Week 9 #2 Aboriginal and Torres Strait Islander Health - Colonisation

Acknowledgment

• Acknowledge Traditional Custodians of the land, their Elders past, present, and emerging, and their continuing connection to land, waterways, and skies.

Important Notice

• Warning: This lecture may contain images/audio of deceased persons and content related to Australia’s history of violence and oppression.
• Self-care is encouraged during this lecture.

Terminology

• Aboriginal and Torres Strait Islander Peoples
• First Nations Peoples
• Specific nations

Cultural Respect

• History of Australia's First Peoples and post-colonial experience.
• First Peoples' culture, beliefs, languages, and practices.
• Diversity of First Peoples' Culture.
• Humility and lifelong learning.
• Cultural Safety in Healthcare: terminology and definitions.

Purpose of Indigenous Health Teaching and Content

• Understanding the definition of health for Aboriginal and Torres Strait Islander peoples.
• Understanding cultural awareness, cultural competence, and cultural safety.
• Outline important politico-historical determinants and how they impact the health of Aboriginal and Torres Strait Islander peoples today (including policy).
• Understand the importance of strengths-based approaches and identify when this is not being practiced.
• Develop an awareness of how communication and protocols differ in Aboriginal and Torres Strait Islander communities.
• Ability to engage in reflexive practice.
• Year 1 Health promotion task.

Poll Question

• How confident are you in interacting appropriately with Aboriginal and/or Torres Strait Islander Peoples?

Participation Question

• What would you like to learn about Aboriginal and Torres Strait Islander Health?

Strengths-Based Approach

• Focus on unique strengths.
• Identify what/who helps overcome challenges.
• Recognize personal passions and commitments.

Deficit Discourse

• Definition: Disempowering patterns representing people in terms of deficiencies and failures.

Examples: Deficit Discourse vs. Strengths-Based Discourse

• Smoking during pregnancy:
  • Deficit: Aboriginal women continue to smoke during pregnancy at a rate of 40% (2022) compared to 8.3% in the non-Indigenous population.
  • Strengths-based: There is a decrease in the proportion of First Nations mothers who reported smoking at any time during pregnancy (49% 2019 to 40% 2022).
• Antenatal appointments:
  • Deficit: First Nations women are less likely to attend an antenatal appointment in the first trimester.
  • Strengths-based: There is an increase in the proportion of First Nations mothers attending an antenatal visit in the first trimester (from 51% 2013 to 71% 2022).

AIATSIS Map of Indigenous Australia

• Map illustrating the diversity of Aboriginal and Torres Strait Islander language groups across Australia.

Indigenous Weather Knowledge

• Aboriginal and Torres Strait Islander people have developed an intricate understanding of the environment over thousands of years.
• Seasonal calendars vary by community.

Understanding Ceremony

• Protocols for introducing oneself: Relation-based, not transaction-based.
• Acknowledgment of cultural practices or events.
• Understanding your own culture and your own ceremonies and rituals as well as being curious about the others.

Understanding Health

• WHO definition: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Aboriginal Health Definition

• Not just physical well-being, but social, emotional, and cultural well-being of the whole Community.
• Enables individuals to achieve their full potential.
• A whole-of-life view encompassing a cyclical concept of life-death-life.

Aboriginal Community Controlled Health Service

• Community-run primary healthcare service
• Comprehensive, culturally informed care.
• Focus on social and emotional well-being (SEWB) and cultural well-being.

Historical Context

• Access to healthcare was denied until the 1960s.

Health and Wellness

• Traditional healers (Ngangkari)
• Practices that isolated illness
• Practices and ceremonies at stages of life.

Impact of Colonization on Aboriginal Health

• Australia's history impacts health.
• Need to understand the Australian Aboriginal experience of collective, historical, and intergenerational trauma.
• Focus on understanding and addressing trauma within communities.

Aboriginal and Torres Strait Islander Concept of Health and Wellbeing

• Connections:
  • Spirit, spirituality & Ancestors
  • Country & land
  • Mind & emotions
  • Culture
  • Community
  • Family & kinship
  • Body & behaviors
• Expressions of social determinants and cultural determinants.
• Historical determinants.

Kinship

• Importance of kinship in Aboriginal and Torres Strait Islander cultures.

Post-British Contact Impact and Life

• Dispossession (1770-1885, 1885-2007)
• Conflict and violence (1778-1928)
• Protectionism (1838-1970s)
• Assimilation (1937-1969)
• Self-determination (1972-1996)

Dispossession (1770-2007)

• Terra nullius
• No compensation
• Settlement from 1788
• Lack of access to resources
• Destruction of social and political infrastructures

Conflict and Violence (1788-1928)

• Violence from military and settlers
• Violence framed as civil disorder rather than warfare
• Doomed race theory

Protectionism (1838-1970s)

• Limiting of rights and separating Aboriginal peoples from society to protect European interests.

Medical Incarceration

• Historical examples of medical incarceration in Australia.

Policy of Assimilation (1937-1969)

• Expecting all Aborigines and part-Aborigines to attain the same manner of living as other Australians.
• Special measures regarded as temporary, intended to meet the need for special care.

Certificate of Exemption

• Exempting individuals from provisions of the Aborigines Protection Act and Regulations.

