and terrifying. In much of the rest of the world, the outbreak increased tensions, but did not change anyone's behavior. Infection of U.S. medical staff (both in West Africa and at home) led to fear and distrust, and restrictions on flights from West Africa was one proposed way to stop the spread of the disease. Ebola first entered the United States via U.S. missionary medical staff who were infected in West Africa and then transported home for treatment. Several other Ebola outbreaks occurred in West Africa in subsequent years, killing thousands of people.

Six years after the massive 2014 epidemic, the people of West Africa faced another disease, but this time they were not alone. The Coronavirus pandemic swept across the globe in a matter of months. While some countries managed the disease far better than others, it affected everyone. Highly industrialized countries, such as China, Italy, and the United States, were early centers of the outbreak. Brazil and India had later increases, as did the U.K. and Russia. Most countries took measures that were considered extreme-closing their borders, forcing schools and businesses to close, transforming their people's lives. Other nations went further, completely shutting down at the discovery of just a few cases. And some countries had mixed responses, typically resulting in high rates of infection and overwhelming losses of life. In Brazil and the United States, for example, political leaders and large swaths of the populations rejected measures to contain the virus. By the time vaccines became widely available, those two countries had the highest numbers of coronavirus death worldwide.

Did the world learn from the Ebola virus epidemics? Or did only parts of it learn? Prior to the United States facing the worst COVID-19 outbreak in the world, the government shut down travel, as did many countries in Europe. This was certainly an important step, but other measures fell short; conflicting messages about mask wearing and social distancing became political weapons amid the country's Presidential election, and localized outbreaks and spikes of deaths were continually traced to gatherings that occurred against scientific guidance. Brazil's president actively disputed medical opinions, rejected any travel or business restrictions, and was in conflict with many people in his own government (even his political allies); with Brazil's slower pace of vaccination compared to the U.S., it saw a steep increase in cases and deaths just as the United States' numbers started to decline.

Both those opposed to heavy restrictions and those who used them to fight the disease acknowledge that the impacts went far beyond physical health. Families shattered by the loss of a loved one had to go through the pain without relatives to support them at funerals or other gatherings. Many who recovered from the virus had serious health issues to contend with, while other people who delayed important treatments had larger problems than they normally would have. Fear, isolation, and strained familial relationships led to emotional problems. Many families lost income. Learning was certainly impacted as education practices went through sudden shifts. The true outcomes will likely not be fully understood for years after the pandemic is under control.

So now, after the height of the coronavirus pandemic, what does "health" mean to you? Does your opinion of it differ from your pre-COVID attitudes? Many people who became severely ill or died from COVID had other health issues (known as comorbidities) such as hypertension and obesity. Do you know people whose attitudes about their general health changed? Do you know people who are more or less suspicious of the government, more or less likely to listen to doctors or scientists? What do you think will be the best way to prevent illness and death should another pandemic strike?

Medical sociology is the systematic study of how humans manage issues of health and illness, disease and disorders, and healthcare for both the sick and the healthy. Medical sociologists study the physical, mental, and social components of health and illness. Major topics for medical sociologists include the doctor/patient relationship, the structure and socioeconomics of healthcare, and how culture impacts attitudes toward disease and wellness.

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Tonja R. Conerly, Kathleen Holmes, Asha Lal Tamang, Tonja R. Conerly, Kathleen Holmes, Asha Lal Tamang

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Ch. 19 Introduction - Introduction to Sociology 3e | OpenStax

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This free textbook is an OpenStax resource written to increase student access to high-quality, peer-reviewed learning materials.

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Global Health Challenges: Examining the Impact on Communities Worldwide

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Education and Privilege

When I think about my time at university, what stands out most is the constant balancing act required just to stay there. My family was not poor, but they were not in a position to financially support my studies. From the beginning, I had to work alongside studying. Government support helped, but it wasn’t enough, so work was not optional—it was necessary. I structured my week around survival rather than learning. I worked night shifts early in the week and attended classes during the day, often with very little sleep. By the weekend, I was exhausted and trying to catch up on assignments. There were times I missed classes because I couldn’t afford to turn down a shift. Other times, I submitted work that didn’t reflect my ability. I remember realising that I wasn’t competing on equal terms with other students, even though we were in the same classes. That became more obvious when I compared my situation to my peers. Many didn’t have to work. Their parents paid their fees, covered their living costs, and allowed them to focus fully on study. Some came from families where university was expected and understood. In contrast, I was the first in my family to attend, so there was little awareness of the workload or pressure. What felt overwhelming to me seemed manageable to others.

Looking back, I understand this through educational inequality, which I see as the way people have different chances of succeeding in education depending on their background. Access might be technically open, but the ability to fully participate is not equal. This also connects to cultural capital, meaning the knowledge and familiarity with systems that some people grow up with. I was learning how to navigate university while also trying to sustain myself within it. What I didn’t expect was how this would shift later. As I moved into postgraduate study, I was already working and could bring that experience into my learning. The structure felt more aligned with my career, and I could apply theory directly to practice. The discipline I had developed earlier became an advantage. I performed at a much higher level, becoming a Dean’s Scholar and receiving academic recognition.

This made me realise that while structural barriers can limit early participation, they can also shape different strengths over time. However, not everyone makes it to that stage. Many are filtered out earlier due to the same pressures. Overall, my experience showed me that success in higher education is shaped not just by ability, but by access to time, resources, and support.

