Amid a concerning rise in respiratory disease among Aboriginal and Torres Strait Islands people, how can we provide more accessible, culturally safe care to close the gap?
By Suzanne Harrison
For 30 years Trish Bushby has been working with First Nations people in the health support sector. During that time, she has seen huge change.
Now an Aboriginal Health Manager with Arche Health in Bentley – which partners with Respiratory Care WA – Ms Bushby said when she first started out, there were only two Aboriginal health workers in the sector.
“We still have a long way to go, but there are a lot more self-led programs and more community programs,” she said.
“We’ve got Aboriginal staff who get to have input in developing services and programs. It’s very exciting to see that.”
But despite positive steps, there is still a significant gap when it comes to culturally safe, easily accessible medical care, particularly now with a recent rise in respiratory disease – it’s the fourth leading cause of death among Indigenous Australians, according to the National Indigenous Australians Agency in 2024.
“Our team delivers support programs to Aboriginal and Torres Strait Islander clients who are living with a variety of chronic conditions,” Ms Bushby adds.
“A large portion of our clients have respiratory conditions that require different levels of education, review, and support to manage their respiratory health.”
Her comments are reflected in the statistics. According to the Australian Institute of Health and Welfare (2023), First Nations people are 2.2 times more likely to report having chronic obstructive pulmonary disease (COPD) and 1.6 times more likely to report asthma, compared to the non-Indigenous population.
In 2021/22, more than 5400 asthma-related emergency department visits were recorded among First Nations people.
Alarming numbers
According to the latest Aboriginal and Torres Strait Islander Health Performance Framework (HPF) reports, respiratory diseases among Indigenous Australians accounted for 10% of all deaths between 2015 and 2019.
Rates of death due to COPD are 2.8 times higher than the non-Indigenous rate, and asthma-related deaths about 2.5 times higher. There has also been a 32% increase in hospitalisations for respiratory diseases among Indigenous Australians over the last decade.
According to Dr Jeanita Wong, Acting Medical Director of the integrated Derbarl Yerrigan Health Service (DYHS), common contributors to respiratory disease – and in fact, all diseases – are barriers including poor housing, awareness, education, and stigma of seeking help from a medical professional.
“It’s ongoing. It comes back to a lot of social determinants, which require a multi-sector responsibility such as safe, reliable housing and people with jobs to pay for their medications,” she told Medical Forum.
Other factors are also at play. The HPF notes that nearly half (47%) of the respiratory disease burden is attributed to smoking.
However, Dr Wong says the DYHS Tackling Indigenous Smoking (TIS) program – a government initiative aimed at reducing smoking rates among Aboriginal and Torres Strait Islander people – has already delivered.
The program has helped more than 100 families create a smoke and vape-free home.
“I would say that smoking rates have improved, which has a lot to do with health promotion. Our TIS team has recently ranked second in the nation for its program.”
Kate Fulford, Associate Director, Strategy and Clinical Innovation of Pramana Medical Centre in Gosnells, said that chronic respiratory conditions are often caused, or significantly worsened by exposure to dust, mould, and chemicals, which are common in overcrowded or substandard housing.
“These exposures make it harder to avoid triggers, leading to chronic inflammation and persistent respiratory issues. Higher rates of smoking and exposure to second-hand smoke also contribute,” she said.
“While smoking rates are thankfully decreasing over time, there’s still more work to be done.”
Culturally safe care
A focus on the importance of community-based, culturally relevant initiatives are at the heart of Respiratory Care WA (RCWA).
It has called for greater access to more culturally safe spaces for education, support, and care that respects and reflects First Nations cultures and identities.
RCWA Acting Chief Executive Rael Rivers told Medical Forum that more people are seeking their services and that partnerships with Aboriginal-led organisations were vital.
“These partnerships enable us to deliver free lung health diagnostics, education, and support in settings that are culturally safe, trusted, and accessible,” she said.
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“However, demand is growing, and many First Nations people – particularly those in remote communities – still face barriers to accessing lung health care.
“While we and our partners are working hard to reduce this inequity, without greater government and corporate investment, our ability to make meaningful progress remains limited.”
Through its partnerships with Aboriginal-led organisations RCWA reaches more than 1100 First Nations people in WA each year.
These sessions are held in culturally safe, familiar settings where community members feel respected, supported, and empowered to ask questions freely.
RCWA Community Outreach Coordinator Melanie Preen said culturally safe care involves being in a space that feels familiar and acknowledges Country and connection to culture.
“These trusted settings help build relationships and encourage patients to open up about their respiratory health and the challenges they’re facing,” she said.
