Perspectives

LGBTQA+SB (lesbian, gay, bisexual, transgender, intersex, queer, asexual, Sistergirl and Brotherboy) participants are rarely identified in Aboriginal and Torres Strait Islander health research data, resulting in persistent gaps in the literature. In this article, we briefly explore the implications of LGBTQA+SB erasure in Aboriginal and Torres Strait Islander health research for decolonisation, policy and practice. We outline approaches to collecting quantitative data, examples of Indigenous research that did identify LGBTQA+SB participants and potential challenges for data collection. Ultimately, we argue that decolonisation requires re-thinking how we define sex, sexuality and gender, unsettling Western biomedical norms that are pervasive in health research.

Shakara Liddelow-Hunt, James H. L. Hill, Kate Daglas, Kaiwarr Clancy, Madi Day, Alistair Ott

Clinical quality registries (CQRs) systematically collect information about the safety and quality of health care, and through risk-adjusted and benchmarked reports drive improvements in patient care. Most commonly however, the information and insights from CQRs remain within clinical units and/or specialties rather than being embedded within organisational governance. We describe the key elements of organisational infrastructure that are essential to translate CQR data into system-wide quality improvement at a health service and jurisdictional level.

Taryn Bessen, Stephen McDonald

Despite advances in cancer treatment, many Australians experience fragmented, poorly coordinated care, particularly those who are most disadvantaged. Strategic Objective 2 of the Australian Cancer Plan commits to improving consumer experience through person-centred, culturally safe, coordinated care across the continuum, yet implementation remains inconsistent. This perspective article examines key challenges, including siloed services, inequitable access to navigation and supportive care and poorly actioned experience measures. We propose scalable solutions: patient decision support tools, equity-oriented navigation and real-time experience measures. Realising this vision requires sustained investment strategies and system integration.

Carla Thamm, Elise Button, Oluwaseyifunmi A. Agbejule, Reegan Knowles, Karen van Gorp, Mark B. Pinkham, Meinir Krishnasamy, Alexandra L. McCarthy, Raymond J. Chan

Australia aims to eliminate hepatitis C as a public health threat by 2030 among all populations. It is timely to review national elimination efforts for First Nations Australians and discuss what is required to reach elimination targets. In 2020, First Nations Australians accounted for 18% of people living with chronic hepatitis C, despite representing 4% of the population. Over the past 5 years, about 15% of hepatitis C cases notified nationally occurred among First Nations peoples, with slower uptake of curative direct-acting antiviral treatment than non-Indigenous people. Achieving elimination will require implementation of strategies with an equity framework applied to address gaps in data and care cascades for hepatitis C.

James Ward, Emily Pegler, Kellie Stacy, Stephen Harfield

Virtual care has become a critical component of contemporary health system reform, offering opportunities to improve access, continuity and efficiency of care. Virtual care is particularly relevant for chronic disease management, as it can support more continuous, coordinated and person-centred models of care. This commentary draws on evidence from a national project titled Smarter Hospitals and examines trends in virtual care use across four service areas (cancer, renal disease, mental health or conditions requiring rehabilitation) over 2019–2024, as well as key factors shaping virtual care use and opportunities to realise its full potential.

Ramya Walsan, Rebecca Mitchell, Karol Petrovska, Tracey Webster, Reema Harrison

Women comprise the majority of Australia's healthcare workforce yet remain underrepresented in leadership. This structural inequity has direct consequences for workforce sustainability and patient outcomes. Australia's new gender equality target-setting requirements, which create binding obligations for large employers, including major healthcare services, offer a timely mechanism to address this structural inequity. In this article, we explain why gender equality targets matter for healthcare, outline who must comply and what is required and describe how health services and training settings can embed targets within governance, clinical accountability and workforce systems. We introduce the Monash Learning Health System Maturity Matrix as a practical tool for aligning targets with organisational maturity and argue that, when implemented well, gender equality targets go beyond compliance, building the institutional resilience and culture that retains talent and delivers better care.

Belinda Garth, Nicole Pope, Jenny Proimos, Helena J. Teede

Attention-deficit/hyperactivity disorder (ADHD) is increasingly diagnosed across the lifespan, yet there is a growing tendency to treat diagnoses as permanently fixed once assigned. Diagnosis requires not only the presence of characteristic symptoms but also clinically significant functional impairment that is most appropriately explained by ADHD, rather than another condition. Longitudinal evidence demonstrates that ADHD trajectories are heterogeneous and non-linear, with fluctuating symptom expression and variable relationships to functional impairment. Rather than conceptualising an ADHD diagnosis as permanently fixed, greater recognition of this complexity supports longitudinal clinical formulation and more adaptive biopsychosocial care across the lifespan.

