Exploring best practices that integrate environmental health and primary healthcare in Indigenous populations: A scoping review

Abstract

Purpose

Country and the environment are essential components of Aboriginal and Torres Strait Islander wellbeing. Colonisation disrupted these essential connections, damaging important reciprocal beneficial relationships that kept Country and community well. As a result, Indigenous populations exhibit poorer health outcomes compared with non-Indigenous Australians, with the life expectancy of Indigenous Australians being 74 years compared with 84 years in the general population. It is reported that 20 to 30 per cent of Indigenous disease burden can be attributed to environmental factors; however, historically, there has been little coordination between the environmental and primary healthcare sectors in Australia. The National Aboriginal Community Controlled Health Organisation (NACCHO) has called for increased collaboration between environmental initiatives and primary healthcare to address various health disparities present within Indigenous Australians. This scoping review aimed to identify and analyse best practices that integrate environmental health initiatives and primary healthcare within Indigenous populations.

Methods

Standard scoping review methodology was employed in accordance with PRISMA-ScR Joannah Briggs Institute guidelines. Databases that were searched included CINAHL, Scopus, MEDLINE and Embase, as well as grey literature, between 2004–24. Inclusion criteria focused on studies involving international Indigenous populations, environmental health factors and primary healthcare integration, with two primary reviewers and a third for resolving conflicts.

Main findings

A total of 32 papers, primarily from Australia, were included in the final review. Regarding environmental determinants, there was a strong focus on housing condition, water quality and Indigenous land management. Various integrated programs demonstrated significant health improvements, such as reduced prevalence of infectious disease, enhanced cardiovascular health and better mental health outcomes. The concept of Indigenous 'caring for Country' emerged as a central theme, demonstrating the benefits of a unified approach to healthcare.

Principal conclusions

These findings demonstrate the value of implementing connections between environmental and primary healthcare services in improving Indigenous health. Factors leading to program success included community participation, Indigenous leadership and targeted, place-based interventions. However, there is a general lack of published evidence that sustainably integrates both environmental health and primary care. The limited number of examples demonstrated positive health outcomes, indicating the need for more community-led and Country-centred initiatives within primary care.