Indigenous Australians Research Articles

Abstract 4138813: The Use of Direct Oral Anticoagulants for Valvular Atrial Fibrillation in Central Australia

Background: In developed countries, valvular atrial fibrillation (vAF) in the setting of rheumatic heart disease (RHD) disproportionately impacts minority groups. In Australia, Indigenous Australians account for 92% of cases despite only representing 3.8% of the population. Studies to date, such as the INVICTUS trial, support the use of Vitamin K antagonists (VKAs) over direct oral anticoagulants (DOACs) in vAF. However, this assumes consistent adherence and regular clinic follow up. Reduced access to monitoring and dispensing clinics in Central Australia remains a challenge in the provision of VKAs and the use of DOACs may address this. Hypothesis: DOACs may be comparably effective with VKAs in preventing major adverse cardiac and cerebrovascular events (MACCE) in a real-world vAF population. Aim: To conduct a real-world retrospective observational study examining rates of MACCE for patients on VKAs or DOACs for vAF in Central Australia over a five-year period. Methods: The Northern Territory RHD Register was accessed to identify patients with RHD and vAF in January 2019. Demographic and five-year outcome data (until January 2024) were collected. The primary outcome was MACCE, a composite of ischaemic stroke, systemic embolism, non-fatal myocardial infarction, cardiovascular death and all-cause mortality. The primary safety endpoint was major bleeding. Statistical analyses were conducted as both intention-to-treat (ITT) based on initial anticoagulation and as-treated (AT) based on anticoagulation prior to MACCE or trial endpoint, each excluding patients without anticoagulation. Results: 61 patients were included. The mean age was 61.9 ± 13.9 years and 68.9% were female. At baseline, 65.6% received VKA, 14.8% DOAC and 19.7% were not anticoagulated. 30.6% of patients crossed over from the ITT analysis, with a non-significant trend favouring switch to DOAC (11 vs 0, p=0.09). In the ITT analysis (n=49), there was no significant difference in MACCE (25.0% vs 22.2%, p=0.86) or major bleeding (20.0% vs 11.1%, p=0.53) between VKA and DOAC groups. In the AT analysis (n=51), there was no significant difference in MACCE (27.3% vs 16.7%, p=0.39) or major bleeding (18.2% vs 22.2%, p=0.73) between VKA and DOAC groups. Conclusion: Over a five-year period, there was a trend towards use of DOACs over VKAs in vAF. This study demonstrates that DOACs may be as effective as VKAs for reducing MACCE in a real-world vAF population however further investigation is required.

The responsiveness and clinical utility of the Australian therapy outcome measure for indigenous clients.

The Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC) is a goal-setting tool designed to measure therapy outcomes with First Australians. It was originally developed and validated for use with First Australian children as a culturally responsive alternative to traditional western outcome measures. This research explored the applicability, responsiveness and clinical utility of the ATOMIC when used with First Australian adults attending an urban health service. Separate parallel studies investigated responsiveness and clinical utility. The first employed quantitative methods to investigate change over time via pre- and post-intervention data. The second employed a qualitative phenomenological approach to determine the clinical utility of the tool. Semi-structured interviews and focus groups were used, respectively, to understand the experience of using the ATOMIC from a client and clinician perspective. Client perspectives on the purpose of the tool and its alignment with their views on health care and therapists' perspective on the ease of use and applicability of the tool to the health service setting were explored. These data were analysed using reflexive thematic analysis. The methodological approach followed National Health and Medical Research Council (NHMRC, 2018) guidelines in considering cultural continuity, reciprocity and equity. This project was initiated and guided by Aboriginal and Torres Strait Islander leaders (the advisory group) as a prioritised need for a robust way of reporting outcomes to complement existing statistical and narrative data within a large community-controlled health service. The advisory group provided high level governance from project conception to conclusion and were involved in yarn-backs about research findings. Responsiveness: Wilcoxon test showed a statistically significant increase (P = 0.00) in ATOMIC scores pre- (mean = 1.8) and post- (mean = 8) intervention. Effect size (Cohen d) was deemed significant calculated at 2.1. Findings included: First Australian clients are adept at self-managing their conditions; the ATOMIC is a clinically useful outcome measure, which reflects this; ATOMIC is an acceptable tool to First Australian clients and clinicians and supports culturally responsive goal setting and occupational therapy practice. The Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC) was created to measure how well therapy works for First Australian children. This research investigates whether it also works with adult First Australians. Two studies were undertaken: a quantitative study to see whether ATOMIC scores changed before and after therapy and a qualitative study, which asked people what they thought about using the ATOMIC. ATOMIC scores went up after therapy, indicating it is sensitive to change, and both clients and therapists liked using the ATOMIC and found it useful. It matched well with how First Australian adults see health care and helped set goals for therapy. The results of the study show that the ATOMIC is helpful for both clients and therapists in understanding how well therapy works and helps to set goals that make sense culturally. This study looked at one health service in one regional area, so more research is needed to establish whether it works elsewhere. Overall, the results indicate the ATOMIC is a promising step towards better therapy for Indigenous Australians.

Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study

BackgroundTogether with addressing social determinants of health, culturally safe healthcare provision is essential for closing the health outcomes gap experienced by Aboriginal and Torres Strait Islander (Indigenous) Australians. Rural placements potentially provide students of the health professions with opportunities to enhance their knowledge and skills regarding cultural safety. We used rural placements data systematically collected from allied health students, including commencement- and end-of-placement questionnaire responses, to investigate the determinants of confidence in working with Indigenous people.MethodsThe study comprised data from all students who provided survey data at both commencement and end of their first placement directly supervised by the administering University Department of Rural Health during the period 2019–2022. Five-point ordered responses to the question ‘How confident do you feel about working with Aboriginal people?’ were used to assess student and placement-related determinants of confidence (Confident/Very confident versus other) at baseline and increased confidence (≥ 1 point) during the placement using crude and adjusted multivariable robust Poisson regression.ResultsParticipating students (N = 489) were from diverse allied health disciplines (including pharmacy n = 94, 19.2%; chiropractic n= 66, 13.5%; physiotherapy n= 65, 13.3%; social work n = 59, 12.1%; and occupational therapy 58, 11.9%). Confidence in dealing with Aboriginal people was lower at commencement among females compared with males (adjusted relative risk [aRR] 0.65; 95% confidence interval [CI] 0.53–0.80), and higher among students of Australian rural origin compared with others (aRR 1.49; CI 1.22–1.83) and those who reported previous experience working with Indigenous people compared with those reporting none (aRR 1.40; CI 1.14–1.72). Placement attributes associated with increased confidence working with Indigenous people between placement commencement and end were interaction with Indigenous people within the placement (aRR 2.32; CI 1.24–4.34), placement model reflecting more structured academic supervision (aRR 1.18; CI 1.02–1.37), and placement length (aRR per additional day 1.002; CI 1.001–1.004). These associations were robust to modelling that accounted for a ceiling effect on increased confidence.ConclusionsWhile influenced by students’ demographic attributes and prior experiences, confidence of allied health students in working with Indigenous people is enhanced during rural placements, particularly through direct contact with Indigenous people.

From Black squares to White guilt: The influence of Black Lives Matter on non-Indigenous views of the Voice to Parliament referendum in Australia

This article examines the impact of the global Black Lives Matter (BLM) movement on decolonization efforts in Australia, focusing on non-Indigenous Australians’ attitudes towards the Voice to Parliament (VtP). This study utilized surveys (122 respondents) and interviews (11) with predominantly non-Indigenous Australians, conducted before the October 2023 VtP referendum. We found that the BLM movement did not bridge the gap between Indigenous and non-Indigenous Australians. Instead, the research highlights a highly polarized environment, particularly evident in the discourse surrounding the VtP referendum. Factors such as the lack of truth-telling regarding Australia's colonial history, media bias, community segregation and political polarization created a complex association between BLM and stances on the VtP. A promising result is that individuals who recognized the link between BLM and challenges faced by Indigenous Australians were more likely to support the VtP. The overall findings indicate that Australia has a way to go towards true reconciliation.

