10 years of preventive health in Australia. Part 2 – centring First Nations sovereignty
Khwanruethai Ngampromwongse
A B * and Alana Gall A
B
C
Abstract
As First Nations public health professionals, we critically examine the National Preventive Health Strategy 2021–2030 (NPHS) and its shortcomings in addressing the structural determinants of health inequities affecting Aboriginal and Torres Strait Islander peoples (hereafter respectfully, First Nations peoples). Although the NPHS aspires to a systems-based and equitable approach, we argue that it fails to meaningfully engage with the enduring impacts of colonisation, systemic racism, and intergenerational trauma. By focusing predominantly on individual behavioural risk factors, the strategy neglects the broader sociopolitical and cultural contexts that continue to drive poorer health outcomes in our communities. True progress in preventive health requires a fundamental shift – one that centres First Nations self-determination; embeds our ways of knowing, being, and healing; and invests in community-led solutions. We call for the re-Indigenisation of the health system, not as a gesture of inclusion, but as an assertion of our sovereignty, knowledge, and leadership in shaping our own health futures. We conclude with a series of actionable recommendations for policymakers grounded in structural reform and driven by the urgent need for systems transformation led by, and accountable to, First Nations peoples.
Keywords: co-design, health policy, Indigenous health, Indigenous people, preventive health, preventive health policy, public health, public health policy, social determinants of health.
References
2 Griffiths K, Coleman C, Lee V, Madden R. How colonisation determines social justice and Indigenous health—a review of the literature. J Popul Res 2016; 33(1): 9-30.
| Crossref | Google Scholar |
3 Sherwood J. Colonisation – It’s bad for your health: The context of Aboriginal health. Contemp Nurse 2013; 46(1): 28-40.
| Crossref | Google Scholar | PubMed |
4 Paradies Y. Colonisation, racism and indigenous health. J Popul Res 2016; 33(1): 83-96.
| Crossref | Google Scholar |
5 Bastos JL, Harnois CE, Paradies YC. Health care barriers, racism, and intersectionality in Australia. Soc Sci Med 2018; 199: 209-18.
| Crossref | Google Scholar | PubMed |
6 William F, Melissa L, Juleigh L, Mary-Jane H. Deficit discourse and strengths-based approaches: Changing the narrative of Aboriginal and Torres Strait Islander health and wellbeing. The Lowitja Institute; 2018. Report No.: 9781921889554 1921889551. Available at https://www.lowitja.org.au/resource/deficit-discourse-strengths-based/ [cited 10 April 2025].
7 Fogarty W, Bulloch H, McDonnell S, Davis M. Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in policy. Melbourne: The Lowitja Institute; 2018. Available at https://www.lowitja.org.au/resource/deficit-discourse-and-indigenous-health/ [cited 10 April 2025].
8 Mayes C. White Medicine, White Ethics: On the Historical Formation of Racism in Australian Healthcare. J Aust Stud 2020; 44(3): 287-302.
| Crossref | Google Scholar |
10 Lowitja Institute. Close the Gap Campaign Report 2024 - Voyage to Voice, Treaty, Truth and Beyond. The Close the Gap Campaign Alliance Group; 2024. Available at https://www.lowitja.org.au/resource/close-the-gap-campaign-report-2024-voyage-to-voice-treaty-truth-and-beyond/ [cited 10 April 2025].
11 Australian Government. National Preventive Health Strategy 2021–2030. In Department of Health, editors. Canberra: Commonwealth of Australia; 2021. Available at https://www.health.gov.au/resources/publications/national-preventive-health-strategy-2021-2030?language=en [cited 10 April 2025]
12 Australian Government. Review of the National Agreement on Closing the Gap: Study report. In Productivity Commission, editors. Canberra: Commonwealth of Australia; 2024. Available at https://www.pc.gov.au/inquiries/completed/closing-the-gap-review/report [cited 10 April 2025].
13 Australian Government. National Agreement on Closing the Gap. In Department of the Prime Minister and Cabinet, editors. Canberra: Commonwealth of Australia; 2020. Available at https://www.closingthegap.gov.au/national-agreement [cited 10 April 2025].
14 National Aboriginal Community Controlled Health Organisation. Aboriginal Community Controlled Health Organisations (ACCHOs): What is the definition of Aboriginal health? Canberra, Australia; 2020. Available at https://www.naccho.org.au/acchos/#:~:text=‘%E2%80%9DAboriginal%20health%E2%80%9D%20means%20not,well%2Dbeing%20of%20their%20Community [cited 10 April 2025].
15 Gall A, Stephens M, Armour D, Hewlett N, Kennedy M, Sainty T, Hulme A, Anderson K, Campbell M, Gall Z, Wardle J. First Nations traditional medicines representation in Australian national health policy: preliminary results. 3rd International Indigenous Health & Wellbeing Conference 2023. Cairns, Australia: Southern Cross University; 2023.
16 Department of Health and Aged Care. National Aboriginal and Torres Strait Islander Health Plan 2021–2031, Australian Government; 2021. Available at https://www.health.gov.au/resources/publications/national-aboriginal-and-torres-strait-islander-health-plan-2021-2031 [viewed 11 January 2025]
17 Maddox R, Morton Ninomiya ME. Indigenous sovereignty in research and epistemic justice: Truth telling through research. Glob Public Health 2025; 20(1): 2436436.
| Crossref | Google Scholar | PubMed |
18 Australian Psychological Society. The APS Apology to Aboriginal and Torres Strait Islander people. 2016. Available at https://psychology.org.au/community/reconciliation-and-the-aps/aps-apology [cited 10 April 2025].
19 MSI Australia. Apology for forced medical procedures linked to colonisation and racism in Australia. 2022. Available at https://www.msiaustralia.org.au/apology-for-forced-medical-procedures-linked-to-colonisation-and-racism-in-australia/ [cited 10 April 2025].
20 Psychiatrists TRANZCo. Apology for the role played by psychiatrists in the Stolen Generations. 1999. Available at https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/apology-for-the-role-played-by-psychiatrists-in-the-stolen-generations [cited 10 April 2025].
21 Speech Pathology Australia. Apology to Aboriginal and Torres Strait Islander Peoples. 2024. Available at https://www.speechpathologyaustralia.org.au/Public/Public/About-Us/Reconciliation/Apology.aspx [cited 10 April 2025].
22 Anderson K, Gall A, Butler T, Ngampromwongse K, Hector D, Turnbull S, et al. Development of Key Principles and Best Practices for Co-Design in Health with First Nations Australians. Int J Environ Res Public Health 2022; 20(1): 147.
| Crossref | Google Scholar | PubMed |
