The Centre of Clinical Research Excellence in Aboriginal Health : an operational rationale and some reflections on progress so far

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.

De-colonizing amnesia: refusing false consciousness

When considering research discourses that pertain to Indigenous knowledges there is a constant reference to the positioning of the researcher in terms of their own cultural background and cultural understandings. This, of course, is related to the empowerment and importance of Indigenous research by Indigenous voices. This is particularly important within the context of Australia in relation Aboriginal and Torres Strait Islander research. My analysis identifies and defines how the notion of ideology contributes to an amnesiac condition in Australia, one that underlines understandings of culture. It is vital to elaborate that the premise of amnesia is predicated on ideology itself. This has wider implications for the many cultures that have experienced the act of colonisation. The aim of this paper is to propose and elaborate a way of thinking about amnesia as premised on ideology. In order to do so, it is necessary to unravel and critique western notions of ideology especially those based on Louis Althusser’s elaboration of ideology as being based on an imaginary condition of existence (Althusser 1971). I have selected an Althusserian ideology in order to conduct a comparative analysis within an Indigenous framework. In this context, Althusserian ideology is an exemplar of representationalist thinking that continues to be dominant and endemic in western representationalist thinking. By identifying this gap, I provide an alternative framework of ideology based on the “real” and integrated conditions of existence that operate in an Indigenous ideology and culture and its ritualised practices. It is this alternative framework that can provide a new way of looking and thinking about how ideology can be reconfigured in their relationship with culture. It is here that relationality prevails. My argument operates within this space. It is within this space that I emphasise the importance of Land (“Country”) in order to demonstrate a “real” alternative ideology that is not based on the imaginary.

Duplicity of meaning

This article considers the ‘duplicitous’ functions of the word ‘wild’ in the arguments over the Queensland’s Wild Rivers Act 2005. Certain traditional owners, environmentalist and state groups have deployed the term pragmatically, simultaneously endorsing its usage (through repetition) and disavowing its colonial associations (through explanation) against protestations by Indigenous and non-Indigenous stakeholders. In a sense, this ambivalent ‘duplicity’ is entirely consistent with relations between the settler-colonial nation state and Aboriginal and Torres Strait Islander polities – relations aptly characterised by Povinelli as shaped by ‘the cunning of recognition’ – which stratify relations between groups through the endorsing of ‘tradition’. Thus ‘the Indigenous’ can be posited both as one political minority amidst a multicultural polity and as a pre-modern and endemic precursor of the settler-colonial nation, constitutively conservationist ‘first Australians’. Arguably, in the legislation’s ‘recognition’ of the ‘wild’ past, Indigenous peoples – who were known in nineteenth century Queensland as ‘wild blacks’ or ‘myalls’ (meaning those who resisted leaving their lands – and ‘could be shot with impunity’) are recouped as the nation’s first caretakers of ‘pristine’ waterways. However, this article regards the current use of this ambivalent word as also potentially authorising those recognised through this mythic form, providing a limited and uncertain opportunity for traditional owners to ground a form of sovereign right in lands and waterways. Against totalising settler-colonial critiques of hegemony, this article argues that the Wild Rivers legislation does not forget indigeneity, but rather relies on indigeneity. While much research concerning ‘natural’ ideologies such as ‘the noble savage’ has worked to show that faith in a belated era of historical fullness or presence can serve to evacuate the present of material details, it may also be that the ‘wild’ can also offer Indigenous peoples a valuable political authority to, in the words of Courtney Jung, ‘contest the exclusions through which it has been constituted’.

A systematic review of published interventions for primary and secondary prevention of ischaemic heart disease (IHD) in rural populations of Australia

BACKGROUND: Rural Australians are known to experience a higher burden of ischaemic heart disease (IHD) than their metropolitan counterparts and the reasons for this appear to be highly complex and not well understood. It is not clear what interventions and prevention efforts have occurred specifically in rural Australia in terms of IHD. A summary of this evidence could have implications for future action and research in improving the health of rural communities. The aim of this study was to review all published interventions conducted in rural Australia that were aimed at the primary and/or secondary prevention of ischaemic heart disease (IHD) in adults.

METHODS: Systematic review of the peer-reviewed literature published between January 1990 and December 2015. Search terms were derived from four major topics: (1) rural; (2) ischaemic heart disease; (3) Australia and; (4) intervention/prevention. Terms were adapted for six databases and three independent researchers screened results. Studies were included if the published work described an intervention focussed on the prevention or reduction of IHD or risk factors, specifically in a rural population of Australia, with outcomes specific to participants including, but not limited to, changes in diet, exercise, cholesterol or blood pressure levels.

RESULTS: Of 791 papers identified in the search, seven studies met the inclusion criteria, and one further study was retrieved from searching reference lists of screened abstracts. Typically, excluded studies focused on cardiovascular diseases without specific reference to IHD, or presented intervention results without stratification by rurality. Larger trials that included metropolitan residents without stratification were excluded due to differences in the specific needs, characteristics and health service access challenges of rural populations. Six interventions were primary prevention studies, one was secondary prevention only and one included both primary and secondary intervention strategies. Two interventions were focussed exclusively on Aboriginal and Torres Strait Islander (Australian Indigenous) populations.

CONCLUSIONS: Few interventions were identified that exclusively focussed on IHD prevention in rural communities, despite these populations being at increased risk of IHD in Australia, and this is consistent with comparable countries, internationally. Although limited, available evidence shows that primary and secondary interventions targeted at IHD and related risk factors can be effective in a rural setting.