Assessing the adequacy and sustainability of the Northern Territory health workforce with respect to burden of disease and injury, 2009-2021: an analysis of administrative data.

To assess the adequacy of the Northern Territory health workforce with respect to population size and burden of disease, overall and by selected health specialties; to assess its sustainability by investigating changes in workforce numbers. Analysis of Australian Health Practitioner Regulation Agency (AHPRA) health workforce data (2013-2021) and burden of disease data (disability-adjusted life-years, DALYs) drawn from national and NT burden of disease studies (and projected for 2019-2021). NT and Australian health workforces, 2009-2021. Adequacy of the NT health workforce, assessed as the ratio of the mean annual numbers of NT health workers per 1000 population or health workers per 1000 DALYs (2009-2013 and 2014-2018) to those of the Australian workforce (2013 and 2018); sustainability of the NT health workforce, defined as the number of health workers per 1000 population or per 1000 DALYs increasing between 2013 and 2021. The number of health workers per 1000 population was slightly higher in the NT than for Australia in both time periods (2009-2013 v 2013: 23.30 v 21.79 per 1000 population, 6.9% larger; 2014-2018 v 2018: 25.79 v 23.47 per 1000 population, 9.9% larger); however, it was smaller with respect to burden of disease (2009-2013 v 2013: 82.6 v 107.4 health workers per 1000 DALYs, 23.1% fewer; 2014-2018 v 2018: 91.5 v 117.1 per 1000 DALYs, 21.8% fewer). In particular, 464 more nurses and midwives (11.4% more than the mean for 2013-2021), 196 more physiotherapists (115%), 189 more psychologists (102%), 152 more pharmacists (79%), and 144 more dentists (106%) are needed in the NT to match the corresponding numbers of health workers by disease burden for Australia as a whole. The number of Aboriginal health practitioners per 100 000 DALYs fell during the study period. Health worker population density alone does not reliably assess health workforce needs; burden of disease information is important for workforce planning that meets population health needs. The NT health workforce needs to be increased by about 28% to reflect the population burden of disease and injury. Shortages in the NT health workforce must be eliminated to close health gaps between Indigenous and non-Indigenous Australians.

Indigenous Australians, genomics, and the law

This article utilises three key characteristics of human genetic information—namely, its ubiquitous nature, its familial relationships and its predictive capacity—to explore how such research continues to exacerbate existing health inequalities for Indigenous Australians. By utilising substantive equality as its theoretical framework, this article explores key regulatory issues as follows: first, and regarding genetic information’s ubiquity, the article discusses how property laws in Australia fail to adequately protect Indigenous Australians from unauthorised usage of historical DNA samples; second, the familial nature of genetic information can leave Indigenous Australian’s liable to hyper-precise genetic definitions of Aboriginality, leading to a potentially adverse impact on claims of Native Title, due to the application of a biological definition to something which has always been more contextual and flexible; finally, the predictive element of genetic information is explored, and it is suggested that without proper regulation, could lead to increased genetic discrimination.

Physical activity interventions to prevent and manage type 2 diabetes in Aboriginal and Torres Strait Islander people: a systematic review.

