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The missing voices of Indigenous Australians in the social, cultural and historical experiences of tuberculosis: a systematic and integrative review
  1. Sue Devlin1,2,
  2. David MacLaren2,
  3. Peter D Massey2,
  4. Richard Widders1,
  5. Jenni A Judd3
  1. 1Public Health Unit, Mid North Coast Local Health District, Lismore, New South Wales, Australia
  2. 2College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
  3. 3School of Health Medical and Applied Sciences/Division Higher Education, Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg Campus, Branyan, Queensland, Australia
  1. Correspondence to Sue Devlin; sue.devlin{at}


Introduction Disparities in tuberculosis (TB) rates exist between Indigenous and non-Indigenous populations in many countries, including Australia. The social determinants of health are central to health inequities including disparities in TB rates. There are limitations in the dominant biomedical and epidemiological approaches to representing, understanding and addressing the unequal burden of TB for Indigenous peoples represented in the literature. This paper applies a social determinants of health approach and examines the structural, programmatic and historical causes of inequities for TB in Indigenous Australia.

Methods Aboriginal Australians’ families in northern New South Wales who are affected by TB initiated this investigation. A systematic search of published literature was conducted using PubMed, PsycINFO, Scopus and Informit ATSIhealth databases, the Australian Indigenous Health, InfoNet and Google. Ninety-five records published between 1885 and 2019 were categorised and graphed over time, inductively coded and thematically analysed.

Results Indigenous Australians’ voices are scarce in the TB literature and absent in the development of TB policies and programmes. Epidemiological reports are descriptive and technical and avoid analysis of social processes involved in the perpetuation of TB. For Indigenous Australians, TB is more than a biomedical diagnosis and treatment; it is a consequence of European invasion and a contributor to dispossession and the ongoing fight for justice. The introduction and spread of TB has resulted in the stealing of lives, family, community and cultures for Indigenous Australians. Racist policies and practices predominate in the experiences of individuals and families as consequences of, and resulting in, ongoing structural and systematic exclusion.

Conclusion Development of TB policies and programmes requires reconfiguration. Space must be given for Indigenous Australians to lead, be partners and to have ownership of decisions about how to eliminate TB. Shared knowledge between Indigenous Australians, policy makers and service managers of the social practices and structures that generate TB disparity for Indigenous Australians is essential.

A social determinant of health approach will shift the focus to the social structures that cause TB. Collaboration with Indigenous partners in research is critical, and use of methods that amplify Indigenous peoples' voices and reconfigure power relations in favour of Indigenous Australians in the process is required.

  • tuberculosis
  • public health
  • systematic review

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Handling editor Seye Abimbola

  • Contributors The corresponding author SD attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The lead author, SD, affirms that the manuscript is an honest, accurate and transparent account of the study being reported, and no important aspects of the study have been omitted.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approval for the research was granted by the Aboriginal Health and Medical Research Council (1043/14), James Cook University (H6315), and the North Coast Health Service (LNR098) Human Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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