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Health Promotion in Indigenous communities in Australia
By Jeanette Pastor
Indigenous communities in Australia are a complicated area of practice for health promotion. Both non-government organisations and government agencies alike have various activities that include health promotion components. The health of Indigenous Australians is a political topic, and everyone wants to be seen to be making a difference to the poor health statistics of Indigenous Australians. It is evident however that despite recognition of the importance of health promotion in addressing the poor health of Indigenous Australians, that there is still improvement needed in this area.
Health Statistics of Indigenous Australians
The Australian Bureau of Statistics states that based on age-specific death rates prevailing during 2005-07, life expectancy at birth for Indigenous males is estimated to be 67.2 years, 11.5 years less than life expectancy at birth for non-Indigenous males (78.7 years). Life expectancy at birth for Indigenous females is estimated to be 72.9 years, 9.7 years less than life expectancy at birth for non-Indigenous females (82.6 years) (1).
In regard to health promotion, many activities are focused on improving nutrition and overall health. Programs aim to address social determinants of health, and seemingly the most obvious starting point is that of nutrition. It is well documented that Indigenous and non-Indigenous Australians alike are increasingly facing obesity as a health problem leading to an array of other health issues, and the prevalence of type 2 diabetes is increasing amongst the overall population (2).
Health promotion in Australia
Over the last three decadesAustralia has adopted and applied the values, methods, and practice of health promotion. In doing so it must be noted that the average life expectancy of Australians overall and the health of the population has improved. The Australian health sector now also includes a specialist workforce dedicated to health promotion. However, despite its significant successes, health promotion inAustralia has had little impact on improving the health of Indigenous Australians (2).
In Australia, Indigenous children are disproportionately affected by poor health. It has been found that poor health combined with social factors around living conditions in Indigenous communities have also contributed to poor education levels compared with non-Indigenous children. From early childhood, infectious diseases are significantly more common among Indigenous children in remote communities. It is recognised that health and education are inextricably linked, yet the Australian government has only recently began to place greater emphasis on addressing education and health with a combined approach, that aligns more to health promotion practice (3).
The need for community control
What is difficult also is that much of the control over what happens in Indigenous communities is not necessarily in the hands of the people within the community. Government agencies and non-government organisations ideally will always consult the community, however not all programs and initiatives are developed alongside the community and enough input from the community. Many studies have found that it is crucial that programs are from the outset aimed at empowering Aboriginal people. There should be greater emphasis placed on ensuring that Aboriginal culture is well respected and not seen as inferior in any way. Instead the focus should be to raise self-esteem, and empower individuals and communities through increasing knowledge and practical action to improve child health, and therefore improve the health of communities overall (4).
A more holistic approach
It is evident that in order to improve the health of Indigenous Australians, a more holistic health promotion approach is needed. In a study following the lives of 15 Aboriginal infants from two remote communities in Northern Australia from birth to their first birthday, it was found that there were significant differences between the parenting methods of these groups and those of mainstream Australians. More specifically, it was found that in these communities, current Aboriginal parenting styles rely on child-led development. The study concluded that without proper understanding of Aboriginal knowledge systems, and the respectful incorporation of Aboriginal cultural beliefs into the programs and initiatives ofAustralia's health systems, it is expected that there will be continued failure of government and health services in Aboriginal communities to address the poor health of Indigenous Australians (5).
Health promotion inAustraliahas without doubt, been instrumental in improving the health of Australians. However it remains that there is a significant gap between the life expectancy of Indigenous Australians and non-Indigenous Australians. It is recognised that there needs to be a more holistic approach to health promotion in Indigenous communities, with a lesser focus on nutrition related activities, and more emphasis placed on a whole of community approach, that also encompasses education and other sectors, and most importantly, where control of the program lies with the community itself. Not until Aboriginal culture is well regarded and communities themselves are able to develop and implement programs as needed can there be a significant improvement in the effectiveness of health promotion toward improving the health of Indigenous Australians.
How do you think health promotion should be conducted in Indigenous communities? Do you have good program examples you can share with others working in the field? Join our community development working group and get connected with others working and interested in the field. Contact Jeanette Pastor for more details.
1. Australian Bureau of Statistics (ABS) 2011, Australian Social Trends, March 2011 http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Mar+2011
2. Wise, M. 2008, 'Health promotion in Australia: Reviewing the past and looking to the future.' Critical Public Health, Dec2008, Vol. 18 Issue 4, p497-508
3. Lyons, Z. & Janca, A. 2012 'Indigenous children in Australia: Health, education and optimism for the future.' Australian Journal of Education, Apr2012, Vol. 56 Issue 1, p5-21
4. McDonald, E., Bailie, R., Grace, J., & Brewster, D., 2010 'An ecological approach to health promotion in remote Australian Aboriginal communities' Health Promotion International, Vol. 25 No. 1, Published by Oxford University Press.
5. Kruske, S., Belton, S., Wardaguga, M., Narjic, C., 2012, 'Growing Up Our Way : The First Year of Life in Remote Aboriginal Australia', Qualitative Health Research 2012 22: 777 originally published online 4 January 2012
Published: HPC, June 2012
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