Abstracts for Issue 2, 2006
Australian federalism and Aboriginal health
Ian Anderson and John Douglass Whyte
In this paper we explore the changing relationship between Aboriginal peoples and the Australian state within the context of Australian federalism. Our particular focus is on the relationship between the institutional organisation of Australian health systems and the equitable provision of health services to Aboriginal Australians. We examine the historical development of this relationship over three key periods. The period from Australian federation in 1901 to the 1967 referendum resulted in the deletion of race clauses from the Australian constitution. The Commonwealth’s racialised constitutional and legislative framework created a structural basis for racial rationing. Incrementally, from 1967 to 1995, the Commonwealth developed a national Aboriginal health program but without a corresponding development of institutional links with national health financing and policy structures. Since 1995 there has been some success in the development of intergovernmental agreements in Aboriginal health (the Framework Agreements for Aboriginal and Torres Strait Islander Health) and a National Strategic Framework for Aboriginal and Torres Strait Islander Health which is linked to the Aboriginal and Torres Strait Islander health performance measurement framework. We argue that these developments provide a platform for the equitable provision of health services to Aboriginal Australians and we identify some of the key barriers to the realisation of this.
Evidence-based policy making in Aboriginal and Torres StraitIslander health
Evidence-based policy making in health is of great importance when addressing issues of Aboriginal and Torres Strait Islander health inequalities. I explore the role of evidence in influencing the decisions of policy makers, and question the relevance and accuracy of current evidence to the life experiences, social and cultural environments, and aspirations of Aboriginal and Torres Strait Islander persons. I examine the concept of evidence and Lin’s (2003) competing rationalities within the context of Aboriginal and Torres Strait Islander health. Lin describes three competing rationalities: cultural, political and technical. A social rationality can also be included, one that relates to how we see and know the world. Social rationalities may differ according to gender, class, age, ethnicity and place. White middle-class persons and politically marginalised Aboriginal and Torres Strait Islander peoples do not think and interpret realities in the same way because of divergent structural positions, histories and cultures. Cultural rationality informs and shapes social, political and technical rationalities because the latter are grounded in and developed by the former.
Putting the users of research in the driver’s seat: the Cooperative Research Centre for Aboriginal Health’s new approach to research development
Jenny Brands and Mick Gooda
Research has a bad name in many Aboriginal communities. There is an often quoted phrase that ‘Aboriginal people are the most researched in the world’, and that researchers take from communities in order to gain academic qualifications with little benefit returned to Aboriginal peoples. But, like most things, research can be both ‘good’ and ‘bad’. Increasingly, since the 1980s, Aboriginal peoples have been asserting their right to control research. Often this control has been applied through ethics processes, or through the use of Indigenous methodologies.
The Cooperative Research Centre for Aboriginal Health represents a further development in the control of Aboriginal health research by Aboriginal peoples. It provides a mechanism for directing the development, funding, conduct and dissemination of research in ways designed to maximise the likely benefits of the research for Aboriginal peoples—to do ‘good’ research. This has led to the development of a new model for the research industry, in which research priorities are set by the Aboriginal health sector, research projects are developed through facilitated collaboration with research users, and even the peer review or quality assurance process is very different.
The Universal Citizen: an Indigenous citizenship framework for the twenty-first century
The present urgency across the world is for Indigenous peoples to take leadership in addressing the spiritual and humanist inadequacies of Western cultural development. It is time to join with others who have found their way out from under the burden of their intellectual heritage of empire to consider future citizenship states that can do more than reduce our ecological expectations to the level of mere survival. A mode of citizenship that is a synthesis of knowledges and interventions with 'place' and 'space' has potentially revolutionary implications in restoring quality of life and ecological justice. Indigenous peoples, ecologists and ethicists (ethical philosophers) are in a prime position to assist the human community in reconnecting itself with nature. As such, it is the fusion of these knowledges that underlies the model of a 'Universal Citizen', a model of universe-referent citizenship that places the universe, and all living and non-living life forces, as the 'primary' for human existence in the future.
Trying to make a difference: a critical analysis of health care during pregnancy for Aboriginal and Torres Strait Islander women
This paper critically examines pregnancy health care and services for Aboriginal and Torres Strait Islander women, to explore the question of what might 'make a difference'. More antenatal care, and in particular Aboriginal women attending for care earlier and more often, is often put forward as what is needed to improve pregnancy outcomes, as well as the health of future populations. However, evidence from epidemiological, clinical and health services research problematises this assertion. An alternative and preferable driver for the reform of maternity services for Aboriginal women would be to allow women themselves to have more say in decision making at both individual and institutional levels.
