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Health Statistics: The Australian Experience and Opportunities

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Public Health Statistics and Risk Assessment".

Deadline for manuscript submissions: closed (15 December 2021) | Viewed by 44316

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Special Issue Editor

Prof. Dr. Richard Madden

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Guest Editor

Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
Interests: statistics policy and governance; health classifications; indigenous statistics; disability policy and statistics

Special Issue Information

Dear Colleagues,

Reliable and relevant health statistics have provided a strong base for policy, planning and financing of health and related services in Australia. States and Territories are responsible for public health, hospitals and many other health and related services, and building national statistics has required cooperation and clear governance as well as strong national data standards. Australia has for more than a century had excellent mortality statistics; more recently a wide range of other data has been developed from administrative sources, where statistics is often a secondary purpose, and registers. Statisticians have had to negotiate to get the information needed, and the data standards to be used, with a wide range of governments and service providers, as well as user and advocacy groups. Statistics on specific groups, notably Aboriginal and Torres Strait Islander peoples, have required collaboration with the communities involved, as well as presenting technical challenges. More complex analyses have , with health expenditure and burden of disease as examples of methodologies where summary statistics must be built on a strong statistical foundation.

While these developments have been underway, electronic systems have progressively been replacing paper, and data are required more quickly and at more local levels. Data linkage is now widely accepted as a means of providing linked information to statisticians and researchers without risking the privacy and confidentiality of individuals. A wide range of the health workforce is involved in data collection, and they may be subject to a range of service delivery and financial pressures which can limit or influence the data they collect.

This special issue aims to report on current Australian health statistics collections, their uses and the challenges they face. It is vital to understand the processes that have led to success, and the hurdles that have had to be overcome. We also want to identify remaining gaps, in subject matter, in populations with specific needs and in data standards, in data accessibility and where Australia may lag behind developments in other countries. Other topics could include governance issues, where the range of conflicting pressures on data providers, analysers and users may endanger reliability. The issue will provide a platform for a wealth of views to be brought together and connected, to give a rare broad view of the health statistics terrain in Australia.

Prof. Dr. Richard Madden
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Aboriginal and Torres Strait Islander peoples and their health
Specific topics such as primary care, hospital statistics, functioning and disability, mental health, aged care, monitoring of population health
Health risk behaviours and environmental risk factors
Information developments associated with COVID-19
Current opportunities and trends including data linkage and electronic data
The contributions that health statistics make to research
Analyses of health statistics including health expenditure and burden of disease
Health information workforce
Health statistics governance, particularly at national level, and health ethics.

Published Papers (12 papers)

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Research

Jump to: Review, Other

9 pages, 271 KiB

Open AccessCommunication

Using Data Integration to Improve Health and Welfare Insights

by Linda R. Jensen

Int. J. Environ. Res. Public Health 2022, 19(2), 836; https://doi.org/10.3390/ijerph19020836 - 12 Jan 2022

Cited by 1 | Viewed by 2770

Abstract

The Australian Institute of Health and Welfare (AIHW) is a leader in the provision of high-quality health and welfare information. Its work program has built a strong evidence base for better decisions that deliver improved health and welfare outcomes. The evolution of the AIHW’s data integration program has exemplified innovation in identifying and addressing key information gaps, as well as responsiveness to opportunities to develop and capture the data required to inform national priorities. The AIHW conducts data integration in partnership with data custodians and specialists in integration and analysis. A linkage project requiring the integration of Australian government data must be undertaken by an accredited integrating authority. The AIHW has met stringent criteria covering project governance, capability, and data management to gain this accreditation. In this capacity, the AIHW is trusted to integrate Australian government data for high-risk research projects. To date, the AIHW’s integration projects have generated improved research outcomes that have identified vulnerable population groups, improved the understanding of health risk factors, and contributed to the development of targeted interventions. These projects have fostered new insights into dementia, disability, health service use, patient experiences of healthcare, and suicide. Upcoming projects aim to further the understanding of interrelationships between determinants of wellbeing. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

14 pages, 861 KiB

Open AccessArticle

Oral Health of Australian Adults: Distribution and Time Trends of Dental Caries, Periodontal Disease and Tooth Loss

by Najith Amarasena, Sergio Chrisopoulos, Lisa M. Jamieson and Liana Luzzi

Int. J. Environ. Res. Public Health 2021, 18(21), 11539; https://doi.org/10.3390/ijerph182111539 - 02 Nov 2021

