Nano White Food and the Reproduction of Whiteness

<h2>Abstract</h2><h3>Purpose</h3> Revised Australian guidelines for heart health checks (cardiovascular disease [CVD] risk assessment) provide an opportunity to better support shared decision-making with Aboriginal and Torres Strait Islander communities. Various models and tools have been developed to support shared decision-making, but their usefulness for Aboriginal and Torres Strait Islander communities has not been well explored. Aboriginal and Torres Strait Islander health workers/practitioners already play a key role in health promotion, and could support shared decision-making about the new guidelines. This study explored the experiences of Aboriginal and Torres Strait Islander community members (consumers) and health workers/practitioners (health professionals) on shared decision-making in the context of cardiovascular disease prevention, to inform the development of new guideline resources. <h3>Methods</h3> An online yarning workshop with Aboriginal and Torres Strait Islander community members (consumers) was conducted in 2022 to introduce them to shared decision-making resources. This was followed by individual yarning sessions with nine consumers and eight Aboriginal and Torres Strait Islander health workers/practitioners. Interview transcripts were analysed using a yarning process and thematically coded. <h3>Main findings</h3> The workshop was used to build rapport and introduce participants to key concepts through shared stories and a demonstration of shared decision-making tools. For consumers, sharing stories about healthcare identified several themes associated with good experiences, including: rapport, continuity, culturally appropriate communication, addressing health literacy needs and different ways of being involved in shared decision-making. Aboriginal and Torres Strait Islander health workers/practitioners explained how they already support shared decision-making about CVD prevention, including pre-screening for CVD risk factors and providing culturally safe healthcare. They also identified opportunities for a greater role in CVD risk assessment for heart health checks, to enable health promotion and education for early prevention. <h3>Principal conclusions</h3> Existing tools and models to support shared decision-making about CVD need to reflect a more holistic model of care for Aboriginal and Torres Strait Islander communities, including cultural considerations. Including Aboriginal and Torres Strait Islander health workers/practitioners in cardiovascular disease risk assessment may provide a more culturally safe and appropriate environment in which to enable shared decision-making about heart health checks.

IntroductionNew Australian guidelines for heart health checks released in 2023 present an opportunity to better support shared decision making with Aboriginal and Torres Strait Islander communities. This project explored the...

Ngaaminya (find, be able to see): summary of key findings from the Which Way? project

