First Nations health: Closing the gap and improving lives

May 16, 2025

Cairns, Queensland, Australia - August 28th, 2005: An Aboriginal Man with body paint, with thoughtful stare in Cairns, Queensland in Australia on 28th August 2005 — Image: © PTW | iStock

Open Access Government examines the factors affecting the health and wellbeing of First Nations people in Australia, highlighting the significance of establishing culturally sensitive healthcare that recognises their specific needs

The intricate tapestry of health and wellbeing among First Nations people in Australia is not merely a matter of individual health metrics but a complex interplay of cultural determinants and historical contexts. Considering how holistic approaches that respect and integrate traditional knowledge have been a key priority for policy leaders as they try to bridge the care gap and support health and wellbeing.

Determinants of First Nations health

Aboriginal and Torres Strait Islander (First Nations) people are the first peoples of Australia. They comprise hundreds of groups that have their own distinct set of languages, histories and cultural traditions and contribute significantly to all aspects of life in Australia and to Australia’s cultural identity.

According to the Australian Institute of Health and Indigenous Welfare (AIHW), in 2021, there were an estimated 984,000 First Nations people living across Australia, representing 3.8% of the total Australian population. While most First Nations people live in cities and regional areas (85% in 2021), just under one in six (15%) live in remote areas. ⁽¹⁾

On average, First Nations people in remote areas face higher disease burden and lower life expectancy compared to those in non-remote areas. This disparity stems from differences in educational and employment opportunities, access to healthcare, housing conditions, and factors that promote healthy behaviours, like the availability of fresh food. However, areas of relative advantage and disadvantage also exist within these regions. ⁽²⁾ Understanding the cultural determinants of health is essential for improving the wellbeing of First Nations people, as they influence identity and resilience. For many, good health encompasses not just the absence of illness but a holistic view that includes physical, social, emotional, cultural, spiritual, and ecological wellbeing for individuals and communities.

Connection to Country is a critical cultural determinant deeply embedded in the cultural identity of First Nations people. This connection encompasses a spiritual relationship with the land, which is considered a source of life, sustenance, and healing. Engaging with the Country through cultural practices, such as ceremonies and land management activities, reinforces this bond and enhances mental and emotional health.

Common health conditions impacting First Nations people

Data from the Australian Burden of Disease Study (AIHW 2022) reveals that in 2018, First Nations people lost nearly 240,000 years of healthy life due to ill health and premature death, averaging 289 years for every 1,000 individuals. Of this total, 53% was due to non-fatal issues and 47% to fatal conditions. In 2024, the five disease groups causing the most burden were cancer, mental health conditions and substance use disorders, musculoskeletal conditions, cardiovascular diseases, and neurological conditions.⁽³⁾

According to the Australian Institute of Health and Welfare (AIHW), in 2023-24, 28% (or 260,000) of the First Nations population received a health check. Additionally, First Nation-specific primary healthcare organisations provided 3.8 million episodes of care in the same period. Furthermore, females demonstrated a higher overall uptake of health checks compared to males, with 30% of females participating compared to 26% of males. ⁽¹⁾

Impact of historical injustices

The rich cultural heritage of First Nations people offers valuable insights into identity and resilience, but the impact of historical injustices remains significant. Events like dispossession and forced removal have disrupted the social, emotional, spiritual, and cultural wellbeing of these communities, leading to lasting health disparities.

Colonisation and systemic racism have led to intergenerational trauma, adversely affecting kinship ties and cultural identity. This has also had a significant impact on the mental health of First Nations people.

Mental health is responsible for 10% of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Data from 2018–2022 shows that the rate of suicide deaths among First Nations people was more than twice that for non-Indigenous Australians, with the differences being greater for people aged under 45. ⁽⁴⁾

To address the mental health challenges, the Aboriginal and Torres Strait Islander mental health program was established and funds Primary Health Networks to engage in culturally appropriate, evidence-based mental health services that meet individuals’ and communities’ needs.

Importance of self-determination

Empowerment is central to First Nations people’s health and wellbeing; recognising self-determination within health policy frameworks is essential for maintaining cultural continuity. Such recognition enables the integration of traditional knowledge and practices into healthcare, guaranteeing that services are more aligned with the values and needs of communities.

Research consistently demonstrates that self-determination significantly improves health outcomes, including mental health and social-emotional wellbeing. When communities are empowered to govern their health services, they experience enhanced agency and resilience, which are vital for overcoming the adverse effects of historical and ongoing challenges.

Furthermore, the commitment to self-determination aligns with global human rights principles, underscoring the importance of First Nations peoples’ perspectives in health-related decision-making.

The National Agreement on Closing the Gap

The 2020 National Agreement on Closing the Gap was developed in collaboration between Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations. This National Agreement acknowledges the ongoing strength and resilience of First Nations people. It is founded on the belief that when First Nations people have a genuine voice in designing and delivering policies, programs, and services that impact their lives, better outcomes are achieved. Additionally, it recognises the necessity for structural changes in how governments interact with Aboriginal and Torres Strait Islander people to address the inequalities they face.

At the heart of the National Agreement are four Priority Reforms that will change how governments engage with Aboriginal and Torres Strait Islander people and communities. These reforms are:

Formal partnerships and shared decision-making
Building the community-controlled sector
Transforming government organisations
Ensuring shared access to data and information at a regional level.

Empowering First Nations people to tackle health disparities through collective action enhances resilience and promotes community governance and identity. This strengthens cultural ties and improves overall wellbeing. By fostering self-determination, First Nations communities can take control of health initiatives, enabling tailored solutions that align with their cultural values and priorities.