Cited by 12 | Viewed by 3279

Abstract

This study was conducted to describe the distribution and trends in dental caries, periodontal disease and tooth loss in Australian adults based on the findings of the National Study of Adult Oral Health 2017–18. A cross-sectional study of a random sample of Australians aged 15+ years was carried out, employing a three-stage stratified probability sampling design. Data were collected via online survey/telephone interviews using a questionnaire to elicit self-reported information about oral health and related characteristics. Participants were then invited to have an oral examination, conducted by calibrated dental practitioners following a standardised protocol in public dental clinics. A total of 15,731 Australians aged 15+ years were interviewed, of which 5022 dentate participants were orally examined. Results showed that nearly one third of Australian adults had at least one tooth surface with untreated dental caries and, on average, 29.7 decayed, missing or filled tooth surfaces per person. Almost 29% of adults presented with gingivitis while the overall prevalence of periodontitis was 30.1%. Overall, 4% of adults were edentulous while, on average, 4.4 teeth were lost due to pathology. Poorer oral health was evident in Australians from lower socioeconomic backgrounds, indicating socioeconomic inequalities in oral health. Time trends revealed that dental caries experience and tooth retention of Australian adults has improved over 30 years, while periodontal health has deteriorated between 2004–06 and 2017–18. These findings can be used to assist policy makers in planning and implementing future oral healthcare programs. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

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Review

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12 pages, 316 KiB

Open AccessReview

Health Statistics in Australia: What We Know and Do Not Know

by Richard Madden, Nicola Fortune and Julie Gordon

Int. J. Environ. Res. Public Health 2022, 19(9), 4959; https://doi.org/10.3390/ijerph19094959 - 19 Apr 2022

Cited by 5 | Viewed by 3856

Abstract

Australia is a federation of six states and two territories (the States). These eight governmental entities share responsibility for health and health services with the Australian Government. Mortality statistics, including causes of death, have been collected since the late 19th century, with national data produced by the (now) Australian Bureau of Statistics (ABS) from 1907. Each State introduced hospital in-patient statistics, assisted by State offices of the ABS. Beginning in the 1970s, the ABS conducts regular health surveys, including specific collections on Aboriginal and Torres Strait Islander peoples. Overall, Australia now has a comprehensive array of health statistics, published regularly without political or commercial interference. Privacy and confidentiality are guaranteed by legislation. Data linkage has grown and become widespread. However, there are gaps, as papers in this issue demonstrate. Most notably, data on primary care patients and encounters reveal stark gaps. This paper accompanies a range of papers from expert authors across the health statistics spectrum in Australia. It is hoped that the collection of papers will inform interested readers and stand as a comprehensive review of the strengths and weaknesses of Australian health statistics in the early 2020s. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

14 pages, 357 KiB

Open AccessReview

Fit for Purpose—Re-Designing Australia’s Mental Health Information System

by Sebastian Rosenberg, Luis Salvador-Carulla, Graham Meadows and Ian Hickie

Int. J. Environ. Res. Public Health 2022, 19(8), 4808; https://doi.org/10.3390/ijerph19084808 - 15 Apr 2022

Cited by 4 | Viewed by 2790

Abstract

Background: Monitoring and reporting mental health is complex. Australia’s first National Mental Health Strategy in 1992 included a new national commitment to accountability and data collection in mental health. This article provides a narrative review of thirty years of experience. Materials and Methods: This review considers key documents, policies, plans and strategies in relation to the evolution of mental health data and reporting. Documents produced by the Federal and the eight state and territory governments are considered, as well as publications produced by key information agencies, statutory authorities and others. A review of this literature demonstrates both its abundance and limitations. Results: Australia’s approach to mental health reporting is characterised by duplication and a lack of clarity. The data available fail to do justice to the mental health services provided in Australia. Mental health data collection and reporting processes are centrally driven, top–down and activity-focused, largely eschewing actual health outcomes, the social determinants of mental health. There is little, if any, link to clearly identifiable service user or carer priorities. Consequently, it is difficult to link this process longitudinally to clinical or systemic quality improvement. Initial links between the focus of national reform efforts and mental health data collection were evident, but these links have weakened over time. Changes to governance and reporting, including under COVID, have made the task of delivering accountability for mental health more difficult. Conclusion: Australia’s current approach is not fit for purpose. It is at a pivotal point in mental health reform, with new capacity to use modelled data to simulate prospective mental health reform options. By drawing on these new techniques and learning the lessons of the past, Australia (and other nations) can design and implement more effective systems of planning, reporting and accountability for mental health. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

8 pages, 290 KiB

Open AccessReview

Health Expenditure Data, Analysis and Policy Relevance in Australia, 1967 to 2020

by John R. Goss

Int. J. Environ. Res. Public Health 2022, 19(4), 2143; https://doi.org/10.3390/ijerph19042143 - 14 Feb 2022

