• William Naughton, Angus A Baumann, Kirsten Neal, Dan Wilson, Richard Johnson, and Anna Holwell.
• Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
• Intern Med J. 2024 Oct 26.

AbstractThe persisting life-expectancy 'gap' between First Nations and non-First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. Inadequate housing has led to some of the highest rates of Streptococcus pyogenes infection in the world, which in turn drives an extremely high prevalence of rheumatic heart disease. Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these 'social determinants' and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed.© 2024 Royal Australasian College of Physicians.

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