Objective Health practitioners' Codes of Conduct and Codes of Ethics articulate practice standards across multiple domains, including the domain of cultural safety. As key tools driving individual practice and systems reform, Codes are integral to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It is, therefore, critical that their contents specify meaningful cultural safety standards as the norm for institutional and individual practice. This research assessed all Codes for cultural safety specific content. Methods Following the release of the Australian Health Practitioner Regulation Agency's (Ahpra) Health and Cultural Safety strategy 2020-25, the 16 Ahpra registered health practitioner Board Codes of Conduct and professional Codes of Ethics were analysed by comparing content to Ahpra's new cultural safety objectives. Two Codes of Conduct, Nursing and Midwifery, met these objectives. The Aboriginal and Torres Strait Islander Health Practitioners Code partially met these objectives. Results Most Codes of Conduct (14 of 16) conflated Aboriginal and Torres Strait Islander peoples with culturally and linguistically diverse (CALD) communities undermining the sovereignty of Australia's First Peoples. Eleven professions had a Code of Ethics, including the Physiotherapy Code of Conduct, which outlined the values and ethical principles of practice commonly associated with a Code of Ethics. Of the 11 professions with a Code of Ethics, two (Pharmacy and Psychology) articulated specific ethical responsibilities to First Peoples. Physiotherapy separately outlined cultural safety obligations through their reconciliation action plan (RAP), meeting all Ahpra cultural safety objectives. The remaining eight advocated respect of culture generally rather than respect for Aboriginal and Torres Strait Islander cultures specifically. Conclusions The review identified multiple areas to improve the codes for cultural safety content for registered health professions, providing a roadmap for action to strengthen individual and systems practice while setting a clear regulatory standard to ensure culturally safe practice becomes the new norm. It recommends the systematic updating of all professional health practitioner Board Codes of Conduct and professional Codes of Ethics based on the objectives outlined in Ahpra's Cultural Safety Strategy. What is known about the topic? Systemic racism and culturally unsafe work environments contribute to poor health outcomes for Aboriginal and Torres Strait Islander peoples. They also contribute to the under-representation of Aboriginal and Torres Strait Islander peoples in the health workforce, denying the system, and the people who use and work in it, much needed Indigenous knowledge. Creating a culturally safe healthcare system requires all health practitioners to reflect on their own cultural background, to gain appreciation of the positive and negative impacts of individually held cultural assumptions on the delivery of healthcare services. Competence in cultural safety as a required standard of practice is therefore essential if broad, sustainable and systemic cultural change across the health professions and ultimately across Australia's healthcare system is to be achieved. Given that Codes of Conduct and Codes of Ethics are integral in setting the practical and moral standards of the professions, their contents with respect to cultural competence are of great importance. What does this paper add? A review of this type has not been undertaken previously. Following the establishment of the Ahpra Aboriginal and Torres Strait Islander Health Strategy Group, release of Ahpra's 2018 Statement of intent, and the 2019 Aboriginal and Torres Strait Islander Health and Cultural Safety strategic plan and Reconciliation Action Plan, we analysed the content of each of the 16 registered health professions Codes of Conduct and Code of Ethics looking for content and guidance in accordance with the new national cultural safety definition. Several opportunities to improve the Codes of Conduct and Codes of Ethics were identified to realise the vision set out in the statement of intent including through the application of the National Law. This analysis provides a baseline for future improvements and confirms that although some current health practitioner Codes of Conduct and Codes of Ethics have begun the journey of recognising the importance of cultural safety in ensuring good health outcomes for Australia's Indigenous peoples, there is broad scope for change. What are the implications for practitioners? The gaps identified in this analysis provide a roadmap for improvement and inclusion of Aboriginal and Torres Strait Islander Health and cultural safety as a required standard in Codes of Conduct and Codes of Ethics for all registered health practitioners. Although it is recognised that Codes alone may not change hearts and minds, codifying the clinical competency of cultural safety provides a portal, and a requirement, for each individual practitioner to engage meaningfully and take responsibility to improve practice individually and organisationally.

Objectives Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers play an important, often critical role providing advocacy and cultural and emotional support for Aboriginal and Torres Strait Islander patients. The main goals of this research are to explore i) how Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers are integrated in the routine delivery of care for Aboriginal and Torres Strait Islander peoples in hospital, and ii) how the role of Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers facilitates quality health outcomes. Methods This study is being conducted in three different hospitals using a multi-method approach including: yarning and Dadirri, patient journey mapping, survey and semi-structured interviews. Ethics approval has been provided from four ethics committees covering the three project sites in Australia (Adelaide, South Australia; Sydney, New South Wales and Alice Springs, Northern Territory). Significance This study uses innovative methodology founded on the privileging of Aboriginal and Torres Strait Islander knowledges to collect Aboriginal and Torres Strait Islander perspectives and understand patient journeys within acute health care systems. This project is led by Aboriginal and Torres Strait Islander researchers and guided by the Project Steering Committee comprised of stakeholders. Implications There is limited research that explores quality acute care processes and the integration of Aboriginal and Torres Strait Islander Health Workers/Practitioners work within health care teams. This research will make a valuable contribution to understanding how hospital services can achieve quality acute health care experiences for Aboriginal and Torres Strait Islander People.

[Extract] The recent article by Parker presents an interesting case for the establishment of a national academic college of Aboriginal and Torres Strait Islander health. The notion has been considered within Aboriginal health policy forums in the past, and the federal parliamentary Inquiry into Indigenous Health noted that an exploration of the merits of creating a new medical specialty for health care providers to Aboriginal and Torres Strait Islander peoples was arguably favourable. On the other hand, the concept has not gained significant support from some existing medical colleges. Broadly, the arguments supporting a college of Aboriginal and Torres Strait Islander health are that the subject is a national health priority, the subject has its own specialised literature, practice within an Aboriginal cultural framework is a specialised activity, technical aspects of health care delivery often require specialist knowledge, and providers of health care for Aboriginal and Torres Strait Islander peoples often act as consultants for other practitioners and policy development. The contrary view is that Aboriginal and Torres Strait Islander health is a health science sub-discipline within general practice, and that existing structures satisfy training needs.