To review evidence regarding the impact of physical activity interventions for preventing and managing type 2 diabetes in Aboriginal and Torres Strait Islander Australians. We searched for published reports of physical activity interventions for preventing and managing type 2 diabetes in Indigenous adults (18 years or older). There were no exclusion criteria regarding study type or duration, frequency, length, or intensity of physical activity, except that short term interventions were excluded. We assessed the quality of each study using the Joanna Briggs Institute (JBI) critical appraisal tools and the ethical and methodological quality of studies from an Indigenous Australian perspective with the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) Critical Appraisal Tool. MEDLINE; Scopus, Embase (Elsevier); Cumulative Index to Nursing and Allied Health Literature (CINAHL), Sports Discus, PsycINFO (EBSCO); Informit Complete; ProQuest Dissertations and Theses, and ProQuest Health and Medicine; each from their inception to 30 October 2022. The database searches identified 703 potentially relevant records; after removing duplicates and initial screening, the full text of 27 articles was assessed for eligibility. Nine studies met our inclusion criteria: two randomised controlled trials, five cohort studies, one quasi-experimental study, and one repeated cross-sectional study. Eight studies were rated as being of low or medium quality (median JBI score, 54%; interquartile range [IQR], 36-64%); seven studies were rated as being of low to medium ethical and methodological quality from the Indigenous perspective (median CREATE score, 50%; IQR, 36-64%). Six studies reported changes in glycated haemoglobin (HbA1c) levels, of which two (both cohort studies) reported significantly lower mean HbA1c levels after the intervention, but only one publication provided detailed results. No randomised controlled trials that investigated the effect of a combination of physical activity and dietary change for Indigenous Australians diagnosed with type 2 diabetes were identified. Differences in study design, outcome variables, and the small number of studies precluded meta-analysis. Quality research into the impact of physical activity interventions on type 2 diabetes in Indigenous people is sparse. To improve research translation, studies that involve Indigenous community members at all levels of the research process are needed. PROSPERO CRD42021247496 (prospective).

First Law a gift to healing and transforming climate and just us!

PurposeThese words of introduction locate me on my tribal ancestral lands, and centres me as belonging to the Martuwarra, Fitzroy River in the Kimberley region of Western Australia. My family and community’s inter-generational lived experiences of colonisation are grounded in the characteristics and learnings of “conflict, manipulation, dived and rule” as invasive unjust strategies of oppression and anti-dialogic action. These characteristics of oppression reflect invasive and unjust developments, colonialism continues to impact on our daily lives and threaten our cultural heritage, lifeways and livelihoods (Freire, 2005).Design/methodology/approachI understand the Net Zero: Heritage for Climate Action is a first of its kind, a capacity development project that aims to use Indigenous knowledge to develop integrated strategies for disaster risk reduction, climate action and peacebuilding (Jarillo and Crivelli, 2024). Importantly, one of the aims of the Net Zero Project is to enhance risk reduction and coping capacities of vulnerable heritage communities. In this way, my video story speaking directly to the International Union for the Conservation of Nature (IUCN) highlights the interconnected issue of heritage safeguard, upholding cultural rights and sustainable development of our people who are vulnerable cultural bearers, importantly, how we are working to effect change locally, while strengthening efforts globally, as we see ourselves as planetary citizens with a duty of care to Mother Earth and humanity (Redvers et al., 2020).FindingsThe opportunity for freedom is being created through the growing coalitions of hope (Poelina, 2020). Organisations with a regenerative focus are connecting, networking, collectively thinking and transforming our world by being brave and challenging legal systems to recognise “rivers” as the lifeblood of our planet and our survival co-dependent on “a declaration of peace with Indigenous Australians with natures laws and first law” (RiverOfLife et al., 2024). Together we are decolonising our thinking; uniting and bringing together a pluriverse of ideas and actions to right size our planet and give humanity and Mother Earth a climate chance (RiverOfLife et al., 2024).Research limitations/implicationsThe final question, I ask my country and the world to sustain my culture, my home, my lifeways and my livelihood “can we achieve peace, harmony and balance”? Can we shift from business as usual, to the new economies, through intentional communities, through bicultural and bioregional planning and development? If the answer is yes, then there is hope for humanity, and the young ones yet to be born. Let us adopt the values, ethics and virtues found in First Law as a gift to healing our lands, our people and climate.Practical implicationsIt is clear from the voices of Yi-Martuwarra people, “If [our] River Dies, We Die” (Moore et al., 2023). When we stand united, we hold the dreaming time, from past, present and future, and we sing together a new “Martuwarra River Time” song. Through this moral and ethical partnership of hope the Net Zero Project Heritage for Climate Action ignites the opportunity to transform climate change, climate chaos and provide the climate chance through just us!Social implicationsYi-Martuwarra people highlight the need for dialogue, unity, cooperation and multiple forms of evidence, to understand the cumulative impacts of development. It is clear from the voices of Yi-Martuwarra people, “If [our] River Dies, We Die” (Moore et al., 2023). When we stand united, we hold the dreaming time, from past, present, and future, and we sing together a new “Martuwarra River Time” song. Through this moral and ethical partnership of hope the Net Zero Project Heritage for Climate Action ignites the opportunity to transform climate change, climate chaos and provide the climate chance through just us!Originality/valueAs the impacts of climate change continue to intensify, it is imperative to centre Indigenous well-being in adaptation efforts by enabling bottom-up approaches via community-led solutions, promoting land rights, protecting traditional heritage and cultural practices and cultivating social connections. Given the increasing recognition of well-being as a fundamental marker of successful adaptation, it should be central to climate change research and policymaking, but for this to be of benefit to Indigenous Peoples and local communities context-specific understandings of health and well-being are necessary (Jarillo and Crivelli, 2024).

