Perspectives

Trauma and social disadvantage are strongly associated with higher rates of chronic disease, partly driven by modifiable risk factors such as physical inactivity and poor diet. Despite strong evidence supporting exercise and dietary interventions for both physical and mental health, access to allied health professionals—particularly exercise physiologists, physiotherapists and dietitians—remains profoundly inequitable. Current prevention efforts predominantly reach individuals with stable living conditions and sufficient resources, ultimately privileging the privileged and entrenching health disparities. To close these gaps, these workforces must be reoriented: embedded within trusted community settings and delivered earlier in the care pathway, in ways that are trauma-informed and responsive to social context.

Simon Rosenbaum, Grace McKeon, Gulsah Kurt, Oscar Lederman, Kemi Wright, Sabuj Kanti Mistry, Jackie E. Curtis, Philip B. Ward, Zachary Steel, Hamish Fibbins, Rachel Morell, Melissa C. Eaton, Andrew Watkins, Ben Harris-Roxas, Brendan Goodger, Eleanor Beck, Megan Teychenne, Joseph Firth, Davy Vancampfort, David Burns, Russell Roberts, Tristan Favaloro, Danielle Weber, Rosanna Barbero, Vasili Maroulis, Melissa Holmes, Stefan Mackenzie, Chiara Mastrogiovanni, Afsana Anwar, Uzma Choudhry, Catherine Sherrington, Jane Currie, Thomas Gadsden, Scott Teasdale

The growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has driven off-label prescriptions and supply shortages, raising equity concerns for First Nations peoples disproportionately affected by diabetes. Pharmaceutical companies have simultaneously accelerated their marketing through disease-awareness campaigns, sponsored events and telehealth models, with many campaigns prominently featuring women of colour, including First Nations women. In this perspective article, we argue, from a commercial determinants of health perspective, that pharmaceutical companies often influence perceptions of body image, medicines policy and prescribing without addressing the systemic conditions driving First Nations health inequity. We urge clinicians and policymakers to ensure decisions remain free from commercial influence.

Troy Walker, Simone Sherriff, Jennifer Browne

Despite Australia's universal breast screening programs, Aboriginal and Torres Strait Islander women have lower screening participation rates and higher breast cancer mortality. Public health explanations focus on awareness of breast cancer risk and the accessibility of screening, yet these framings often overlook how biomedical screening practices assume a colonial anatomical lens of the body that does not align with Indigenous relational understandings of embodiment. Drawing on Indigenous scholarship, feminist body theory and trauma-aware care, this article argues that breast screening encounters can become sites where bodily sovereignty and biomedical surveillance intersect. Relational, culturally safe, healing-centred and sovereignty-affirming practices, supported by Indigenous-led initiatives, such as culturally designed screening shawls, can transform screening from a clinical encounter into health care that offers a therapeutic relationship built on trust, dignity and informed consent.

Devaleena Das, Jessica Gildersleeve, Amy Thomson, Aunty Gracelyn Smallwood, Lorelle Holland

Nitrous oxide (N2O) accounts for the majority of Australian healthcare's direct anaesthetic gas-related greenhouse gas emissions due to reticulated system leaks. Updated Australasian guidelines no longer mandate a reticulated N2O supply. We present the efforts of four Melbourne hospitals to reduce N2O emissions across diverse clinical contexts. Two have decommissioned reticulated N2O and adopted cylinder supplies as required through clinical consultation and interdisciplinary collaboration. Two face ongoing high clinical demand for N2O, with multiple locations sharing infrastructure, and are pursuing audits and trials to guide change. These case studies illustrate the diverse strategies and challenges involved in reducing N2O emissions.

Ross Robertson, Andrew Downey, Daryl Williams, Bjorn Makein, Ben Dunne, Tugce Ozturk, Ying Gu, Rebecca McIntyre

Racism impedes the achievement of equity in healthcare by permeating individual, community, societal and institutional levels. Cancer is the leading contributor to global mortality and continues to have a disproportionately higher impact on First Nations Peoples. Research specific to First Nations Peoples, conducted in accordance with the principles of Indigenous research, is critical to justify the advocacy and delivery of measures that yield relevant, translatable outcomes and benefits. The following article presents a case study of a longitudinal cohort project assessing human papillomavirus-associated oral cancer in First Nations Peoples of South Australia. The article discusses decolonising methodologies, their application and relevance.

Sneha Sethi, Simon Naylor, Catherine Leane (Dharug/Gabrigal), Gail Garvey (Kamilaroi), Joanne Hedges (Yamatji), Lisa M. Jamieson, Nicolas Reid (Dharug/Gabrigal)

Antivirals for mild-to-moderate coronavirus disease 2019 (COVID-19) were adopted for use based on trials in unvaccinated adults during the pre-Omicron period. In today's broadly immune populations, where the risk of hospitalisation and death has decreased substantially, there is a lack of high-quality contemporary evidence to support routine antiviral use for mild-to-moderate disease. Comparing the Australian and New Zealand experiences in the evolving COVID-19 landscape highlights differences in policy and prescribing practice. Treatment guidelines should be informed by systematic evaluation of emerging data, given uncertainty regarding antiviral effectiveness in a context of widespread immunity and milder disease, which have altered the balance of risks and benefits.