Calina Ouliaris

Elimination of rheumatic heart disease (RHD) as a public health problem requires a multifaceted approach, including better primordial and primary prevention and early case detection and treatment of rheumatic fever, the autoimmune precursor to RHD. Here, we reflect on progress made in the decade since the 2015 revision of the Jones Criteria for rheumatic fever diagnosis. Advances in understanding rheumatic fever pathophysiology, the identification of potential biomarkers and improved clinical insights are bringing us closer to a diagnostic test for rheumatic fever and to targeted treatments that could prevent progression to RHD.

Anna P. Ralph, Rachel Webb, Tom Parks, Nicole J. Moreland, Asha C. Bowen, Benjamin Jones, Emma Ndagire, Andrea Z. Beaton

Culturally safe, racism-free healthcare is essential in Australia, yet Aboriginal and Torres Strait Islander people continue to face inequitable access, experiences and outcomes. Although cultural safety is widely cited, implementation remains shallow and disconnected from patients' realities. We argue that meaningful cultural safety requires Aboriginal and Torres Strait Islander governance, robust measurement and institutional accountability. Evidence shows that culturally unsafe care, including racism, creates psychological distress, leads to care avoidance and results in poorer outcomes, whereas Indigenous-led models perform considerably better. We propose a framework to strengthen cultural safety through Aboriginal and Torres Strait Islander community-governed assessment, greater accountability, data sovereignty and mandated cultural safety and anti-racism standards.

Elissa Elvidge, Roianne West, Karen Nicholls, Kiara Harvey, Yeena Thompson, Geraint B. Rogers, Yin Paradies

Aboriginal and Torres Strait Islander doctors remain under-represented in non-general practice specialties. Although parity is often used as a benchmark for workforce reform, targets alone cannot address the structural challenges that constrain entry, progression and retention. Specialist training systems must be redesigned through Indigenous leadership, shared authority, culturally safe workplaces, protected mentorship and recognition of cultural labour. Parity is not the goal; it is the consequence of systems that are equitable, accountable and grounded in Aboriginal and Torres Strait Islander self-determination. Building such systems will strengthen specialist care and improve outcomes for Aboriginal and Torres Strait Islander patients and communities.

Ryan Dashwood

For over 40 years, First Nations communities in Australia have called for community-controlled birthing and maternal–infant health programs that restore First Nations-led, community-controlled birthing systems grounded in cultural authority and sovereignty. ‘Birthing on Country’ services have demonstrated improved First Nations maternal–infant health outcomes, more babies kept out of the child protection system, and reduced health system costs. Restoration and expansion of Birthing on Country services across regions has been inconsistent, and has lacked support for national implementation. In 2022, a large national gathering (‘Best Start to Life’) was co-hosted in Mparntwe (Alice Springs). The focus was Birthing on Country service implementation to address inequities in birthing service provision for First Nations communities. A deliverable of this gathering was the National Roadmap for Birthing on Country Services 2026–2036 (the Roadmap). The co-creation of the Roadmap maintained enhanced engagement from a range of stakeholders, to produce inclusive and democratic solutions to perpetual perinatal inequities in health. A two-phased process facilitated national co-creation where national priorities in the reclamation of First Nations Birth Rights were upheld. The Roadmap builds on an evidence-informed and First Nations knowledge-grounded framework, the RISE Implementation Framework. The formation of the Roadmap contrasts against traditional policy creation, transitioning from an evidence-based proposal to a First Nations-endorsed national framework, ready for implementation and government adoption. This novel, national strategic approach to upscale Birthing on Country services has received formal endorsement nationally. The Roadmap provides detailed strategies to address structural reform, and its foundational co-creation process demonstrates that to change practice, researchers must do more than publish evidence in journals for policy change and knowledge translation. The 10-year key deliverables in the Roadmap are a call to action to recognise Birthing on Country as an inherent sovereign right grounded in First Nations Law and governance.

Res McCalman, Anneka J. Bowman, Roianne West, Kristie Watego, Jyai Allen, Claire Clack, Sue Kildea, Sue Kruske, Melanie Briggs, Cleone Wellington, Rebecca Coddington, Yu Gao, Isabella Garti, Sascha Kowalenko, Sarah Ireland, Catherine Austin, John D. Boffa, Marah Prior, Kelsie Kahl, Bettina Chaseling, Sarah Khaw, Emily Armstrong, Donna Hartz, Yvette Roe

In response to the revised Australian Medical Council Standards for Assessment and Accreditation of Primary Medical Programs, many medical education providers are adapting to meet increased expectations regarding First Nations Health and Cultural Safety. Rather than a competency-based approach, which is prevalent throughout medical education, the revised expectations require a fundamental shift in institutional ideological, ontological and epistemological function. To meaningfully engage in this transformation, medical education providers must consider principles and qualities that enable development in these focus areas. To realise progress, an ongoing, personal and collective critical self-reflexive process that centres First Nations self-determination, and that is underpinned by humility, courage, accountability, responsiveness and perseverance, is beneficial for providers and their staff. Conversely, those institutions and individuals who omit such practise, risk inertia in their development.

Sophie Pitt, Ashlee Williams-Barnes, Ryan Dashwood, Keira Edwards, Paul Saunders