Impact of Victorian Quality Indicator (QI) on Kidney Transplant Wait-Lists for Indigenous and Nonindigenous Australians

Impact of Victorian Quality Indicator (QI) on Kidney Transplant Wait-Lists for Indigenous and Nonindigenous Australians

Hospitalisations for non-specific low back pain in people presenting to South Australian public hospital emergency departments.

The present study sought to investigate predictors of hospitalisation in adults diagnosed with non-specific low back pain (LBP) and/or sciatica from an ED. A 5-year, multicentre retrospective observational study was conducted across six public hospitals (metropolitan and regional) using data from electronic medical records. Patient presentations were identified using LBP diagnostic codes and key data extracted (patient demographics, clinical activity, discharge destination). Descriptive statistics and logistic regression were used to measure associations between identified variables and hospitalisation. There were 11 709 ED presentations across the study period. People aged ≥65 years (odds ratio [OR] 2.84, 95% confidence interval [CI] 2.61-3.10) and those who arrived at the ED via ambulance (age-adjusted OR 2.68, 95% CI 2.44-2.95) were more likely to be hospitalised. People were also more likely to be hospitalised when triaged as more urgent, when blood tests or advanced spinal imaging were ordered, and when i.v./subcutaneous opioids or oral benzodiazepines were administered. Hospitalisation rates for LBP were lower in regional hospitals, in people residing in lower socioeconomic areas and in Indigenous Australians. Certain patient characteristics and ED clinical activity are associated with hospitalisations for LBP. Understanding these factors will better inform the design and delivery of appropriate high-quality care.

Perspectives on improving wound care for Aboriginal health workers in rural and remote communities in Queensland, Australia