In this paper I will describe some of the sentinel events in Aboriginal and Torres Strait Islander health policy and strategy during 2003 and the early part of 2004. This will involve discussion on the:• National Strategic Framework in Aboriginal and Torres Strait Islander Health• National Strategic Framework for Aboriginal and Torres Strait Islander Peoples Mental Health and Social and Emotional Well Being 2004–2009• National Aboriginal and Torres Strait Islander Health Performance Framework• The roll-out of the Primary Health Care Access Program• The National Aboriginal and Torres Strait Islander Social Survey and the National Indigenous Health SurveyThese developments are consistent with a policy agenda that has evolved, in general terms, since the release of the National Aboriginal Health Strategy in 1989. However, I will also consider significant developments in the broader context for Aboriginal and Torres Strait Islander affairs, particularly the decision made in early 2004 by the Howard government to abolish the Aboriginal and Torres Strait Islander Commission (ATSIC). While the key events and developments that are reported in this paper elaborate on an agenda that has been developing for more than a decade, the decision to abolish ATSIC is likely to have a revolutionary impact on the future development of Aboriginal health strategy.

Australian Aboriginal peoples are the oldest living culture in the world, with Euro-Western academic research and science currently dating a continuing connection to Country at over 75 000 years.1 Aboriginal and Torres Strait Islander birthing practices have been critical to the oldest living culture, comprising a living discipline with origins that predate Euro-Western medicine by millennia and continue to foster environments for Aboriginal and Torres Strait Islander peoples to thrive.2 However, the ongoing nature of colonisation, associated policies and systemic racism3 continue to impact Aboriginal and Torres Strait Islander peoples today, including maternal and child health outcomes.4 One factor contributing to this is smoking, which has been systematically embedded through colonisation. Colonisers used tobacco to exploit Aboriginal and Torres Strait Islander peoples’ labour and services, providing tobacco as payment in lieu of wages and in rations until the late 1960s. This entrenched smoking among Aboriginal and Torres Strait Islander peoples.5 The mechanics of colonisation also increase exposure to the basic causes or drivers of tobacco use, including economic and educational exclusion.6 Such racialised inequities result in Aboriginal and Torres Strait Islander smoking during pregnancy being over three times higher than among their non-Indigenous counterparts.5 Identifying culturally safe and acceptable strategies that increase effectiveness for Aboriginal and Torres Strait Islander women to quit smoking are urgently required. However, appropriate evidence to inform smoking cessation care, particularly during pregnancy, drawn from Indigenous peoples is scarce. Evidence included in this MJA supplement aims to privilege Aboriginal and Torres Strait Islander women in the development of Indigenous-led evidence on smoking cessation care.7, 8 Most health care providers have and will continue to encounter Aboriginal and Torres Strait Islander peoples in their daily practice. As such, identifying respectful and effective strategies that resonate with Aboriginal and Torres Strait Islander peoples to quit tobacco use, particularly during pregnancy, through health care systems are required. Researchers and clinicians have conducted qualitative,9-13 quantitative14-16 and pilot trials17-19 and one randomised trial20 to develop an evidence base to address the disproportionate smoking rates experienced by Aboriginal and Torres Strait Islander women during pregnancy. All trials have incorporated health provider smoking cessation training and resources for women and health providers and offered nicotine replacement therapy to pregnant women who we unable to quit unaided.17-20 Two included peer support groups and financial incentives.18, 19 One considered the wider social and economic context of smoking in pregnancy and tailored supports to incorporate broader support services for women.19 However, to date no trial has been able to report effective strategies to empower smoke-free pregnancies and the evidence base is still lacking. Research and evaluation are particularly important to better tailor supports for Aboriginal and Torres Strait Islander peoples, especially given the diverse language, social and nation groups. Research has the potential to quantify the nature and characteristics of smoking in pregnancy and what types of smoking cessation supports resonate with Aboriginal and Torres Strait Islander women.21 Generally, data from diverse nation groups across Australia report smoking characteristics as a binary outcome (yes/no). However, our previous research reports that Aboriginal and Torres Strait Islander women are making multiple quit attempts during pregnancy,22 with national data commonly failing to accurately detail such nuance in the quitting journey that can be critical to guiding best practice. Given the lack of Indigenous-specific evidence and the substantial room for improvement in health outcomes, the Which Way? study, reported in this supplement of the MJA,7, 8 aims to address an urgent need to better understand smoking, for and by Aboriginal and Torres Strait Islander women, using community-led research questions informed through an Indigenous lens.23 In the words of Linda Tuhiwai Smith: When Indigenous peoples become the researchers and not merely the researched, the activity of research is transformed. Questions are framed differently, priorities are ranked differently, problems are defined differently, people participate on different terms.24 The foundations of Which Way? are derived from Aboriginal and Torres Strait Islander-led research which recognised that Aboriginal and Torres Strait Islander women want to quit smoking and are interested in non-pharmacological options to be smoke-free.22 The project aims to build an Indigenous-led evidence base for culturally responsive smoking cessation care and to inform policymakers and health service providers on how improvements can be made to the health and wellbeing of Aboriginal and Torres Strait Islander mothers and babies. Which Way? is a culturally responsive, co-designed and co-owned study with urban and regional Aboriginal communities in New South Wales.25 The study is consistent with the United Nations Declaration on the Rights of Indigenous Peoples,26 the World Health Organization Framework Convention on Tobacco Control,27 and the updated Aboriginal Health and Medical Research Council guidelines for ethical research with communities.28 This national cross-sectional survey was developed through collaborative, community-driven processes with partnering communities to understand community-led research questions, address current knowledge gaps, and refine content and questions for relevance, cultural acceptability and sensitivities. This process was iterative and completed during COVID-19 lockdowns. The survey was developed and then approved by community partners, and included pilot testing with 15 Aboriginal women known to the