Australia has a well developed, although somewhat fragmented, system for collecting health and health related information. The health measures used in different collections will reflect the purpose of the collection, the collection methodology, and the level of knowledge of the data providers (e.g. health professionals or members of the public). The available data sources are of two main types: administrative by product, and survey information. There is a range of sources of national health data. The major ABS collections and some representative administrative by product sources are described below. The measurement issues associated with both administrative and survey sources of health data are discussed above.National Health Survey (ABS)
The National Health Survey (NHS) has been conducted in 1977, 1983, 1989-90 and 1995 with a triennial program from 2001 onwards. This survey collects information about the health status of Australians of all ages, their use of health services, and health-related aspects of their lifestyle. It obtains data on all types of health conditions, with a focus on the National Health Priority Areas described earlier in this chapter. In addition, data is collected about general health and wellbeing, women's health issues, behavioural risk factors (such as smoking), the use of health services and medications and days of reduced activity due to illness conditions. A small Indigenous supplementary survey is being conducted for the 2001 NHS, with a larger Indigenous supplement planned the for 2004-05 NHS and every second NHS thereafter.
NATIONAL NUTRITION SURVEY (ABS)
This dietary survey was a joint project between ABS and the Commonwealth Department of Health and Aged Care (DHAC) (formerly Health and Family Services). It was conducted on a sub-sample of respondents in the 1995 NHS and provided information for people aged two years and over from urban and rural areas in all States and Territories. Detailed data on food and beverage intake was collected using a 24 hour recall methodology, covering the day before interview. In addition, a range of physical measurements such as height, weight, waist and hip circumference and blood pressure were taken. Additional information was collected on food-related habits and attitudes, and the usual frequency of consumption of selected foods over the previous 12 months.
The data available from this survey includes socio-demographic information, body mass index and blood pressure, daily intakes of energy and macronutrients (such as carbohydrate, fat and fibre), selected micronutrients (such as thiamine and calcium) and the food sources of these nutrients.
MENTAL HEALTH AND WELLBEING SURVEY OF ADULTS (ABS)
This survey, conducted in 1997, with funding support form the DHAC was designed to provide estimates of the prevalence of major mental disorders in Australians aged 18 years and over. Information was collected on a range of demographic and socioeconomic characteristics, chronic physical conditions, disability associated with mental disorders, health service use for a mental health problem, and perceived need for health services for a mental health problem. Data relating to mental health disorders was collected using a World Health Organisation endorsed instrument, the Composite International Diagnostic Instrument (CIDI) which enabled major mental disorders to be scored according to both ICD-10 and Diagnostic Statistical Manual (DSM-IV) criteria. Other international modules were used to collect information about levels of general wellbeing and to assess disability.
SURVEY OF DISABILITY, AGEING AND CARERS (ABS)
The Disability, Ageing and Carers Survey provides information on three populations of interest to government policy: people aged 60 years and over, people with disabilities, and their carers. The survey was last conducted in 1998 and is expected to be conducted six yearly in future. People with disability are identified through filter questions on impairment and underlying health conditions. This population is then asked about their need for, and receipt of, assistance with a range of common activities. The survey provides details on prevalence of disability and levels of restriction; activity limitations leading to a need for assistance in the 'activities of daily living' (self-care, mobility and communication), plus health care; and participation restrictions leading to a need for assistance in the 'instrumental activities of daily living' (housework, property maintenance, meal preparation, transport, and personal business affairs). The sample was selected from households and cared accommodation settings.
CHILDREN'S IMMUNISATION AND HEALTH SCREENING SURVEY (ABS)
The Children's Immunisation and Health Screening Survey was conducted as a Monthly Population Survey (MPS) topic in April 1995. Previous information on children's immunisation has been collected in the 1983 MPS and the 1989-90 NHS. These surveys obtained information about the immunisation coverage of children aged 0-6 years, relative to the National Health and Medical Research Council's (NH&MRC) Standard Childhood Vaccination Schedule. The surveys aim to determine the immunisation status of children, overall and within population groups, and to enable changes in immunisation levels and patterns to be monitored over time.
The health screening component in the 1995 MPS collected information on the sight, hearing and dental screening of children aged 0-14 years. More general information on the use of health services by children was obtained in the 1983, 1989-90 and 1995 NHS.
