The Health of Aboriginal and Torres Strait Islander Peoples

Last updated 1 Jun 2026 · Indigenous Health

📋 Key Information Summary

📋

Aboriginal and Torres Strait Islander peoples experience a life expectancy gap of approximately 8 years for males and 8 years for females compared with non-Indigenous Australians (AIHW, 2023).
Chronic diseases — cardiovascular disease, type 2 diabetes, chronic kidney disease, respiratory disease and cancer — account for the majority of the health gap and are largely preventable.
Type 2 diabetes prevalence in Aboriginal and Torres Strait Islander adults is 3–4 times that of the non-Indigenous population; early screening from age 18 is recommended.
Rheumatic heart disease (RHD) remains endemic in many remote and regional communities, with incidence rates among the highest in the world.
Culturally safe, trauma-informed care is a clinical obligation — not merely an aspiration — and requires ongoing self-reflection, cultural humility and partnership with Aboriginal Community Controlled Health Organisations (ACCHOs).
The Australian Government's National Agreement on Closing the Gap (2020) sets 17 socioeconomic targets with shared decision-making between governments and Aboriginal and Torres Strait Islander representatives.
Medicare Benefits Schedule (MBS) items 715 (health assessment) and 721/723 (GP Management Plans / Team Care Arrangements) are central to chronic disease management in primary care for Indigenous patients.
Social determinants — housing, education, incarceration, food security and racism — are the primary drivers of health inequity and must be addressed alongside clinical care.
Smoking rates remain approximately 2.5 times higher in Indigenous Australians; culturally tailored cessation programmes show better engagement than generic approaches.
GPs should proactively offer Aboriginal and Torres Strait Islander health checks (MBS 715) to every Indigenous patient and link findings to GP Management Plans.
Remote and very remote communities face acute workforce shortages; telehealth and visiting specialist models are essential to close access gaps.
Strengthening the Indigenous health workforce — including Aboriginal Health Workers and Aboriginal Health Practitioners — is a key Closing the Gap priority.

Introduction & Australian Epidemiology

Aboriginal and Torres Strait Islander peoples are the First Nations peoples of Australia, with continuous connection to Country spanning more than 65,000 years. Health and wellbeing are understood holistically, encompassing physical, social, emotional, cultural and spiritual dimensions — a perspective recognised in the National Aboriginal Health Strategy and increasingly embedded in Australian health policy.

Despite improvements over recent decades, significant health inequities persist between Indigenous and non-Indigenous Australians. These disparities are not explained by biology alone; they are driven by the legacy of colonisation, dispossession, intergenerational trauma and ongoing systemic racism. The burden of chronic disease, mental health conditions, communicable diseases and perinatal complications is disproportionately borne by Aboriginal and Torres Strait Islander communities.

As of the 2021 Census, approximately 984,000 people in Australia identify as Aboriginal and Torres Strait Islander, representing 3.8% of the total population. Around 38% live in major cities, 22% in inner regional areas, 20% in outer regional areas, 10% in remote areas and 9% in very remote areas. Health outcomes vary markedly by remoteness, with substantially worse indicators in remote and very remote settings.

General practitioners are frequently the first point of contact with the health system for Aboriginal and Torres Strait Islander people and play a pivotal role in preventive care, chronic disease management, culturally safe practice and advocacy. This article summarises key health inequalities, the chronic disease burden, principles of culturally safe care and the national Closing the Gap framework as they relate to Australian primary care.

⚠️

GP obligation: Every Aboriginal and Torres Strait Islander patient is entitled to a comprehensive health check under MBS Item 715 at least once per year, with follow-up through GP Management Plans (MBS 721) and Team Care Arrangements (MBS 723) as clinically indicated. Failure to offer these proactively represents a missed opportunity for preventive care.

Health Inequalities & Key Health Statistics

The health gap between Aboriginal and Torres Strait Islander peoples and other Australians is wide, persistent and structurally determined. Understanding the scale and nature of these inequalities is essential for every clinician working in Australian primary care.

Life Expectancy & Mortality

Life expectancy at birth: Indigenous males 71.6 years vs non-Indigenous males 80.2 years; Indigenous females 75.6 years vs non-Indigenous females 83.4 years (2015–2017 ABS estimates).
Age-standardised mortality rate is approximately 1.5 times higher for Indigenous Australians.
Infant mortality: Indigenous rate approximately twice the non-Indigenous rate (4.6 vs 3.1 per 1,000 live births, 2019).
The leading causes of death are ischaemic heart disease, diabetes, chronic lower respiratory diseases, cerebrovascular disease and lung cancer.