BackgroundThe care of wounds is an ongoing issue for Indigenous people worldwide, yet culturally safe Indigenous wound care training programs for rural and remote Australian Aboriginal Health Workers are largely unavailable. The higher prevalence of chronic disease, lower socioeconomic status and poorer access to services experienced by Aboriginal and Torres Strait Islanders compared to non-Indigenous people, leads to a greater incidence of chronic wounds in Aboriginal and Torres Strait Islander people. Identifying the barriers and enablers for delivering wound care will establish areas of need for facilitating the development of a specific wound care program for Aboriginal Health Workers and Aboriginal Health Practitioners. This paper reports the first phase of a larger project directly aligned to the Indigenous Australians’ Health Program’s objective of supporting the delivery and access to high quality, culturally appropriate health care and services to Aboriginal and Torres Strait Islander Australians. This study aimed to examine experiences of Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses for managing chronic wounds within rural and remote Aboriginal Medical Services in Queensland, Australia.MethodsYarning facilitated by two Aboriginal researchers among Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses currently employed within four Aboriginal Medical Services located in rural and remote areas of Queensland, Australia.ResultsTwo themes were developed through rigorous data analysis of yarning information and responses: participants’ experiences of managing wounds and barriers and enablers to effective wound care.ConclusionsThis study contributes an insight into the experiences of Aboriginal Health Workers on the current barriers and enablers to timely treatment of chronic wounds. Results from this study indicate a significant barrier to obtaining timely and effective wound care in regional and remote settings is access to an appropriately skilled, culturally competent, and resourced health work force. A lack of education and professional development for Aboriginal Health Workers can compromise their ability to maximise patient outcomes and delay wound healing. Findings have informed the development of an evidence based, culturally competent open access chronic wound care education program for Aboriginal Health Workers.

Vision loss and diabetic retinopathy prevalence and risk among a cohort of Indigenous and non-Indigenous Australians with type 2 diabetes receiving renal haemodialysis treatment: The retinopathy in people currently on renal dialysis (RiPCORD) study

AimsDiabetic nephropathy, vision loss and diabetic retinopathy (DR) are frequent comorbidities among individuals with type 2 diabetes (T2D). The Retinopathy in People Currently On Renal Dialysis (RiPCORD) study sought to examine the epidemiology and risk of vision impairment (VI) and DR among a cohort of Indigenous and non-Indigenous Australians with T2D currently receiving haemodialysis for end-stage renal failure (ESRF). MethodsA total of 106 Indigenous and 109 non-Indigenous Australians were recruited in RiPCORD across five haemodialysis centres in urban and remote settings. Clinical assessments, questionnaires and medical record data determined the rates of ocular complications and risk factor profiles. ResultsPrevalence rates include unilateral VI, 23.5 %; bilateral VI, 11.7 %; unilateral blindness, 14.2 %; and bilateral blindness, 3.7 %, with no significant differences between sub-cohorts (p=0.30). DR prevalence rates were 78.0 % among non-Indigenous Australians and 93.1 % among Indigenous Australians (p=<0.001). Non-Indigenous ethnicity (OR: 0.28) and pre-dialysis diastolic blood pressure (OR: 0.84 per 10-mmHg) were protective, while peripheral vascular disease (OR: 2.79) increased DR risk. ConclusionsOcular complications among individuals with T2D and ESRF are disproportionately high, especially for Indigenous Australians, and beyond what can be accounted for by risk factor variation. Findings suggest a need to improve screening and preventative efforts within this high-risk population group.

Aboriginal and Torres Strait Islander Attitudes to Organ Donation in Central Australia: A Qualitative Pilot Study.

Organ transplantation is a well-established intervention but is reliant on the donation of organs and tissues, mostly from deceased donors. The proportion of Australians proceeding to organ donation (OD) has increased, but the proportion of Indigenous Australians proceeding remains two-thirds that of non-Indigenous Australians. We sought to explore perceived barriers and enablers for the involvement of Indigenous peoples in the OD process. Qualitative methodology centered around focus groups was used to capture the experiences and perspectives of Indigenous people regarding OD. A purposively sampled group of Aboriginal Liaison Officers working within the Alice Springs Hospital Intensive Care Unit (ASH ICU) participated in up to 6 focus groups during 2021 with subsequent thematic analysis of the enablers and barriers to Indigenous participation in the OD process. The ASH ICU is the only ICU servicing Central Australia, and 70% of admissions are Indigenous patients. Four primary themes emerged: OD is a new and culturally taboo topic; conversations related to OD are confronting; education is needed (both about OD and cultural education for clinicians); and lack of trust in the healthcare system. There are cultural barriers to engaging in the OD process and clinicians need more training on the delivery of culturally safe communication is needed. Despite this, there was a recognition that OD is important. Education about OD needs to be place based, culturally and linguistically appropriate, informed by local knowledge, delivered in community, and occur before a family member is admitted to ICU.