Hadar Mudrik-Zohar, Tim Cutfield, Susan Morpeth, Thomas Hills, Eamon Duffy, Laura J. Edwards, Allen C. Cheng, Steven Y. C. Tong

Household overcrowding is a major driver of acute rheumatic fever and rheumatic heart disease, along with other adverse social, cultural and health outcomes in remote Aboriginal communities. Overcrowding is compounded by poor thermal performance of current housing, energy insecurity and climate change. Despite strong evidence of the causes of rheumatic heart disease, upstream prevention through housing design remains underexplored. Wilya Janta, an Aboriginal-led organisation in Tennant Creek, has developed the Explain Home design: a culturally responsive, climate-adapted prototype designed to reduce overcrowding-related harms. With an unprecedented $4 billion investment in remote housing, health professionals have a critical role in advocating for evidence-informed, culturally safe housing as a form of preventive health intervention to improve equity and outcomes.

Simon Quilty, Veronica Matthews, Angus Baumann, James Marangou, Bo Remenyi, Gavin Wheaton, Serena Morton Nabanunga, Norman Frank Jupurrurla, Simon Robinson, Steve Mintern, Cary Duffield, Joshua R. Francis, Paul C. Memmott

Australia's rate of living donor kidney transplantation has stagnated. In 2024, there were 253 living donor kidney transplants, down from 354 in 2008, with the living donor rate falling to 9.5 donors per million population—well below peer nations. Despite growth in deceased donation, waiting list times continue to lengthen and can now reach 6–7years for some groups, reflecting the rising numbers of Australians living with kidney failure. Access is unequal: First Nations people receive few living donor transplants; women are more likely to donate than men but are less likely to receive a living donor transplant; and people from lower socio-economic groups are disadvantaged. Barriers include information gaps, limited multilingual resources, time-intensive workups and financial disincentives. A coordinated reset, supported by national leadership, contemporary guidance, better data and streamlined, culturally safe pathways can restore growth.

Melanie Wyld, Nicole M. Isbel, Kate Wyburn

Autism diagnoses have increased over the past decade, prompting debate on potential causes. In September 2025, US President Donald Trump claimed that paracetamol is a ‘big factor’ in autism, citing a systematic review based solely on observational studies. The review's selective reporting, methodological flaws (including applying an environmental health rather than evidence-based medicine framework) and lack of causal evidence provided weak justifications for its conclusions and have fuelled public confusion about paracetamol safety in pregnancy. This article critically appraises the review and examines how scientific uncertainty can be manipulated and amplified within broader public health domains.

David J. Tunnicliffe, Miranda Cumpston, Debra Kennedy, Margie Danchin, Armando Teixeira-Pinto

Chronic kidney disease (CKD) affects over 2 million Australians and imposes substantial clinical, societal and economic burdens. A pervasive yet under-recognised consequence is progressive muscle loss and functional decline, manifesting as sarcopenia and frailty, which are highly prevalent across CKD stages and strongly associated with hospitalisation, disability and mortality. Although exercise-based interventions improve physical function, quality of life and cardiovascular risk profiles, access and participation remain limited. Furthermore, compared with cardiac and pulmonary rehabilitation, funding for CKD-specific allied health services is fragmented and inadequate, with no dedicated funding pathways. Strategic policy reform is urgently needed to embed renal rehabilitation into standard kidney care.

Limy Wong, Lawrence P. McMahon

Seasonal influenza causes significant morbidity and mortality in Australia. Despite long-standing recommendations for influenza vaccination and nationally funded programs for higher risk age or population groups, coverage remains suboptimal, especially among children. Introduction of the intranasal live attenuated influenza vaccine (LAIV) in 2026 offers an additional safe and effective needle-free vaccine option. Easier administration may improve access by making delivery by a range of health care providers possible. This perspective article outlines the evidence supporting the use of the LAIV and its potential to improve vaccination uptake among children in Australia.

Cyra Patel, Alexis Pillsbury, Tran Nguyen, Xia Wang, Helen E. Quinn, Clayton K. Chiu, Allen C. Cheng, Katie L. Flanagan, Zhicheng Wang

Mentoring programmes are increasingly used in the health sector to provide career support and guidance for health professionals. However, a number of mentoring experiences and programmes fall short of their potential, with variable outcomes reported. This article summarises the mentoring literature, which clearly demonstrates that mentoring is an important evidence-informed component of advancing women in leadership. We provide a perspective on mentoring in the context of promoting gender equity within workplaces and propose a new nuanced and integrated model to consider for the advancement of women in leadership.

Jenny Proimos, Helena J. Teede, Belinda Garth

The Bondi Beach terrorist attack has caused widespread community distress resulting in complex psychosocial challenges that require urgent attention to protect population mental health. Acute reactions including shock, fear and anger are normative, while the psychological responses unfolding over time may vary from adaptive to dysfunctional. A range of mental health and psychosocial services have been mobilised to address acute needs; however, to ensure a sustained and coherent framework of care, interventions should be guided by a set of principles that accurately respond to the unique nature of the event. We provide an overview of the Adaptation and Development After Persecution and Trauma (ADAPT) model as an overarching framework that can guide psychosocial interventions and promote adaptive coping, recovery and resilience.

Susan J. Rees, Derrick M. Silove