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Cultural safety represents a key philosophical shift from providing a service regardless of difference to care that takes account of peoples’ unique needs. Cultural safety is central to Aboriginal and Torres Strait Islander people and their relationships with the health system. Cultural safety describes a state, where people are enabled and feel they can access health care that suits their needs, are able to challenge personal or institutional racism (when they experience it), establish trust in services and expect effective, quality care.

It requires all people to undertake an ongoing process of self-reflection and cultural self-awareness and an acknowledgement of how these impact on interactions and service delivery. Critically, cultural safety does not necessarily require the study of any culture other than one’s own: it is essentially about being open-minded and flexible in attitudes towards others. Identifying what makes others different is simple – however, understanding our own culture and its influence on how we think, feel and behave is much more complex, and often goes unquestioned.

If Cultural Safety describes the state we are aiming to reach – safe, accessible, person-oriented and informed care – Cultural Responsiveness is the practice to enable it.

Culture is a foundation for Aboriginal and Torres Strait Islander health and well-being. Culture provides protection across the life course and has a direct influence on broader social determinant outcomes. Gains across these broader determinants, in turn, reinforce cultural connectedness, maintenance, resurgence, nation building and pride in cultural identity.

Accordingly, the Cultural Determinations of Health are factors such as connection to Country, family, kinship and community; knowledge and beliefs, cultural expression and continuity; language, self-determination, and leadership.

These cultural determinants are embedded in the National Aboriginal and Torres Strait Islander Health Plan 2021-2031 and were informed by the Mayi Kuwayu study on Aboriginal and Torres Strait Islander well-being and further work by the Lowitja Institute, Australia’s national institute for Aboriginal and Torres Strait Islander health research.

The National Aboriginal and Torres Strait Islander Health Plan 2021-2031 stresses that addressing the social determinants of health is key to achieving health equity for Aboriginal and Torres Strait Islander people.

This requires shared action across maternal health and early childhood development, community and family safety, education and youth, employment and income, racism, housing, environment and infrastructure, interactions with government systems and services, law and justice, poverty, welfare dependency, food security and access to nutritious food, and experiences with alcohol, tobacco and other drugs.

The social determinants of health account for 34% of the total health gap between Aboriginal and Torres Strait Islander and non-Indigenous health outcomes. The social determinants that account for the majority of the health gap are household income, employment and hours worked, and health risk factors, such as smoking and obesity. Of the social determinants, racism is one of the most impactful for Aboriginal and Torres Strait Islander people.

The National Aboriginal and Torres Strait Islander Health Plan 2021-2031 acknowledges that the history of policy making in Australia has largely excluded Aboriginal and Torres Strait Islander people in the laws and policy decisions that have impacted our own health and well-being. Health Policy has generally revolved around consultation process that have tended to be ignored that have resulted failed policy development and program designs.

Consultation alone does not enable or include any decision-making authority or control over outcomes. Self-determination requires more than participation in service delivery. In a participation model, Aboriginal and Torres Strait Islander people have not determined the nature of the service and the ways in which the service is provided. For there to be self-determination for Aboriginal and Torres Strait Islander peoples, we must be involved in the decision making in the implementation of this Health Plan.

Self-determination is part of the Aboriginal and Torres Strait Islander Nation (re)building process to strengthen collective identity and capacity for effective Aboriginal and Torres Strait Islander governance, and sustained self-determination for community and economic development.

Recognition of Aboriginal and Torres Strait Islander people would acknowledge their powerful sense of identity, pride, history and belonging to this land. It would promote opportunities for full participation in all that Australia has to offer and be a significant step towards equity between Indigenous and non-Indigenous Australia.

Recognition, participation and equity would, in turn, have profound positive consequences for wellbeing, and therefore health. There is significant evidence from health research to indicate that being connected to the wider community, having a strong identity and feeling socially supported, all have significant positive impacts on health.

The story of Aboriginal and Torres Strait Islander Australia is a powerful shared national story that needs to be acknowledged in the Constitution for the wellbeing of Australia’s First Peoples, and the nation as a whole.

Lowitja Institute 2015

The Voice to Parliament (and Executive Government) and action under the National Agreement to Closing the Gap are complementary actions rather than alternatives and both are needed. The Voice requires someone to listen – and even more importantly, hear and act. History has shown that action without the Voice has not been all that successful to close the gap health outcomes and general socioeconomic position for many Aboriginal and Torres Strait Islander peoples.  Hearing and acting on the Voice is a core requirement for successful policy design and program delivery. There are many and various non-Indigenous organisations across the social and economic spectrum in this country showing support for the Voice to acknowledge that it is time to be truthful of our history and for our First Nations people to be recognised in our foundational document – the Constitution of Australia.  The Voice is the practical application of recognition and a start to do something different rather than maintaining the status quo.  The NIHLA supports the Voice and calls for the full Implementation of the Uluru Statement of the Heart.

2020

• Submission – Cancer Australia – Public Consultation Lung Cancer Screening Inquiry
• Submission – Council of Attorneys-General Review of Age of Criminal Responsibility
• Submission – House of Representatives Standing Committee on Indigenous Affairs – Pathways and Participation Opportunities for Indigenous Australians in Employment and Business
• Submission – Royal Commission into violence abuse, neglect and exploitation of people with a disability
• NIHLA_Submission_House of Representatives_Homelessness
• NIHLA_Submission_NPHS Consultation Paper

2019

• MBS Taskforce
• Productivity Commission IES
• Senate Inquiry – Nationhood etc
• Aged Care Royal Commission

2018

• Constitutional Recognition

2016

• ANAO Audit submission

2015

• Indigenous Australians’ Health Programme Park A ‐ Program Guidelines – July 2015

• NIHLA_Submission_NPHS Consultation Paper
• NIHLA_Submission_Joint Standing Committee_UNDRIP
• NIHLA_Submission_PC_CTG Review Paper 2
• NIHLA and FPDN_Submission_New-Aged-Care-Act_March-2024