‘Actions-based’ updated National Guide launched

An updated guide on preventive healthcare for Aboriginal and Torres Strait Islander people has been launched on day two of GP24, with the new edition led by Aboriginal and Torres Strait Islander people including an increase of Aboriginal and Torres Strait Islander authors.
 
The fourth edition of the National guide to preventive healthcare for Aboriginal and Torres Strait Islander people comes after years of collaborative work from the RACGP and the National Aboriginal Community Controlled Health Organisation (NACCHO).
 
First conceived of by NACCHO in 2001, the now fourth edition consists of 21 chapters, including the six additions – health impacts of racism, healthy eating, sleep, vaping, preconception care, and health impacts of climate change.
 
NACCHO Senior Medical Advisor and GP Dr Jason Agostino told newsGP the updated National Guide has ‘a great focus on implementation’.
 
‘Not everyone works in Aboriginal community controlled health organisations like I do, and sees Aboriginal and Torres Strait Islander patients every day, but there are important differences in screening guidelines for certain conditions, as well as really important implementation tips about how we apply the evidence,’ he said.
 
RACGP Aboriginal and Torres Strait Islander Health Chair Dr Karen Nicholls told newsGP the new chapters are particularly important as they ‘really haven’t been discussed anywhere’.
 
‘The first one, is racism and its health impacts, and these are recommendations that are, rather than just being aspirational, more action-based,’ she said.
 
‘Climate and health is another one, the impacts of climate change on health are significant, so to have that new topic is really, really exciting, and I’m looking forward to how we can support GPs in being able to implement these.’
 
Dr Agostino added that the new healthy eating chapter highlights the strengths-based language in the new guide.
 
‘All we had in the past was a chapter talking about overweight and obesity,’ he said.
 
‘Now we’ve got something that thinks about what healthy eating is, which stresses the importance of the social determinants in whether someone can access or store healthy foods.’
 
Health impacts of racism
The guide emphasises the importance for clinicians to provide culturally safe, trauma-informed care that holistically assesses the risk factors and addresses the physiological impacts of stress directly caused by the racial discrimination that is common among Aboriginal and Torres Strait Islander people in everyday life.
 
Health impacts of climate change
It states the importance of the inclusion of the health impacts of climate change for the first time in the National Guide as ‘an opportunity to bring the broad evidence around health impacts of the climate crisis into the primary care setting in practical and actionable ways’.
 
It acknowledges that ‘Aboriginal and Torres Strait Islander communities are disproportionately exposed to environmental degradation, rising seas and extreme weather, unjustly compounding existing health and wellbeing inequities’.
 
Healthy eating
The healthy eating section has been separated from the overweight and obesity topic to establish it as a foundation to good health and wellbeing that is grounded in ‘positive and strong cultural framing’.
 
Preconception care
Preconception care builds on asking about pregnancy intention to identify significant opportunities in primary preventive healthcare that can influence the life trajectory of infants and people.
 
Sleep
Sleep has been included ‘as one of the foundations of good health’ and provides guidance for clinicians to include assessment and effective interventions to identify problems and improve the quality of sleep.
 
Vaping
As an emerging health issue, its inclusion in the National Guide provides clinicians with guidance in an area where there is ‘minimal evidence about what is and is not known’.

 
There have also been key changes made to existing topics and recommendations across the board, including trauma-informed responses, expanded environmental recommendations and screening guidelines.
 
Immunisation has been expanded to ‘Immunisation across the lifetime’ to cover people of all ages, with a section on emerging and re-emerging diseases.
 
Advice around alcohol and smoking has moved away from the 5As (Ask, Assess, Advise, Assist and Arrange) approach to the three-step Ask, Advise, Help (AAH) model.
 
Dr Nicholls said this fourth edition includes input from 11 new Aboriginal and Torres Strait Islander authors.
 
‘That is great because it’s building our research capacity,’ she said.
 
‘It’s about the lens that’s provided and knowing, in terms of the recommendations, what resonates with Aboriginal and Torres Strait Islander people.
 
‘The recommendations are in line with the holistic belief of health being more than just merely the absence of disease, but it’s about the wellbeing of the individual, the family, the community, Country, spirit and connection.’
 
Dr Agostino echoed this, stating the prioritisation of Aboriginal and Torres Strait Islander authors and authors that work in Aboriginal and Torres Strait Islander health settings ‘brings their expertise alongside the evidence that’s out there’.
 
‘That makes the quality of the recommendations better and their importance in [being] put into primary care more applicable,’ he said.
 
The National Guide’s release comes one day after the first-of-its-kind Aboriginal and Torres Strait Islander Cultural and Health Training Framework was launched.
 
Dr Nicholls said she believes GPs want to be able to ‘deliver high quality, evidence-based care’ for Aboriginal and Torres Strait Islander people and hopes this resource will give them the tools they need.
 
‘Sometimes the anxiety that might come with not knowing how and getting it wrong can be a barrier,’ she said.
 
‘Government data shows almost two-thirds (64%) of the fatal burden of disease for those aged under 75 are deaths that could potentially have been avoided with high-quality culturally and clinically safe preventive healthcare.
 
‘My hope is that these two resources will be well utilised, well discussed and well implemented.’
 
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Aboriginal and Torres Strait Islander health GP24 NACCHO National Guide preventive health