The NSQHS Standards require health service organisations to address six actions that are specific to Aboriginal and Torres Strait Islander people.
Aboriginal and Torres Strait Islander people have the right to feel confident and safe in accessing the Australian healthcare system, and the system must be able to respond to their needs. For this to occur, health service organisations should ensure that service provision is equitable, and that patient needs drive the level and range of care that can be accessed.
It is evident that there are health disparities between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, and treatment inequities in the health system.
Combined with the level of comorbidities in Aboriginal and Torres Strait Islander people, their age at diagnosis and their socioeconomic position, these disparities require a refocusing of health care to meet the unique needs of each patient.
Like safety and quality more broadly, the safety and quality of care for Aboriginal and Torres Strait Islander people can only be improved when everyone who works in the health service organisation recognises that they are responsible for providing equitable care – it is not solely the responsibility of Aboriginal and Torres Strait Islander employees and services.1
The six actions in the National Safety and Quality Health Service Standards that focus specifically on meeting the needs of Aboriginal and Torres Strait Islander people are:
Partnering with Consumers Standard
Action 2.13 - The health service organisation works in partnership with Aboriginal and Torres Strait Islander communities to meet their healthcare needs
Clinical Governance Standard
Action 1.2 - The governing body ensures that the organisation’s safety and quality priorities address the specific health needs of Aboriginal and Torres Strait Islander people
Action 1.4 - The health service organisation implements and monitors strategies to meet the organisation’s safety and quality priorities for Aboriginal and Torres Strait Islander people
Action 1.21 - The health service organisation has strategies to improve the cultural awareness and cultural competency of the workforce to meet the needs of its Aboriginal and Torres Strait Islander patients
Action 1.33 - The health service organisation demonstrates a welcoming environment that recognises the importance of cultural beliefs and practices of Aboriginal and Torres Strait Islander people
Comprehensive Care Standard
Action 5.8 - The health service organisation has processes to routinely ask patients if they identify as being of Aboriginal and/or Torres Strait Islander origin, and to record this information in administrative and clinical information systems
Addressing the six specific actions to meet the needs of Aboriginal and Torres Strait Islander people
To provide safe and high-quality care to Aboriginal and Torres Strait Islander people, the health service organisation must have a knowledge of the community’s needs and priorities. This can only be achieved by working in respectful and meaningful partnership with the Aboriginal and Torres Strait Islander community (Action 2.13). Establishment and maintenance of such partnerships are vital to the effective implementation of the other five Aboriginal and Torres Strait Islander–specific actions (Figure 1). Through these partnerships, the Aboriginal and Torres Strait Islander community will help provide necessary input and guidance on priority health needs, and cultural beliefs and practices that have impacts on healthcare provision.
View the topic items below for specific strategies to support the implementation of these actions.
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).
National Aboriginal and Torres Strait Islander Health Standing Committee of the Australian Health Ministers’ Advisory Council. Cultural respect framework 2016–2026 for Aboriginal and Torres Strait Islander health. Canberra: AHMAC; 2016.
Marmot M. Social determinants and the health of Indigenous Australians. Med J Aust 2011;194:51–13.
Brown N. Pacific caucus intervention to the 12th session of the United Nations Permanent Forum on Indigenous Issues. New York: 20–31 May 2013.
Aboriginal and Torres Strait Islander Social Justice Commissioner, Steering Committee for Indigenous Health Equality. Close the gap: national Indigenous health equality targets. Sydney: Human Rights and Equal Opportunity Commission; 2008.
Franks C, Curr B. Keeping company: an inter-cultural conversation. Wollongong: Centre for Indigenous Development Education and Research, University of Wollongong; 1996.
National Aboriginal Health Strategy Working Party. A national Aboriginal health strategy. Canberra: National Aboriginal Health Strategy Working Party; 1989.