The burden of stroke, a leading cause of death and disability in Australia, is not equally shared across different sections of the population. Many Australians are disproportionately affected by virtue of their socioeconomic living circumstances, location, and by virtue of being Indigenous. Over two thirds of the population in outer regional, remote or very remote areas are Indigenous Australians, and over half of them are classified high in deprivation indices. Regional disparities are amplified by variations in the uptake of preventative medication and access to primary care services, the reasons for which are likely to be related to poor knowledge of health conditions and the role of modern medicines, and of financial, social and geographical access barriers.

Stroke in Indigenous Australians presents particular challenges to management: the disease is often complicated by co-mordid conditions (i.e. diabetes mellitus and renal failure), previously unrecognised or poorly controlled; counselling patients and family members requires sensitivity to educational, social and cultural context; the organisation of rehabilitation, traditionally emphasising inpatient therapy, requires a re-orientation towards relevant patient (and family) goals; and there needs to be awareness of the impact of the disabled stroke survivor on family dynamics from altered roles and economic strain, for which community support services can play an important role in easing the burden of care.

This lecture draws on the experience of stroke physicians working with Indigenous Australians, adds a spice of epidemiology, and presents some research and health service models 'ideas' for consideration/discussion.