Policy context and narrative leading to the commissioning of the Australian Indigenous Burden of Disease study

Jessica R Botfield, Anthony B Zwi, Peter S Hill

Burden of disease (BoD) studies have been conducted in numerous international settings since the early 1990's. Two national BoD studies have been undertaken in Australia, in 1998 and 2003, although neither study estimated the BoD specifically for Indigenous Australians. In 2005 the Australian Government Department of Health and Ageing Office for Aboriginal and Torres Strait Islander Health formally commissioned the University of Queensland to undertake, in parallel with the second national BoD study, the "Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples" study, drawing on available data up to 2003. This paper is part of a broader NHMRC-funded project that examines the uptake of evidence to policy, using the 2007 Indigenous BoD (IBoD) study as a case study. This study aims to explore the policy context and narrative in the lead up to commissioning the IBoD study, focusing on relevant contextual factors and insights regarding the perspectives and anticipated value of the study by key stakeholders. A systematic review of the literature was undertaken in late 2013 and early 2014, and the findings triangulated with 38 key informant interviews with Indigenous and non-Indigenous academics, researchers, statisticians, policy advisors, and policymakers, conducted between 2011 and 2013. Contextual features which led to commissioning the IBoD study included widespread recognition of longstanding Indigenous disadvantage, lower life expectancy than non-Indigenous Australians, and the lack of an adequate evidence base upon which to determine priorities for interventions. Several anticipated benefits and expectations of key stakeholders were identified. Most informants held at least one of the following expectations of the study: that it would inform the evidence base, contribute to priority setting, and/or inform policy. There were differing or entirely contrasting views to this however, with some sharing concerns about the study being undertaken at all. The IBoD study, in concept, offered the potential to generate much desired 'answers', in the form of a quantified ranking of health risks and disease burden, and it was hoped by many that the results of the study would feed into determining priorities and informing Indigenous health policy.