(Photo by Chris Olszewski via Wikimedia Commons/CC BY-SA 4.0)
Health is shaped by far more than biology. The environments people grow up in, the stability of their housing, the level of education they can access, the income they earn, and how easily they can reach and use health services all contribute to their overall well-being. For Aboriginal and Torres Strait Islander Peoples in Australia, cultural and relational determinants accompany general ones. These include identity, family and kinship, country, knowledge and beliefs, language, access to traditional lands, and participation in cultural activities. Together, these elements form the foundation of individual and community health, each influencing the other.
Yet, despite their centrality to Australian life and culture, many Indigenous People continue to confront deep-rooted inequality, political marginalisation, intergenerational trauma and the ongoing manifestations of institutional racism.
To overcome such inequalities, the Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organizations have come together to develop the 2020 National Agreement on Closing the Gap. Through this Agreement, they committed to rebuilding the way policies affecting Indigenous Peoples are designed and delivered. Their goal is to ensure that Aboriginal and Torres Strait Islander Peoples can enjoy the same life expectancy, wellbeing and opportunities as non-Indigenous Australians.
The Agreement lays out four areas for reform and socioeconomic targets to measure not only health outcomes but also lived experiences. Despite this national commitment, healthcare remains one of the areas where inequity is most visible.
Colonization and the Foundations of Health Inequality
The health landscape for First Nations today cannot be understood without acknowledging the long shadow of colonisation. The arrival of settlers brought widespread violence, dispossession and introduced diseases that devastated Indigenous populations. Land occupation by settlers and the confinement of Indigenous people to “reserves” disrupted cultural practices and traditional systems of care, fracturing communities’ ability to sustain themselves physically and socially.
The forced removal of children compounded this trauma, severing ties to family, culture and identity. The consequences of these policies did not end with those who lived through them but continue to reverberate through generations.
Colonial systems left a damaging legacy in healthcare. One particularly stark example can be seen in the Lock Hospitals. These institutions, framed as ones for public health, were brutal tools of racial control, surveillance and protecting colonial regimes. Indigenous Peoples were removed to distant islands, often without proper diagnosis or treatment, and children were sometimes taken by the same officials who forcibly relocated adults. Patients were even shackled with neck chains—a practice defended by senior medical authorities.
The effects of these policies continue to influence the relationships between Indigenous Peoples and mainstream healthcare, with patterns of distrust, the avoidance of medical services and the persistence of unequal treatment.
How Mainstream Healthcare Continues to Fail Indigenous Communities
Many Indigenous Peoples still encounter discrimination when seeking medical care. Reports of being dismissed, stereotyped or provided inadequate treatment remain common, and reinforce a sense of exclusion. The consequences of this systemic failure are evident.
In 2018, the overall burden of disease for Aboriginal and Torres Strait Islander Peoples was more than double that of non-Indigenous Australians. Additional hurdles to access to good healthcare include geography, costs, limited service availability and a shortage of culturally safe practitioners. Many Indigenous communities live with higher rates of preventable illnesses and premature mortality than those in urban settings.
Another key indicator that shows the disparities in health between Indigenous and non-Indigenous Australians is life expectancy. Between 2020 and 2022, life expectancy at birth was estimated at 71.9 years for Indigenous men and 75.6 years for Indigenous women. This represents a gap of about 8.8 years for men and 8.1 years for women compared with non-Indigenous Australians.
As Indigenous leaders and advocates have repeatedly emphasized, truth-telling, education about colonial impacts, and meaningful self-determination are essential to changing these patterns. Health is not simply a matter of medical treatment. For First Nations people, well-being is grounded in culture and tradition. Therefore, when health systems overlook these foundations, the result is not only inadequate care but a continuation of the very inequalities the Closing the Gap Agreement seeks to dismantle.
Aboriginal Community Controlled Health Organisations Lighting The Way
In response to these persistent inequalities, Aboriginal Community Controlled Health Organisations (ACCHOs) emerged as a community-driven alternative to mainstream health services. Their creation was not merely a policy initiative but an expression of self-determination, an assertion that Indigenous communities are best placed to provide the care they need.
ACCHOs offer holistic, culturally grounded healthcare that extends beyond clinical treatment. They integrate physical, social, emotional and spiritual wellbeing, recognising that health cannot be separated from culture, family or country. Because they are governed and operated by the communities they serve, ACCHOs also foster environments where Aboriginal and Torres Strait Islander Peoples feel respected, understood and safe. This sense of cultural security is central to improving health outcomes.
As Indigenous leaders have articulated, community-controlled health embodies a way of working from the ground up. Indeed, the ACCHOs model is built on strong governance, integrated clinical care, community-informed policy and programs, and a commitment to promoting empowerment and wellness across generations. It demonstrates, in practical terms, how health systems can function when communities are not passive recipients of services but active designers and decision-makers.
Case Study: Akeyulerre Healing Centre
ACCHOs demonstrate how community-led health services are only one part of a broader ecosystem of culturally grounded approaches to wellbeing. Many Indigenous communities also draw strength from cultural healing centres, which focus not only on physical health but on the deeper social and emotional foundations that keep individuals, families and communities strong. These spaces show, in a very practical way, how cultural knowledge, connection and community authority can address various intertwined health challenges that mainstream services often fail to meet.
The Akeyulerre Healing Centre offers a powerful example of what culturally driven healing looks like in practice. Situated in Alice Springs (Northern Territory), the centre was created by Arrernte Peoples for Arrernte Peoples, and embraces cultural knowledge and practice as the core of its work. It supports traditional healers (called Angangkere), whose expertise is sought by families across Central Australia. The centre also produces bush medicine and brings people of all generations together to strengthen cultural pride and identity.
Akeyulerre’s work also extends to a dedicated Family Service that supports Arrernte families through culturally grounded, relationship-based work. The service walks alongside parents, carers and young people, helping them navigate challenges while staying anchored in culture, language and kinship. This includes everything from practical family support to strengthening cultural identity, reconnecting with the land and nurturing social and emotional wellbeing that underpins healthy family life.
Akeyulerre offers an environment where Elders are honoured, young people can learn from those before them, and community members feel seen and valued. All decisions are guided by Arrernte law and cultural authority, ensuring the center remains a place where culture is lived rather than simply acknowledged. In doing so, it demonstrates how cultural revitalization, community strength, and Indigenous Law(s) are integral to mental health and broader wellbeing.
Towards a System Rooted in Self-Determination
Improving First Nations health requires more than incremental reform, but calls for a fundamental shift in how health systems are designed and governed. Community co-design must become the standard, not the exception, ensuring that programs reflect the priorities and cultural realities of the people they are intended to serve. ACCHOs need sustained and adequate funding so they can continue to provide comprehensive, culturally grounded care at the scale required.
Health policy must acknowledge and actively respond to cultural determinants of wellbeing—identity, kinship, ancestral ties and custodianship of Country. Health systems that ignore these factors reproduce the same paternalistic structures that have historically failed Indigenous Peoples. Cultural safety, respect and accountability must be central features of all healthcare settings. This means training non-Indigenous practitioners in culturally responsive practice, confronting systemic racism, and embedding self-determination as a guiding principle rather than an optional add-on.
Ultimately, health services must be shaped with communities, not simply for them. Only through genuine partnership, truth-telling and structural change can Australia begin to dismantle longstanding inequalities and support Aboriginal and Torres Strait Islander Peoples to live healthy, empowered and self-determined lives.
Edited by Gabrielle Andrychuk
