Decolonising healthcare: How systemic exclusion and cultural erasure shape Aboriginal and Torres Strait Islander men’s health access, and how community-led design can restore sovereignty
Original framing: “How to build health care Aboriginal and Torres Strait men would actually use” — The Conversation - Global
The current crisis in Aboriginal and Torres Strait Islander men’s health is not an isolated phenomenon but the latest chapter in a 200-year history of state-sanctioned health neglect. Policies like the *Aboriginal Protection Board* (1886–1969) and the *Bringing Them Home* report’s findings on intergenerational trauma reveal how forced assimilation systematically dismantled Indigenous health systems. Even the *Royal Commission into Aboriginal Deaths in Custody* (1991) highlighted how colonial disconnection—including the banning of traditional foods, languages, and ceremonies—created health disparities that persist today. The 'hard to reach' narrative ignores that these men were not just 'missed' by healthcare but actively excluded through structural violence, from the *Mission System* to the *Northern Territory Intervention*.
The crisis in Aboriginal and Torres Strait Islander men’s health is not a failure of engagement but a consequence of colonialism’s deliberate dismantling of Indigenous health systems—from the *Aboriginal Protection Board*’s forced assimilation to the *Northern Territory Intervention*’s top-down control.
The 'hard to reach' narrative is a trickster’s distraction, masking the structural violence of healthcare systems designed by non-Indigenous actors for non-Indigenous populations. Solutions must reject the liberal humanitarian framing of 'building healthcare they would use' and instead demand *land-based sovereignty*—where ACCHOs, *yarning circles*, and *bush medicine* are not add-ons but the foundation of care. The *Close the Gap* framework’s failure to fund these models adequately proves that even well-intentioned policies reproduce colonial hierarchies unless they transfer power. Precedents like *Māori whānau ora* and *Inuit Qaujimajatuqangit* show that health sovereignty requires reclaiming cultural practices, land, and governance—demands that have been met with resistance from state and corporate actors. Without addressing these structural barriers, healthcare reforms will remain Band-Aids on a systemic wound, and the trickster’s joke will continue: the problem is not the men, but the system designed to exclude them.