research team before going live. Online recruitment for research of this sensitive nature was not common research practice in Aboriginal and Torres Strait Islander health research at the time of recruitment, but we recognise that COVID-19 has also driven significant changes in innovative recruitment processes. As such, establishing trust and rapport, and highlighting social accountability in this research was critical. All Aboriginal community partners shared posts recruiting participants in the study. Sharing of posts was also supported by peak bodies, such as the National Aboriginal Community Controlled Health Organisation. The project also utilised paid advertisement and sharing via community pages such as Tiddas for Tiddas, to increase reach and provide the opportunity to participate, particularly for Aboriginal and Torres Strait Islander women who did not use or follow an Aboriginal health service. Indigenous governance and meaningful engagement of Aboriginal and Torres Strait Islander peoples informed the analysis and reporting but was embedded from conception to reporting the study findings, consistent with the United Nations Declaration on the Rights of Indigenous Peoples and the Framework Convention on Tobacco Control. Australia is a party to the Framework Convention on Tobacco Control, which details the need for Aboriginal and Torres Strait Islander peoples to be engaged in the development, implementation and evaluation of tobacco control programs. The analysis and reporting process privileged Aboriginal and Torres Strait Islander voices, knowledges and experiences, particularly communities as the knowledge holders, to address the health and wellbeing of their peoples. In facilitating meaningful analysis and interpretation, an iterative analysis process was undertaken in partnership with community partners and guided by an Indigenous-led analysis team. Preliminary findings were initially exported using REDCap electronic data capture software, and summarised for community partners. Lead researcher (MK) provided presentations to community partners for response and direction, including prioritising analysis in an iterative process. All analysis plans were driven by community partners’ questions, and only community relevant factors were reported. Shifting from problem-based to solution-focused Aboriginal and Torres Strait Islander-led tobacco control enacts Indigenous sovereignty to be ultimately free from nicotine dependence and related death and disease. In the words of Walter and Anderson: From an Indigenous ontology the more important question is not what differences exist, but why? A reversing of the ontological lens would compel different questions in a different research agenda.23 The Which Way? project upholds the prioritisation of the CONSIDER statement29 and acknowledges the need for transparency of research practice (Box). Governance: The community governance committee oversees all aspects of the research, guiding and strengthening the research process and ensuring all conducted research is held accountable. This means the research is Aboriginal-led, Aboriginal-owned, and upholds the prioritisation of Aboriginal communities. Prioritisation: Strong community partnerships are developed and sustained through ongoing respect, consultation and appropriate dissemination of research and continued transparency with all communities. The research priorities are built on community strengths, interests, and worldviews. Development of lasting relationships with partnered community services and engagement of staff and community at all services ensures research aims address specific community priorities. Methodology: The research acknowledges the importance of building on gulbanha (knowledge), to ensure the research is relevant and meaningful to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples. Indigenous knowledges are the processes and the outcome of the research. Participation: The seeking of individual and community consent is imperative to mitigate the burden placed upon both the individual and the communities involved in the research. This upholds Indigenous data sovereignty, and ensures the safety and security of participants remains unidentified throughout the research. Capacity: Guidance and mentorship is woven through the research process at every level. Capacity building is enabled through the mentorship of two Aboriginal and Torres Strait Islander medical students working as research assistants throughout the research. Through respectful relationships with partnering communities, 360° learning and knowledge sharing is offered, to build capacity within the academy in Indigenous and wellbeing, as well as in the health sector with diverse community health needs, research design and implementation, knowledge translation, and health promotion. This is reflected through, but not limited to, authorship opportunities and governance committee membership. Analysis and interpretation: Aboriginal and Torres Strait Islander communities direct the analysis and interpretation that is then undertaken by an Indigenous-led team. Dissemination: Accountability of the research is upheld through monthly updates and consultation with partnering services, governance committees and communities. Ongoing translation plans are co-developed with the research team, governing bodies and community partners to appropriately acknowledge the wisdom, leadership and expertise of partnering communities in developing an Indigenous-led evidence base for smoking cessation care. Outcomes of this research have been presented through a range of webinars with peak bodies (Cancer Institute NSW, the Aboriginal Health and Medical Research Council, the Victorian Aboriginal Community Controlled Health Organisation). We have also developed infographics for community to share, and have developed and conducted workshops for Tackling Indigenous Smoking teams nationally. The Which Way? study reported in this MJA supplement highlights the need to embed culturally safe care, including cessation supports, into everyday practice. The study also provides an example of how research in Aboriginal and Torres Strait Islander contexts can be undertaken in a “good way”, with Aboriginal and Torres Strait Islander communities. Michelle Kennedy is funded by an NHMRC Early Career Fellowship, grant number 1158670. This study was funded by the National Heart Foundation Aboriginal and Torres Strait Islander Award, grant number 102458. The funding bodies were not involved in the conduct of this research. We acknowledge the partnering services and staff for their time and commitment to this long term project, including the Dhanggan Gudjagang team, Yerin Eleanor Duncan Aboriginal Health Centre, Tamworth Aboriginal Medical Service, Nunyara Aboriginal Health Clinics, and Waminda South Coast Women’s Health and Welfare Aboriginal Corporation. We also acknowledge all the Aboriginal and Torres Strait Islander women who contributed to this research project — thank you for sharing your experiences with us, it is our honour to privilege your voices. Open access publishing facilitated by The University of Newcastle, as part of the Wiley - The University of Newcastle agreement via the Council of Australian University Librarians. No relevant disclosures. Commissioned; externally peer reviewed.