Infective endocarditis outcomes at a tertiary hospital in Western Australia: a retrospective cohort study from 2016 to 2021.

Infective endocarditis (IE) is a severe infection with considerable mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner. To evaluate the characteristics and management outcomes of patients with IE in Royal Perth Hospital (RPH). A single-centre, retrospective cohort study. Data were collected from medical records of 131 patients with a diagnosis of IE admitted to RPH between 2016 and 2021. Eighty-four patients with definite IE were included for analysis. The median age of patients was 51.5 years and 77.4% were male. Compared to the general Australian population, there was disproportionately greater representation of Indigenous Australians (21.4%), those with a history of injecting drug use (IDU) (27.4%), rheumatic heart disease (14.3%) and previous IE (13.1%). The most commonly affected valve was the mitral valve in 46.4% of patients, and the most common pathogen was Staphylococcus aureus in 47.6% of patients. Twelve-month mortality was 16.7%, with significantly increased mortality in those treated non-surgically (25.6% vs 7.3%, P = 0.025). Factors associated with undergoing surgery included the presence of aortic valve disease, perivalvular extension of infection and infection with Enterococcus faecalis, whereas IDU, tricuspid valve disease and S. aureus infection were associated with non-surgical management. Adherence to multidisciplinary team review was 75.0%, and surgical management was performed in 70.7% of patients meeting an indication for surgery. IE mortality rates remain high, particularly in patients who do not undergo surgical management. Streamlined MDT assessment and referral for surgical management where appropriate is necessary to improve outcomes.

Inequality and education in Australia

Abstract Australia’s education system is one of the most developed globally and also one of the most privatised. Despite the substantial expenditure by state governments and the federal government, it is profoundly unequal with respect to access, funding, resources, and results from early childhood education to university. The inequality has class and spatial features, and Indigenous Australians are at the bottom of the rung. Drawing on Bourdieu’s concepts of cultural, social, and economic capital, I show that the education system, whilst certainly allowing for some mobility, facilitates the reproduction of the existing class structure. Children from low-income households are more likely to not attend childcare, to attend a school that lacks resources and where going on to university is viewed as exceptional rather than the rule. In contrast, the economic capital of wealthier households allows them to access childcare and elite private schools. The cultural and social capital of these schools reproduces a born to rule ethos, and progression to an elite university is an assumed path.

Cross-sectional study of the prevalence of chronic liver disease risk factors and liver fibrosis in a remotely living Indigenous Australian population

ObjectivesRemotely living Indigenous Australians have a disproportionate mortality from cirrhosis and hepatocellular cancer (HCC). However, there are no local population studies examining the prevalence of chronic liver disease (CLD) in...

Exotic ceramics from the Murray Islands, Eastern Torres Strait

The discovery of Lapita-decorated ceramics in the Massim region and southern Papua New Guinea coast, along with finds of pottery on Jiigurru (Lizard Island) in the Great Barrier Reef and in the Torres Strait demonstrates the presence of seaborne movements in the Coral Sea as early as ∼ 2900–2500 cal. BP (Ulm et al. 2024). As an introduced Austronesian technology, ceramics are central to archaeological understandings of early maritime routes and cross-cultural relationships between Island Southeast Asians, Papuan peoples, and Indigenous Australians. In the Torres Strait only a small number of pot sherds have been reported. Those found in the western islands were probably made using local materials, while the ceramics from eastern islands have been sourced to southern Papua New Guinea (Carter 2004). In this paper, petrographic examination of sherd tempers recently recovered from the Eastern Torres Strait islands of Dauar and Waier indicate derivation from the Purari River basin in southern New Guinea. A distinct granitic temper sherd dated to ∼ 2600 cal. BP differs from known sherd tempers and likely originates from the Western Torres Strait. The provenance of this granitic sherd is consistent with the early movement of ceramic-making groups along the south New Guinea coast and into the Torres Strait, and with the ability of these groups to make long-distance passages in the Arafura and Coral Seas.

