Indigenous health

Vishnu Khanal · Deborah J Russell · John Wakerman

Aboriginal and Torres Strait Islander communities remain invisible in data which is used to inform policy, clinical models of care, health services and initiatives

Courtney Ryder · Sadia Hossain · Leanne Howard · Julia Severin · Rebecca Ivers

This Special Issue of the Medical Journal of Australia is in partnership with the Lowitja Institute, Australia's only national Aboriginal Community Controlled Research Institute. This inaugural partnership publication has been timed to coincide with NAIDOC week — with the theme “Keep the fire burning! Blak, loud and proud” — and recognises and celebrates Aboriginal and Torres Strait Islander leadership and excellence in health and medical research. This article is a collaboration between the MJA Editorial Team and the Guest Editors, where we jointly reflect on the thinking and processes behind this Special Issue. Scholarly publishing sits at the core of issues of power, privilege, and the production of knowledge in health and medicine. As Australia's national medical journal, the MJA plays important roles not only in knowledge dissemination, but also in defining, legitimising and validating what types of knowledge matter in health and medical research, practice and policy making. To date, the Journal predominantly operated from a biomedical perspective that has embedded colonial practices, norms and assumptions that produce and sustain inequalities in health and unjust outcomes for Indigenous Australians. This inaugural collaboration between the Lowitja Institute and the MJA stems from the recognition that currently “Indigenous health research in Australia is largely informed by non‐Indigenous world views, led by non‐Indigenous people, and undertaken in non‐Indigenous organisations” (https://doi.org/10.5694/mja2.51757). In embarking on this Special Issue, then, the Journal accepted that the current model of publishing practices has not served Indigenous research and researchers well, and that in fact the Journal has, to some extent, become perceived as unwelcoming. In response to a letter to the editor, submitted by Lowitja CEO and a collective of Aboriginal and Torres Strait Islander researchers (https://doi.org/10.5694/mja2.51281), the MJA began discussions with the Lowitja Institute. This engagement affirmed that a meaningful approach to improve the ethical publishing practices at MJA required that the Journal relinquish control and hand over decision making for this issue to Aboriginal and Torres Strait Islander experts. The Lowitja Institute engaged a panel of Guest Editors who are recognised leaders in the fields of public health and clinical medicine. Guest editors were recently recognised in national awards both by the Lowitja Institute (https://www.lowitjaconference.org.au/awards) and the NAIDOC committee for their leadership and contribution to Aboriginal and Torres Strait Islander health. Guest Editors, along with Lowitja Institute executives, took on the collective care and responsibility of defining the scope and aims of the Special Issue, assessing and selecting its content, determining its editorial requirements, and nominating peer reviewers, with the support of the MJA editorial team. The editorial practices to develop this Special Issue draw on Aboriginal and Torres Strait Islander ways of knowing, being and doing. In this issue, the Guest Editors have held the sovereignty of our voices and experiences all the way, until you have opened and read this today. All care has been taken with the journey of researchers submitting articles to this issue, with collective caretaking of their knowledges. A call for papers was made in October 2023, with content eligible for consideration if it addressed an area of health and wellbeing that is a priority to Aboriginal and Torres Strait Islander communities, was led by Aboriginal and Torres Strait Islander authors (first or last authors), included an ethical research statement that addressed the Consolidated criteria for strengthening reporting of health research involving Indigenous peoples (CONSIDER) statement (https://doi.org/10.1186/s12874‐019‐0815‐8), and described the positionality of the author team. Authors were also given the opportunity in their articles to acknowledge the Indigenous knowledges that informed their work and to include their Language Groups in the authorship line. These practices uphold what Indigenous people have called for in ethical publishing practices (https://doi.org/10.5694/mja2.51281 and https://doi.org/10.1136/tc‐2022‐057702). Guest Editors were not involved in editorial decision making about submissions that they authored. The large number of high quality submissions received in response to the call for papers highlights the extraordinary breadth and depth of Aboriginal and Torres Strait Islander‐led research incorporating our knowledges on all areas of our health and wellbeing. It also demonstrates the importance of relationships and relationship building in this space, including the roles of the Guest Editor team and others in disseminating the call for papers and encouraging submissions to a journal that many authors might not have considered a natural home for their work. The resulting Special Issue contains 12 articles that span a wide range of study designs and topics. The manuscripts have been ordered (while confining to a standard layout) as a narrative, privileging Aboriginal and Torres Strait Islander strengths and providing courageous conversations on system failures that impact the health and wellbeing of Indigenous peoples. The research within covers the life course and pays homage to the late patron Dr Lowitja O'Donoghue AC CBE DSG, who dedicated her life to fighting for human rights of Aboriginal and Torres Strait Islander peoples and worked across many of the fields of health covered in this Special Issue. Owing to time and space constraints, some articles submitted for consideration of the themed issue will be published by the MJA later in the year in a regular issue of the Journal. The first article, a perspective article by Carmen Parter and colleagues (https://doi.org/10.5694/mja2.52352), frames the Special Issue with a discussion of racism and the cultural determinants of health, and ends with a call for “all within the health care sector to take a purposeful journey of learning by walking alongside Aboriginal and Torres Strait Islander people and listening to their knowledges of cultural ways of being, knowing and doing, with open minds and hearts”. An Editorial by Jaquelyne Hughes and colleagues (https://doi.org/10.5694/mja2.52351) asserts sovereignty with the announcement of the Zenadh Health Science Research and Education Council to drive long overdue improvements for the Zenadh peoples. The Council brings together Zenadh experts in diverse knowledges, intellect and skills while drawing from the best of Eurocentric science epistemology. And a research article (https://doi.org/10.5694/mja2.52353) draws our attention to our older Aboriginal and Torres Strait Islander population. With Aboriginal and Torres Strait Islander governance, Odette Pearson and colleagues, provide quantitative evidence to support the multitude of stories told about the failure of the aged care system to care for our elders. They leave us with a determination that we must do better for all our elders, ensuring we do not leave anyone behind. This Special Issue was a deliberate attempt by the MJA to cede editorial decision‐making responsibility to a group of external expert Aboriginal and Torres Strait Islander Guest Editors. For the MJA team, this was a new experience and served as a lesson that ceding power is a prerequisite if progress is to be made in Indigenous health, and is a process that should feel uncomfortable and unfamiliar. For the MJA it was also a specific response to the outcome of the Voice referendum in 2024 (https://doi.org/10.5694/mja2.52074) — a recognition that meaningful change will only come when those in power are prepared to step aside and let Aboriginal and Torres Strait Islander peoples lead their own affairs while supporting where required. Editors are accustomed to being in the position of power, defining a journal's (and for a journal like the MJA, national) priorities, including concepts of research quality and likely impact. At the same time, being open to different perspectives on editorial priorities and practices and being willing to change is fundamental for the sustainability of any journal and its ability to effectively serve the communities that it represents — and wishes to represent. Working with the Guest Editor team to help enact their vision for the theme issue was a hugely rewarding experience for the MJA editors and a reminder that the Western norms the Journal has operated within can be far from the best way of working. The MJA team are deeply grateful for the generosity that the Guest Editors demonstrated in offering their time and expertise to producing this Special Issue. Many of the innovations introduced here will be taken forward by the MJA as we update our author requirements, including encouraging use of positionality statements when submitting work to the Journal. We extend a heartful thanks to all the authors and reviewers who contributed to producing this Special Issue, and look forward to feedback from readers. We hope this is the first of many future collaborations.