Key Comparative Statistics

Indicator	Indigenous	Non-Indigenous	Ratio / Gap
Life expectancy (male)	71.6 years	80.2 years	8.6-year gap
Life expectancy (female)	75.6 years	83.4 years	7.8-year gap
Type 2 diabetes prevalence	~12%	~4%	3× higher
Current smoking (adults ≥18)	~40%	~14%	~2.9× higher
End-stage kidney disease (incidence)	Higher	Baseline	~2–3× higher
Rheumatic heart disease notification	~60 per 100,000 (NT)	Rare	Near-unique burden
Hospitalisation for all causes	Elevated	Baseline	1.4× higher age-standardised

Social Determinants Driving Inequity

Health inequalities cannot be addressed through clinical care alone. The major upstream determinants include:

Housing and infrastructure: Overcrowding rates 3–4 times higher; limited access to safe water and sanitation in some remote communities.
Education: Lower Year 12 attainment; limited access to culturally appropriate health literacy resources.
Employment and income: Higher unemployment, lower median household income, greater reliance on government payments.
Incarceration: Aboriginal and Torres Strait Islander peoples constitute ~30% of the adult prison population but only 3.8% of the general population. Health care in custody is often inadequate.
Food security: Remote stores often charge 50–100% more for fresh fruit and vegetables compared with urban supermarkets.
Racism and discrimination: Documented as an independent risk factor for poor mental and physical health outcomes.

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Clinical note: GPs should be aware that patients presenting with chronic disease may be simultaneously managing acute social stressors — insecure housing, food insecurity, family disruption or recent bereavement. Holistic assessment that addresses social needs is more effective than disease-focused management alone.

Chronic Disease Burden

Chronic diseases are the primary driver of the Indigenous health gap, accounting for approximately 70% of the life expectancy difference. The five major contributors are cardiovascular disease, type 2 diabetes, chronic kidney disease, chronic respiratory disease and cancer. Many of these conditions share common risk factors — smoking, obesity, physical inactivity and poor nutrition — and are amenable to prevention and early intervention in primary care.

Cardiovascular Disease

Ischaemic heart disease is the leading single cause of death in Aboriginal and Torres Strait Islander peoples.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain endemic, particularly in NT, northern WA and northern QLD, predominantly affecting children and young adults.
Absolute cardiovascular risk (CVR) assessment using the Australian CV Risk Calculator should be offered from age 30 (or earlier with risk factors). Indigenous Australians should be flagged as having higher baseline risk.
Statin therapy for primary prevention is recommended at lower thresholds (≥10% 5-year absolute CVR vs ≥15% in general population guidelines for some risk categories).

Type 2 Diabetes

Prevalence approximately 3–4 times the non-Indigenous rate; onset is often a decade earlier with more aggressive complications.
Screening should commence from age 18 (or earlier if overweight/obese with additional risk factors) using fasting glucose, HbA1c or oral glucose tolerance test.
Diabetic kidney disease, retinopathy and peripheral neuropathy develop earlier and more frequently.
Multidisciplinary care with access to diabetes educators (preferably Indigenous), dietitians and podiatrists is essential.

Chronic Kidney Disease (CKD)

Indigenous Australians are 2–3 times more likely to have CKD and disproportionately progress to end-stage kidney disease (ESKD).
ESKD incidence rates in remote NT communities are among the highest in Australia.
Regular eGFR and urine ACR monitoring should begin from age 18 in all Indigenous patients.
ACE inhibitors / ARBs are first-line renoprotective therapy; SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin) are now recommended for CKD with or without diabetes.

Chronic Respiratory Disease

Chronic obstructive pulmonary disease (COPD) and asthma prevalence is higher, linked to smoking, indoor biomass smoke exposure and childhood respiratory infections.
Bronchiectasis remains significantly more common in Indigenous children, especially in remote communities.
Smoking cessation is the single most impactful intervention for respiratory health.