ALLIED HEALTH INDUSTRIES SURVEY (ABS)
This survey conducted in 1997-98 was designed to collect information on a range of health related industries (e.g. dental services, optometry and optical dispensing, physiotherapy services and chiropractic services). The output from the survey will include employment details, income and expenses dissected by their major components, assets and liabilities and performance ratios.
PRIVATE MEDICAL PRACTICE INDUSTRY COLLECTION (ABS)
This collection comprises two 1994-95 surveys: one from private medical practitioners and one from private medical businesses. The first collected information on medical practitioner demographics, qualifications, number of hours worked per week and number of patient contacts per week.
The survey of medical businesses collected employment and financial data for the specialist medical service industry and the pathology services industry for the 1994-95 financial year. The items measured included the income, expenses, profitability, employment, state, size of medical practice and capital expenditure for private general practice and private specialist practice industries in Australia.
CENSUS OF POPULATION AND HOUSING (ABS)
Conducted every five years, the Census collects detailed small area and national data. Among the person-level data provided by the Census are employment characteristics and a full occupation classification, which provide information on the distribution and characteristics of people employed in the health industry.
CAUSE OF DEATH COLLECTION (ABS)
This collection contains information on all deaths (excluding stillbirths) registered by State and Territory registrars, and has been compiled for each year from 1907. Information collected includes underlying cause of death, year of registration and occurrence, usual area of residence and some demographic characteristics. From 1997 onwards, multiple causes of death information has been coded using an automated coding system according to ICD-10.
PERINATAL DEATHS COLLECTION (ABS)
Perinatal deaths comprise still births (foetal deaths) and deaths occurring within 28 days of birth (neonatal deaths). The collection comprises information supplied by State and Territory Registrars to the ABS from cause of Perinatal Death Medical Certificates prepared by the certifying medical practitioner. Perinatal deaths information coded according to the ICD-10 is used as a basis for research by medical researchers and health professionals. Causes of death are assigned in terms of the main condition in the foetus/infant and the main condition in the mother. Perinatal deaths are commonly cross classified by birthweight, gestational age, age group of mother and State or Territory of birth or usual residence of the mother.
PRIVATE HOSPITALS ESTABLISHMENT COLLECTION (ABS)
The annual Private Hospitals Establishment Collection (PHEC) provides information about the facilities, activities, staffing and finances of all private, acute, psychiatric and free standing day hospital facilities in Australia. The PHEC provides information about facilities (beds available, special units, etc.), activities (patient throughput, days of hospitalisation provided, bed occupancy rates), and patients (types of admitted patients, outpatients and operations performed). The PHEC data is used by policy makers, health industry analysts, and health-care researchers.
THE AUSTRALIAN LONGITUDINAL STUDY ON WOMEN'S HEALTH
This study of women's health is being conducted by the Research Institute for Gender and Health (University of Newcastle), and is designed to explore a wide range of health and health related issues, ranging from general wellbeing, to weight, exercise and health behaviours, time-use, social support and health care utilisation.
The baseline year was 1996, and the project intends to follow up respondents for up to 20 years. The cohorts consist of young, mid-age and older women and include samples from urban, rural and remote areas across Australia. The project will determine which health services could be improved, by learning about women's health problems, their lifestyles and their views on health services. Further detail is available from the website: http://www.newcastle.edu.au/
NATIONAL DRUG STRATEGY HOUSEHOLD SURVEY
The most recent National Drug Strategy Household Survey (NDSHS) was conducted by the Australian Institute of Health and Welfare (AIHW) in 2001 with funding from DHAC. The data collected is intended to provide information on the prevalence, attitudes and correlates of legal and illegal drug taking to inform policies and programs which are in turn designed to reduce the harmful effects of drug taking. The NDSHS contained questions on drug-related knowledge, awareness, attitudes, use and behaviours. It was the sixth survey conducted under the auspices of the National Drug Strategy. Previous surveys were conducted in 1985, 1988, 1991, 1993 and 1995. An Indigenous (urban) supplement to the survey was conducted in 1994.
NATIONAL PHYSICAL ACTIVITY SURVEY
First run in 1997 as the Active Australia survey, the second National Physical Activity Survey was conducted in 1999 through joint funding by the AIHW and DHAC. The purpose of the survey was to monitor the prevalence of activity levels of Australians and assess the impact of the Active Australia initiative. The survey collected self-reported information from respondents on the duration, frequency, intensity and type of exercise, as well as height and weight and socio-demographic items.