Describe perceptions of how well researchers conducting Aboriginal and Torres Strait Islander health and medical research apply ethical research practices. Cross-sectional online survey. Researchers who included Aboriginal and Torres Strait Islander people or their data in their projects, and current or past members (previous 5 years) of a human research ethics committee that assessed Aboriginal and Torres Strait Islander research. Researchers' engagement with 15 ethical research practices (on a 5-point Likert scale, poor to excellent). 561 participants (382 researchers [68.1%] and 179 human research ethics committee members [31.9%]) completed the survey. Across all research practices, a rating of excellent was least frequently endorsed, with the highest frequency being for employing Aboriginal and Torres Strait Islander team members (38 participants [6.8%]). A rating of poor was most common for enacting Indigenous data sovereignty and governance principles (156 participants [27.8%]). Aboriginal and Torres Strait Islander respondents had significantly lower odds of perceiving high levels of adherence to ethical principles than non-Aboriginal and Torres Strait Islander respondents for all ethical principles, except employing Aboriginal and Torres Strait Islander team members. In particular, Aboriginal and Torres Strait Islander participants had 65% lower odds of perceiving that researchers have high rates of adhering to disseminating results back to the community (odds ratio [OR], 0.35; 95% CI, 0.22-0.57), 56% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in research implementation (OR, 0.44; 95% CI, 0.27-0.73), and 54% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in developing research questions (OR, 0.46; 95% CI, 0.28-0.75). Researchers are not consistently implementing all ethical practices outlined in guidelines for research involving Aboriginal and Torres Strait Islander people. We call for commitment from researchers, institutions and funding bodies to address shortfalls, embed processes, and hold researchers accountable to Aboriginal and Torres Strait Islander people, communities and the principles and guidelines they have established.

