This chapter explores Aboriginal and Torres Strait Islander community-controlled health services (ACCHOS) and looks at the important role they play in improving health outcomes for Aboriginal and Torres Strait Islander people. It is difficult to understand the Aboriginal community-controlled health sector of today without considering how the sector developed. This chapter therefore outlines the conception and establishment of the services and the political realities facing Aboriginal and Torres Strait Islander people at the time of their commencement. This chapter is organised around a case study of the Aboriginal and Torres Strait Islander Health Service in Brisbane, which celebrated its 50th anniversary in 2023. To complement the case study, the chapter includes an overview of the governance structures of the community-controlled sector, as this is an area that can be difficult for health professionals to understand. The scenarios, case studies and reflective questions focus on experiences that nurses and midwives might have working in an Aboriginal community-controlled health service.

Prior to colonisation, Aboriginal and Torres Strait Islander peoples thrived on the continent now known as Australia. However, long-term health conditions such as cardiovascular disease, diabetes, kidney disease and respiratory illnesses are disproportionately prevalent in Aboriginal and Torres Strait Islander communities due to systemic inequities, intergenerational trauma and barriers to healthcare access. This chapter examines the prevalence and impact of long-term health conditions among Aboriginal and Torres Strait Islander peoples, the determinants that shape health outcomes and the importance of self-management in long-term health conditions. Also underscored is the need for healthcare systems to prioritise Indigenous-led solutions, community empowerment and a strengths-based approach to improving long-term health condition outcomes among Aboriginal and Torres Strait Islander people.

Indigenous Australians have thrived on the continent of Australia for at least 65,000 years. This history demonstrates a relationality to which few cultures maintain or link their cultural practices. For Indigenous Australians, everything is connected. No individual person exists in isolation.The invasion and colonisation of Australia had a colossal impact on the Australian continent. The land has been transformed and damaged in the name of profit, progress and nation-building. Successive governments have supported an extraction-based economy that focuses on stripping resources from the land and ignoring Indigenous Australians’ knowledge about how to care for Country. Despite this, Indigenous Australians continue to hold intricate, sacred and nuanced knowledges of Country and respect the way Country has nurtured and supported our ways of knowing, being and doing for millennia.

Research is important in the creation of new knowledge or as a way of understanding phenomena. This chapter primarily concerns quantitative research. The chapter begins with a discussion about quantitative research and Indigenous peoples in context to provide an overview of the vexed discussion of methodological approaches advocated in Indigenous research. This is followed by an overview of Indigenous quantitative research in the Aboriginal and Torres Strait Islander context, including what is defined as research and the key differences between research methodology and methods. The authors then introduce concepts of Indigenous quantitative research practices and include a case study on the Yawuru wellbeing framework to illuminate how methodology affects research and therefore understanding. The final section describes participatory action research as an appropriate methodology when conducting research with Aboriginal and Torres Strait Islander peoples in Australia, and looks at how appropriate quantitative methods can contribute to new knowledge and understanding through the case study of an Aboriginal Ranger in Central Australia.

This chapter discusses the challenges that face Aboriginal and Torres Strait Islander women and their families in urban and regional maternity settings. It is written from the framework of cultural safety in midwifery care (discussed in Chapter 2). Giving birth is a significant, intimate, personal and life-changing experience – for all women, across all cultures. It is also a topic of great debate among Indigenous and non-Indigenous health professionals, Elders, communities, women and their families. The debates centre on issues that are particularly relevant to Aboriginal and Torres Strait Islander women, such as accepted birthing and midwifery practices, where women choose to give birth (and whether they are able to choose the location) and whether they have the right to practise cultural and spiritual beliefs about women’s business. To explore these issues, this chapter provides an historical perspective on birthing and midwifery practices among Aboriginal and Torres Strait Islander women. It then explores some contemporary issues and discusses some of the author’s own midwifery experiences.

This chapter explores the health and wellbeing of Elders and older Aboriginal and Torres Strait Islander peoples and the factors that are important to consider in their care, including chronic conditions, a shorter lifespan and culturally safe and appropriate aged care. Older Aboriginal and Torres Strait Islander people and their families make conscious decisions around care, and the role of the nurse is to support individuals and their families in making informed decisions. Reasons are presented for why some Aboriginal and Torres Strait Islander people may be viewed by various health professionals as non-compliant or disengaging from the health system and their ongoing care, including palliative care, when in fact they are making conscious choices that can be culturally defined and seen as a cultural determinant of health.

