Use and access of cultural medicines by First Peoples in Australia: Exploratory national insights and implications for health sovereignty

Purpose Aboriginal and Torres Strait Islander Peoples (hereafter First Peoples) define health and wellbeing as grounded in Country, yet institutionalised national health systems in Australia rarely recognise or resource cultural medicines. Cultural medicines, such as smoking ceremonies, being on Country, and engagement with traditional healers are central to health sovereignty; however, most research has examined traditional, complementary and integrative medicines without focusing on cultural medicines or equity of access. This study reports the first Australia-wide exploratory survey of cultural medicines utilisation, access and intention to use among First Peoples in Australia. Methods This exploratory, cross-sectional study formed part of a national co-design project on cultural medicines in healthcare. A co-design research group adapted the I-CAM-Q instrument to reflect cultural medicines using iterative, culturally governed co-design. An online survey of First Peoples aged 18 or more years was disseminated through the co-design research group's networks and social media between December 2023 and January 2024. Demographic characteristics and responses on utilisation, access and desire to use cultural medicines were analysed descriptively, with attention to unmet needs and access barriers, and interpreted as exploratory, given the likely under-representation of older knowledge holders, men and people in remote communities. Main findings A total of 186 First Peoples adults participated (81.7% female; predominantly aged 30–49 years). Demand for cultural medicines was high but access was limited. Only 9.7 per cent reported easy access to traditional healers, yet over 94 per cent of those without access indicated that they would use healers if available. Use of Country as medicine and smoking ceremonies were most common, while song-based ceremonies, insect-based native foods and traditional healers showed lowest engagement. Respondents preferred accessing cultural medicines through Aboriginal community-controlled health services. Most wanted family members to have access to healing ceremonies for grieving as part of their end-of-life care (i.e. palliative care). Only a small minority did not want access to cultural medicines. Principal conclusions Cultural medicines remain a critical yet under-supported health practice for First Peoples in Australia. Despite limited access, these findings demonstrate strong intent to use cultural medicines and unmet need linked to structural barriers in the health system. Ensuring health equity requires culturally safe healthcare models that respect and integrate cultural medicines under First Peoples' governance, supported by policy frameworks that protect Indigenous knowledges and uphold health sovereignty and Indigenous rights.