Cancer

Cancer mortality is approximately 1.4 times higher in Indigenous Australians, with lower five-year survival rates attributed to later stage at diagnosis, lower screening participation and reduced access to treatment.
Lung, liver, cervical and head/neck cancers are disproportionately represented.
Cervical cancer is largely preventable through HPV vaccination and regular screening; the National Cervical Screening Program remains a priority area.

Key Medications for Chronic Disease Management

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Metformin

Diaformex® · Diabex® · First-line oral hypoglycaemic

Adult dose 500 mg PO BD with meals, titrate to 1 g BD over weeks as tolerated

Renal adjustment eGFR 30–45: reduce dose; eGFR <30: contraindicated

PBS status ✔ PBS General Benefit

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Perindopril

Coversyl® · ACE inhibitor — CV and renal protection

Adult dose 5 mg PO daily, titrate to 10 mg daily for CV/renal protection

Renal adjustment Start 2.5 mg if eGFR <30; monitor potassium and creatinine

PBS status ✔ PBS General Benefit

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Dapagliflozin

Forxiga® · SGLT2 inhibitor — renal and cardioprotective

Adult dose 10 mg PO daily for CKD or heart failure (with or without T2DM)

Renal adjustment Initiate if eGFR ≥20; may continue below with ongoing benefit

PBS status ⚠ PBS Authority Required

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Atorvastatin

Lipitor® · Statin — CV risk reduction

Adult dose 20–40 mg PO nocte; up to 80 mg for high/very high CVR

Renal adjustment No specific adjustment required

PBS status ✔ PBS General Benefit

Culturally Safe Care

Cultural safety extends beyond cultural awareness or cultural sensitivity. It requires that the patient determines whether care is safe and respectful — placing the locus of assessment with the recipient of care, not the provider. In Australian general practice, culturally safe care for Aboriginal and Torres Strait Islander patients is both an ethical obligation and a clinical necessity: patients who feel unsafe or judged are less likely to attend appointments, disclose symptoms, adhere to treatment or return for follow-up.

Core Principles of Culturally Safe Practice

Self-reflection & cultural humility

Examine your own biases, assumptions and privilege. Cultural safety is a continuous journey, not a certificate on the wall. Engage in regular reflective practice and seek feedback.

Yarning-based communication

Use a conversational, unhurried approach. Allow silences. Avoid rapid-fire closed questions. Building rapport through yarning often yields more clinically useful information than structured questioning alone.

Acknowledging Country and identity

Ask about Country, language group and family connections. Acknowledge the traditional owners of the land on which your practice sits. Understanding kinship and community structures informs holistic care.

Gender-sensitive practice

Some patients strongly prefer a practitioner of the same gender for sensitive examinations (e.g., sexual health, breast/prostate, obstetric). Offer this option and facilitate access when possible.

Family-inclusive decision-making

Health decisions may involve extended family or community Elders. With patient consent, include family members in consultations and care planning.

Understanding sorry business and grief

Bereavement practices may involve extended absence from work or clinic. Sorry business is culturally critical — appointments may be cancelled. Show understanding, not frustration.

Trauma-Informed Care

Many Aboriginal and Torres Strait Islander patients carry the cumulative burden of intergenerational trauma (forced removals, Stolen Generations, institutional racism) and individual trauma. A trauma-informed approach involves:

Recognising the high prevalence of trauma without requiring patients to recount it.
Ensuring physical and emotional safety in the clinical environment.
Offering choice and control at every step — including the option to stop, defer or bring a support person.
Avoiding re-traumatisation through insensitive questioning, physical examination without explanation, or involuntary treatment.

Practical Steps for General Practice

Action	Detail
Identify Indigenous patients	Proactively and respectfully ask all patients about Aboriginal or Torres Strait Islander identification at registration. This enables access to MBS 715 and other targeted programmes.
Employ Aboriginal Health Workers / Practitioners	AHWs and AHPs bridge clinical and cultural worlds. They improve engagement, health literacy and follow-up. Fund positions through practice incentive payments and state/territory programmes.
Display culturally safe signage	Welcome signage in local language(s), Aboriginal and Torres Strait Islander flags, acknowledgement of Country in waiting areas.
Flexible appointment systems	Allow longer consults, walk-in availability and reduced emphasis on strict punctuality for non-acute visits. Avoid punitive policies for missed appointments.
Link with ACCHOs	Establish referral pathways and shared care arrangements with local Aboriginal Community Controlled Health Organisations.
Use of interpreters	For patients whose first language is not English (including many remote community residents), arrange an interpreter — ideally from the Aboriginal Interpreter Service (NT) or equivalent state service. Avoid using family members (especially children) as interpreters for sensitive topics.