on behalf of the MJA Editorial Team

Colleges must direct efforts to centre the development of critical allyship to support Indigenous peoples

Paul Saunders

Queensland Health must act on the coronial recommendations to avoid more preventable deaths in Doomadgee

Avelina Tarrago (Wangkamahdla) · Ella Veit‐Prince · Claire E Brolan

A larger, population-based study of the incidence of stroke in Aboriginal people is both feasible and needed

Angela Dos Santos (Gumbaynggirr, Kwiamble) · Edmund Cheong · Anna H Balabanski · Kendall Goldsmith · Luke Burchill (Yorta Yorta, Dja Dja Wurrung) · James Burrow · Stephen Brady · Ferdous Alam · Mark Parsons · Judith M Katzenellenbogen · Amanda G Thrift · Timothy J Kleinig · Alex Brown (Wadi Wadi)

Improving transplant access within five years of dialysis commencement should be a priority

Swasti Chaturvedi · Shahid Ullah · Jaquelyne T Hughes (Wagadagam)

Improving their social and emotional wellbeing could help reduce the number of Aboriginal people in Australian prisons by reducing recidivism

Pat Dudgeon (Bardi) · Ee Pin Chang · Joan Chan · Carolyn Mascall · Gillian King (Noongar) · Jemma R Collova · Angela Ryder (Noongar)

Researchers and institutions should be accountable for ensuring that knowledge translation is embedded throughout the research process

Michelle Kennedy (Wiradjuri) · Melody Morton Ninomiya · Maya Morton Ninomiya · Simon Brascoupé (Anishinabeg/Haudenausanee) · Janet Smylie (Mѐtis) · Tom Calma (Kungarakan, Iwaidja) · Janine Mohamed (Narrunga Kaurna) · Paul J Stewart (Taungurung) · Raglan Maddox (Bagumani, Modewa)

The normal spirometry values of healthy First Nations Australians may be substantially higher than previously reported

Andrew J Collaro · Rachel Foong · Anne B Chang · Julie M Marchant · Tamara L Blake · Johanna F Cole · Glenn Pearson · Rebecca Hii · Henry Brown · Mark D Chatfield · Graham Hall · Margaret S McElrea

Our evidence-based profile of people who smoke can inform population and targeted interventions for reducing tobacco use

Jessica Yi Han Aw · Christina Heris · Raglan Maddox · Grace Joshy · Emily Banks AM