Most Aboriginal and Torres Strait Islander young people are able to promote their wellbeing by harnessing cultural, community and personal strengths despite the immense challenges of ongoing colonisation, racism and socioeconomic disadvantage. The Aboriginal and Torres Strait Islander health assessments can be an effective way of identifying previously undetected social and emotional wellbeing, and other health concerns, but have low uptake among young people and are often adult oriented. This study aimed to explore young Aboriginal and Torres Strait Islander people's perspectives on appropriate content of Aboriginal and Torres Strait Islander health checks. This qualitative study was conducted using a Dadirri Indigenist methodology, and semi-structured and focus group interviews with Aboriginal and Torres Strait Islander young people aged 12-25years from the Inala community in south-east Queensland. We used reflexive thematic analysis to analyse interview and focus group data. Oversight was provided by a youth advisory group and the Inala Community Jury for Aboriginal and Torres Strait Islander Health Research. We interviewed 14 participants in three focus groups and four individual semi-structured interviews. Young people reported strength in culture, family relationships and autonomy in their daily lives. Threats to social and emotional wellbeing in the context of racism and ongoing colonisation included domestic violence, not having the words or safe space to discuss traumatic emotions, and described substance use as a response to trauma. Many were sceptical of mental health questionnaires and preferred open-ended conversations. Participants wanted health checks to start with identity and cultural connection, ask meaningful questions about mental health, food security, daily routine, and be conducted in a yarning style by trusted Aboriginal or Torres Strait Islander health workers of the same gender as the young person having the health check. Health checks can be done in a way that leave young Aboriginal and Torres Strait Islander people feeling uncomfortable, confused, and avoidant of future health care. A shift is needed from transactional, tick-box approaches to relational, culturally safe practices. Youth-centred health checks should be co-designed and delivered by trusted Aboriginal and Torres Strait Islander health workers.