Conducted in 2000, the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) is the first national study to provide estimates of the number of people with diabetes based on blood tests, and on the public health and social impact of diabetes. The AusDiab study was undertaken by the International Diabetes Institute and has received funding from a wide range of public and private organisations including DHAC, State and Territory health agencies and a number of Pharmaceutical bodies. The objectives of the survey include to estimate the prevalence of diabetes and related conditions (including risk factors) and assess the distribution and relationships of cardiovascular risk factors and assess trends in risk factor levels as compared to those obtained in previous surveys in Australia. The data collected in AusDiab include: socio-demographic variables, diabetes status, medical and family history, general health and wellbeing, risk factors, and health service use. Further detail is available from the AusDiab website http://www.diabetes.org
BETTERING THE EVALUATION AND CARE OF HEALTH
Known as the BEACH project, this is an ongoing survey of general practice conducted by AIHW and the General Practitioner Statistics Collection Unit (GPSCU) from the University of Sydney. The project is financially supported by DHAC and a consortium of pharmaceutical bodies. BEACH surveys around 1,000 general practitioners (GPs) from across Australia annually, selected from the Medicare Benefits Scheme provider database. The aims of the program are to establish an ongoing database of GP-patient encounter information and to assess patient based risk factors and the relationship these factors have with health service activity. The data is intended for use by government bodies, GP organisations, consumers, researchers, and the pharmaceutical industry.
Data items collected from the GP include demographic information, duration of practice, size of practice, number of patients seen. Patient data collected includes demographic information, whether used the practice before, reason for consultation and type of management (such as prescribed drug treatment) of health conditions. Further detail is available from the website http://www.fmru.org.au/beach.htm#1
AUSTRALIAN STUDY OF HEALTH AND RELATIONSHIPS
This national survey is being conducted in 2001 by LaTrobe University and the Central Sydney Area Health Service with funding from DHAC, a number of State and Territory health agencies and the NH&MRC. The aim of the study is to collect information on sexual health and related issues from people aged 16-59 years. The study design is similar to that used in a number of overseas surveys. The data collected covers sexual attitudes and experiences, general health status indicators and risk behaviours, as well as a range of demographic information. The results of the study are planned for release in 2002.
Further detail is available from the La Trobe University website http://www.latrobe.edu.au/www/ashr
DENTAL STATISTICS AND RESEARCH UNIT COLLECTIONS
Established in 1988, the Dental Statistics and Research Unit (DSRU) is a collaborative unit of the AIHW based at Adelaide University. The DSRU aims to improve the oral health of Australians through the collection, analysis and reporting of dental statistics and through research on dental health status, dental practices and use of dental services and the dental labour force. In addition to a number of South Australian-specific surveys, the DSRU maintain national data collections, which include:
The Child Dental Health Survey - an annual monitoring survey of the oral health of children under care of State and Territory school dental services. Records provided by State and Territory health authorities are analysed to document the oral health status of children cared for by school dental services and the provision of care to those children. Redesign of this collection is being undertaken to improve representativeness of estimates, provide linkage with social and service provision data, and allow longitudinal linkage of unit record files.
The Adult Dental Programs Survey - a survey which monitors the oral health of adults receiving public-funded dental care. Collection of the survey will be extended to all States and Territories through the development of new management information systems which can capture oral health data.
Further detail is available from the Dental Statistics and Research Unit website http://www.adelaide.edu.au/socprev-dent/dsru/data_frame.html
NATIONAL CANCER REGISTRY
Cancer is a notifiable disease in all States and Territories, and is the only major disease category for which an almost complete coverage of incidence data is available. The National Cancer Statistics Clearing House (NCSCH) at the AIHW receives incidence data from individual State and Territory cancer registries on all cancers diagnosed among Australian residents. This commenced with cases first diagnosed in 1982. The AIHW produces national statistics on cancer incidence and mortality. The data items collected include clinical information on type of cancer and histology, as well as sex, date of birth, country of birth and place of residence. These data items provided to the NCSCH by the State and Territory cancer registries enable record linkage and facilitate the analysis of cancer by type, site and behaviour. Further detail is available from the AIHW website http://www.aihw.gov.au/cancer/index.cfm.
