Refugee and humanitarian entrant health
Refugees and humanitarian entrants have unique experiences which may impact their health outcomes. They are a subset of a group of people from culturally and linguistically diverse backgrounds, who have been identified as a population of interest across the health sector, including in several key Australian Government strategies.
Understanding patterns of health outcomes and service use within this population is important to address the health needs of refugees and humanitarian entrants and to inform the design and delivery of health care services, homelessness services and settlement services for them.
While data is routinely collected on the health and welfare outcomes of the broader Australian population, there is no information to identify the refugee and humanitarian population in health and welfare data sets. As a result, there is currently limited data available to assess refugees and humanitarian entrants’ health outcomes.
In June 2022, the Australian Institute of Health and Welfare (AIHW) was funded by the Department of Home Affairs to develop data and information that will help to build a more comprehensive picture of the health and welfare status of refugees and humanitarian entrants. This project will provide more data to potentially identify areas of need, including information on chronic health conditions, health service usage, medication dispensing patterns, mental health service usage, risk factors and use of homelessness services. For this project the AIHW will report on health indicators using two main linked data sources:
- Stage 1 will use the Multi-Agency Data Integration Project (MADIP) to report on health service use, medication use, mortality, immunisation and health status and risk factors.
- Stage 2 will develop a new data set by linking data from the Department of Home Affairs’ Settlement Database with health and welfare data sets to provide further information on the health status and outcomes of the refugee and humanitarian population and their use of health, including hospital and homelessness services.
Information to identify refugees and humanitarian entrants in health and welfare data sets is limited, and data on refugee and humanitarian entrant health are not collected consistently and routinely reported on. Using linked data can provide a solution to some of these data challenges. Linking data from a data set that contains information about the refugee and humanitarian population (such as the Settlement Database) with health and welfare data sets can provide a more complete picture of the health and welfare status of refugees and humanitarian entrants.
What is data linkage?
Data linkage is the process of identifying, matching, and merging records that correspond to the same person or entity from several data sets or even within one data set.
This improves data completeness and provides a rich person-level source of information beyond that available through routine disease surveillance and single data sources. The AIHW uses robust methods to carry out data linkage, and more information can be found at AIHW's data linkage services.
Why is it important?
This project will provide a more complete picture of the health and welfare status of the refugee and humanitarian population. This will help to understand the health care needs of this population and identify potential service delivery gaps.
Findings from this project will also inform the development and evaluation of policies and settlement services to support people migrating to Australia and improve the broader health and welfare outcomes of refugees and humanitarian entrants and migrants.
Stage 1: Using the Multi Agency Data Integration Project to report on health indicators
This stage of the project will use data available in the Multi Agency Data Integration Project (MADIP) to identify refugees and humanitarian entrants and permanent migrants and report on a number of health indicators including health service use, medication use, mortality, immunisation and health status and risk factors. The analysis will include refugees and humanitarian entrants and permanent migrants who have arrived in Australia from 1 January 2000.
The MADIP is a partnership among Australian Government agencies to develop a secure and enduring approach for combining information on healthcare, education, government payments, personal income tax, and population demographics to create a comprehensive picture of Australia over time. This project will use the following data in MADIP:
- the Australian Bureau of Statistics (ABS) persons linkage spine (combined population from the Medicare Consumer Directory, the DOMINO Centrelink Administrative Data and the Personal Income Tax)
- the Migrants data
- the Pharmaceutical Benefits Scheme
- the Medicare Benefits Schedule
- the Census of Housing and Population
- the National Health Survey
- the Australian Immunisation Register
- the Causes of Death
- the Deaths Registrations.
The MADIP is under the custodianship of the Australian Bureau of Statistics, and more details can be found on the ABS website.
This stage of the project will take 9 to 12 months to complete.
Stage 2: Developing a new health and welfare linked data set for the refugee and humanitarian population
The AIHW will develop a new data set by linking permanent migrants’ data from the Department of Home Affairs' Settlement Database with health and welfare data sets held by the AIHW to provide further information on the patterns of health service use, treatment pathways and the health and welfare outcomes of the refugee and humanitarian population who arrived in Australia from 1 January 2000.
The data sets that will be included are:
National Hospital Morbidity Database
Medicare Consumer Directory
National Non-Admitted Patient Emergency Department Care Database
Medicare Benefits Schedule
National Death Index
Pharmaceutical Benefits Scheme
Specialist Homelessness Services Collection
This linked data set will include hospitalisation and homelessness service data not available in the MADIP.
Data from the linked data set will be analysed to report on the health status and outcomes of the refugee and humanitarian population including on hospitalisation, emergency department care, medication use, maternal and perinatal outcomes, COVID-19 hospitalisations and deaths. The use of homelessness services in the refugee and humanitarian population will also be investigated using this linked data set.
The focus of the project is refugee and humanitarian entrants and children born in Australia to refugee and humanitarian visa holders. However, comparisons will be made with other permanent migrant groups, and they will be included in the linked data set.
The timeframe for this stage of the project is 12 to 18 months.
How is your privacy protected?
The AIHW manages this data with respect for its sensitivity, and with privacy and confidentiality assured through legislation, accountability practices and procedures. The AIHW also manages relationships with data custodians to ensure accountability and appropriate use of the relevant data collections.
The AIHW adheres to the strict confidentiality provisions under the Section 95 of the Privacy Act 1988 (Cwlth) (Privacy Act) and Section 29 of the Australian Institute of Health and Welfare Act 1987 (Cwlth) (AIHW Act).
The AIHW protects the privacy of an individual through a process of de-identification. This involves removing identifying information (for example, a person's name or address) so that researchers analysing the linked data set are unable to tell who the information belongs to.
In accordance with the Privacy Act, the collection, use and disclosure of records containing personal information for this project has been assessed and approved by the AIHW's Ethics Committee (EO2022-4-1359).
The AIHW uses the Five Safes Framework to reinforce management of the privacy and confidentiality of data. Five Safes is an approach to assessing and managing risks associated with data sharing and release. Under the framework, the risk of re-identification is minimised, particularly as data are accessed in secure access environments where outputs are checked by the AIHW.