Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory

Objective: To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory. Design and setting: Analysis of Northern Territory data for 1 January 1994 to 30 December 1998 from multiple sources. Main outcome measures: Disability-adjusted life-years (DALYs), by age, sex, cause and Aboriginality. Results: Cardiovascular disease was the leading contributor (14.9%) to the total burden of disease and injury in the NT, followed by mental disorders (14.5%) and malignant neoplasms (11.2%). There was also a substantial contribution from unintentional injury (10.4%) and intentional injury (4.9%). Overall, the NT Aboriginal population had a rate of burden of disease 2.5 times higher than the non-Aboriginal population; in the 35-54-year age group their DALY rate was 4.1 times higher. The leading causes of disease burden were cardiovascular disease for both Aboriginal men (19.1%) and women (15.7%) and mental disorders for both non-Aboriginal men (16.7%) and women (22.3%). Conclusions: A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.

Urinary excretion of cadmium among Torres Strait Islanders (Australia) at risk of elevated dietary exposure through traditional foods

This study explored urinary cadmium levels among Torres Strait Islanders in response to concerns about potential health impact of high levels of cadmium in some traditional seafood (dugong and turtle liver and kidney). Cadmium levels were measured by inductively coupled mass spectrometry in de-identified urine samples collected during general screening programs in 1996 in two communities with varying dugong and turtle catch statistics. Statistical analysis was performed to identify links between cadmium levels and demographic and background health information. Geometric mean cadmium level among the sample group was 0.83 mu g/g creatinine with 12% containing over 2 mu g/g creatinine. Cadmium level was most strongly associated with age (46% of variation), followed by sex (females > males, 7%) and current smoking status (smokers > non-smokers, 4.7%). Adjusting model conditions suggested further positive associations between cadmium level and diabetes (p = 0.05) and residence in the predicted higher exposure community (p = 0.07). Positive correlations between cadmium and body fat in bivariate analysis were eliminated by control for age and sex. This study found only suggestive differences in cadmium levels between two communities with predicted variation in exposure from traditional foods. However, the data indicate that factors linked with higher cadmium accumulation overlap with those of renal disease risk (i.e. older, females, smokers, diabetes) and suggest that levels may be sufficient to contribute to renal pathology. More direct assessment of exposure and health risks of cadmium to Torres Strait Islanders is needed given the disproportionate level of diet-related disease and the cultural importance of dugong and turtle. This study highlights the need to consider social and cultural variation in exposure and to de. ne "safe'' cadmium levels during diabetes given its rising global prevalence.

Diversity, disruption, continuity: Parenting and social and emotional wellbeing amongst Aboriginal peoples and Torres Strait Islanders

This paper reviews the diversity in parenting values and practices amongst Aboriginal peoples and Torres Strait Islanders. Firstly, issues arising from the historical traumatic disruption of families’ attachments are discussed, Then the contribution Indigenous parenting makes to the development of healthy and vulnerable individuals becomes the central focus. Family therapists can draw from a broad understanding of the diversity of parenting values and practices in the context of a strength-based approach.

“We don’t tell people what to do”: Ethical practice and Indigenous health promotion

Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people’s autonomy, health promotion also imposes a particular, health promotion-sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion’s paternalistic control over people, rather than people’s control over their own health. Here in we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion ‘interventions’. Moreover, the potential stigmatisation produced in any paternalistic acts ‘done for their own good’ cannot be assumed to have evaporated within the self-proclaimed ‘empowering’ narratives of health promotion. This issue’s guest editor’s call for health promotion to engage ‘with politics and with philosophical ideas about the state and the citizen’ is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion’s central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion’s broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion’s general failure to reduce health inequalities experienced by Indigenous Australians.

