Social Determinants of Health, the ‘Control Factor’ and the Family Wellbeing Empowerment Program

Abstract

Objective:To explore links between the social determinants of health, the 'control factor', and an Aboriginal empowerment program.Methods: The evidence that rank or social status is one of the most important determinants of health is briefly presented. This is followed by a critique of the Australian policy and intervention framework for tackling and reducing social inequalities. The concept of 'control' as an important element in addressing social determinants of health is examined next and the Family Wellbeing empowerment program is analysed to illustrate how the concept of control might be operationalised at program or intervention level. Implications for health practitioners are identified.Results: By providing a safe group environment for participants to explore sets of critical questions about themselves, their families and communities, through the process of participatory action research, Family Wellbeing has demonstrated its potential to 'enable' Indigenous people to take greater control and responsibility for their situation. While program participants first address personal and immediate family issues, evidence is emerging of a ripple effect of increasing harmony and capacity to address issues within the wider community Conclusions:The social determinants of health are complex and multilayered and so addressing them needs to involve multilevel thinking and action. The control factor is only one element, albeit an important one, and Family Wellbeing is providing evidence that 'control' can be addressed in Indigenous settings. For empowerment programs to achieve their full potential, however, there is a need to ensure that such programs reach a critical mass of the target group. It is also imperative that policy-makers and practitioners take a longer-term approach, including properly resourced longitudinal studies to document and enhance the evidence base for such interventions. As health practitioners it is vital we consider our work within this broader context, creatively seek to enhance linkages between services and programs, and support processes for change or intervention at other levels.

Aboriginal and Torres Strait Islander Suicide in Context

“…Drawing on individual and group empowerment through narrative approaches, and in line with the broader conception of individuals and communities at risk, emphasis has shifted to developing means to operationalize concepts of 'empowerment' in Indigenous families and communities (Tsey, Deemal, Whiteside et al, 2003) with adaptations to specific target groups, such as young men (Tsey, Patterson, Whiteside et al, 2004). Of course there is a contradiction implicit in project and program based solutions (to Indigenous health and social problems more generally as well as to suicide specifically) and critics have pointed out that replacing or undermining Indigenous cultural capabilities and responsibilities can, ultimately, be disempowering (Trudgen, 2000).…”

Balancing Empiricism and Local Cultural Knowledge in the Design of Prevention Research

“…As such, CBPR has been employed in many recent AIAN prevention studies. [59][60][61][62][63][64][65][66][67][68] …”

Disadvantage and discontent: A review of issues relevant to the mental health of rural and remote Indigenous Australians

“…In these settings it will also require broad, transdisciplinary, health-affirming approaches that are attuned to the circumstances and priorities of remote communities, 46 and initiatives that support empowerment at individual, family and community levels. 47 In particular, real change will demand that these approaches are responsive to the needs of remote children. 48 There are existing examples of each (see citations).…”