Cited by 7 | Viewed by 3578

Abstract

Since 1985, the Australian Institute of Health and Welfare (AIHW) has published 85 health expenditure publications. It has gradually extended the scope of these publications by extending the health accounts to detail expenditure by disease and age/sex, by State, Territory and remoteness and by Indigenous status. These enhanced health expenditure databases were then used to understand in detail the drivers of health expenditure. Understanding the drivers of health expenditure enables policy makers to understand where to intervene so as to maximise the health improvements that arise from health expenditure growth. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

20 pages, 410 KiB

Open AccessReview

Generating Real-World Evidence on the Quality Use, Benefits and Safety of Medicines in Australia: History, Challenges and a Roadmap for the Future

by Sallie-Anne Pearson, Nicole Pratt, Juliana de Oliveira Costa, Helga Zoega, Tracey-Lea Laba, Christopher Etherton-Beer, Frank M. Sanfilippo, Alice Morgan, Lisa Kalisch Ellett, Claudia Bruno, Erin Kelty, Maarten IJzerman, David B. Preen, Claire M. Vajdic and David Henry

Int. J. Environ. Res. Public Health 2021, 18(24), 13345; https://doi.org/10.3390/ijerph182413345 - 18 Dec 2021

Cited by 15 | Viewed by 4662

Abstract

Australia spends more than $20 billion annually on medicines, delivering significant health benefits for the population. However, inappropriate prescribing and medicine use also result in harm to individuals and populations, and waste of precious health resources. Medication data linked with other routine collections enable evidence generation in pharmacoepidemiology; the science of quantifying the use, effectiveness and safety of medicines in real-world clinical practice. This review details the history of medicines policy and data access in Australia, the strengths of existing data sources, and the infrastructure and governance enabling and impeding evidence generation in the field. Currently, substantial gaps persist with respect to cohesive, contemporary linked data sources supporting quality use of medicines, effectiveness and safety research; exemplified by Australia’s limited capacity to contribute to the global effort in real-world studies of vaccine and disease-modifying treatments for COVID-19. We propose a roadmap to bolster the discipline, and population health more broadly, underpinned by a distinct capability governing and streamlining access to linked data assets for accredited researchers. Robust real-world evidence generation requires current data roadblocks to be remedied as a matter of urgency to deliver efficient and equitable health care and improve the health and well-being of all Australians. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

15 pages, 380 KiB

Open AccessReview

Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps

by Nicola Fortune, Rosamond H. Madden and Shane Clifton

Int. J. Environ. Res. Public Health 2021, 18(21), 11705; https://doi.org/10.3390/ijerph182111705 - 08 Nov 2021

Cited by 14 | Viewed by 6118

Abstract

The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory to the CRPD, Australia is required to collect appropriate information, including statistical and research data, to inform development and implementation of policies to give effect to the Convention. In this commentary, we first describe how the International Classification of Functioning, Disability and Health (ICF) conceptual model of disability can be operationalised in statistical data collections, with a focus on how this is achieved in key Australian data sources such that people with disability can be identified as a population group. We then review existing statistical data on health and health service use for people with disability in Australia, highlighting data gaps and limitations. Finally, we outline priorities and considerations for improving data on health and access to health services for people with disability. As well as conceptual, practical, and ethical considerations, a key principle that must guide future disability data development is that people with disability and their representative organisations must be involved and participate fully in the development of disability data and statistics, and in their use. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

9 pages, 307 KiB

Open AccessReview

Data Linkage in Australia: The First 50 Years

by Merran Smith and Felicity Flack

Int. J. Environ. Res. Public Health 2021, 18(21), 11339; https://doi.org/10.3390/ijerph182111339 - 28 Oct 2021

Cited by 18 | Viewed by 3133

Abstract

Population-based data linkage has a long history in Australia from its beginnings in Western Australia in the 1970s to the coordinated national data linkage infrastructure that exists today. This article describes the journey from an idea to a national data linkage network which has impacts on the health and well-being of Australians from preventing developmental anomalies to responding to the COVID-19 pandemic. Many enthusiastic and dedicated people have contributed to Australia’s data linkage capability over the last 50 years. They have managed to overcome a number of challenges including gaining stakeholder and community support; navigating complex legal and ethical environments; establishing cross-jurisdictional collaborations, and gaining ongoing financial support. The future is bright for linked data in Australia as the infrastructure built over the last 50 years provides a firm foundation for further expansion and development, ensuring that Australia’s linked health and human services data continues to be available to address the evolving challenges of the next half century. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

15 pages, 2049 KiB

Open AccessReview

Australian Aboriginal and Torres Strait Islander Health Information: Progress, Pitfalls, and Prospects

by Ian Ring and Kalinda Griffiths

Int. J. Environ. Res. Public Health 2021, 18(19), 10274; https://doi.org/10.3390/ijerph181910274 - 29 Sep 2021

