What's new 4th edition

National Guide to preventive healthcare for Aboriginal and <br/>Torres Strait Islander people

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National Guide

What's new 4th edition

The fourth edition of the National Guide to preventive healthcare for Aboriginal and Torres Strait Islander people has updated all existing topics, as well as adding new topics that reflect emerging health priorities and opportunities identified by users of the National Guide and by the project reference group.

The National Guide and the RACGP Guidelines for preventive activities in general practice, 10th edition (the Red Book) complement each other by providing guidance for primary care clinicians on preventive healthcare. The National Guide addresses issues that are specific to the Aboriginal and Torres Strait Islander population. The Red Book has guidance on additional common topics, such as incontinence, that are not included in the National Guide. The range of topics and emphases within topics varies between the guides, and healthcare professionals are encouraged to refer to both.

New topics in the fourth edition
Health impacts of racism	Racism is increasingly recognised as a major determinant of health and a driver of disparity in health and social outcomes. Inclusion in the National Guide is an opportunity to translate evidence into practice. This topic has recommendations to support awareness of bias, antiracist practice and the provision of culturally safe healthcare.
Healthy eating	This topic has been separated from the Overweight and obesity topic to strengthen the health promoting messages of healthy eating as a foundation to good health and wellbeing, with positive and strong cultural framing.
Sleep	One of the foundations of good health and wellbeing is sleep. Poor-quality sleep is a risk factor for many chronic health conditions. This topic provides guidance for clinicians to include assessment and effective interventions to identify problems and improve the quality of sleep.
Vaping	Vaping is a highly visible, contentious and important health issue that has emerged over recent years, particularly with marketing targeted at young people. Inclusion in the guide provides clinicians with guidance in this area, where there is minimal evidence about what is and is not known.
Preconception care	Supporting healthy pregnancy supports better infant and maternal health outcomes and is a major opportunity to provide primary preventive healthcare and influence the life trajectory of infants/people. This topic builds on asking about pregnancy intention to identify opportunities for appropriate preconception care.
Health impacts of climate change	Including this topic for the first time in the National Guide is an opportunity to bring the broad evidence around health impacts of the climate crisis into the primary care setting in practical and actionable ways.