'getting em n keeping em': Indigenous issues in nursing education
The health of Indigenous Australians has been unacceptable for many years. Generations have never recovered from the effects of colonisation, genocide, and attempted assimilation. Introduced diseases, poor nutrition, dislocation of families and clans from traditional lands, poverty, and human rights issues have historically combined to impact on Indigenous health and wellbeing. Vast distances, lack of educational opportunities, and reduced access to higher education have contributed to serious under-representation of Indigenous persons in the health professions, including nursing, a profession that, along with other health disciplines, has not always welcomed Indigenous persons nor been inclusive of Indigenous health issues in its educational curricula.
In 2000 four nurse leaders collaborated to become the Indigenous Nursing Education Working Group. In 2003 INEWG released the 'gettin em n keepin em' report, which made 32 recommendations aimed at encouraging universities to recruit and retain more Indigenous persons in nursing. Strategies to increase the awareness, knowledge and skills of nurses to care for Indigenous people can be incorporated into nursing curricula. Better cultural acceptance of Indigenous people in the university sector has been emphasised.
They used to call it Sandy Blight: Aboriginal health and censorship in Australia
Jilpia Nappaljari Jones, Leila Smith and Gordon Briscoe
In 1977, a documentary film entitled They used to call it Sandy Blight was produced by independent filmmakers on the National Trachoma and Eye Health Program, a program to survey and treat the eye health of rural Australians, particularly Aborigines and Torres Strait Islanders. The documentary raised awareness of and generated support for Aboriginal health. In this paper we discuss the eye health of Aboriginal peoples prior to and at the time of the documentary and the debate surrounding calls for the film’s censorship.
Raising the profile of Aboriginal and Torres Strait Islander men’s health: an Indigenous man’s perspective
This is a statement paper of Aboriginal and Torres Strait Islander men's health issues and recent policy initiatives at the national level. During colonisation, Indigenous men were dispossessed of land and livelihood, status and authority, and meaning and purpose. The health of Aboriginal and Torres Strait Islander men today is unacceptable in a wealthy post-industrial society. The complexity of men's health issues relates not only to the determinants of health but also to how men care for their health. The paper discusses recent national initiatives in Indigenous men’s health, particularly the formation of the National Aboriginal and Torres Strait Islander Male Health and Well-being Reference Committee in 1999 and the establishment of The National Framework for Improving the Health and Well-being of Aboriginal and Torres Strait Islander Males in 2003.
‘If we come together our health will be happy': Aboriginal men seeking ways to better health
Brian F McCoy
This paper arose out of research with men of the Western Desert of the Kimberley, Western Australia. While Aboriginal health is well known to be poor, not much is known about Aboriginal male experiences and perspectives of their health. In particular, this research picks up the concept of kanyirninpa ('holding') as developed by Myers with the Pintupi 30 years ago. It explores kanyirninpa as understood today by another desert people and what it means for men’s health. I consider examples where men continue to seek health that is culturally based, creative and controlled by themselves, concluding by suggesting some implications for Aboriginal men's health.
East Kimberley concepts of health and illness: a contribution to intercultural health programs in northern Australia
East Kimberley concepts of health and illness can be discussed within a framework of Aboriginal cosmologies, ontologies, and relational practices. In Australian Aboriginal traditions, the cosmos and its lifeforms were composed of ancestral substances and energies. East Kimberley peoples subscribe to a flow theory of life and a relational-moral causality. However, biomedical regimes are tailored to the requirements of atomistic individuals, and chronic conditions self-management programs are articulated in terms of self-motivating, goal-directed clients. Health programs which cohere with Aboriginal social requirements will be more successful than initiatives directed at the individual level. Notions of social, relational and family efficacies can be developed to facilitate behavioural change in relational cultures. Indigenous concepts of the body, health and illness can be used to humanise Western physiology and produce health programs that are meaningful to Aboriginal peoples.
Shifting expectations of treatment: from 'patient as individual' to 'patient as social person'
With focus on an all-Aboriginal community in rural central-western New South Wales, and developing the notion of treatment as 'a site of negotiation', I illustrate the socially and culturally distinctive understandings of what it means to be 'a healthy Aboriginal person'. In this community, it is not necessarily understandings of 'health' that diverge from what appears to be a miscommunication between Aboriginal patients and health care professionals; disjunctures can emerge from expectations of treatment regimes. By analysing mainstream health practices in the context of the socialising paradigms inherent in Aboriginal peoples’ practices, I propose that the emphases of treatment be shifted in order to better integrate Aboriginal understandings of 'health', which entails preserving 'cultural security'; for Aboriginal persons in their dealings with the health system. Aboriginal persons who participated in my research indicated that the quality of their immediate social life, as expressed in their relationships to others (patient as 'social person'), is of greater value than the biophysical needs of their sick bodies (patient as 'individual'). I examine the implications of these relationships for bodily health.