We need transformative change in Aboriginal health

Quinn

Wilson

et al. 2019

BMC Health Serv Res

Background Australia provides health care services for Indigenous peoples as part of its effort to enhance Indigenous peoples’ wellbeing. However, biomedical frameworks shape Australia’s health care system, often without reference to Indigenous wellbeing priorities. Under Indigenous leadership the Interplay research project explored wellbeing for Indigenous Australians in remote regions, through defining and quantifying Indigenous people’s values and priorities. This article aimed to quantify relationships between health care access, mental and physical health, and wellbeing to guide services to enhance wellbeing for Indigenous Australians in remote regions. Methods Indigenous and non-Indigenous researchers worked with Indigenous people in remote Australia to create a framework of wellbeing priorities. Indigenous community priorities were community, culture and empowerment; these interplay with government priorities for Indigenous development of health, education and employment. The wellbeing framework was further explored in four Indigenous communities through a survey which measured aspects of the wellbeing priorities. Indigenous community researchers administered the survey in their home communities to 841 Indigenous people aged 15 to 34 years from June 2014. From the survey items, exploratory factor analysis was used to develop constructs for mental and physical health, barriers to health care access and wellbeing. Relationships between these constructs were quantified through structural equation modelling. Results Participants reported high levels of health and physical health (mean scores (3.17/4 [SD 0.96]; and 3.76/4 [SD 0.73]) and wellbeing 8.07/10 [SD 1.94]. Transport and costs comprised the construct for barriers to health care access (mean access score 0.89/1 [SD 0.28]). Structural equation modelling showed that mental health, but not physical health was associated with wellbeing (β = 0.25, P < 0.001; β = − 0.038, P = 0.3). Health care access had an indirect positive relationship with wellbeing through mental health (β = 0.047, P = 0.007). Relationships differed significantly for participants in remote compared with those in very remote communities. Conclusions Greater attention to mental health and recognition of the role of services outside the health care sector may have positive impacts on wellbeing for Indigenous people in remote/ very remote Australia. Aggregation of remote and very remote populations may obscure important differences between Indigenous communities.

Section: Discussionmentioning

confidence: 99%

Structural modelling of wellbeing for Indigenous Australians: importance of mental health

Quinn

Wilson

et al. 2019

BMC Health Serv Res

“…Indigenous experts have called for a transformation in health care for Indigenous Australians because of the unacceptable costs of current vertical, disease-focused approaches, and noted that this will require reshaping policies, reinventing organizations, and working across sectors [46].…”

Section: Discussionmentioning

confidence: 99%

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

Abbott²,

Yamaguchi

et al. 2018

BMC Health Serv Res

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.

“…Currently, Australian health care services are funded to address clinical indicators for Aboriginal Peoples, rather than to contribute to empowerment, despite demonstrated benefits of empowerment interventions (Tsey et al, 2005). Addressing empowerment through health services, especially for women, may be a key element in the transformative change in health care needed to improve both health and wellbeing for Aboriginal Australians (Houston, 2016). For Aboriginal men, there is a need to address barriers to health service access (Canuto, Wittert, Harfield, & Brown, 2018).…”

Section: Empowermentmentioning

confidence: 99%

Quantification of Interplaying Relationships Between Wellbeing Priorities of Aboriginal People in Remote Australia

Quinn

Abbott³

et al. 2019

iipj

Wellbeing is a useful indicator of social progress because its subjectivity accounts for diverse aspirations. The Interplay research project developed a wellbeing framework for Aboriginal people in remote Australia comprising government and community wellbeing priorities. This article describes statistical modelling of community priorities based on surveys administered by community researchers to 841 participants from four remote settlements. Constructs for Aboriginal language literacy, cultural practice, and empowerment were identified through exploratory factor analysis (EFA); structural equation modeling (SEM) was used to confirm relationships. Cultural practice was associated with Aboriginal language literacy and empowerment, which were both associated with wellbeing. Aboriginal literacy and empowerment mediated negative direct relationships between cultural practice and wellbeing. Direct relationships were significant only for females for whom empowerment and Aboriginal literacy appear key to enhancing wellbeing.