A National Diabetes Register, based at the AIHW, provides a database that can be used to keep an accurate account of the number of Australians who are diagnosed with diabetes, providing researchers with statistics on diabetics who use insulin. The information is collected from two principal sources: records of people using the National Diabetic Services Scheme and the State-based registers of the Australian Paediatric Endocrine Group. The Diabetes Register is limited to counting the number of diabetics who are using insulin, the majority being type 1 diabetics, and contains records for Australians that are diagnosed with diabetes after 1 January 1999.
NATIONAL NOTIFIABLE DISEASES SURVEILLANCE SYSTEM
This collection was established in 1990 under the auspices of the Communicable Diseases Network Australia New Zealand (CDNANZ) to facilitate the detection, monitoring and control of disease outbreaks. The System coordinates the national surveillance of more than 40 communicable diseases or disease groups endorsed by the NH&MRC. Under this scheme, notifications are made to the States or Territory health authority under the provisions of the public health legislation in their jurisdiction. Computerised, de-identified unit records of notifications are supplied to the Network secretariat at DHAC for collation, analysis and publication in the Communicable Diseases Intelligence bulletin. Data provided for each notification include a unique record reference number, State or Territory code, disease code, date of onset, date of notification to the relevant health authority and demographic and geographic items. Further detail is available from the DHAC website http://www.health.gov.au/.
NATIONAL HOSPITAL MORBIDITY DATABASE
The National Hospital Morbidity Database (NHMD) is compiled by the AIHW from data supplied by the State and Territory health authorities. It is a collection of electronic confidentialised summary records for admitted patients separated in public and private hospitals in Australia. All data are based on records of separation from hospitals. The data items collected include location and type of hospital, demographic data, clinical diagnosis, procedures, type of care, length of stay, and administrative data such as insurance status, compensation status and accommodation status. National data are held from 1993-94 onwards.
Further detail is available from the AIHW website http://www.aihw.gov.au/hospitals/index.cfm.
HEALTH INSURANCE COMMISSION DATA SOURCES
Medicare Benefits Schedule Data Collection - Introduced in 1984, Medicare, Australia's public health insurance scheme, was designed to make health care affordable, to give all access to services, and to provide high quality care. Medicare provides free or subsidised access to hospitals, medical practitioners, participating optometrists or dentists. Details are recorded for every health system transaction involving Medicare. The transaction details are recorded in the Medicare Benefits Schedule Data Collection. The data collected includes patient demographics, type of service and the Medicare contribution to the service.
Pharmaceutical Benefits Schedule Data Collection - The Pharmaceutical Benefits Schedule (PBS) provides access to necessary and lifesaving medicines at an affordable price for Australian residents. Most medicines available on prescription are subsided under the Government's PBS. Data from the PBS collection are available from 1991 and contain the details of all prescribed medicines with prices above certain thresholds, the category of entitlement and the amount of the benefit.
Australian Childhood Immunisation Register - The register commenced in 1996 and enables parents and health care providers to check on a child's immunisation status. The Register is also used to monitor immunisation coverage levels, service delivery and disease outbreaks. The Immunisation Register records details such as type of vaccinations and the age sex and postcode of child. Further detail is available from the HIC website http://www1.hic.gov.au/general/acircirghome
NATIONAL MIDWIVES COLLECTION
The Australian Institute of Health and Welfare's National Perinatal Statistics Unit compiles perinatal data from each State and Territory from midwives and other staff. The information is obtained from mothers and from hospital or other records including complete notification forms for each birth. The collection has been operating since 1979, and the information collected includes characteristics of the mother; previous pregnancies; the current pregnancy; labour, delivery and the puerperium; and the baby’s birth status (live birth or stillbirth), sex, birthweight, Apgar scores and outcome. The Midwives data is combined with ABS births and perinatal deaths data into the annual report 'Australia's Mothers and Babies', which examines demographic and pregnancy factors of mothers and the characteristics and health outcomes of their babies. Further detail is available from the National Perinatal Statistics Unit websitehttp://www.npsu.unsw.edu.au/
COMMONWEALTH DISABILITY SERVICES CENSUS
The Commonwealth Disability Services Census run annually by the Department of Family and Community Services covers all Commonwealth funded disability employment, print disability, advocacy and information services. The collection provides information to assist in the planning, development and management of Commonwealth disability programs and enables the Commonwealth to fulfil its reporting obligations under the Commonwealth State Disability Agreement. Consumer data collected includes: service type received; demographic information; method of communication; accommodation type; primary disability group; other significant disability groups; need for support/assistance; support commencement date; employment information (including standard hours worked per week).