Perspectives

Breast milk provides both short-term and long-term health benefits and is critical for infants admitted to neonatal intensive care units (NICUs). Presently, there is a large focus on increasing breastfeeding rates among Aboriginal and Torres Strait Islander women; however, culturally safe breastfeeding support is under-recognised and inadequately addressed in the NICU setting. This perspective highlights cultural and structural barriers and calls for urgent action to include the following four proposed strategies: strengthening the Aboriginal lactation workforce, embedding culturally inclusive education, partnering with community-controlled services, and developing a culturally specific NICU breastfeeding policy to improve outcomes.

Jessica Bennett, Jamie Bryant, Kade Booth, Michelle Kennedy

Reports of rising stillbirth rates in Australia have generated concern among affected parents and other stakeholders. Review of the national data suggests that much of the rise is being driven by an increase in terminations of pregnancy after 20 weeks' gestation. This increase coincides with legislative changes expanding access to terminations beyond 20 weeks. Alongside publishing stillbirth rates according to the legal definition (stillbirths from 20 weeks' gestation including terminations of pregnancy), national reporting bodies should routinely publish stillbirth rates among births from 28 weeks' gestation excluding terminations of pregnancy as the latter is most relevant to Australia's current stillbirth prevention initiatives.

Aleena M. Wojcieszek, Kirstine Sketcher-Baker, Christine Andrews, Michael Coory, Imogen Kettle, Melissa Malivoire, David Ellwood, Vicki Flenady

Cancer remains a global health challenge, with rising survivorship rates highlighting the need for integrated interdisciplinary rehabilitation care. Survivors frequently experience persistent physical, functional, psychological, cognitive and behavioural challenges, including fatigue, deconditioning, neuropathy, pain and psychological distress, with up to two-thirds reporting significant unmet needs and reduced quality of life. Interdisciplinary rehabilitation, encompassing exercise, education, nutrition, task-specific functional retraining, psychosocial support and vocational interventions, effectively mitigates these disabilities, improving function and promoting societal participation. Despite strong evidence, rehabilitation remains underutilised in Australia and New Zealand due to workforce, infrastructure, referral, funding and awareness barriers. Embedding rehabilitation as standard cancer care is essential to optimise survivorship outcomes and deliver sustainable health system benefits.

Krystal Song, Steven G. Faux, Fary Khan

The psychosocial hazards of healthcare are well-recognized and are now subject to new legislation in Australia. Missing from this discussion has been the recognition of the second victim phenomenon—the distress experienced by healthcare workers involved in an adverse event, medical error or unexpected patient outcome—which appears to meet criteria for a psychosocial hazard. Organizations should ensure support for second victims by building a restorative and just culture, including ensuring all staff are educated on the second victim phenomenon and can support their colleagues, implementing a staff peer-support programme and ensuring that specialist mental health supports, such as an employee assistance programme, are geared towards supporting the second victim.

Sarah Michael

Rural and remote Australians experience persistent health inequities. Although randomised controlled trials (RCTs) remain the most rigorous method for establishing causal relationships and informing equitable health policy, they are challenging to conduct in rural settings, contributing to under-representation in research. When RCTs are not feasible, observational analyses using the target trial framework provide a rigorous and pragmatic alternative. Despite growing international adoption, this approach has not been applied to rural contexts. The recently published TARGET guideline offers transparent reporting standards for these studies, providing a new methodological tool to advance rural and remote health research.

Tanvir Kapoor, Harrison J. Hansford, Brooke A. Spaeth, Adam D. Irwin, Aidan G. Cashin

The world is on the brink of tipping points for climate disaster and transformative action. Decisions taken now will shape the health of millions. So, will the Australian Government use its COP31 Presidency of Negotiations to prioritise the health of current and future generations and champion the end of fossil fuels? Despite recent positive shifts in some areas of climate policy, Australia's status as the world's third largest exporter of fossil fuels means strong pressure must be applied from the health professions to maximise political, social and economic progress towards a health-focussed transition to a sustainable society.

Catherine G. A. Pendrey, Angie Bone, Aletha Ward, Francis Nona, Michelle Isles, Paul M. Kelly, Nicholas J. Talley

Youth mental ill health has increased worldwide, and non-inclusive technology design practice risks overlooking queer youth. This article calls for greater inclusivity and equity in the design of digital technologies used by queer youth to access mental health resources, support and service pathways across diverse global contexts, including internet-based tools, digital platforms and digitally enabled therapeutic interventions, such as mobile applications (apps), online services, chatbots and social media. It warns of threats such as persistent invisibility and prejudiced technology design practice markedly affecting mental health equity and access for queer youth. It proposes three key principles to guide practitioners and researchers in designing digital technologies used by queer youth for mental health: (i) partner and design with queer young people; (ii) embed queer theory into research and design; and (iii) design for sustainability. The principles and recommendations presented here are also relevant to other digital health fields and practitioners should consider applying them in their own practice, where appropriate, to advance inclusivity and equity in technology design.

