Why ‘Asking the Question’ is important
Aboriginal and Torres Strait Islander Peoples experience two and a half times more disease burden than non-Indigenous people, of which a major proportion accounts to chronic disease.
Aboriginal and Torres Strait Islander health is one of the seven key priorities set for the Primary Health Networks (PHNs). Closing the Gap is the Australian Government’s strategy dedicated towards enabling and empowering Indigenous people to live a healthy and prosperous life.
Under-identification of Aboriginal and Torres Strait Islander Peoples accessing health services play a crucial role in adding to health discrepancies between the Indigenous and non-Indigenous population. It leads to inconsistencies in data collection and to inaccuracies in analysing the progress of Closing the Gap.
In order to initiate voluntary self-identification of the Indigenous population, service providers need to ensure their practice is welcoming and demonstrates a culturally safe environment.
Asking the Question?
Asking the Question is part one of Australian Institute of Health and Welfare’s (AIHW) ‘National best practice guidelines for collecting Indigenous status in health data sets (March 2010)’.
It addresses a systematic national approach to collecting and recording Indigenous health status, which included:
- Phrasing a standard question for all patients – “are you (is the person) of Aboriginal or Torres Strait Islander origin?”
- Standard response options to be (i) No, (ii) Yes, Aboriginal, (iii) Yes, Torres Strait Islander or (iv) Yes, both Aboriginal and Torres Strait Islander. The response should be followed up if not recorded in the patient form
- Asking the Question should be followed as the standard protocol along with collection of other basic information by staff responsible for registering patients to a practice. Indigenous status should be enquired and recorded for every patient irrespective of appearance, place of birth or previous knowledge of staff asking the question.
If a patient identifies as an Aboriginal and/or Torres Strait Islander origin:
A medical practitioner can undertake the Medicare health assessment for Aboriginal and Torres Strait Islander Peoples (MBS item 715) for the individual upon receiving consent. It covers the full age spectrum for Indigenous people and includes information collection (patient history, examination and investigation), overall assessment, providing recommendations and information on appropriate interventions and offering a written record of report.
If the patient declines to respond:
If the Indigenous status section is not filled in on a patient form, staff collecting the data are encouraged to ask the question in a respectful and profession manner. It is required that individuals self-identify their Indigenous status and it is the patient’s discretion to disclose their identity or decline the question. The staff member is not obliged to convince a patient to answer. Individuals have the choice to update or change their Indigenous status, irrespective of their response to the question during past visits.
If the patient has further concerns with the use of data and requests information on how the data will be used, the staff member can refer the patient to AIHW or Australian Bureau of Statistics website for further details.
Staff members asking the question can use the following statements to explain the reason for enquiring Indigenous status:
- Indigenous status is one of the standard questions we ask to all patients visiting our practice.
- You may choose to answer the question or not. Your answer will not affect the level of services provided to you.
- Additional services can be identified, and potentially accessed, by patients who identify as Aboriginal and Torres Strait Islander such as specific immunisations and Pharmaceutical Benefits Scheme (PBS) listings. Other assistance such as access to Aboriginal liaison officers and health workers.
- Understanding the Indigenous status of our patients helps in the planning of services, and to monitor and improve health outcomes for the population.
- We encourage our patients to self-identify their Indigenous status to ensure relevant services can be provided to them.
- All personal information, including Indigenous status is protected under the privacy act and will not be used for any purpose other than the reason for which it was originally collected.
Health concerns for Aboriginal and Torres Strait Islanders in the Western Victoria PHN region include:
68.2% of the Indigenous population aged 15yrs and older suffer from long-term health conditions with 27.1% reporting fair or poor health.
15.2% of the Indigenous population have reported to be suffering from asthma. Mental health is the top health issue of Aboriginal and Torres Strait Islanders in 2018. 37.5% of the Indigenous population in Victoria report of high/very high level of psychological distress.
Aboriginal Community Controlled Organisations identify adverse effects of trauma on the social and emotional wellbeing of the Indigenous population in the region. National mortality rate from suicide is 2.1 times greater among the Indigenous population as compared to the non-Indigenous population.
Service providers identified alcohol and other drug use as one of the top three health issues among Aboriginal and Torres Strait Islanders in the region. In 2016, accidental drug related deaths in Australia was 3.2 times more prevalent among Indigenous population than non-Indigenous populations.
During 2014-2016, 10% of infants were born with a low birthweight to Indigenous families in Western Victoria with Ballarat (11.3%) and Wimmera-Grampians (11.8%) exhibiting values higher than national figures (10.4%).