Aboriginal primary health care: an evidence-based approach.
- Rosemary Aldrich
- Aust Prescr 2004;27:9
- 1 February 2004
- DOI: 10.18773/austprescr.2004.006
Anybody who read or used the first edition of
Couzos and Murray's book1
will recall that it represented a vast amount of
work by many individuals. People who work in
clinical medicine will also know how quickly
such a collection of evidence can become dated.
The second edition of 'Aboriginal primary health
care: an evidence-based approach' is therefore
welcome and impressive. There are new sections,
expanded sections, and all sections have been
The book aims to be a reference for organisations regarding defined Aboriginal health issues. It also serves as a guide to clinical practice through explicit supported statements, while recognising the desirability of local adaptation of advice and essential 'respectful engagement with the local knowledge and experience of Indigenous people'.
The whole book is a product of the experience of Indigenous people, beginning with the first chapter 'Aboriginal health and the policy process'. Recognising his wisdom and legacy, each chapter is prefaced by a quote from the late Dr Puggy Hunter, a long-time chairman of the National Aboriginal Community Controlled Health Organisation. The book demonstrates that to be involved in Aboriginal primary health care is to be involved in a struggle for self-determination and community identity, and it successfully presents both the clinical evidence and the imperative to respect, recognise and promote autonomy and self-value among patients as foundations of good health care.
While the book is lengthy - at more than 600 pages it is about half as long again as the 1999 edition, with bigger pages - its structure assists in finding desired information. As with the first edition, each chapter concerned with a specific condition begins with a summary. This is expanded upon in the pages that follow, in a systematic order: goals and targets (published statements of intent relating to that condition), burden of disease, risk factors, case definition, diagnostic procedures, effectiveness of prevention, implementation of programs, data collection and, for most, performance indicators. References and notes are at the end of the chapters. Each chapter has shaded boxes of key points, which I found added to the presentation of the information.
Importantly, the second edition has chapters on substance abuse, custodial health and suicide and self-harm, recognising tragic realities for many Aboriginal people and communities. In these and other chapters the book successfully injects evidence about the mediating effect that socio-economic and other determinants of health (such as history, ethnicity, geography) might have in health outcomes, and provides practical advice about how to practise optimally given those considerations. Notably, a National Health and Medical Research Council review on the use of socio-economic evidence in clinical practice guidelines found that the first edition of this book and other related guidelines were one of only two sets of guidelines worldwide into which evidence about the socio-economic determinants of health had been incorporated.2
The book's use of evidence, ease of access despite the complexity of information and its courage in grappling with difficult issues make this book a resource which no primary healthcare practitioner should be without.
NHMRC Scholar, Aboriginal and Torres Strait Islander Health, University of New South Wales
Conjoint Academic, University of Newcastle, NSW