Adam Poulsen, Ian B. Hickie, Samuel J. Hockey, Frank Iorfino, Haley M. LaMonica

Ethnocultural minority communities may require specialised emergency response frameworks during mass casualty incidents (MCIs). This article describes the Sydney Jewish community's preparation for, and medical response to, the Bondi Beach terror attack of 14 December 2025. We present a timeline of events during the attack and outline the immediate medical response and recovery actions undertaken in the first hours and days following the incident, including first-hand accounts of responders from the scene. Alongside this account, we present a novel response model implemented by the New South Wales Community Health Support (CHS). CHS is a community-operated, not-for-profit emergency medical response organisation that provides telehealth advice and dispatches volunteer community first responders (including health professionals and trained emergency healthcare workers) to urgent and emergency health incidents within the local community. CHS operates alongside statutory emergency services and is embedded within the community it serves. It is hoped that the lessons identified from this incident may be valuable to the broader international medical community, emergency management agencies and policymakers, and that it may serve as an exemplar for other communities seeking to strengthen preparedness, coordination and resilience in the face of future MCIs.

Aidan Baron, Jesse Lenn, Zachariah Seidman, Matthew N. Lowy, Jeffrey L. Engelman

Chronic hepatitis D virus (HDV) infection always occurs as a coinfection with hepatitis B virus (HBV) and is the most severe form of viral hepatitis, associated with a high risk of cirrhosis, liver cancer and death. Effective treatment is now available for HDV–HBV coinfection and HDV screening is recommended for all people living with HBV, yet most people in Australia with HDV–HBV are diagnosed too late to prevent complications. This article calls for an urgent change in HDV testing policy and funding to implement reflex HDV antibody (anti-HDV) testing for all people diagnosed with HBV infection, thus enabling timely diagnosis of HDV–HBV coinfection and rapid access to life-saving treatment.

Jessica Howell, Lauren Andersson, Miriam T. Levy, James O'Beirne, Leon Adams, Katharine Irvine, Avik Majumdar, Golo Ahlenstiel, Kathy Jackson, Krispin Hajkowicz, Joseph Doyle, Jane Davies, Sarah Cherian, Wayne Dimech, Alexander J. Thompson

Child health inequities remain a persistent challenge, with well-described long-term consequences. Advances in cross-sector administrative data linkage and causal inference methods offer powerful opportunities to transform data into evidence for addressing inequities. This article explores how linked administrative data support timely, precise, agile and coordinated policy responses and monitor their impact. We outline conditions needed to realise this potential, including sustained cross-sector data infrastructure, analytic capability and increased efforts to translate evidence into action. We argue linked administrative data can inform pathways to more equitable child health and, with investment, help deliver on lasting returns for children, families and society.

Sarah Gray, Shuaijun Guo, Meredith O'Connor, Elodie O'Connor, Katrina Williams, Hannah Badland, Susan Woolfenden, Josie Dickerson, Gerry Redmond, Marnie Downes, Sharon R. Goldfeld

Lung cancer remains Australia's leading cause of cancer death, with a disproportionately high burden on Aboriginal and Torres Strait Islander peoples. The recent launch of the National Lung Cancer Screening Program (NLCSP) offers an exciting and critical opportunity to improve outcomes. However, the program's full potential may not be met due to substantial systemic shortfalls. Key challenges include inadequate access to multidisciplinary workforce, limited access to personalised medicine and a lack of a national clinical quality registry. To maximise the NLCSP's impact, strategic investment is urgently needed to strengthen clinical infrastructure, enhance research and ensure equitable access to care.

Fraser J. Brims

Natalie Taylor, Zhicheng Li, Cathelijne van Kemenade, Jackie Curtis, Patrick Bolton

Over recent decades, the medical profession has undergone significant changes due to the influence of managerialism, which is characterised by standardisation, efficiency and cost control. Although these principles aim to improve sustainability and transparency within healthcare systems, they often conflict with fundamental aspects of medical professionalism and patient-centred care. This perspective explores how managerialism may negatively affect the medical profession, focussing on its impact on clinician autonomy, the changing nature of medical work, professional identity and collegial relationships within hospital settings. Key challenges faced by doctors include diminishing control over patient care, growing administrative burden, increasing burn-out, erosion of professional values and identity, and fragmentation of collegiality. To address these issues, this perspective advocates for institutional change such as hybrid governance models that integrate professional and managerial expertise to ensure managerial goals remain aligned with clinical realities. Professional bodies and institutions should empower doctors with managerial and leadership competencies to influence organisational change, reconcile clinical and managerial priorities, and uphold professional values and quality patient care within the evolving healthcare landscape. Effective reform requires the considerate integration of managerial systems into healthcare to strengthen, rather than undermine, the professional foundations and ethical values that give medicine its integrity and meaning.

Evelyn He, Behnam Shaygi, Anousha Yazdabadi, Christen D. Barras, Paul M. Parizel, Hamed Asadi