How the whiteness embedded in health services impacts on the health and well-being of Aboriginal peoples

Aboriginal women are treated differently by non-indigenous health care providers based on perceptions of Aboriginality and skin colour and white race privilege within health care environments. The experiences shared below are from some of the Aboriginal woman respondents in a research project undertaken within Rockhampton, a regional area in Central Queensland (Fredericks, 2003). The experiences give an insight into how the Aboriginal women interviewed felt and their observations of how other Aboriginal women were treated within health care settings based on skin colour and perceptions of Aboriginality. A number of the women demonstrated a personal in-depth analysis of the issues surrounding place, skin colour and Aboriginality. For example, one of the women, who I named Kay, identified one particular health service organisation and stated that, ‘it is a totally white designed space. There is nothing that identifies me to that place. I just won’t go there as a client because I don’t feel they cater for me as a black woman’. Kay’s words give us an understanding of the reality experienced by Aboriginal women as they move in and out of places within health environments and broader society. Some of these experiences are examples of direct racism, whilst other examples are subtle and demonstrate how whiteness manifests and plays out within places. I offer acknowledgement and honour to the Aboriginal women who shared their stories and gave me a glimpse of their realities in the research project from which the findings presented in this chapter are taken. It is to this research project that is the subject of this chapter.

There is nothing that 'identifies me to that place' : Aboriginal Women's perceptions of health spaces and places

There is a growing body of literature within social and cultural geography that explores notions of place, space, culture, race and identity. The more recent works suggest that places are experienced and understood in multiple ways and are embedded within an array of politics. Memmott and Long, who have undertaken place-based research with Australian Indigenous people, present the theoretical position that ‘place is made and takes on meaning through an interaction process involving mutual accommodation between people and the environment’. They outline that places and their cultural meanings are generated through one or a combination of three types of people–environment interactions. These include: a place that is created by altering the physical characteristics of a piece of environment and which might encompass a feature or features which are natural or made; a place that is created totally through behaviour that is carried out within a specific area, therefore that specific behaviour becomes connected to that specific place; and a place created by people moving or being moved from one environment to another and establishing a new place where boundaries are created and activities carried out. All these ideas of places are challenged and confirmed by what Indigenous women have said about their particular use of, and relationship with, space within several health services in Rockhampton, Central Queensland. As my title suggests, Indigenous women do not see themselves as ‘neutral’ or ‘non-racialised’ citizens who enter and ‘use’ a supposedly neutral health service. Instead, Aboriginal women demonstrate they are active recognisers of places that would identify them within the particular health place. That is, they as Aboriginal women didn’t just ‘make’ place, the places and spaces ‘make’ them. The health services were identified as sites within which spatial relations could begin to grow with recognition of themselves as Aboriginal women in place, or instead create a sense of marginality in the failure of the spaces to identify them. The women’s voices within this paper are drawn from interviews undertaken with twenty Aboriginal women in Rockhampton, Central Queensland, Australia, who participated in a research project exploring ‘how the relationship between health services and Aboriginal women can be more empowering from the viewpoints of Aboriginal women’. The assumption underpinning this study was that empowering and re-empowering practices for Aboriginal women can lead to improved health outcomes. Throughout the interviews women shared some of their lived realities including some of their thoughts on identity, the body, employment in the health sector, service delivery and their notions of health service spaces and places. Their thoughts on health service spaces and places provide an understanding of the lived reality for Aboriginal women and are explored and incorporated within this paper.

Little theory, big plans : social capital and community building in Aboriginal Australia

The discourse surrounding recent Aboriginal social policy regularly refers to pragmatism and partnership. In a simpler world, we might call this ‘getting things done with Aboriginal people.’ To that extent, the discourse draws on an indisputable common sense, and it is not surprising that a variety of political agendas can be packaged within such language. While many things need to be done, the quantity and particularly the quality of social networks required to take effective policy into effective practice is something we ought to consider more carefully. This is where the concept of social capital could be useful, since it focuses attention on the social resources required to construct social policy, as well as the social resources that could be produced by effective social policy. Partnerships and pragmatism are therefore related at a most fundamental level in terms of social policy. We question whether this important conceptual bedrock has been fully explored. Hence we review here some recent ‘big plans’ for Aboriginal Australia, and ask whether the size of the theory matches the size of the plans.

