A Review of Programs That Targeted Environmental Determinants of Aboriginal and Torres Strait Islander Health

Abstract

Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.

Follow‐up of Indigenous‐specific health assessments ‐ a socioecological analysis

“…However, many of the identified barriers related to delivery of follow‐up care rather than billing for follow‐up items. Ecological models require themes to be categorised, and this process may be overly Western‐centric 22 . In conducting the analysis our team (which included Indigenous members) was sensitive to this risk.…”

Promotion de l’activité physique en milieu rural ou éloigné et dans les régions du Nord : un appel pancanadien à l’action

“…Le cinquième article de synthèse abordait les corrélats et les modèles de l'activité phy sique au sein des collectivités autochtones du Canada et des ÉtatsUnis et fournissait un aperçu des études sur les interven tions 45 . Les articles de synthèse rassemblaient des études réalisées en Australie 41,42 , aux ÉtatsUnis 4345 et au Canada 4345 .…”

“…En revanche, Johnston et collab. 41 et Shilton et Brown 42 ont étudié l'aménagement de piscines dans deux collectivités autoch tones éloignées d'AustralieOccidentale dont l'objectif était d'améliorer la fréquentation scolaire et les résultats en matière de soins de santé primaires. Les articles de synthèse indiquaient que de telles interventions révélaient l'importance de la mise en oeuvre de stratégies exhaustives pour répondre à l'éventail des besoins des col lectivités en milieu éloigné, qui disposent d'un nombre limité de ressources.…”

Critique of a Community-Based Population Health Intervention in First Nations Community: Public Health and Cultural Anthropology Perspectives

“…Therefore, Benyshek, Martin, and Johnston (2001) rightly named it a "political disease" (p. 52) whereby historical records of deprivation, social, and economic disruptions are all consistent with findings showing that chronic protein energy malnutrition underlies the cause of diabetes (p. 41). A systematic review shows that similar programs in Australia aiming to improve nutrition typically target a range of structural determinants including food supply, food policy, and family (Johnston et al, 2013). Although SLHDP achieved a change in the food supply by establishing the Northern Store Program, it relied on foods shipped from long distances by air cargo and sold at high prices.…”

“…Interventions aimed to address Aboriginal health must keep in mind this evolution pathway and endeavour to foster the Aboriginal concept of health that embraces emotional, intellectual, spiritual, cultural, and social aspects of wellbeing (Johnston et al, 2013). SLHDP attempted to address the physical, cultural, and some social aspects of health, but no efforts were made in dealing with the spiritual and emotional aspects.…”