Suggested priority areas for Aboriginal and Torres Strait Islander adolescent health & wellbeing and indicators for their measure

Adolescence is now understood as a critical phase of growth and acquisition of capabilities that underpins human capital. Key developments include physical changes (such as puberty, changes in height and body composition), neurocognitive development (including increasing ability to make independent decisions), and social-role transitions which are central to socioeconomic wellbeing (such as completion of education and transition into employment). The need to bring a particular focus to the health and wellbeing of Aboriginal and Torres Strait Islander (Indigenous) adolescents is increasingly recognised. This is because:
o One third of the Indigenous Australian population are adolescents (aged 10 – 24 years);
o Indigenous adolescents have substantial health needs (particularly around mental health, sexual and reproductive health, injuries, and metabolic disease) which remain largely unmet by the current health and social system;
o Adolescence is a time of transition in some of the most important social and cultural determinants of health including education, employment, cultural identity and participation. Poor physical and mental health during adolescence can affect these opportunities and have the potential to undermine wellbeing across the life-course;
o Many Indigenous adolescents are parents or play important caring roles, and as such, there is an opportunity to assure the best start to life for the next generation;
o Risks for non-communicable diseases (which drive the life expectancy gap between Indigenous and non-Indigenous adolescents) commonly arise during adolescence and are also potentially most modifiable during this developmental stage;
o Indigenous adolescents are now recognised as a priority population in the National Aboriginal and Torres Strait Islander Health Plan; and
o There are substantial opportunities for health gain. For example, more than 80% of mortality experienced by Indigenous adolescents is potentially avoidable within the current health system.

Yet despite these incentives, Indigenous adolescents have remained largely at the margins of existing policy frameworks and initiatives. For example, the National Aboriginal and Torres Strait Islander Health Plan includes four goals with respect to Indigenous adolescent health; three of these relate to tobacco smoking and the fourth to health checks. The need for more comprehensive and integrated policy responses to Indigenous adolescent health are well recognised. Indeed, the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan recommends understanding the key needs for Indigenous young people so as to focus policy and actions.

This report was commissioned by the Commonwealth Department of Health with the purpose of suggesting some priority areas of health need for Aboriginal and Torres Strait Islander (Indigenous) adolescents. Using the defined priorities as a framework, the report also defines indicators harmonised with data availability and populates select indicators with data for Indigenous adolescents nationally and at a jurisdictional level where possible to do so.

Three key inputs were drawn together to suggest priority areas of need. The first included health needs as reported by young Indigenous people themselves; this is particularly crucial to ensuring that young people have ‘voice’ in issues that concern them. This input included consultations with young people in the Northern Territory (as commissioned by the Department of Health) and also a synthesis of qualitative data available in the literature. The second included consideration of health needs that are of public health significance- this included leading causes of death, disease, and key drivers of health inequity. The third included consideration of health needs that are of existing policy relevance. These individual inputs were used to define priority areas of need that could be measured, summarised on the next page.