What health services within rural communities tell us about Aboriginal people and Aboriginal health

There is a growing body of literature within social and cultural geography that explores notions of place, space, culture, race and identity. When health services in rural communities are explored using these notions, it can lead to multiple ways of understanding the cultural meanings inscribed within health services and how they can be embedded with an array of politics. For example, health services can often reflect the symbolic place that each individual holds within that rural community. Through the use of a rural health service case study, this paper will demonstrate how the physical sites and appearances of health services can act as social texts that convey messages of belonging and welcome, or exclusion and domination. They can also produce and reproduce power and control relations. In this way, they can influence the ways that Aboriginal people engage in health service environments – either as places where Aboriginal people feel welcome, comfortable, secure and culturally safe and happy to use the health service, or as places where they utilise the service provided with a great deal of effort, angst and energy. It is important to understand how these complex notions play out in rural communities if the health and wellbeing of Aboriginal people is going to be addressed.

Aboriginal community control and decolonizing health policy : a yarn from Australia

This chapter outlines: a brief history of Australian Aboriginal health and health policy and then moves on to demonstrate how the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) undertakes its work and is an example of 'decolonizing policy in action'. Moreover, it highlights how Aboriginal participation in the development of policy and in the planning, delivery, management and evaluation of health programs enables policies and programs to respond effectively to the needs of Aboriginal people and to change future health outcomes for them. It showcases how Aboriginal decision-making has gone some way to decolonizing policymaking and has addressed the power imbalance - both of which have been critical in the improvement in Aboriginal health outcomes.

Aboriginal public health and education : has it made a difference in practice?

Over the years, public health in relation to Australian Aboriginal people has involved many individuals and groups including health professionals, governments, politicians, special interest groups and corporate organisations. Since colonisation commenced until the1980s, public health relating to Aboriginal and Torres Strait Islander people was not necessarily in the best interests of Aboriginal and Torres Strait Islander people, but rather in the interests of the non-Aboriginal population. The attention that was paid focussed more generally around the subject of reproduction and issues of prostitution, exploitation, abuse and venereal diseases (Kidd, 1997). Since the late 1980s there has been a shift in the broader public health agenda (see Baum, 1998) along with public health in relation to Aboriginal and Torres Strait Islander people (NHMRC, 2003). This has been coupled with increasing calls to develop appropriate tertiary curriculum and to educate, train, and employ more Aboriginal and Torres Strait Islander and non-Aboriginal people in public health (Anderson et al., 2004; Genat, 2007; PHERP, 2008a, 2008b). Aboriginal and Torres Strait Islander people have been engaged in public health in ways in which they are in a position to influence the public health agenda (Anderson 2004; 2008; Anderson et al., 2004; NATSIHC, 2003). There have been numerous projects, programs and strategies that have sought to develop the Aboriginal and Torres Strait Islander Public Health workforce (AHMAC, 2002; Oldenburg et al., 2005; SCATSIH, 2002). In recent times the Aboriginal community controlled health sector has joined forces with other peak bodies and governments to find solutions and strategies to improve the health outcomes of Aboriginal and Torres Strait Islander peoples (NACCHO & Oxfam, 2007). This case study chapter will not address these broader activities. Instead it will explore the activities and roles of staff within the Public Health and Research Unit (PHRU) at the Victorian Aboriginal Community Controlled Health Organisation (VACCHO). It will focus on their experiences with education institutions, their work in public health and their thoughts on gaps and where improvements can be made in public health, research and education. What will be demonstrated is the diversity of education qualifications and experience. What will also be reflected is how people work within public health on a daily basis to enact change for equity in health and contribute to the improvement of future health outcomes of the Victorian Aboriginal community.