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PRACTICE TIP: The RACGP's Specific Interests: Aboriginal and Torres Strait Islander Health faculty provides free online training modules for GPs, including cultural safety and trauma-informed care. RACGP CPD points may apply.

Closing the Gap Priorities

The National Agreement on Closing the Gap (July 2020) represents a landmark shift in Australian health policy. Developed through genuine partnership between the Coalition of Aboriginal and Torres Strait Islander Peak Organisations (Coalition of Peaks) and Australian governments, the agreement establishes 17 socio-economic targets across four Priority Reforms and 17 outcome areas.

Four Priority Reforms

Reform 1

Shared Decision-Making

Formal partnerships between governments and Aboriginal and Torres Strait Islander representatives in the design, implementation and evaluation of policies and programmes.

Reform 2

Building Community-Controlled Sector

Strengthening the Aboriginal Community Controlled Health sector to deliver services. ACCHOs deliver comprehensive, culturally safe primary care and are the preferred model of care for many communities.

Reform 3

Transforming Government Organisations

Governments and institutions must address systemic racism and improve cultural safety within their own organisations, including hospitals, health departments and funding bodies.

Reform 4

Shared Access to Data

Aboriginal and Torres Strait Islander communities should have access to data about their own populations to drive locally informed decision-making and accountability.

Key Health-Related Outcome Areas

Outcome Area 1 — Life expectancy: Close the life expectancy gap by 2031 (progress: limited).
Outcome Area 2 — Babies with healthy birthweight: Increase the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to 91% by 2031.
Outcome Area 3 — Early childhood development: Increase proportion of children assessed as developmentally on track in all five AEDC domains.
Outcome Area 4 — Children in out-of-home care: Reduce the rate of over-representation.
Outcome Area 14 — Social and emotional wellbeing: Reduce suicide rates towards zero (an aspirational, not numerical, target).

Role of General Practice in Closing the Gap

Provision of annual Aboriginal and Torres Strait Islander health assessments (MBS Item 715).
Development and review of GP Management Plans (MBS 721) and Team Care Arrangements (MBS 723) for patients with chronic conditions.
Practising within the Practice Incentives Program (PIP) Indigenous Health Incentive framework — registering Indigenous patients, completing health assessments and linking to chronic disease management.
Supporting continuity of care — preferential booking with the same GP, recall systems and outreach into community settings.
Advocacy: GPs are trusted community voices. Writing letters of support for housing, NDIS access or social services can be as clinically important as prescribing medication.

ℹ️

MBS Item 715 reminder: The Aboriginal and Torres Strait Islander health assessment (MBS Item 715) can be claimed once per patient per 9-month rolling period. It is a comprehensive, holistic assessment — not a brief check-up. Templates are available from RACGP, NACCHO and state health departments. Completing a 715 also opens access to follow-up services under MBS Items 10987 (follow-up by a health worker) and 721/723.

ACCHOs: The Preferred Model

Aboriginal Community Controlled Health Organisations (ACCHOs) are the largest single provider of primary health care to Aboriginal and Torres Strait Islander peoples in Australia, delivering over 3 million episodes of care annually through more than 200 organisations. ACCHOs are governed by local Aboriginal and Torres Strait Islander communities and deliver holistic, comprehensive, culturally safe care. GPs in mainstream practice should establish strong referral and shared-care relationships with their local ACCHO.

Special Populations

Within the Aboriginal and Torres Strait Islander population, certain subgroups face additional layers of vulnerability. Tailored approaches are required.

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Children & Young People

Higher rates of otitis media, skin infections (scabies, impetigo), rheumatic fever and bronchiectasis.

Ensure scheduled immunisation is up to date — use the Australian Immunisation Register and recall systems.

FASD screening should be considered in children with developmental or behavioural concerns.

Ear health checks at every 715 assessment; refer for audiology if recurrent otitis media.

Benzathine penicillin G 900 mg IM every 28 days (secondary prophylaxis for ARF) — weight-based dosing applies for children <20 kg (450 mg IM).

PBS: Benzathine penicillin G — ✔ PBS General Benefit

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Pregnant Women

Higher rates of pre-term birth, low birthweight and maternal complications (gestational diabetes, pre-eclampsia).

