It is important to remember that for Aboriginal and Torres Strait Islander peoples, health is more than the absence of disease. Health is holistic. It encompasses the health and wellbeing of the individual, family, community and environment.
Connection to culture, community, language and country is central to maintaining health and wellbeing. This concept does not always align with the biomedical model of health. There are challenges and complexity in addressing the social determinants of health, the caonditions in which we are born, live, work and age.
These philosophies underpin the National Aboriginal Community Controlled Health Organisation (NACCHO) and The Royal Australian College of General Practitioners (RACGP) National guide to preventive healthcare for Aboriginal and Torres Strait Islander people (National Guide).1 Development of the National Guide is built on Aboriginal and Torres Strait Islander leadership and knowledge systems, strengths- based approaches and strong collaboration. It represents a long-standing NACCHO–RACGP partnership in a preventive care approach to health for Aboriginal and Torres Strait Islander peoples.
Within this issue of Australian Journal of General Practice, three articles explore topics in the National Guide and explore the accessible, user-friendly recommendations for best practice preventive healthcare for Aboriginal and Torres Strait Islander patients.2–4 The National Guide is also the foundation for evidence-based recommendations for high-quality Aboriginal and Torres Strait Islander health assessments (health checks) to be delivered in primary care. Quality health checks identify patient priorities and goals and are more than a tick-box exercise when done well.
The article by Wilkes et al2 explores an important new topic in the fourth edition of the National Guide – the health impacts of racism. Cultural safety is a critical component of any care provided to Aboriginal and Torres Strait Islander patients. This article is a necessarily challenging read, and it highlights the link between racism and health via chronic stress (triggering the fight-or-flight response). It outlines recommendations from the National Guide around the provision of culturally safe, trauma-informed care tailored to the individual patient and emphasises the importance of clinicians’ ongoing critical self-reflexivity.
A good start to life is crucial, and Carter outlines the latest evidence to support strengths-based preconception and pregnancy care.3
Tobacco smoking is a significant public health issue, and Thomas summarises the evidence and recommendations in the fourth edition of the National Guide to address this.4 As outlined in the article, general practitioners have a significant part to play in promoting anti-tobacco messaging and continuing to support their patients in these efforts.
Selman et al write of the key importance of the Aboriginal Community Controlled Health Organisation (ACCHO) sector in providing holistic, culturally safe care with the underlying principle of self-determination.5 Drawing on an example of the success of ACCHOs during COVID-19, this article also stresses the important role for culturally safe mainstream primary health services if there is to be more improvements in health outcomes.
Wheeler et al consider outcomes from a culturally responsive medication management service within the Aboriginal Health Service and the benefit that could be present for patients with such a collaborative service.6
I encourage you to explore the full breadth of articles in this issue. Addressing the causes of health disparities for Aboriginal and Torres Strait Islander peoples is the responsibility of all healthcare providers. Improvement in life expectancy is important, but so is quality of life and upholding the right of Aboriginal and Torres Strait Islander peoples and families to benefit from full participation in all aspects of society. This may require healthcare providers to explore some of the more uncomfortable aspects of the impacts of systemic racism on the lived experiences of Aboriginal and Torres Strait Islander patients, to enhance collaboration with allied health providers and explore innovative models for engagement of community and service delivery. I can say confidently that doing so will enhance your clinical practice across the board.