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How taking a gap year helped socialise me far more than the institutions of family or education…..

When I finished high school at 17, I was academically ready for university but not prepared for independence. My parents had been quite protective, which gave me structure but limited my exposure to how the world actually worked. Looking back, I realise I lacked confidence in navigating basic responsibilities and decision-making.Taking a gap year and working in a supermarket changed that. I moved into roles as an afternoon and night manager, which shifted my position from following instructions to being responsible for others. For the first time, I had to make decisions that had direct consequences. I wasn’t asking for permission anymore—I was the one giving it. I had to manage staff, resolve issues, and ensure things ran smoothly. That responsibility forced me to engage with the realities of adult roles in a way I hadn’t before.

Outside of work, I also began to understand everyday expectations—managing money, organising my time, and balancing competing demands. These were things I hadn’t fully encountered within my family environment. I remember realising that being an adult wasn’t something that just happened with age, but something you learn through experience. Looking back, I understand this through the idea of socialisation, which I see as the process of learning how to function in society—understanding expectations, roles, and behaviours. While the family plays a major role early on, my experience showed me that other institutions, like workplaces, are just as important. In my case, work acted as a form of secondary socialisation, helping me develop skills and awareness that I hadn’t previously gained.

This also made me think about how some people can remain dependent on family structures if they don’t have access to other environments that push them into new roles. Without that transition, it would be easy to remain in a kind of extended childhood, where independence is delayed. The experience of managing others also changed how I understood responsibility and authority. It made clear that roles in society come with expectations and consequences, not just status. Overall, taking a gap year was less about delaying university and more about becoming ready for it. It made me realise that independence and capability are shaped by experience and exposure, not just age, and that different pathways can play an important role in that transition.

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Learning about Aged Care Inequality through my maternal grandmother and my paternal grandfather’s experiences going into care.

One of the earliest experiences that shaped how I understand inequality was visiting my maternal grandmother in a public dementia facility. At the time, I didn’t have the language for it, but I remember feeling uncomfortable and unsettled. She had early-onset dementia and Alzheimer’s disease, and by then had lost both her independence and financial control. The facility felt restrictive and impersonal. Residents were lined up in chairs for most of the day, many restrained to prevent movement. Some were sedated, others called out without much response. My grandmother, who I had known as expressive and active, was now quiet and immobilised. I remember leaving with the sense that something about it wasn’t right, even if I couldn’t explain why.

That feeling became clearer when I later compared her experience to my grandfather’s. As a World War II veteran, he had access to a well-resourced care facility. His environment included structured activities, meal choices, regular visits from health professionals, and more consistent staff interaction. He maintained a sense of dignity and routine. The contrast made me realise that ageing is not experienced equally, even when care needs are similar. Looking back, I understand this through the idea of social determinants of health, which I see as the conditions in society that shape people’s health outcomes—things like income, access to services, and support systems. In my grandparents’ case, my grandfather’s veteran status gave him access to better care, while my grandmother, without those resources, was placed in an underfunded system where care focused more on management than wellbeing.

This also reflects broader social inequality, where resources are distributed unevenly. I began to see that the system was not necessarily responding to need, but to access. Practices like restraint, which I once just found confronting, now seem tied to institutional pressure—limited staff, high demand, and risk management priorities. It also made me think about how different groups experience this system. Elderly people without financial resources, particularly those with complex conditions like dementia, are more likely to end up in under-resourced care. Families who lack knowledge or confidence in navigating the system may also struggle to advocate for better options. Migrant families, in particular, may face additional barriers. This experience made me realise that ageing is not just a biological process but a social one. The level of care and dignity someone experiences at the end of life is shaped heavily by access to resources and institutional support, rather than need alone.

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How taking a gap year helped socialise me far more than the institutions of family or education…..

When I finished high school at 17, I was academically ready for university but not prepared for independence. My parents had been quite protective, which gave me structure but limited my exposure to how the world actually worked. Looking back, I realise I lacked confidence in navigating basic responsibilities and decision-making.Taking a gap year and working in a supermarket changed that. I moved into roles as an afternoon and night manager, which shifted my position from following instructions to being responsible for others. For the first time, I had to make decisions that had direct consequences. I wasn’t asking for permission anymore—I was the one giving it. I had to manage staff, resolve issues, and ensure things ran smoothly. That responsibility forced me to engage with the realities of adult roles in a way I hadn’t before.

Outside of work, I also began to understand everyday expectations—managing money, organising my time, and balancing competing demands. These were things I hadn’t fully encountered within my family environment. I remember realising that being an adult wasn’t something that just happened with age, but something you learn through experience. Looking back, I understand this through the idea of socialisation, which I see as the process of learning how to function in society—understanding expectations, roles, and behaviours. While the family plays a major role early on, my experience showed me that other institutions, like workplaces, are just as important. In my case, work acted as a form of secondary socialisation, helping me develop skills and awareness that I hadn’t previously gained.

This also made me think about how some people can remain dependent on family structures if they don’t have access to other environments that push them into new roles. Without that transition, it would be easy to remain in a kind of extended childhood, where independence is delayed. The experience of managing others also changed how I understood responsibility and authority. It made clear that roles in society come with expectations and consequences, not just status. Overall, taking a gap year was less about delaying university and more about becoming ready for it. It made me realise that independence and capability are shaped by experience and exposure, not just age, and that different pathways can play an important role in that transition.

399