Indigenous health

Indigenous children are seen as an intrinsic, systematic foundation of hope in Aboriginal conceptualisations of hope, yet are grossly overrepresented in Australian suicide statistics. Despite being a target of the Australian Government's almost 20-year-long Closing the Gap campaign, the numbers are only getting worse. ‘It's not depression, it's despair’ are words that echo a sentiment so ghastly for parents of Indigenous children who only hope to bestow them with the gift of exactly that: hope. It is only sensible to counteract this with holistic, culturally empowered, strengths-based well-being programs to both develop Cultural strength while concurrently instilling a sense of Cultural pride and identity.

Rudi Louis Taylor-Bragge

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

Objectives To identify drivers of routine vaccination for Aboriginal and Torres Strait Islander children, from a health service provider perspective, to increase and maintain uptake.DesignThis qualitative study was designed, analysed and guided by Indigenous data sovereignty and governance principles. Data were analysed using inductive content analysis. Subcategories were refined using Miro (Miro Inc), an online collaboration platform. Aboriginal and Torres Strait Islander worldviews were privileged, with Aboriginal researchers leading data analysis in New South Wales (NSW) and contributing to analysis in the Northern Territory (NT).SettingThe study was conducted in NSW and the NT, Australia, with health service providers from urban, rural and remote settings.ParticipantsIndividual and group interviews were undertaken in person or online between 2 May and 28 August 2024, with 18 health service provider participants in the Hunter New England Local Health District in NSW and 17 health service provider participants in the NT.ResultsWe identified six key themes addressing drivers of vaccination for Aboriginal and Torres Strait Islander children for families (knowledge, attitudes and information sources; decision-making), health staff (workforce roles, responsibilities and relationships) and health services (improving access; health service operations; data for decision-making). Providers recommended strategies to improve uptake.ConclusionsHealth service providers in urban, rural and remote locations in Australia can provide valuable insights to inform tailored strategies to improve declining vaccine coverage for Aboriginal and Torres Strait Islander children, aligned with the priorities of the National Immunisation Strategy 2025–2030.

Bianca F. Middleton, Kristy Crooks, Kylie Taylor, Elizabeth Harwood, Katrina K. Clark, Caitlin Kent, Kelly McCrory, Marita Hefler, Jessica Kaufman, David N. Durrheim, Margie H. Danchin

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

Objectives Our goal was to explore and compare risk factors, patterns of management and survival outcomes in Indigenous compared with non-Indigenous Australian patients using the Victorian Lung Cancer Registry (VLCR).Study TypeA retrospective observational cohort study of the VLCR.SettingData collected from the VLCR between 18 January 2011 and 24 January 2024.ParticipantsPrimary lung cancer patients in the VLCR.Main Outcome MeasuresPatient, disease and management characteristics of Indigenous and non-Indigenous Australian patients. Impacts of patient and clinical variables on treatment and survival, measured by multivariable Cox regression and propensity-matched survival analysis.ResultsWe included 186 Indigenous and 17,439 non-Indigenous Australian patients. Indigenous Australian lung cancer patients were younger in age {median, 62 years (interquartile range [IQR], 55–69 years) vs. median, 71 years (IQR, 63–77 years); p < 0.001}, had lower socio-economic status (lowest quintile, 57 patients [31%] vs. 3274 patients [19%]; p < 0.001), were more likely to be current smokers (118 patients [65%] vs. 5963 patients [35%]; p < 0.001) and had higher levels of respiratory comorbidity (64 patients [34%] vs. 4088 patients [23%]; p < 0.001). There were no statistically significant differences in receipt of guideline-concordant treatment (82 patients [51%] vs. 8036 patients [56%]; p = 0.12) and survival outcomes (median survival, 1.4 vs. 1.5 years; hazard ratio, 1.06 [95% confidence interval, 0.88–1.27]).ConclusionWe found lung cancer patients of Indigenous status were more likely to have demographic disadvantage and clinical risk factors that may contribute to discrepancies in management compared with patients of non-Indigenous status. Identifying barriers to healthcare and treatment in the Indigenous Australian population is an important research priority to improve disparities between the two populations.