Cited by 5 | Viewed by 4815

Abstract

Despite significant developments in Aboriginal and Torres Strait Islander Health information over the last 25 years, many challenges remain. There are still uncertainties about the accuracy of estimates of the summary measure of life expectancy, and methods to estimate changes in life expectancy over time are unreliable because of changing patterns of identification. Far too little use is made of the wealth of information that is available, and formal systems for systematically using that information are often vestigial to non-existent. Available information has focussed largely on traditional biomedical topics and too little on access to, expenditure on, and availability of services required to improve health outcomes, and on the underpinning issues of social and emotional wellbeing. It is of concern that statistical artefacts may have been misrepresented as indicating real progress in key health indices. Challenges and opportunities for the future include improving the accuracy of estimation of life expectancy, provision of community level data, information on the availability and effectiveness of health services, measurement of the underpinning issues of racism, culture and social and emotional wellbeing (SEWB), enhancing the interoperability of data systems, and capacity building and mechanisms for Indigenous data governance. There is little point in having information unless it is used, and formal mechanisms for making full use of information in a proper policy/planning cycle are urgently required. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

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Other

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10 pages, 306 KiB

Open AccessCommentary

General Practice Statistics in Australia: Pushing a Round Peg into a Square Hole

by Julie Gordon, Helena Britt, Graeme C. Miller, Joan Henderson, Anthony Scott and Christopher Harrison

Int. J. Environ. Res. Public Health 2022, 19(4), 1912; https://doi.org/10.3390/ijerph19041912 - 09 Feb 2022

Cited by 13 | Viewed by 2652

Abstract

In Australia, general practice forms a core part of the health system, with general practitioners (GPs) having a gatekeeper role for patients to receive care from other health services. GPs manage the care of patients across their lifespan and have roles in preventive health care, chronic condition management, multimorbidity and population health. Most people in Australia see a GP once in any given year. Draft reforms have been released by the Australian Government that may change the model of general practice currently implemented in Australia. In order to quantify the impact and effectiveness of any implemented reforms in the future, reliable and valid data about general practice clinical activity over time, will be needed. In this context, this commentary outlines the historical and current approaches used to obtain general practice statistics in Australia and highlights the benefits and limitations of these approaches. The role of data generated from GP electronic health record extractions is discussed. A methodology to generate high quality statistics from Australian general practice in the future is presented. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

6 pages, 245 KiB

Open AccessBrief Report

Enhancing Australian Mortality Data to Meet Future Health Information Demands

by James Eynstone-Hinkins and Lauren Moran

Int. J. Environ. Res. Public Health 2022, 19(1), 603; https://doi.org/10.3390/ijerph19010603 - 05 Jan 2022

Cited by 2 | Viewed by 1954

Abstract

The Australian mortality data are a foundational health dataset which supports research, policy and planning. The COVID-19 pandemic necessitated the need for more timely mortality data that could assist in monitoring direct mortality from the virus as well as indirect mortality due to social and economic societal change. This paper discusses the evolution of mortality data in Australia during the pandemic and looks at emerging opportunities associated with electronic infrastructure such as electronic Medical Certificates of Cause of Death (eMCCDs), ICD-11 and automated coding tools that will form the foundations of a more responsive and comprehensive future mortality dataset. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

11 pages, 1619 KiB

Open AccessBrief Report

Mental Health Services Data Dashboards for Reporting to Australian Governments during COVID-19

by Sonam Shelly, Emily Lodge, Carly Heyman, Felicity Summers, Amy Young, Jennifer Brew and Matthew James

Int. J. Environ. Res. Public Health 2021, 18(19), 10514; https://doi.org/10.3390/ijerph181910514 - 07 Oct 2021

Cited by 3 | Viewed by 2486

Abstract

The Australian Institute of Health and Welfare (AIHW) has been providing support to the Australian Government Department of Health to report on mental health-related data to Australian governments on a frequent basis since April 2020 in the form of COVID-19 mental health services data dashboards. These dashboards feature extensive use of data visualizations which illustrate the change in mental health service use over time as well as comparisons with pre-pandemic levels of service use. Data are included from the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS/RPBS), Australian Government-funded crisis and support organizations, and key findings from emerging research. Demand for telehealth, crisis and support organizations and online mental health information services, in particular, have increased during the pandemic. The dashboards incorporate both new and existing data sources and represent an innovative way of reporting mental health services data to Australian governments. The reporting has enabled timely, targeted adjustments to mental health service delivery during the pandemic with improved cooperative data sharing arrangements having the potential to yield ongoing benefits. Full article

(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)

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