“It encourages openness, builds trust, and helps people engage in meaningful learning.”
During yarning circles held in 2024 and 2025, RCWA said participants shared powerful stories about their experiences with respiratory illness.
One elder reflected: “For the first time, I felt comfortable talking about my asthma and learned how to manage it better so that I can be there for my family and help the grandkids with their asthma too.”
There are many Aboriginal Health Services in WA, including community-controlled and mainstream services, all working toward trauma-informed, accessible, and culturally safe care.
“Culturally safe care shouldn’t be limited to specific services,” Ms Fulford said.
“It should be embedded across all health and social services, so that every patient can receive equitable care, no matter their background.”
How GPs can help
Sending this message to the community is a positive step towards closing the health gap, but how can GPs prepare themselves to offer culturally safe care, or refer patients to those who are the best fit for their needs?
“One key area is better understanding and addressing the social determinants of health — particularly housing — alongside medical treatment,” Ms Fulford said.
“A puffer alone won’t be effective if a patient is living with constant environmental triggers.
“It’s also essential to ensure correct diagnosis through tools like spirometry or full lung function tests to avoid misdiagnosis or overdiagnosis of asthma, which is common due to fragmented care or old, inaccurate medical records.”
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She adds that at Pramana Medical Centre they find lung function testing invaluable, not just for diagnosis, but also as an opportunity for patient education.
“It helps explain how and why to use inhalers properly, and why preventers are essential, not just relievers,” she said.
“We’re fortunate to have Respiratory Care WA visit our clinic monthly to conduct these tests and deliver patient education. We’ve observed a strong correlation between this education and improved inhaler technique and medication adherence.”
Smoking cessation is also critical and should be addressed at every patient interaction in a non-judgemental, supportive manner.
For a community health worker like Ms Bushby, one of the best things GPs could do is complete an awareness of culture training program.
“Then they are not just looking at the illness, but what may have impacted that person’s ability to access healthcare. There is a lot of fear in the community still about not wanting to come in and talk,” she said.
By undertaking a culturally safe care course, GPs will also be more aware of what services are out there for First Nations people and can refer them on to the right support, Ms Bushy explained.
In Australia, the Royal Australian College of GPs offers an online activity – Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practice – which aims to improve the health of Aboriginal and Torres Strait Islander people by enhancing GPs cultural awareness.
It’s an online module aimed at helping participants extend their knowledge about history and culture; explore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical setting; and discuss how the practice team can be more culturally aware.
Tallying the costs
Despite growing efforts from service providers, challenges still remain when it comes to respiratory care. Staff at DYHS report that transport barriers and low health literacy often prevent younger adults from accessing early diagnosis support.
Rosedie Milne, Specialist and Allied Health Coordinator at DYHS, said: “While we offer transport for elderly patients, there’s little support for younger people aged 20–40.”
To help address this, DYHS has partnered with RCWA to deliver integrated respiratory assessments, combining specialist consultations and lung function testing in a single visit.
However, due to limited resources, only eight of these dual-service appointments are available each month.
“Our clients see the same visiting specialist at each appointment, which helps build trust in a culturally safe setting. Over time, that consistency encourages Aboriginal and Torres Strait Islander clients to speak up about health concerns, and those concerns are addressed in a way that respects cultural values,” Ms Milne said.
RCWA adds that this work requires sustainable funding, supportive policies, and strong partnerships that respect and uplift Indigenous knowledge and voices.
An example of this is its partnership with Arche Health, whereby they deliver culturally safe lung function testing and education programs.
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Ms Bushby said this promotes a better client experience: “It promotes positive interactions between their staff and our clients and leads to valuable learning around maintaining good respiratory health.
“Breaking down information shared in client consults and delivering it in culturally appropriate ways – particularly with medication reviews to check if the client has the right medications and is using them correctly – has led to a vast improvement in many of our clients’ respiratory health and understanding of their conditions.”
Ms Bushby told Medical Forum that Arche has a good relationship with funding representatives, but with costs for equipment and demand increasing, more reliable funding is imperative.
For example, education in the community about sleep apnoea has improved greatly, resulting in an increase in diagnoses, but that means more Continuous Positive Airway Pressure (CPAC) equipment is required.
“It would also be great for more people to be on the ground to bring more services to the community; not just at the top level. It needs to hit the grass roots,” Ms Bushby adds.
Ms Fulford concludes: “It’s critical that First Nations people have real choice in where they access care, not just from designated services in specific locations.
“Siloing healthcare doesn’t improve outcomes. We all need to work collaboratively and ensure more integrated and inclusive access to care, rather than selective or restricted access.”
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