Key changes to existing topics and recommendations
Physical activity and sedentary behaviour	Positive and stronger cultural framing, including specific recommendations about screen time
Smoking	Change from the 5As (Ask, Assess, Advise, Assist and Arrange) approach to brief intervention to the three-step Ask, Advise, Help (AAH) model New recommendations added about preventing smoking uptake and exposure to second-hand smoke among children
Alcohol	Updated Australian guidelines for reducing harms from alcohol, including recommendations for three groups: adults, children aged <18 years and women who are pregnant or breastfeeding Updated guidelines for alcohol (and other drug) treatments and implementing prevention strategies when working with Aboriginal and Torres Strait Islander people New recommendations about providing information on how to reduce the risk of harms from alcohol, including risk of prenatal exposure New recommendation to recommend abstinence from alcohol for children aged 12–17 years
Immunisation across the life course (previously Immunisation)	Topic expanded to discussion and recommendations for people of all ages Section on emerging and re-emerging diseases
Child maltreatment: Supporting families to optimise child safety and wellbeing (previously in the ‘Child health’ chapter, now in ‘Child and family safety’ chapter)	Stronger strengths-based approach and recommendations around support for families with complex needs New recommendation not to routinely screen for child maltreatment New recommendation to be alert to signs and indicators of child maltreatment
Preventing and recognising family abuse and violence (FAV) (previously a standalone topic, now in ‘Child and family safety’ chapter)	New recommendations about the need for service-level systems and protocols, as well as staff training to support effective and appropriate responses to FAV Broader recommendations to enquire about FAV and being alert to signs and indicators of FAV in children
Pregnancy care	Added trauma-informed understanding in the context of engagement with antenatal care Change in screening recommendation for gonorrhoea for women from high-prevalence settings to routinely testing all pregnant women New screening recommendation for all pregnant women to include hepatitis C and HIV, as well as hepatitis B if immune or infectious status not known New screening and management recommendations for hypertensive disorders, including pre-eclampsia New recommendation about first trimester non-invasive pre-natal testing.
Childhood growth and development (previously Growth failure)	Shift from a focus on growth failure to consideration of a holistic, comprehensive approach to promoting growth and development, with a focus on what supports families and communities so that children flourish Centres the critical importance of cultural safety, and the central role culture must play in optimising child health, growth and development Acknowledges the role of a life-course approach to reducing the burden of non-communicable diseases later in life Acknowledges both under- and overweight and promotes a focus on healthy weight
Childhood anaemia	Recommendations about recognising and managing anaemia in pregnancy as primary prevention of anaemia in infants Expanded environmental recommendations
Childhood kidney disease	Expanded environmental recommendations
Fetal alcohol spectrum disorder	New screening recommendation to ask about pregnancy intention
The health of young people: Sexual and reproductive health in adolescence (previously ‘Unplanned pregnancy’)	Topic expanded to include a broader range of sexual health issues
The health of young people: Substance use in adolescence (previously ‘Illicit drug use’)	Shift in emphasis to trauma-informed understanding in the context of harmful substance use
Brain health, cognition and dementia (previously Dementia)	New screening recommendation for people aged 50 years and over to assess risk factors and ask about memory and thinking New recommendation to ask about, assess and treat hearing impairment
Osteoporosis	Environmental recommendation to increase awareness of air pollution as a risk factor.
Trachoma and trichiasis	Shift in emphasis from individual face washing (and responsibility) to contribution of environmental and living conditions New recommendation to refer for ophthalmology assessment when trichiasis is detected New recommendation to consider epilation as a temporary measure while awaiting surgery Expanded environmental recommendations
Ear health and hearing	Expanded across life course New recommendations for ear health and hearing checks in children New recommendations about noise protection Expanded environmental recommendations
Acute rheumatic fever and rheumatic heart disease	New screening recommendation for echocardiography, when available and well supported, as the appropriate screening activity for people from high-risk groups or living in high-risk settings for acute rheumatic fever/rheumatic heart disease New recommendations for preconception and pregnancy care Expanded environmental recommendations
Sexually transmissible infections (STIs) and blood-borne viruses	New immunisation recommendations for HPV HIV and syphilis added to chlamydia and gonorrhoea in basic STI screening Age for STI screening in remote areas increased to 34 years New hepatitis B recommendation to test all adults not previously screened or whose immune or infective status is not known New recommendation for patient-delivered partner therapy for STIs
Asthma	Recommendations for COVID-19 and annual influenza immunisation added New recommendation to encourage breastfeeding and to not delay solids in infancy New recommendation to address psychosocial stress in the prevention and management of asthma
Chronic obstructive pulmonary disease	COVID-19 added to immunisation recommendations
Bronchiectasis and chronic suppurative lung disease	New screening recommendation to ask about chronic wet cough in children and adults New recommendation about adequate nutrition, including vitamin D New recommendation about air pollution Expanded environmental recommendations
Overweight and obesity	Moved from the Lifestyle chapter to a standalone topic alongside other comparable chronic conditions, such as cardiovascular disease and diabetes New recommendation to encourage the intake of traditional foods or equivalents
Cardiovascular disease (CVD)	New recommendation to begin annual assessment of individual CVD risk factors for Aboriginal and Torres Strait Islander people from age 18 years (at the latest) New recommendation to use the Australian CVD risk calculator from age 30 years (at the latest) for Aboriginal and Torres Strait Islander people and consideration given to adjusting risk assessment upwards if close to a risk threshold New recommendation to screen for atrial fibrillation from age 50 years by palpation of the pulse followed by a full electrocardiogram (ECG) or ECG rhythm strip using a hand-held ECG when further assessment is indicated
Type 2 diabetes	New recommendation for screening in children aged 10 years and older with identified risk factors for diabetes
Chronic kidney disease	New screening recommendations that include screening for red flags and additional factors New recommendation to complete kidney health check (blood pressure, estimated glomerular filtration rate, urinary albumin-to-creatinine ratio) at least annually for people aged 18 years and older New recommendation to advise sodium–glucose cotransporter 2 inhibitor for adults with albuminuria New recommendation to consider glucagon-like peptide-1 agonists for adults with chronic kidney disease and diabetes
Lung cancer	New recommendation to discuss the potential benefits and harms of low-dose computed tomography screening for people aged 50–70 years at higher risk of lung cancer (30 or more pack-years of smoking) in line with National Lung Cancer Screening Program commencing July 2025
Bowel (colorectal) cancer	Age to recommend starting screening In National Bowel Cancer screening Program lowered to 45 years New recommendations about access to immunochemical faecal occult blood test
Liver (hepatocellular) cancer	New recommendations about hepatitis B and hepatitis C screening New recommendations about healthy living and health risk advice, and management to prevent metabolic-associated fatty liver disease New recommendations about liver function tests and follow-up of abnormal results New recommendations about timing of liver ultrasound and α-fetoprotein testing
Cervical cancer	Age of target population and eligibility for funded human papillomavirus vaccination expanded Human papillomavirus cervical screening sample can be routinely self-collected Increased recommendations for abnormal screening results
Breast cancer	New recommendation to consider screening mammography in women aged 40–49 years (funded via BreastScreen) Changes to screening commencement ages based on level of risk
Prostate cancer	Expanded age-based screening recommendations
Depression	Increasing evidence that connection to culture is protective of social and emotional wellbeing

