Impact of COVID-19
To contextualise the impacts of the pandemic on the use of health checks in different months and jurisdictions, the ‘relative time that people spent at residences’, based on Google’s mobility reports, was used as a combined indicator of:
- the degree of COVID-19 within the community
- the extent of stay-at-home requirements
- general hesitance in the population to move about freely.
The relative time spent at residences is defined such that positive values of the parameter correspond to people on average spending more time at home than in comparison to the pre-pandemic reference period. More information about alternative indicators of COVID-19, as well as a more detailed definition of time spent at residences, can be found under Progression of the pandemic.
Comparing the variation in health check use during the COVID‑19 pandemic to the progression of the pandemic requires indicators of key circumstances that may influence the willingness and ability of people to visit health services. Examples of possible indicators could be the number of COVID‑19 cases in the (Indigenous or overall) population, health outcomes related to COVID‑19 or the extent of government restrictions such as stay-at-home orders. Four possible indicators were analysed for this report: relative case numbers, relative hospitalisation numbers, the extent of stay-at-home orders and relative time spent at residences (Figure 4).
Figure 4: Timeline of selected indicators of the COVID‑19 pandemic, by state and territory, 2020 to 2021
An interactive line graph showing four indicators relating to the COVID-19 pandemic. States and territories can be selected from a dropdown menu. Refer to tables 'CV04a’ through ‘CV04d’ in data tables.
These COVID‑19 indicators were chosen based on data availability and their potential to influence the use and delivery of Indigenous-specific health checks. The 4 indicators are interrelated. Surges in case numbers result in surges in hospitalisation numbers a short time after. Stay-at-home orders (lockdown restrictions) increase the time that people spend at home, which reduces the numbers of cases, hospitalisations and deaths. Community perception of the risk-level and consequences of catching COVID‑19 influence people’s behaviour as well. If the data were available, another potentially informative indicator would have been the capacity of health services to deliver Indigenous-specific health checks since this may have varied in response to the changing circumstances.
The analysis for this report made use of COVID‑19 case (COVID Live 2022a) and hospitalisation (COVID Live 2022b) numbers, based on the total Indigenous and non-Indigenous population, expressing the numbers as a percentage of the highest number reported up until (and including) the current day for the given location. For example, if the highest 7-day average case number reported up till 30-Jun-2020 had been 500, and the 7-day average case number on 30-Jun-2020 were 100, then the relative cases on that date would be 20%. This type of analysis was chosen so that smaller waves could still be seen, even if they were dwarfed by later waves, given that they would have been considered relatively prominent at the time. Mobility was represented by the Australian subnational output on stay-at-home orders from the Oxford COVID‑19 Government Response Tracker (ANU 2022, Hale et al. 2021) and anonymised data from mobile applications reporting on relative time spent at residences (Box 1), as reported by Google (COVID‑19 Data 2022).
All 4 indicators presented in this analysis were found to have some level of correlation with the variation in health check numbers and with the other indicators. However, the indicator that tended to have the strongest association with the variation in health check numbers was the relative time spent at residences (Box 1).
Box 1: Time spent at residences
Mobility in terms of time people spent at home was calculated using anonymised data from Google Maps and other applications in which the user had turned Location History on. It is expressed as a percentagewise change from a baseline value, representing how much time people typically spent at home at the beginning of 2020, before lockdown restrictions were introduced. For example, a score of 0% means people were spending around the same amount of time at home as during the baseline period, while a score of 20% means people were spending around 20% more time at home than during the baseline period.
The baseline was calculated using a median for each of the days of the week, based on a 5-week period from 3 January to 6 February 2020. The daily mobility is reported as a 7-day moving average (COVID‑19 Data 2022).
It is important to note that the anonymised data on mobility were collected from the general population, not only from Indigenous Australians, and are therefore not a perfect reflection of variation in the mobility of Indigenous Australians specifically, especially for regions where the Indigenous population and total population have considerably different geographic distributions. The baseline period also covered part of the summer holidays and some of the time of the year that is the wet season in parts of Australia with a pronounced wet season.
Figure 5 shows the relative time spent at residences alongside the change in Indigenous health check use in 2020 and 2021 from prior years. The monthly changes in service use were mostly decreases when comparing 2020 and 2021 with 2019, which was the year with the highest number of Indigenous health checks. Because the month-to-month pattern in health check numbers is somewhat variable, particularly in areas with small Indigenous populations, Figure 5 also includes the option to compare the 2020 and 2021 service use to the numbers in 2017 and 2018.
Comparing the health check numbers in 2020 and 2021 with the numbers from 2019, health check numbers generally tended to decrease when the relative time spent at residences was high across Australia (Figure 5). This relationship was particularly strong in New South Wales and Victoria, which were impacted strongly by COVID‑19 (Figure 4, in 'Progression of the pandemic'), and less obvious in states with smaller Indigenous Australian populations, and where the pattern of month-to-month variation differed significantly across the years (Figure 3). The changes in health check use relative to 2019 were at times of notable size, sometimes at a scale comparable to that seen during the initial wave of COVID‑19 in April 2020, without an accompanying change in the time spent at residences. This suggests that this mobility measure only partially captures the reasons why the month-to-month variation in use of health checks over the course of 2020 and 2021 was different to what was seen before the pandemic.
Figure 5: Relative time spent at residences and change from prior years in number of Indigenous-specific health checks, by month, telehealth status, and location, 2020 to 2021
An interactive line graph showing the number of Indigenous-specific health checks in each month of 2020 and 2021 relative to the same month in an earlier year, by telehealth status. Population mobility, represented by relative time spent at residences, is shown as well. Location and comparison year can be selected from a dropdown menu. Refer to tables 'CV05' and ‘CV04d’ in data tables.
ANU (Australian National University) (2022) Oxford COVID‑19 Government Response Tracker: Australian Subnational dataset, ANU website, accessed 20 December 2022.
COVID‑19 Data (2022) Mobility data, covid19data.com.au website, accessed 7 September 2022.
COVID Live (2022a) New cases, COVID Live website, accessed 9 February 2023.
COVID Live (2022b) Hospitalisations, COVID Live website, accessed 9 September 2022.
Hale T, Angrist N, Goldszmidt R, Kira B, Petherick A, Phillips T, Webster S, Cameron-Blake E, Hallas L, Majumdar S and Tatlow H (2021) ‘A global panel database of pandemic policies (Oxford COVID‑19 Government Response Tracker)’ Nature Human Behaviour 5:529-538, doi: doi.org/10.1038/s41562-021-01079-8.