Goal 11: Aboriginal Victorians enjoy health and longevity

Closing the Gap - How Victoria is tracking nationally

Outcome 1: Nationally, Aboriginal and Torres Strait Islander males born in 2020-22 are expected to live to 71.9 years and females to 75.6 years, and non-Indigenous males and females to 80.2 years and 83.4 years respectively. Nationally, based on progress from the baseline, the target shows improvement but is not on track to be met for males or females. Aboriginal and Torres Strait Islander estimates of life expectancy are currently not produced for Victoria due to under-identification in deaths records, small sample sizes, data collection issues and statistical challenges associated with the calculation methods. There are ongoing efforts to improve the quality of Aboriginal and Torres Strait Islander deaths data. There are ongoing efforts to improve the quality of data on Aboriginal and Torres Strait Islander deaths.

Measure 11.1.1 Expectation of life at birth, by sex

Life expectancy estimates are important measures of population health. Aboriginal and Torres Strait Islander life expectancy estimates include deaths from all states and territories. It is not currently possible to construct separate reliable life expectancy estimates for Victoria, South Australia, Tasmania, the Australian Capital Territory. This is due to several factors including the small number of Aboriginal and Torres Strait Islander deaths. There is also an under-reporting of Aboriginal deaths in Victoria due to incomplete or inaccurate Aboriginal identification. The Department of Health is working with the Registry of Births, Deaths and Marriages and the Coroners Court to identify opportunities to improve Aboriginal identification. This will support a joint action plan to ensure the availability of robust Aboriginal life expectancy estimates for Victoria.

Measure 11.1.2 Proportion reporting ‘excellent or very good’ health status, by sex

In 2023, Aboriginal Victorians were more likely to report excellent or very good health than in 2022, but less likely than in 2017. Age standardised results for self-assessed health status from the Victorian Population Health Survey (VPHS) have increased to 29.6 per cent, up from 27.6 per cent of respondents in 2022. Over the long term, the self-assessed health of Aboriginal adults in Victoria has remained relatively stable. In 2017, 30.3 per cent of Aboriginal respondents said their health was excellent/very good. Survey results for non-Aboriginal Victorians have also remained stable over the period. 40.0 per cent of non-Aboriginal respondents reported very good and excellent health in 2023 compared with 43.5 per cent in 2022. When analysing the prevalence ratio, dividing Aboriginal per cent respondents with non-Aboriginal per cent respondents, the difference between Aboriginal and non-Aboriginal self-assessed health has remained consistent. Non-Aboriginal respondents since 2017 have reported 0.7 times greater self-assessed health.

Measure 11.1.3 Rate of daily smoking

In 2023, the proportion of daily tobacco smokers increased among Aboriginal Victorians aged 18+ to 25.3 per cent. This is the second year in a row that the proportion has increased. Before 2022, the percentage of Aboriginal daily smokers had been declining since 2017. When analysing the proportion of non-Aboriginal daily smokers, the trend is not the same. For non-Aboriginal people, smoking has remained consistent in the short term with 9.8 per cent of respondents in 2023 as daily smokers. Over the long term the proportion of non-Aboriginal daily smokers has been slowly declining from 12.2 per cent in 2017. The daily smoking question in the Victorian Population Health Survey does not explicitly include the use of e-cigarettes or vapes. As such, current data does not include non-tobacco smoking.

Measure 11.1.4 Rate of hospitalisations for potentially preventable causes (vaccine preventable, acute, chronic and all)

In 2022-23, 54.8 per 1,000 Aboriginal people in Victoria were hospitalised for potentially preventable causes (vaccine-related, acute and chronic). This rate has remained stable after a decline by 10.3 per 1,000 people in 2020-21. However, it is more than double the rate of non-Aboriginal people (24.5 per 1,000 people). Aboriginal people continue to experience barriers to access preventable health care, including lack of culturally safe services and Aboriginal-led healthcare.

Of the reported potentially preventable causes for hospitalisation, the highest cause for Aboriginal people is chronic potentially preventable causes. In 2022-23, 30.2 per 1,000 Aboriginal people were hospitalised for chronic potentially preventable causes compared to 20.8 per 1,000 Aboriginal people for acute potentially preventable causes and 4.5 per 1,000 Aboriginal people for vaccine-related potentially preventable causes. Chronic potentially preventable causes are conditions that could have been prevented through appropriate health interventions and early disease management. These interventions would usually be administered at primary health care or community-based settings, such as General Practitioner and Community health services.

Measure 11.1.5 Incidence of selected cancers

In 2018-22, lung cancer accounted for 15.8 per cent of all cancer incidences for Aboriginal people. Prostate, bowel, and breast cancer accounted for 10.4, 10.4, and 10.3 per cent of cancer incidences respectively. These cancer sites are the four most common cancer sites for Aboriginal people. The incidences of lung cancer increased by 116 incidences to 260 between 2012-16 and 2018-22. The highest percentage increase in cancer incidences for Aboriginal people in the same period was liver cancer. Liver cancer accounted for 63 cancer incidences in Aboriginal people in 2018-22. In 2012-16, there were 34 incidences of liver cancer. This is nearly double the amount, an 85 per cent increase, of liver cancer incidences.

