Highlighting equity and inequity in Australia’s health system

Equity and inequity in Australia's health system are major themes in this latest issue of the MJA. From the beginning, when research is funded, through to how clinical guidelines are developed, how research is conducted, and, finally, in health outcomes, the articles in this issue explore gender and racial inequities from several angles, including what progress has been made, and where deficiencies remain. Together they highlight how diversity and inclusivity in generating and applying medical evidence is fundamental to ensuring our health system achieves equitable and high quality outcomes for all patients.

In her Perspective Towards gender equity in Australian health and medical research funding, the NHMRC CEO, Professor Anne Kelso, describes an important new initiative by the leading Australian health research funder to reduce gender disparities in one key area: the Leadership levels of the Investigator Grant scheme. This measure, informed by evidence and consultation across the Australian health research sector, is welcome, and is hopefully a start towards reducing the attrition of women at early and mid‐career stages. I was especially heartened to see that its “goals are defined, its effectiveness will be monitored annually, and it will cease if it is found to be ineffective or to have achieved its goals” (doi: 10.5694/mja2.51767).

Continuing the theme of gender inequity, Anna Shalit and colleagues found that women were underrepresented in Australian clinical guideline development groups over the 10‐year period, 2010–2020, especially when it comes to women in leadership as panel chairs. The authors recommend that organisations which “develop or endorse guidelines should adopt effective policies for gender balance on their guideline panels and regularly monitor progress toward this target” (doi: 10.5694/mja2.51831).

For their Research article on Ethical conduct in research with Aboriginal and Torres Strait Islander peoples and communities, Luke Burchill and colleagues surveyed people working in Indigenous health research in Australia about their use of the 2018 NHMRC guidelines, and the degree of Indigenous governance and participation in their research. Their findings are essential reading for anyone working in Indigenous health. Although the NHMRC guidelines are widely used, along with local guidelines, the authors conclude that “Indigenous governance and participation was inadequate at each stage of research” and that “Indigenous health research in Australia is largely informed by non‐Indigenous world views, led by non‐Indigenous people, and undertaken in non‐Indigenous organisations” (doi: 10.5694/mja2.51757).

In their linked editorial, Aboriginal and Torres Strait Islander health research leadership, Candice McKenzie and Lilon Bandler emphasise how sobering these findings are, noting that “As only 38% of [the survey] respondents had received any formal education in the history of health research involving Indigenous people, more than 60% may not have properly understood the historical background underpinning the need for and value of the [NHMRC] guidelines.” They call for more than just a commitment to strengthening capacity building among Aboriginal and Torres Strait Islander health researchers: “We support the development of a required course on the ‘legacy of health research exploiting Indigenous Peoples’ that examines the eight domains of the Consolidated criteria for strengthening the reporting of health research involving Indigenous Peoples (CONSIDER) statement” (doi: 10.5694/mja2.51827).

The complex interplay of societal and health system factors that lead to inequitable health outcomes is examined by Paul Secombe and colleagues in their analysis of 12‐month mortality for Indigenous and non‐Indigenous people admitted to intensive care units in Australia. They find that “survival outcomes are poorer for Indigenous than non‐Indigenous people admitted to ICUs”, but conclude that it “is likely that the difference is less directly attributable to the ICU admission than to a complex interplay between pre‐ and post‐hospitalisation factors, socio‐economic disadvantage, remoteness, and chronic disease trajectory”. This is a message that should resonate well beyond this article across the entire Australian health system (doi: 10.5694/mja2.51763).

2023 is likely to be another challenging year for the Australian — and the global — health systems. The MJA team is committed to addressing these challenges in the research and commentary we publish, and look forward to working with authors, reviewers, and other colleagues from across the health community in the year ahead.