At the heart of this report is the recognition of Aboriginal and Torres Strait Islander empowerment as vital to wellbeing. The featured case studies have been selected to highlight Aboriginal and Torres Strait Islander-driven approaches to health policy and program reform across four domains of the cultural determinants:

Self-determination and leadership involve practices and processes that incorporate not only self-governance and shared decision-making, but also rights to express and pass on culture, language, and relationships with Country. Aboriginal and Torres Strait Islander Community Controlled Health Organisations and the Coalition of Peaks are examples of self-determination and leadership in action. Self-determination and leadership in health and wellbeing empowers communities through culturally centred processes of decision making and delivers solutions that respond to local context.

Indigenous beliefs and knowledge
Aboriginal and Torres Strait Islander people hold complex and important knowledge systems. Embedding Aboriginal and Torres Strait Islander holistic definitions of health and wellbeing in the way we deliver health services is critical to improving outcomes. Recognising the expertise of Aboriginal and Torres Strait Islander people and communities in health research, policy and program development is key.

Cultural expression and continuity are great sources of strength and resilience for Aboriginal and Torres Strait Islander people. The trauma of cultural disruption and suppression has had a profound effect on Aboriginal and Torres Strait Islander people’s health and wellbeing. Ongoing racism within the health system and externally continues to contribute to this trauma. Measures to promote cultural expression as a health protective factor and ensure the cultural safety of the health system are two elements that can be progressed under this domain.

Connection to Country
Aboriginal and Torres Strait Islander society is interconnected with land, sea and Country. Identity, cultural practices, social systems, traditions and concepts of spirituality are all drawn from, and depend upon, connection to Country. Aboriginal and Torres Strait Islander people are uniquely affected by accelerating climate change and it is with increasing urgency that we must consider connection to Country in health and wellbeing policy.