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Closing the Gap reporting figures were released by the Australian Government earlier this month. New data confirms that work to close the gap in life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous people is not on track. 

Chronic diseases - including heart disease, kidney disease and diabetes - are major contributors to the disparity in life expectancy. Culturally safe and comprehensive primary care is known to reduce the effects of chronic disease.

A newly published systematic literature review of research on chronic disease care for Aboriginal and Torres Strait Islander people has identified a range of barriers and enablers to effective primary care delivery.

The findings highlight the need for needs-based investment in primary health care systems and workforce. A comprehensive approach to chronic disease care requires that social and cultural determinants of health are addressed.

“The healthcare system must identify and address holistic needs of Aboriginal and Torres Strait Islander people and communities which include initiatives to address unmet social and cultural needs. For example, access to healthy and nutritious food, housing, transportation and referral networks to other allied health and community resources can improve the health and wellbeing of people and the system needs flexible funding to support this kind of referral.” says Dr Uday Narayan Yadav from ANU National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, the lead author of the research.

Cultural safety was found to be a key characteristic of effective primary care. In addition to actions and attitudes of staff, culturally welcoming spaces with artwork and resources can contribute to a sense of community belonging. Primary care clinics which act as hubs to connect people to other clinical and non-clinical services can also unmet social and cultural needs of the community.

“We know that Aboriginal and Torres Strait Islander leadership in healthcare design and delivery results in more accessible and effective health care for our people. The evidence in this review overwhelming supports this. Services can purposefully embed and support Aboriginal leadership”, says senior author, A/Prof Odette Pearson, co-lead of the Wardliparingga Aboriginal Health Research unit at SAHMRI and senior author of the article.

Implementation of these findings should be localised. Each community has its own needs, priorities and experiences. A collaborative approach to primary care that centres the needs of the community and other stakeholders is the most likely to be effective in providing effective primary care for chronic disease.

“Comprehensive, culturally safe, primary care is critical to addressing the inequitable burden of chronic disease for Aboriginal and Torres Strait Islander people. This research highlights a range of approaches which can be locally-adapted to fit the needs of different contexts and communities” summarised Dr Rosemary Wyber, general practitioner and study co-author ANU National Centre for Aboriginal and Torres Strait Islander Wellbeing Research.

The study has been published in Health Research Policy and Systems. 

You can read more about the work of the Enhancing Chronic Disease Care team here.