Introduction by Croakey: A public hearing is being held today at Parliament House in Canberra, on Ngunnawal Country, for the Senate Standing Committee on Community Affairs’ Inquiry into Excess Mortality.
Witnesses include the Australian Bureau of Statistics, National Rural Health Alliance, Australian Institute of Health and Welfare, the Royal Australian College of General Practitioners and the Department of Health and Aged Care.
Alison Barrett reports below on a number of the submissions relating to Aboriginal and Torres Strait Island and rural population excess mortality issues, as well as challenges reporting excess mortality moving forward.
Alison Barrett writes:
Recommendations to improve collection and publication of data on excess mortality among Aboriginal and Torres Strait Islander people have been made in submissions to the Senate Standing Committee on Community Affairs Inquiry into Excess Mortality.
The inquiry was set up in March 2024 to look overall at excess deaths during the pandemic years of 2020, 2021 and 2023. The inquiry has now received 35 submissions from groups including Asthma Australia, Heart Foundation, and several individuals.
According to the Department of Health and Aged Care’s submission, COVID-19 data are becoming “increasingly unreliable” due to changes in the way states and territories report the data.
However, the Department said it continues to monitor the impact of COVID-19 in the community, including publishing reports on deaths and case numbers in residential aged care.
Improving data collection and reducing excess mortality align with the National Agreement on Closing the Gap and its four Priority Reform Areas, the National Aboriginal Community Controlled Health Organisation (NACCHO) wrote in its submission to the inquiry.
This is particularly important as currently the provisional mortality data used by the Australian Bureau of Statistics to show excess deaths does not include Indigenous status, according to NACCHO.
While improvements have been made in the “underlying data quality” in recent years, NACCHO wrote that “further data improvement is required to ensure that mortality data adequately captures people from Aboriginal and Torres Strait Islander backgrounds”.
NACCHO said it is also important to address the social, structural, cultural and other determinants that influence health outcomes for Aboriginal and Torres Strait Islander peoples and that Aboriginal Community Controlled Health Organisations “are uniquely placed to address the social determinants of health”.
“A well-resourced Aboriginal community-controlled health sector addresses many potential drivers of excess mortality,” it said.
Impacts of limited data
The current available data “hampers the ability” to fully understand how preventable drivers of excess mortality affect Aboriginal and Torres Strait Islander populations.
“As long as Indigenous status is not included in reporting, the variation between populations cannot be understood, including what factors may drive this variability,” NACCHO wrote.
Similarly, in its submission to the inquiry, the National Rural Health Alliance commented on limitations in mortality data.
“The absence of geographical data makes it impossible to fully understand the impacts of excess mortality on rural and remote consumers…
“Tailored datasets and rural specific models of care are imperative to addressing ongoing healthcare inequities,” it wrote.
The Alliance recommends creating datasets to demonstrate excess mortality in relation to remoteness, as well as prioritising research that examines how pandemics and other disasters impact health systems in rural Australia.
Planning for periods of increased admission to rural healthcare services – such as seasonal respiratory viruses – and designing interventions to bolster the workforce during these periods are also recommended.
The Alliance also highlights the importance of engaging with Aboriginal and Torres Strait Islander researchers to explore the drivers behind disproportionate outcomes.
Preventing excess mortality
Excess mortality would be reduced by greater uptake of vaccinations against infectious diseases, including COVID-19, and greater use of non-pharmaceutical measures against airborne diseases, the Actuaries Institute recommend in its submission.
They emphasise the “clear role for government” in supplying vaccines for COVID-19 and influenza, personal protective equipment, encouragement of sanitisation and mask wearing, isolation when unwell and the messaging around these measures.
In addition, the Institute recommends improved ventilation and air filtration in crowded places, and exploring other interventions to reduce mortality, including ambulance response times and ramping, emergency department treatment times, and waiting lists for elective/planned surgery.
It notes that while its members are not medical professionals, the recommendations are based on the Institute’s Mortality Working Group’s understanding of issues as “explained to them by medical practitioners”.
The Mortality Working Group has frequently reported on excess mortality throughout the pandemic, finding that it was driven during 2020 to 2023 “by deaths from and with COVID-19”.
While COVID-19 was a large contributor to excess mortality, other factors may include:
- Mortality displacement – where deaths from existing underlying health problems are delayed due to reduced circulation of many respiratory and other diseases in 2020 and 2021, which may have otherwise contributed to deaths in those years.
- Delays in emergency care during COVID-19 waves and influenza outbreaks.
- Ageing population.
- Long-term health impacts of COVID-19 infection, or where COVID-19 may have exacerbated other health conditions.
- Delays or reductions in seeking routine healthcare.
Government response
According to the Department, it has implemented the following measures to improve the timeliness and accessibility of healthcare in general:
- Ongoing promotion and provision of vaccination against COVID-19 and influenza, particularly to higher-risk groups. The Australian Technical Advisory Group on Immunisation (ATAGI) continue to monitor the evolving risk profile of the Australian population to inform COVID-19 vaccine advice.
- Ongoing infection prevention and control measures to reduce the spread and impact of COVID-19, influenza and other communicable diseases in high-risk settings such as aged care and hospitals. The Australian Commission on Safety and Quality in Health Care and the Aged Care Safety and Quality Commission are leading this.
- Opening of Medicare Urgent Care Clinics to take the pressure off emergency departments and general practice.
These measures “will likely assist in maintaining downward pressure on excess mortality”, said the Department’s submission.
On preventing excess mortality, the Department said the Australian Government “recognises the critical role preventive health plays in keeping people well for longer”.
It notes that an implementation and evaluation plan is being developed to support the implementation of the National Preventive Health Strategy, which was launched in December 2021.
New challenges
As with the Actuaries Institute, the Australian Bureau of Statistics found that COVID-19 associated deaths were the main contributor to excess deaths during 2020 to 2023.
In 2022, the ABS calculated that excess mortality was 11.7 percent, of which COVID-19 accounted for two-thirds.
As we move further from the start of the pandemic, new ways of considering excess deaths are required it said, writing that the ABS has begun work to address new questions now that COVID-19 is “an established factor influencing mortality”.
To date, excess mortality has addressed the question: how does the number of deaths which has occurred during the COVID-19 pandemic compare to the number of deaths expected had the pandemic not occurred? using pre-pandemic data as baseline for expected number of deaths.
Moving forward, estimates of expected mortality will need to include COVID-19 in the baseline when calculating excess mortality, according to the ABS.
This is needed for several reasons, it wrote:
- To provide new insights into mortality expectations accounting for the virus.
- The further from the start of the pandemic we move, the more factors influence current mortality profile (including influenza and other respiratory diseases).
- The older the data used to model a current year of expected mortality, the less robust the estimate will be.
“Mortality has largely not followed expected patterns during the pandemic and understanding what a ‘usual’ mortality pattern now looks like requires consideration,” the ABS wrote.
Terms of reference
Submissions to the inquiry responded, where they could, to these terms of reference:
- ABS data showing excess deaths in recent years, with particular reference to all-cause provisional mortality data reported by states and territories to the ABS, the difference between all-cause provisional mortality data for 2021, 22 and 23 and the preceding years of 2015 to 2020 (inclusive)
- Factors contributing to excess mortality in 2021, 2022 and 2023.
- Recommendations on how to address any identified preventable drivers of excess mortality.
- Any other related matter.
More submissions to the Senate Community Affairs References Committee Inquiry into Excess Mortality can be viewed here.
See Croakey’s archive of articles on COVID-19 here.