Yarning and knitting words: a cross-cultural thought experiment on writing beyond school

This article provides an account of a yarn between a First Nations Australian researcher and an Anglo-Celtic Australian researcher about the future of writing curriculum in subject English education, if school in its current settler-colonial form were to be abolished and completely re-imagined. Yarning is an Indigenous research method evolving from Indigenous cultures and ways of knowing; it is a form of knowledge production. The original yarn, on which this further creative dialogue is based, takes the form of a recorded podcast conversation between the authors, who are academic colleagues at the same university and former English teachers. The research focus of the conversation was what a post-Treaty, post-school writing education might be. However, rather than providing ready answers, our relational thinking foregrounds the challenges in asking this question, and in non-Indigenous Australians expecting Indigenous Australians to provide fixes for the problems engendered by the ongoing injustices of colonisation.

Thinking the Other: From Terra Australis Incognita to Terra Nullius

At the end of the 18th century, when Sir Joseph Banks, president of the Royal Society, recommended Botany Bay in Australia as an “advantageous” site to establish a new British penal colony, he did so with the knowledge that the east coast of the country was inhabited by Indigenous Australians, having traveled to the South Continent with Lieutenant James Cook. As a naturalist and imperial botanist on board the Endeavour, Banks’s primary duty had been to identify and classify Australian flora and fauna. Yet, the multiple observations that he made based on his interactions with Aboriginal people also contributed to establish his influence in scientific and political circles at the turn of the 19th century. Banks’s ethnographic accounts recorded in his Endeavour Journal shed light on his mind-set and convictions during his time in Australia as well as his impressions that later played their part in making him the greatest proponent of settlement in New South Wales and motivating the decision to colonize the country. In a time when exploration records significantly shaped the perceptions of the public about human nature and the beliefs and theories of the scientific community on questions of race and otherness, the writings of Joseph Banks offer a window into science and history in the making. As the scientific exploration of distant lands progressively gave way to political and economic interests, the transition from geographical othering to racial othering in the representation of Indigenous Australians turned Terra Australis Incognita into terra nullius.

The burden of rheumatologic disease in Aboriginal and Torres Strait Islander Australians.

The objective of this article is to summarise the current knowledge regarding the prevalence of six rheumatological conditions in indigenous Australians - rheumatoid arthritis (RA), osteoarthritis (OA), osteoporosis (OSP), systemic lupus erythematosus (SLE), gout and musculoskeletal (MSK) pain. Online medical literature databases were searched for 'indigenous', 'Aboriginal' and 'Torres Strait Islander', as well as the names of the six conditions. Other included search terms were 'crystal', 'urate', 'arthritis' and 'arthropathy'. No limitations were placed on publication data or language. Forty-five articles examining the prevalence of the six conditions were identified. Based on the published literature, SLE appears to have a higher prevalence, while RA appears to have a lower prevalence in indigenous Australians compared to the non-indigenous community. MSK pain is prevalent, has a significant impact on indigenous people and is perceived as an important area of need. There is a paucity of data regarding these conditions in indigenous Australians. This may be impacted by the uncertainty of case ascertainment by self-report, differences in disease phenotypes and prevalence between the metropolitan compared to the rural or remote indigenous population, and difficulty with access to healthcare. Further studies in conjunction with local indigenous communities are needed to accurately determine the burden of rheumatological disease in the indigenous population. This will assist with resource and workforce planning to deliver culturally appropriate interventions. Strategies for future clinical work and research include the development and dissemination of culturally safe rheumatology resources, rheumatology training of Aboriginal Health Workers and wider integration of rheumatology clinics into community-controlled Aboriginal Health Services.