Early antenatal booking (<14 weeks) improves outcomes; engage AHWs for outreach.

Offer smoking cessation support (nicotine replacement therapy if needed) and alcohol screening using AUDIT-C.

Group B Streptococcus screening and syphilis serology are essential — congenital syphilis is re-emerging in northern Australia.

Referral to Aboriginal Maternal and Infant Health Services where available.

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Elderly / Elders

The Indigenous population is younger overall, but the proportion of older adults is growing. Chronic disease burden accumulates with age.

Elders hold significant cultural authority — their involvement in care planning is highly valued.

Ageing-related conditions (dementia, falls, osteoporosis) are under-recognised. Screen with validated tools.

Palliative care preferences may differ — family, Country and community are central to end-of-life care.

Advance care planning should be initiated proactively and revisited regularly, incorporating cultural and spiritual values.

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Remote & Very Remote Communities

Severe workforce shortages — many communities rely on fly-in/fly-out (FIFO) GPs and visiting specialists.

Limited access to diagnostics (imaging, pathology specimen transport), pharmacy services and allied health.

Higher burden of infectious diseases (trachoma, rheumatic fever, skin infections, STIs).

Telehealth has expanded access but requires reliable internet — a significant barrier in some communities.

Ring-fenced chronic disease funding through Practice Incentives Program (PIP) Indigenous Health Incentive.

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health — Practice Integration

Given that this entire article concerns Aboriginal and Torres Strait Islander health, this section focuses on practical integration into mainstream general practice — ensuring that every consultation, not just the annual 715 check, is culturally informed.

Systematic identification

Collect Aboriginal and Torres Strait Islander status at every new patient registration and confirm periodically. Use practice software flags to prompt MBS 715 eligibility and chronic disease recall.

Clinical decision support

Ensure your practice software includes Indigenous-specific templates for 715 assessments. Include population-specific risk calculators (e.g., CV risk adjusted for higher baseline risk, earlier CKD screening).

Workforce capacity

Invest in training all staff — receptionists, nurses, GPs — in cultural safety. Appoint Aboriginal Health Workers or Liaison Officers where possible. Retention requires culturally safe workplaces, not just recruitment incentives.

Addressing implicit bias

Evidence shows that implicit bias affects clinical decision-making, pain management and referral patterns for Indigenous patients. Regular CPD on equity, unconscious bias and structural determinants of health is essential.

Data sovereignty

Aboriginal and Torres Strait Islander communities have the right to govern how data about their peoples are collected, stored and used. Ensure practice data governance aligns with the principles of Indigenous data sovereignty.

Continuity of care

Offer consistent GP preference for Indigenous patients, minimise unnecessary transfers between providers, and maintain warm handovers to specialists and hospital teams. Document cultural preferences in the patient record.

⚠️

Medication access in remote areas: PBS medicines may be supplied through Remote Area Aboriginal Health Services under Section 100 arrangements. Medicines may also be available through CARPA Standard Treatment Manual protocols in very remote settings. GPs should be aware of these arrangements when prescribing for patients in remote communities.

📚 References

1. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary report 2023. Canberra: AIHW; 2023.
2. Australian Government Department of the Prime Minister and Cabinet. National Agreement on Closing the Gap. Canberra: Commonwealth of Australia; 2020.
3. Australian Bureau of Statistics (ABS). Estimates of Aboriginal and Torres Strait Islander Australians, 2021. Canberra: ABS; 2023.
4. Peiris D, Patel A, Cass A, et al. Cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings: a systematic review. Med J Aust. 2009;190(7):405–409.
5. Australian Institute of Health and Welfare (AIHW). The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples: 2015. Cat. no. IHW 147. Canberra: AIHW; 2015.
6. Dudgeon P, Milroy H, Walker R, eds. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. 2nd ed. Canberra: Commonwealth of Australia; 2014.
7. The Royal Australian College of General Practitioners (RACGP). Specific Interests: Aboriginal and Torres Strait Islander Health — Health assessments for Aboriginal and Torres Strait Islander people. Melbourne: RACGP; 2023.
8. National Aboriginal Community Controlled Health Organisation (NACCHO). Position statement: Aboriginal health — closing the gap. Canberra: NACCHO; 2023.
9. RHDAustralia (ARF/RHD Program, Menzies School of Health Research). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: RHDAustralia; 2020.
10. Australian Institute of Health and Welfare (AIHW). Chronic disease and Aboriginal and Torres Strait Islander people. Cat. no. IHW 140. Canberra: AIHW; 2023.
11. Brown A, O'Shea RL, Mott K, McBride KF, Lawson T, Jennings GL. Essential service standards for equitable national cardiovascular care for Aboriginal and Torres Strait Islander people. Heart Lung Circ. 2015;24(2):126–141.
12. Eades SJ, Taylor B, Bailey S, Williamson JC, Couzos S, Boffa J. The health of Indigenous Australians. South Melbourne: Oxford University Press; 2010.
13. Australian Medical Association (AMA). AMA Position Statement: Aboriginal and Torres Strait Islander Health — 2023. Canberra: AMA; 2023.
14. Kidney Health Australia. Chronic Kidney Disease Management in Primary Care. 4th ed. Melbourne: Kidney Health Australia; 2020.

