Position paper

Aboriginal and Torres Strait Islander patient identification – 2019: position statement

Indigenous health Cultural awareness Cultural identity Medicine Australia

Throughout Australia, typical standards of identification for Aboriginal and Torres Strait Islander Peoples include a three-part definition, which are that a person be of Aboriginal or Torres Strait Islander descent, that they identify as Aboriginal or Torres Strait Islander and that they are accepted as such by the community in which they live or have lived. It is accepted that this type of formal identification should be excluded by health care providers and instead, providers should ensure that there is a standard question asked of all patients, irrespective of country of birth, age, appearance, clothing, language or other characteristics. Evidence-based practice is a foundational element of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. The plan acknowledges that we need accurate data to monitor health outcomes and redress systemic racism in the healthcare system. 
Under-identification is a key issue in data collection for Aboriginal and Torres Strait Islander Peoples. It results in gaps in data, therefore policy and service provision may be impeded. Under representation in data collection is also a prevalent issue in other areas, such as higher education and victim identification . Addressing under-identification should include discussions around the best ways to ask the identification question, which should adhere to best practice for asking and recording the identification of Aboriginal and Torres Strait Islander patients.

Key Findings:

  • Identification of Aboriginal and Torres Strait Islander patients is a point of concern across all specialties due to the impact under-identification has on data quality. Community education and the cultural competency of staff is essential to ensure that the standard Indigenous identity question is asked both appropriately and consistently, and that the patient response is accurately recorded. We advocate for best practice in patient identification and recognise its importance in the development of policy and services for Aboriginal and Torres Strait Islander Peoples and communities.
  • Literature indicates that health staff often express reasons for not asking the Aboriginal and Torres Strait Islander identification question appropriately, citing motives such as fear of aggression and wanting to treat all patients equally. AIDA advocates for cultural safety training for all staff who provide frontline service delivery to ensure they are respectful and able to break down barriers in collection and accurate reporting of identification information.
  • Information about Indigenous identification in the healthcare system, and the ways in which this data is used to inform improved health programs and policies should be freely accessible to all Indigenous and nonIndigenous community members. This supports self-identification, which has been recognised as the most accurate way to collect this information.
  • A study in the Australian Capital Territory found there were significant cultural barriers to collecting identifying data. These barriers include a reluctance by some patients to self-identify in certain situations, and resistance by those at data collection points – medical centres, pathology laboratories and hospital services entry points – to ask what is perceived by many to be either an irrelevant or a culturally insensitive question.
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