Aboriginal people are more likely to be diagnosed with cancer than non-Aboriginal people. In 2018-22, the cancer incidence rates for Aboriginal people were higher across all reported age cohorts (under 20, 20-29, 30-39, 40-49, 50-59, 60-69 and 70+). For Aboriginal and non-Aboriginal people, the cancer incidence rate increases with age which means that those aged 70+ have the highest cancer incidence rate. Between 2018 to 2022, Aboriginal people aged 70+ had a cancer incidence rate of 505.3 per 10,000 Aboriginal men and 384.1 per 10,000 Aboriginal women. This is more than 1.5 times the rate for non-Aboriginal men aged 70+ (303.6 per 10,000 non-Aboriginal men) and more than 2 times the rate for non-Aboriginal women aged 70+ (182.9 per 10,000 non-Aboriginal women).

When comparing the change in cancer incidence rates by gender, Aboriginal men are far more likely to have cancer now than at the beginning of the time series. The largest growth in age specific cancer rates for men is the 40-49 age range, growing 42.3 per cent since the 2012-2016 period. For Aboriginal women the largest growth is in the under 20 age cohort growing 6.2 per cent in the same period.

The standard incidence ratio (SIR) for cancer is a measure of how much more likely it is for Aboriginal people to have a cancer incidence compared to their non-Aboriginal peers. Aboriginal people have equal incidence of cancer where the SIR is equal to one, more incidence where it is greater than one and less incidence where it is less than one.

In 2018-22, the SIRs for lung, liver, head and neck, and cervical cancer for Aboriginal women were 3.8, 4.4, 1.9, and 2.1 respectively. For lung and liver cancer, the SIRs have increased in the long term (since 2012-16). For head and neck and cervical cancer, the SIRs have decreased in the same period.

For Aboriginal men in 2018-22, the SIRs for lung, liver, and head and neck cancer increased over the long term to 3.1, 3.7, and 2.0 respectively. It is interesting to note that that the SIRs for liver and lung cancer for Aboriginal women is higher than for Aboriginal men.

There are many drivers of cancer incidence in the environment and in our lifestyles. These can include smoking, alcohol consumption, diet, physical inactivity, obesity and chronic infections.[15] These external risk factors are only part of the story. Growing research suggest social factors such as racism and discrimination drive cancer prevalence while cultural identity, access to traditional lands and language can be protective factors. [16][17]

Measure 11.1.6 Rate of emergency department presentations for alcohol or drug-related harm

In 2023-24, 2,248 Aboriginal people presented to the emergency department for an alcohol or drug-related harm. The rate of emergency department presentations for alcohol or drug-related harm for Aboriginal people of all ages was 32.3 per 1,000 Aboriginal people. This is an increase of 5.8 per 1,000 Aboriginal people since 2022-23 and is the highest rate recorded between 2008-09 and 2023-24. This rate is also double the rate a decade prior (15.8 per 1,000 Aboriginal people in 2014-15). For Aboriginal people aged 15-25, the rate was higher at 40.4 per 1,000 Aboriginal people. This is an increase in rate by 9.5 per 1,000 Aboriginal people since 2022-23 and is the first increase since 2021-22. This rate is also the highest recorded between 2008-09 to 2023-24 and is more than double the rate a decade prior (17.4 per 1,000 Aboriginal people in 2014-15).

The rate of emergency department presentations for alcohol or drug-related harm is significantly lower for non-Aboriginal people. In 2023-24, the rate was 4 per 1,000 non-Aboriginal people of all ages. This is 8.1 times less than the rate for Aboriginal people of all ages. For non-Aboriginal people aged 15-24, the rate was slightly higher at 6.6 per 1,000 non-Aboriginal people. This is 6.2 times less than the rate for Aboriginal people aged 15-24. Compared to a decade prior, the rate has remained similar for non-Aboriginal people of all ages (4.7 per 1,000 non-Aboriginal people of all ages in 2014-15) and decreased for non-Aboriginal people aged 15-24 (9.4 per 1,000 non-Aboriginal people aged 15-24 in 2014-15).

Measure 11.1.7 Specialist alcohol and other drug treatment services provided to Aboriginal Victorians

In 2022-23, there were 10,328 closed episodes for alcohol and other drug treatment services. This is an increase of 426 closed episodes since 2021-22. The rate of alcohol and other drug treatment services for First Peoples in 2022-23 was 152.3 per 1,000 people. This rate has more than doubled in the past 10 years (67.3 closed episodes per 1,000 people in 2013-14). In 2022-23, the rate for non-Aboriginal people also increased but not to the same degree. The rate of closed episodes for alcohol and other drug treatment services were 11.8 per 1,000 non-Aboriginal people. This rate is 40 per cent higher than what it was in 2013-14 (8.5 per 1,000 people).

In 2022-23, Aboriginal Victorians were 12.8 times more likely to access alcohol and other drug treatment services than non-Aboriginal Victorians. In 2013-14, this was only 7.9 times. A treatment episode is considered closed where any of the following occurs: treatment is completed or has ceased, there has been no contact between the client and treatment provider for 3 months, or there is a change in the main treatment type, principal drug of concern or delivery setting.

Footnotes