Clinical relevance To meet accreditation requirements to embed Aboriginal and Torres Strait Islander health into optometry curricula, educators would benefit from access to a curated repository of high-quality resources. Background Since 2023, Australian and Aotearoa/New Zealand optometry programmes have been required to teach and assess students’ competency to provide culturally safe care for First Nations Peoples. This study aimed to develop consensus-based guidelines for creating an online repository of Aboriginal and Torres Strait Islander health educational resources to support optometry educators. Methods A modified Delphi study was conducted over five months, involving up to three rounds of consensus-building. The first two rounds consisted of online surveys addressing repository content, structure, maintenance and governance. The third round was a video-conference workshop facilitated by an Aboriginal subject expert. Results Following round one, 66 unique responses were collated for prioritization. By the end of round three, stakeholders agreed on 12 recommendations. A key recommendation was that the repository structure align with the Optometry Aboriginal and Torres Strait Islander Health Curriculum Framework. The Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) Guide to Evaluating and Selecting Education Resources was recommended for assessing resource quality. While strengths-based resources were prioritised, deficit-based resources could be included if their purpose was clearly contextualised (e.g. to illustrate racism). Governance was recommended to include Aboriginal and Torres Strait Islander members, alongside members with teaching expertise and cultural safety training. Conclusion Collaboration between non-Indigenous and Aboriginal and Torres Strait Islander stakeholders, with prioritisation of Aboriginal and Torres Strait Islander voices, was critical in establishing trust and commitment. These consensus-based guidelines will support the development of an effective online repository for optometry educators.

Ten years have passed since the release of the final report of the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH),1 a landmark document that provided a global blue‐print for the health promotion community and the stakeholders we work with. Three overarching recommendations were outlined, improving daily living conditions; tackling the inequitable distribution of power, money and resources; and measuring and understanding the problem and assessing the impact of action.1 The extent to which progress has been, and continues to be, made is contested. This editorial briefly reflects on what has been achieved over the past decade—in broad terms—about action on the social determinants of health (SDH) in Australia. We deliberately take a balanced view by highlighting the weaknesses and strengths in what has been achieved by governments, non‐government organisations, research institutions, peak bodies and civil society. We also reflect on the ongoing role that the Australian Health Promotion Association (AHPA) has played in advancing our understanding about, and action on, the SDH.

Background: Racism is responsible for health inequity and the harm perpetrated upon Aboriginal and Torres Strait Islander peoples by white institutions, building on attitudes and beliefs dominated by assumptions of white superiority. The National Aboriginal and Torres Strait Islander Health Curriculum Framework ‘Curriculum Framework’, released in 2014, was introduced to provide a framework for nursing programs and included the introduction of discrete Aboriginal and Torres Strait Islander health courses to draw attention to the relationship between racism health outcomes of Aboriginal and Torres Strait Islander peoples within health care settings. Methods: Using an Indigenist research paradigm with Colonial Critical Race Theory as the methodology and framework, this study presents a document analysis of discrete Aboriginal and Torres Strait Islander health courses taught in undergraduate nursing programs at 31 Australian Universities. Results: This work draws on the collective activism of Aboriginal and Torres Strait Islander nurses in challenging the systemic racism embedded in the Australian nursing curriculum. We demonstrate the utility of the Racial Segregation Audit Tool (RSAT), as an innovative approach to identify and respond to racism embedded in course learning outcomes. Conclusions: This study explores and uncovers how the learning outcomes assert the social construction of race as a tool of oppressive segregation.

Introduction Many Australian university medical schools have struggled over the past decade to implement the professional standards and guidelines in Aboriginal and Torres Strait Islander health into their already crowded curricula. Bond University was no exception – with good intent but mixed results. In 2012 Bond renewed it medical program curricula and developed an innovative Aboriginal and Torres Strait Islander health education program, which is experiencing great success. Methodology The methodology included: establishing an Aboriginal and Torres Strait Islander health group (n=9); undertaking an extensive mapping process of the learning outcomes (n=63) from the standards and guidelines set by the profession; fleshing out the content which was allocated to years, semesters, and cases; developing an innovative implementation process based on a set of principles, and using structured program evaluation and a 5 year longitudinal study to measure the impact. Results Bond are now in their fifth year of implementing the Aboriginal and Torres Strait Islander health education with an innovative program that includes cultural immersion in the first year, problem based learning through identified cases, innovative processes for teaching difficult issues such as racism, as well as a structured assessment processes. Conclusion Aboriginal and Torres Strait Islander health is a well-integrated and accepted part of the normal medical curriculum and assessment process. Employing the right people, undertaking the extensive mapping process, having a documented implementation plan that all staff and students understood and accepted, based on the standards and guidelines of the profession, supported by strong leadership was critical for success.

Ian Anderson: transforming Indigenous medicine and education