Melanie Wong, Mike Lloyd, Jessie Zeng, Sanuki Tissera, Kalinda E. Griffiths, Justine Clark, Jonathan Gillies, Lisa Briggs, Jacqueline Lesage, Tom Wood, Craig Underhill, Sagun Parakh, Louis B. Irving, Wasek Faisal, Rob Blum, Gary E. Richardson, Phillip Parente, Michelle Caldecott, Inger Olesen, Javier Torres, Evangeline Samuel, Christopher Lyne, Katharine See, David Langton, Thomas John, Gavin Wright, Matthew Conron, James Bartlett, Golsa Adabi, Maggie Moore, Susan Harden, Zoe K. McQuilten, John R. Zalcberg, Rob Stirling

The scale and complexity of diabetes in rural and remote Indigenous communities is an urgent health issue. Progress in improving diabetes care, closing entrenched gaps and, ultimately, improving the health of Indigenous people and communities nationwide can be achieved with concerted, multidisciplinary, culturally informed evidence-based efforts

Natalie Nanayakkara · Sharon Atkinson‐Briggs · Alicia J Jenkins · Neale D Cohen

We stand at the beginning of the next bioscience revolution in asthma

Anthony Flynn · Wendy Edmondson · Alan James · Caroline Lodge · Vanessa M McDonald · Christine R Jenkins · John Blakey · Gary P Anderson

Cures for asthma will require a sustained, decade-long program of discovery science partnered with best clinical expertise

Gary P Anderson · Anthony Flynn · Phil G Bardin · John D Blakey · Shyamali C Dharmage · Paul Foster · Peter G Gibson · Adam Jaffe · Alan James · Christine R Jenkins · Sundram Sivamalai · Peter D Sly · Guy B Marks · Vanessa M McDonald · Judy Wetttenhall

Journalism and independent media are important for supporting public health through contributing to a healthy information environment, fostering dialogue and respect for rights, making governments more transparent and accountable, and societies more informed, inclusive and sustainable

Bronwyn Fredericks · Neha Lalchandani · Melissa A Sweet · Alex Cramb · Carmel Williams

The Indigenous Nation-led learning charter sets the aspirations for all Aboriginal and Torres Strait Islander learners learning on a specific Country. It provides guidance and leadership in partnership with schools that centres First Nations learners

Hayley McQuire · Melinda Mann

It will take decades for the gaps to close completely at the current rates of change

Esther Davis

This issue of the MJA is the second of this year with a specific focus on Aboriginal and Torres Strait Islander health. It includes three articles that were originally selected by the Guest Editors for the NAIDOC week Special Issue, which was published in July, 2025.1,2 We were in the fortunate position of having too many accepted articles for that issue, so we are delighted to now publish them, alongside other articles on Indigenous health that went through regular MJA editorial processes. Two of the articles previously selected are research articles: a study by Alasdair Vance and colleagues evaluates Elder‐governed cultural therapy for Aboriginal and Torres Strait Islander young people with mental health conditions,3 and Karrina DeMasi and colleagues describe the development of an Aboriginal women‐led maternal and child health model when cardiometabolic complications are experienced in pregnancy.4 The third article is a perspective from Paul Gray and colleagues that discusses the need to move towards epistemic pluralism, cultural safety, and critical reflexivity in Australian psychology.5 Together, these articles reflect the depth and strength of Aboriginal and Torres Islander‐led research and community, strength‐based approaches. These values are also reflected in the other articles of this issue, which demonstrate a huge diversity of Aboriginal and Torres Strait Islander research and critical thought, ranging from voluntary assisted dying in remote Aboriginal communities in the Northern Territory, to exploring the need for meaningful partnerships in health and medical research grant applications. This issue was timed for the 18th anniversary of the United Nations Declaration on the Rights of Indigenous Peoples — an important international resolution. The editorial for this issue reflects on the Declaration and, despite endorsing it, the failure of successive Australian governments to incorporate it into national law. As the editorial concludes “The 18th anniversary of UNDRIP is a historical marker but serves as a powerful call to action. It reminds us that health is inextricably linked to human rights, self‐determination and cultural integrity”. The cover for this issue of the MJA features an image of Mer Island in the Torres Strait. Sophie Pitt, who authored the editorial, explains the how this image calls us to recognise the links between the escalating climate crisis, Indigenous rights, and health, as it represents “both a celebration of the enduring connection to Country and a reminder of what can be lost” (Box). For this issue, as for the previous NAIDOC week issue, we are very grateful for all the expertise and wisdom generously provided by the Guest Editors, and the care they took in assessing and selecting papers for these two Indigenous health issues. Box – Cover connection

Virginia Barbour

Examination of an Australian government scheme to fund health and medical research targeted at Aboriginal and Torres Strait Islander people

Heather McCormack · Troy Combo · Bridget G Haire