Changes in development and format

Increased contribution by Aboriginal and Torres Strait Islander people across the project – in governance and staff developing the guide, as authors and reviewers (individual and organisational) and from topic-specialist NACCHO teams

Authorship model broadened to include authors from a wider range of health disciplines, including clinical and research roles, and coauthors rather than single authors in many topics.

Audience broadened from being primarily GPs to the whole primary healthcare team – use of plain language as much as possible

Strengths-based approach and being explicit about what protects, supports and strengthens health and wellbeing, emphasising individual and collective strengths of Aboriginal and Torres Strait Islander people in the way health and healthcare is understood and provided

Key messages for each topic

Changes to the way recommendations are presented, including:

strength of recommendation
naming the type of key source(s) as well as providing the reference(s)
rationale/key considerations informing the recommendation (online version)

Changing recommendations from specific inclusion of preventive activity in annual health checks to recommending timing/interval and/or opportunistically

Increased emphasis on implementation and translation into practice, including in culturally appropriate ways with implementation tips in each topic

Changes to the published formats

a print version, which includes key messages, recommendations and key tables, implementation tips, resources and selected references
an online version, which includes all the above as well as a discussion of the topic, the synthesis of evidence and a full reference list, and presented in a collapse-and-expand format rather than as a digitised document (HTML or PDF)

Expanded environmental recommendations to support referral to environmental support services when available and advocacy in topics where environmental and living conditions strongly contribute to morbidity (environmental attribution). These include childhood and adult kidney disease, ear health and hearing, child anaemia, acute rheumatic fever and rheumatic heart disease, trachoma, cardiovascular disease, asthma, bronchiectasis and climate change

Key changes to existing naming

National Guide title changed from ‘health assessment’ to ‘healthcare’

In recognition that preventive healthcare (health promotion and disease prevention) is embedded across primary healthcare as well as in dedicated health assessments

‘Lifestyle’ chapter changed to ‘Healthy living and health risks’

The new title is an example of the strengths-based approach. It recognises the contribution of individual behaviours while rejecting the implication of ‘lifestyle’; that individuals have full control and responsibility for the factors that influence all behaviours and health risks

New chapter ‘Family and child safety’

Strengths-based principles, includes existing topics Family abuse and violence and Preventing child maltreatment: Supporting families to optimise child safety and wellbeing

‘Immunisation across the life course’ (previously ‘Immunisation’)

‘Pneumococcal disease prevention’ and ‘Influenza prevention’

Title changed to reflect expanded scope and moved from the Child health chapter to a standalone topic

Pneumococcal disease prevention and Influenza prevention

No longer standalone topics; the content of these topics is included in the Immunisation across the life course and Respiratory health topics

‘Suicide: Recognising and responding to risk’ (previously ‘Prevention of suicide’)

Title changed to better reflect where clinicians can effectively offer services/intervene

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