for PBS scripts. Utilise ACCHS pharmacies and Remote Area Aboriginal Health Worker programs for medication supply in remote areas. Avoid initiating benzodiazepines; support holistic pain management including community-based exercise programs.

Preventive health

Promote bone health: encourage vitamin D supplementation (1000 IU daily in deficient individuals), smoking cessation support, reduction of alcohol intake, and weight-bearing exercise. MBS Item 715 health checks provide a structured opportunity to assess bone health, screen for osteoporosis risk factors, and discuss musculoskeletal health in a culturally safe context.

Quick Reference: Differential Diagnosis at a Glance

Costovertebral dysfunction

Paracetamol ± NSAID; manual therapy

2–6 weeks

Provocable on palpation; no red flags

Thoracic compression fracture

Paracetamol; ± calcitonin; DXA + osteoporosis Rx

6–12 weeks healing

Elderly; osteoporosis; acute onset

ACS (posterior MI)

Aspirin 300 mg, GTN, heparin; urgent PCI

Time-critical

ECG, troponin; CV risk factors

Aortic dissection

IV labetalol; urgent CT aortogram; surgery (Type A)

Time-critical

Tearing pain; BP differential >20 mmHg

Vertebral osteomyelitis

IV antibiotics (vancomycin + ceftriaxone initially); ID consult

6 weeks IV antibiotics

Fever, elevated CRP, IV drug use

Biliary colic / cholecystitis

Paracetamol ± morphine; lap cholecystectomy

Surgical within 72 h (cholecystitis)

RUQ/infrascapular; post-prandial; RUQ US

📚 References

1. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.
2. National Health and Medical Research Council (NHMRC). Evidence-based management of acute musculoskeletal pain. Canberra: NHMRC; 2003 (updated 2020).
3. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary report 2023. Canberra: AIHW; 2023.
4. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760–765.
5. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Europ Spine J. 2018;27(1):60–75.
6. Erwin WM, Jackson PC, Homonko DA. Innervation of the human costovertebral joint: implications for clinical back pain syndromes. J Manipulative Physiol Ther. 2000;23(6):395–403.
7. Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th edn. Melbourne: RACGP; 2018 (updated 2023).
8. Hirsch JA, Singh V, Falco FJE, et al. Thoracic facet joint interventions. Pain Physician. 2016;19(4):E581–E593.
9. Erwin WM, Jackson PC. The costovertebral joint: anatomy, biomechanics, and clinical significance in thoracic back pain syndromes. J Can Chiropr Assoc. 2003;47(2):112–120.
10. Strayer RJ, Gunnerson JM, Brown LH, et al. Aortic dissection: clinical features, diagnosis, and management. Aust Crit Care. 2019;32(2):144–153.
11. Ombregt L. A system of orthopaedic medicine. 3rd edn. Edinburgh: Churchill Livingstone Elsevier; 2013. Chapter 18: Thoracic spine.
12. Lin CC, Chen KH, Li DM, et al. Characteristics and outcomes of patients presenting with thoracic back pain to the emergency department. Emerg Med Australas. 2020;32(5):805–811.

for PBS-listed medicines at participating pharmacies.

Cultural safety

Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.

Medication adherence

Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.

Specific conditions

Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.

Referral pathways

Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).

for PBS-listed medicines at participating pharmacies.

Cultural safety

Medication adherence

Specific conditions

Referral pathways

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
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