10 years of preventive health in Australia. Part 2 – centring First Nations sovereignty

As First Nations public health professionals, we critically examine the National Preventive Health Strategy 2021-2030 (NPHS) and its shortcomings in addressing the structural determinants of health inequities affecting Aboriginal and Torres Strait Islander peoples (hereafter respectfully, First Nations peoples). Although the NPHS aspires to a systems-based and equitable approach, we argue that it fails to meaningfully engage with the enduring impacts of colonisation, systemic racism, and intergenerational trauma. By focusing predominantly on individual behavioural risk factors, the strategy neglects the broader sociopolitical and cultural contexts that continue to drive poorer health outcomes in our communities. True progress in preventive health requires a fundamental shift - one that centres First Nations self-determination; embeds our ways of knowing, being, and healing; and invests in community-led solutions. We call for the re-Indigenisation of the health system, not as a gesture of inclusion, but as an assertion of our sovereignty, knowledge, and leadership in shaping our own health futures. We conclude with a series of actionable recommendations for policymakers grounded in structural reform and driven by the urgent need for systems transformation led by, and accountable to, First Nations peoples.