Indigenous Australians' cardiovascular death rate fell 18%. Suicide got worse.

Australia's national framework for tracking Aboriginal and Torres Strait Islander health found a 2018 disease burden 2.3 times that of non-Indigenous Australians [s1] — and a decade of data showing real, measured progress on several specific fronts sitting alongside stagnation or outright decline on others, rather than uniform improvement or uniform failure.

Where the AIHW says the gap actually comes from

The AIHW's own analysis attributes roughly 35% of the total health disparity to social determinants — factors like housing, education, and income — and roughly 30% to specific health risk factors like smoking and diet, leaving about 35% unexplained by either category [s1]. That's a notable admission from the body producing the framework: over a third of the measured gap isn't accounted for by the two explanatory categories researchers typically look to first, which limits how confidently any single policy lever — addressing smoking rates, or housing, for instance — can be expected to close the disparity on its own.

The clearest wins in the data

Several individual measures moved substantially in the right direction over the past decade. Smoking among First Nations people 15 and older fell from 45% in 2008 to 37% in 2018–19 [s1]. Year 12 completion among 20-to-24-year-olds rose from 52% to 68% between 2011 and 2021, narrowing the gap with non-Indigenous Australians from 34 to 23 percentage points over that period [s1]. Cardiovascular disease mortality fell 18% and kidney disease mortality fell 36% between 2010 and 2019 [s1], and youth justice supervision rates dropped from 180 to 121 per 10,000 between 2012–13 and 2021–22 [s1]. Employment among 25-to-64-year-olds rose from 51.0% to 55.7% between 2016 and 2021, and the Indigenous health workforce grew from 255 to 309 per 10,000 employed between 2011 and 2021 [s1].

Where the same decade shows no movement, or reversal

Against those gains, the framework reports no significant change in infant mortality, perinatal mortality, or avoidable mortality overall [s1] — meaning some of the most fundamental health outcome measures haven't moved despite progress on risk factors like smoking and specific disease categories like cardiovascular and kidney mortality. More strikingly, several measures got worse over the same period: suicide, cancer deaths, hospitalizations from assault, children placed in out-of-home care, and adult imprisonment rates are all reported as having worsened [s1]. A framework showing simultaneous 18-36% mortality declines in two specific disease categories and worsening suicide and imprisonment rates isn't internally contradictory — it's evidence that different categories of harm respond to different interventions on different timelines, and that clinical-disease-focused progress doesn't automatically translate into progress on outcomes rooted more directly in social and justice-system factors.

The access barrier still sitting underneath all of this

Separate from the outcome trends, the framework reports that approximately 30% of First Nations people who needed healthcare didn't access it, citing cost, unavailability, distance, or wait times as the barriers [s1]. That's a striking figure to sit alongside the mortality-decline data: nearly a third of people who needed care didn't get it, for reasons that are about health-system access rather than disease severity or personal choice — meaning at least some of the areas showing no progress could plausibly be linked to this access gap, though the framework as summarized here doesn't draw that specific causal connection.

What this data can't settle

The framework tracks outcomes over time; it doesn't, in what's summarized here, isolate which specific policies or programs drove the measured improvements in smoking, education, or cardiovascular mortality, or explain why suicide and imprisonment moved in the opposite direction over the same period. The roughly 35% of the health gap AIHW itself describes as unexplained is a direct acknowledgment of that limit.

What to watch next

Whether the areas showing worsening trends — suicide, imprisonment, out-of-home care — become explicit targets of future policy the way smoking and cardiovascular disease evidently were over the tracked decade, and whether the 30% healthcare-access gap narrows in future editions of this framework.