Indigenous land management as primary health care: qualitative analysis from the Interplay research project in remote Australia

Abstract

BackgroundFor Indigenous Australians, health transcends the absence of disease, and includes the health and wellbeing of their community and Country: their whole physical, cultural and spiritual environment. Stronger relationships with Country and greater involvement in cultural practices enhance the wellbeing of Indigenous Australians, and those in more remote regions have greater access to their Country and higher levels of wellbeing. However this does not translate into improvements in clinical indicators, and Indigenous Australians in more remote regions suffer higher levels of morbidity and mortality than Indigenous people in non-remote areas, and other Australians.The Interplay research project aimed to explore how Indigenous Australians in remote regions experience high levels of wellbeing despite poor health statistics, and how services could more effectively enhance both health and wellbeing.MethodsIndigenous Australians in remote regions, together with researchers and government representatives developed a wellbeing framework, comprising government and community priorities: education, employment and health, and community, culture and empowerment respectively. To explore these priorities Indigenous community researchers recruited participants from diverse Indigenous organizations, including Indigenous land management, art, business development, education, employment, health and municipal services. Fourteen focus groups and seven interviews, involving 75 Indigenous and ten non-Indigenous service providers and users were conducted. These were recorded, transcribed and analyzed, using thematic analysis, based on the wellbeing framework.ResultsResearch participants highlighted Indigenous land management as a source of wellbeing, through strengthened identity and empowerment, access to traditional food sources, enjoyable physical activity, and escape from communities where high levels of alcohol are consumed. Participants described how collaboration and partnerships between services, and recognition of Indigenous languages could enhance wellbeing, while competition between services undermines wellbeing. Indigenous land management programs work across different sectors and promote collaboration between services, serving as a source of comprehensive primary health care.ConclusionsDeveloping primary health care to reflect distinctive health needs of Indigenous Australians will enhance their health and wellbeing, which includes their communities and Country. Indigenous land management consolidates aspects of comprehensive primary health care, providing both clinical benefits and wellbeing, and can provide a focus for service collaboration.

“Everything is provided free, but they are still hesitant to access healthcare services”: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare?

“…The lack of timebound action on the social determinants, especially returning their lands, gave the impression to the Indigenous communities that they had to continue in their status quo while depending on handouts from the government while key structural issues were bypassed. Addressing social determinants of health such as restoring lands, access to natural resources and so on are key to empowering Indigenous communities, restoring trust in the system and so improving access to healthcare [62]. The failure to acknowledge the structural inequity in which these communities live means we reduce their health and the determinants of access to a series of clinical issues that need corresponding interventions to resolve them.…”

Is investment in Indigenous land and sea management going to the right places to provide multiple co-benefits?

“…By focusing on these wide ranging objectives, this article seeks to encompass benefits that go beyond the confines of financial or social return on investment analysis (for example, as considered by (Social Ventures Australia 2016a, 2016b, 2016c)). Evidence is accumulating that involvement in Indigenous land management provides benefits to health, well-being, culture, local languages and knowledge systems, spirituality and societal cohesion that are welcomed by participants and the broader Indigenous communities (Schultz et al 2018;Schultz et al 2019).…”

The case for cultural economic participation: achieving social and political change for Aboriginal peoples through community owned and run businesses

“…Increased cultural engagement-that is, activities with culture and Country-is strongly linked to improved health outcomes, including reduction in health risk factors (Jones et al 2018, p. 2;Schultz et al 2018, p. 1). Using cultural knowledge and practices in business, and employment, strengthens identity and culture for all Aboriginal peoples involved: the business owner/s, employee/s, and communities (Jones et al 2018;Schultz et al 2018;PwC 2018). Aboriginal and Torres Strait Islander peoples own or control between 20 and 40 per cent of Australia's land (PwC 2018, p. 11).…”

“…Aboriginal and Torres Strait Islander peoples own or control between 20 and 40 per cent of Australia's land (PwC 2018, p. 11). Cultural connection to land, as well as ownership and control, has led to establishment of employment in Indigenous Land Management and Ranger roles (Jones et al 2018;PwC 2018, p. 11;Schultz et al 2018). Employment in these roles invites Aboriginal employees to draw from cultural as well as contemporary knowledge to manage lands and seas (Schultz et al 2018, p. 2).…”

“…Employment in these roles invites Aboriginal employees to draw from cultural as well as contemporary knowledge to manage lands and seas (Schultz et al 2018, p. 2). Such roles have been noted in the literature as successful employment practices for achieving social and political change by affirming culture and identity and improving health and wellbeing (Jones et al 2018;Schultz et al 2018).…”