The quality of our health is largely determined by foetal development in pregnancy and the experiences and environments to which we are exposed in infancy and childhood. These factors shape and contribute to lifelong health effects that occur into adult life. While there is little documentation about the health of Aboriginal and Torres Strait Islander children prior to the invasion, and it is conflicted, it is known that Aboriginal and Torres Strait Islander children were few and precious and their holistic health needs were met within their strong and extended family structures. Child mortality and morbidity were accepted parts of life in pre-invasion times; this is reflected in traditional birthing practices and women’s business. Traditionally, our children learnt culture, food-gathering, ceremony, kinship relationships, law, gender-specific work and other important values and structures throughout childhood. Post-invasion, the introduction of disease, the impacts of loss of traditional food sources due to dispossession of lands and the fracturing and removal of traditional family and community structures fuelled the increased rates of Indigenous mortality and morbidity evidenced today.

Research is vital to the health professions. It has the potential to inform and change health policy and practice and, through that change, to improve Indigenous health outcomes. However, while research is vitally important, it is not values neutral. Historically, much research has been conducted on rather than with Indigenous communities. Typically, research has been carried out by non-Indigenous researchers who want to find out about Indigenous peoples and their cultures. Research has traditionally been designed to suit the agenda and interests of the non-Indigenous people conducting research. The research of the past was often conducted in ways that did not address Indigenous defined priorities or benefit Indigenous communities in any way. In many cases, the research brought no benefit to the peoples being studied or was harmful and destructive for communities.

Remote area nursing is a unique and challenging role, characterised by geographical, social and professional isolation. Remote area nurses (RANs) are generalist specialist nurses who predominantly work in remote Aboriginal and/or Torres Strait Islander communities but can also be found working in communities established around activities such as mining, agriculture, fishing, tourism and refugee detention facilities. They coordinate and deliver a diverse range of healthcare services in remote and extreme environments with limited resources. This chapter reflects on the authors’ practice and experience of working as RANs. It explores the scope of RAN practice and discusses complexities such as cultural obligation, cultural safety, burden of disease and isolation when working in a remote Indigenous community. It reflects on our experiences in different remote nursing roles and jurisdictions.

This chapter aims to educate the reader about providing nursing care for First Nations people so it promotes culturally safe social and emotional wellbeing (SEWB). The term ‘social and emotional wellbeing’ is used instead of the dominant health culture terminology ‘mental health’. We are not attempting to be controversial in doing so; rather, we are adopting a First Nations standpoint to help us understand and discuss mental health and mental illness in a relevant context for First Nations people. We also suggest that it is not a case of simply treating mental health as an alternative terminology; instead, it is necessary to understand social and emotional wellbeing as a phenomenon that is particular to First Nations people, and then to explore mental health from that perspective. The standpoint we use is important because, from a theoretical perspective, it helps us understand how we interpret the social and emotional health, and the mental health, of people generally.

This chapter examines the role of the Aboriginal and Torres Strait Islander health worker (ATSIHW) and the Aboriginal and Torres Strait Islander health practitioner (ATSIHP), and discusses their relationships with nurses and midwives. It introduces the IHW and IHP roles because an understanding of them is important for nurses and midwives in order to optimise interprofessional practice with these practitioners. The chapter also discusses the application of nursing and midwifery professional standards to the interprofessional relationships between nurses, midwives, IHWs and IHPs.

Historically, Aboriginal and Torres Strait Islander women and men held defined gendered realities. Within each clan group and across Indigenous nations, the common ties of culture held people together, but gendered realities defined the specific roles of women and men. Women’s business defined the knowledge and activities shared among women – for example, birthing practices – which would not be shared with men. In turn, men’s business defined the knowledge and activities that were shared among men and kept separate from women. Aboriginal and Torres Strait Islander men and women had processes for mediating and negotiating their shared responsibilities. Their communication was defined by their gendered realities and occurred within the cisgendered cultural boundaries that were accepted by the group. Men and women held distinct, defined roles that were of vital importance to the balance of community. Even today, some Aboriginal and Torres Strait Islander people and communities maintain the separation of women’s business and men’s business.

Australia is made up of many culturally distinct, unceded Aboriginal and Torres Strait Islander nations, which may create confusion when discussing issues facing our people. Throughout this chapter, we respectfully use the term ‘Indigenous Australians’ when collectively referring to Aboriginal and Torres Strait Islander people unless referring to specific individuals or groups who identify as either Aboriginal (person or descendant of Tasmania’s and/or mainland Australia’s traditional custodians) or Torres Strait Islander people (person or descendant of the Torres Strait Islands north of Queensland’s coast). We intend no disrespect and embrace our cultural diversity. Note: While many of the resources and references we use throughout this chapter use marginalising and stigmatising terminology, we do not endorse this practice.

In 2019, the Australian Nursing and Midwifery Accreditation Council (ANMAC) released the updated Registered Nurse Accreditation Standards. The new standards mandated that cultural safety for all people be included in programs of study. Within Australia, across a range of health-related documents, we are bombarded with terms such as ‘cultural competency’, ‘cultural humility’, ‘cultural responsibility’ and ‘cultural awareness’. There has been much confusion and foggy thinking about the meaning of cultural safety within Australia. This chapter outlines the development of Irihapeti Ramsden’s cultural safety framework. Cultural safety is placed within an historical context and is defined as a journey that all nurses and midwives need to undertake. Nursing and midwifery students are required to consider the potential influence of their own cultures on their nursing and midwifery practice. This chapter uses an Indigenist historical lens to explore the establishment of nursing in Australia, and therefore the ‘whiteness’ of nursing, and its impacts on Indigenous Australian peoples and our health.