Other Significant Policy Impacts

• White Australia Policy
• Mabo and Wik
• Northern Territory Intervention
• National Apology
• Closing the Gap
• The Voice Referendum

Removal of Children

• Stolen Generations

Examples of Institutions

• Scarba Welfare House for Children
• St Christopher's Home for Little Children
• Aborigines Inland Mission Bible Training College
• Crusaders Camp Mission Hostel
• Blackburn South Cottages
• East Perth Girls' Home

Current Health Impacts of Colonisation

• Suicide/self-harm
• Child Safety
• Incarceration
• Drug and ETOH abuse
• Chronic Disease
• Cancer
• Social determinants of health
• Social exclusion and racism

United Nations Declaration of the Rights of Indigenous Peoples

• Article 2: Freedom from discrimination.
• Article 3: Right to self-determination.
• Article 7: Rights to life, physical and mental integrity, liberty and security of person.
• Article 24: Right to traditional medicines and health practices, and access to social and health services.

Social Determinants of Health

• Income and social protection
• Education
• Unemployment and job insecurity
• Working life conditions
• Food insecurity
• Housing, basic amenities and the environment
• Early childhood development
• Social inclusion and non-discrimination
• Structural conflict
• Access to affordable health services of decent quality (WHO 2022).

Cultural Determinants of Health

• Living relationship with ancestors, the spiritual dimension of existence, and connection to Country and language.
• Individual and community control over their physical environment, dignity and self-esteem.
• Respect for Aboriginal and Torres Strait Islander people’s rights and a perception of just and fair treatment are also important to social and emotional wellbeing.

Domains and Sub-domains for Describing Culture

The six domains are:

• Connection to Country:
  • spiritual connection
  • health and traditional foods
  • living on Country
  • land rights and autonomy
  • caring for Country
• Family, kinship and community:
  • family and kinship
  • community
• Indigenous beliefs and knowledge:
  • spiritual and religious beliefs
  • traditional knowledge
  • traditional healing
  • knowledge transmission and continuity
• Cultural expression and continuity:
  • identity
  • cultural practices
  • art and music
• Indigenous language:
  • impacts of language on health
  • language revitalisation
  • Aboriginal and Torres Strait Islander language education
• Self-determination and leadership:
  • cultural safety
  • self-determination and wellbeing
  • leadership.

Commercial Determinants of Health

• Definition: Private sector activities impacting public health, either positively or negatively, and the enabling political economic systems and norms.

The Cause of the Cause

• Colonisation
• Social Determinants of Health
• Burden of Disease
• Cultural Determinants of Health

Cultural Safety

• Determined by Aboriginal and Torres Strait Islander individuals, families, and communities.

Harvard Implicit Association Test

• Three in four people hold a negative view of Indigenous Australians.
• Most Australians tested for unconscious bias hold a negative view of Indigenous Australians, which can lead to widespread racism.

Gibbs' Reflective Cycle

• Description: What happened?
• Feelings: What were you thinking and feeling?
• Evaluation: What was good and bad about the experience?
• Analysis: What sense can you make of a situation?
• Conclusion: What else could you have done?
• Action plan: If it arose again, what would you do?

Indigeneity

• A daily socio-cultural practice.

Health Promotion Task

• Programs identified and led by Aboriginal and Torres Strait Islander community control or equivalent
• Principles of self-determination
• Principles of strengths-based approaches
• Principles of Primary Prevention
• Ideally evidence-based
• Culturally acceptable
• Achievable
• Continuity of care and consistency of service

Assessment Requirements (Due 28th May 2025)

• Demonstrate understanding of Aboriginal and Torres Strait Islander cultural identity and beliefs.
• Describe the impact of history, colonisation, and government policies on Aboriginal and Torres Strait Islander health.
• Explore the impacts of social determinants of health faced by Aboriginal and Torres Strait Islander communities.
• Demonstrate understanding of cultural considerations when assessing and planning successful health promotion programs.
• Describe the principles for collaboration and engagement with Aboriginal and Torres Strait Islander communities.
• Small group task (3-4 students from PBL group).

Introduction

• Pick a health promotion activity
• Relational approach to introductions rather than 'professional' approach

Research the Community

• Present information about the community
• Avoid othering language, use a strengths-based approach
• What has impacted the community
• Do deep research, if you cannot find information contact Thurru Unit

Impact of the Issue

• Why and how did the community identify this issue
• Impact the issues is having in community
• What are the causes of the cause (SDH) but also identify any cultural determinants that are in the community
• Consider the social and emotional wellbeing wheel
• Avoid othering language, use a strengths-based approach

Health Promotion Program

• What is the program
• How has co-design, collaboration, self-determination been supported in this program
• How has it benefited the community
• If evaluation occurred, how was self-determination supported and how was it given back to the community

References

• Vancouver Referencing style

Assignment Guide

• Read the assignment guide and know it well
• Read the rubric and ensure that all components have been completed

Cultural Orientation Training

• Online course focusing on allied health, but much of the content is generic to all health professionals.

Key Resources

• NSW Health Communicating Positively: A Guide to Appropriate Aboriginal Terminology
• Australian Indigenous HealthInfoNet: Providing the evidence base to inform practice and policy in Aboriginal and Torres Strait Islander health.