User Guide for Aboriginal and Torres Strait Islander Health

The two compelling reasons to have specific actions that meet the needs of Aboriginal and Torres Strait Islander people are:

• The historical and contemporary context of Aboriginal and Torres Strait Islander health
• The unique and diverse cultures of Aboriginal and Torres Strait Islander people.

Historical and contemporary context of Aboriginal and Torres Strait Islander health

Aboriginal and Torres Strait Islander people are among the most socially and economically disadvantaged groups in Australia.²



The current poor health and wellbeing of many Aboriginal and Torres Strait Islander people stems largely from the effects of colonial policies and their ongoing legacy. These policies have resulted in loss of land, family and community connections, and denial of free cultural expression and growth across generations. They affect the physical, emotional, social and spiritual dimensions of wellbeing for Aboriginal and Torres Strait Islander individuals and communities.



The continuing impacts on health and wellbeing are evident in the unacceptable gaps between Aboriginal and Torres Strait Islander people and other Australians in health outcomes, including infant and child mortality, disease burden, and life expectancy. Significant barriers to accessing effective and safe health care contribute to these gaps. Therefore, it is important that people experience safe and high-quality health care based on need.



Meaningful, lasting relationships with the Aboriginal and Torres Strait Islander community are integral to redressing past wrongs and moving towards an equitable healthcare system for all Australians.



We represent the oldest continuous culture in the world; we are also diverse and have managed to persevere despite the odds because of our adaptability, our survival skills and because we represent an evolving cultural spectrum inclusive of traditional and contemporary practices. At our best, we bring our traditional principles and practices – respect, generosity, collective benefit, collective ownership – to our daily expression of our identity and culture in a contemporary context. When we are empowered to do this, and where systems facilitate this reclamation, protection and promotion, we are healthy, well and successful, and our  communities thrive. (Dr Ngaire Brown, New York, 2012)³



Closing the Gap⁴ in Aboriginal and Torres Strait Islander disadvantage is a national priority that the Australian Government and all state and territory governments are committed to addressing. It is the responsibility of all health service organisations to consider and action their part in closing the gap in health disparities experienced by Aboriginal and Torres Strait Islander people.

Unique and diverse cultures of Aboriginal and Torres Strait Islander people

Aboriginal and Torres Strait Islander people have world views that differ from other Australians. Although language varies across the country, four core concepts are found consistently among Aboriginal and Torres Strait Islander communities.



In the Arrernte (A), Warlpiri (W), Pitjantjatjara (P) and Luritja (L) language groups of South Australia and the Northern Territory, these concepts are:

• Altyerre (A), Jukurrpa (W), Tjukurpa (P) or Tjukurrpa (L). The religious interpretations of the profound bonding of people to one another, to their country and to the species of animals and plants inhabiting it. It is continually renewed by its expression in song, dance, verbal narratives of creation stories and re-enacted continually in ceremonial journeys
• Walytja (L, P) or Warlalja (W). The system of extended kinship; the organisational scaffolding for social roles and authority; the pathways of distribution and communication
• Ngura (L, P) or Ngurra (W). Country to which people belong; which they may use; always subject to the obligations of looking after it and care …; including its celebration
• Kanyini (L, P) or Mardarni (W). Which is to have, to hold [and] to care. Kanyini is a verb which reflects a commitment, a full engagement; vitalising again and again all that went before and all that will go after.⁵

Aboriginal and Torres Strait Islander people have a holistic view of health that is not adequately met by the biomedical model of health care. For Aboriginal

and Torres Strait Islander people, health is:

… not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole-of-life view and includes the cyclical concept of life–death–life.⁶



While there are similarities, there is also much diversity. There were more than 250 Aboriginal and Torres Strait Islander language groups across Australia, and it is estimated that 120 languages are still spoken today.⁵ It is important to note that each language group has its own unique values and belief systems. Therefore, if a health service organisation is to provide effective care to its local Aboriginal and Torres Strait Islander people, or the communities that regularly access care, it will need to understand the diverse cultures and values of the people in the organisation’s catchment and of the patients using its services.

This guide provides information for health service organisations to help them improve the quality of care and health outcomes for Aboriginal and Torres Strait Islander people.



Health service organisations can achieve the greatest impact when they:

• Strengthen relationships and partnerships with local and relevant other Aboriginal and Torres Strait Islander communities; these relationships will be most effective when they are respectful and mutual, and value the knowledge and experiences of Aboriginal and Torres Strait Islander people
• Ensure equity in access and quality of care, according to need
• Recognise that racist attitudes have had a marked impact on the health outcomes of Aboriginal and Torres Strait Islander people, and that racism in all its forms (personal, casual and institutionalised) must be identified and actions must be taken to eliminate it
• Demonstrate an understanding of, and respect for, the cultural identity of Aboriginal and Torres Strait Islander clients and families, and provide culturally safe care
• Consider the individual as a whole – incorporating physical, social, emotional, cultural and spiritual aspects of wellbeing – when providing care across the life span
• Include family and/or designated decision-makers in all patient planning and decision-making
• Maximise opportunities to provide care by taking a comprehensive approach to addressing health concerns at the point of service
• Strengthen links between primary care and acute sector health service organisations so that patients are not lost to follow-up and receive continuity in care
• Strengthen the current Aboriginal and Torres Strait Islander workforce by increasing the number of Aboriginal and Torres Strait Islander employees, and supporting them to achieve their potential
• Engage with Aboriginal and Torres Strait Islander community organisations, services and individuals in ways that are relevant to their circumstances, concerns and priorities, and that minimise the risk of overburden.

• Develop partnerships with Aboriginal and Torres Strait Islander communities and relevant Aboriginal community controlled health services, and mechanisms to ensure that these partnerships are sustainable and of mutual benefit (Action 2.13)
• Ensure that the safety and quality care needs of Aboriginal and Torres Strait Islander people are addressed in the health service organisation’s priorities (Action 1.2)
• Undertake a gap analysis to help inform strategies and understand the specific needs of Aboriginal and Torres Strait Islander people in the health service organisation’s catchment (Action 1.4)
• Using the identified priorities, develop and implement strategies, in partnership with Aboriginal and Torres Strait Islander people, and establish associated monitoring and evaluation systems (Action 1.4)
• Develop strategies to address the remaining actions (Actions 1.21, 1.33 and 5.8).