This chapter offers an historical examination of Aboriginal and Torres Strait Islander healthcare from a nursing viewpoint. It considers how the current shape of Aboriginal and Torres Strait Islander health has been formed by actions taken since European colonisation. It discusses the status of Aboriginal and Torres Strait Islander health during different historical periods, including what is known about the pre-invasion health system and health service provision during the periods of initial contact, separation and protection. Finally, the chapter discusses the rise of the Aboriginal and Torres Strait Islander community-controlled health system and contemporary choices for Aboriginal and Torres Strait Islander people in the delivery of healthcare and health outcomes. It further discusses the approach taken by all Australian governments of working with Aboriginal and Torres Strait Islander people, communities and organisations to implement the new National Agreement on Closing the Gap at the national, state and territory, and local levels. Each section of this chapter is framed within the prism of nursing, exploring the role of nursing in health systems and the delivery of healthcare.

Australia’s First Nations peoples are a collection of multiple language groups; they are the sovereign peoples of the lands and waterways of their countries, which are now confined within the boundaries of the modern-day colonial nation-state of Australia. Torres Strait Islanders (Islanders) are a collection of First Nations peoples from the region commonly known as the Torres Strait, which for Islanders is increasingly being reclaimed and renown as Zenadth Kes. The assertion of using the local name instead of the colonial name is an exercise of sovereignty. The reclaiming of places through knowing their local name is an important part of truth-telling and decolonising Country. This chapter invites you to learn more about Zenadth Kes and the people who belong to it. Specifically, in keeping with cultural safety, this chapter aims to highlight the limitations of the colonial perceptions of Islanders. These imaginations of Islanders have historically informed what opportunities were afforded to them. This includes equitable access to health inclusive of social and cultural determinants of health, compared with that of non-Indigenous Australians.Today, Islanders reside all over Australia.

On the surface, Australian metal music can be read—quite fairly—as a white, working-class, hypermasculine phenomenon. With further excavation, however, the way metal music materializes in local Australian scenes around the country in various ways reveals its power in negotiating complex structures of identity and belonging. Australian metal music is paradoxical and complex, and fans ‘use’ metal in a variety of political ways. Quite specific to Australian metal music, too, are the ways in which it has long been constructed as a frontier space—a space sitting ‘on the edge’ both geographically and politically, wherein metal’s tendency for extremes—its celebration of brutality, and its perpetuation of hegemonic white masculinity—is only matched by its potential for counter-hegemonic politics, radical change, and boundary-pushing. The Australian frontier functions symbolically in our reading, both as a space dominated by the centralizing figure of the colonial white man, but also as a precarious space in which women’s resilience and Aboriginal and Torres Strait Islander people’s agency in pushing back against colonial normativity rise to destabilize the accepted narratives of invasion politics.

This chapter discusses the health of Aboriginal and Torres Strait Islander peoples from a gendered perspective, considering the different health needs and outcomes experienced by men and women. It begins by unpacking the construct of gender and discussing how gender and gender variations are viewed and accepted by Aboriginal and Torres Strait Islander communities. The Indigenous understandings of women’s business and men’s business are discussed from historical and contemporary perspectives, with a strong focus on the National Aboriginal Health Strategy’s definitions of the two. The chapter then discusses the differences in health outcomes between Indigenous and non-Indigenous men and women, and how the different views they have of health may affect them, before considering how nurses can best provide gender-appropriate care to their Aboriginal and Torres Strait Islander patients. The chapter concludes by considering how Australian policies have varied in meeting the gendered needs of Indigenous Australians, and how the health of Aboriginal and Torres Strait Islander men and women is changing and will continue to do so into the future.

This chapter provides a contextual overview of Torres Strait Islander’s health and wellbeing. It begins by discussing the location and pre-colonisation history of the Torres Strait Islands and their peoples and notes that there is a shift back towards calling the region by its local name, Zenadth Kes. It considers Torres Strait Islanders connections to Country, including the sea, and Kin, and their belonging within tribes and clans. It then discusses Torres Strait Islanders’ perspectives of health and wellbeing both before and after invasion and colonisation and makes suggestions for culturally safe practice that incorporates Torres Strait Islanders’ history. It outlines the current provision of primary health care in the Torres Strait and looks at how this can holistically incorporate traditional medicine practices. The final section of the chapter considers the threat of climate change and its impact on Torres Strait Islanders’ physical and spiritual connection to their Country and consequently their health and wellbeing.