Week 9 Health Promotion in Aboriginal and Torres Strait Islander Communities #2

Social and Emotional Wellbeing

Nine Guiding Principles

The nine guiding principles for health promotion in Aboriginal and Torres Strait Islander communities, as outlined in the National Strategic Framework, emphasize:

• A holistic understanding of health encompassing mental, physical, cultural, and spiritual dimensions. Land is central to wellbeing.
• Self-determination as a key element in working with Indigenous people.
• Culturally valid understandings to shape the provision of services.
• The recognition of trauma and loss resulting from European colonization and its disruption to cultural wellbeing.
• Respect for Indigenous human rights.
• The acknowledgement of ongoing stressors such as racism, stigma, environmental adversity, and social disadvantage and their negative impacts on mental health and wellbeing.
• Recognition of the centrality of family and kinship with bonds of reciprocity.
• Acknowledgement of the diversity among Aboriginal and Torres Strait Islander groups.
• Recognition of the great strengths, creativity, and endurance of these communities, as well as their deep understanding of the relationship between humans and their environment.

These principles, initially proposed in the 1989 National Aboriginal Health Strategy and expanded in the 1995 Ways Forward report, are summarized in the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023 and have remained relevant over time.

Circle of Social and Emotional Wellbeing

The Circle of Social and Emotional Wellbeing encompasses several interconnected elements:

• Connection to spirit, spirituality, and ancestors.
• Connection to body and behaviors.
• Connection to country and land.
• Connection to mind and emotions.
• Connection to culture.
• Connection to community.
• Connection to family and kinship.

It also acknowledges the influence of historical, cultural, social, and political determinants, as well as experiences.

Social and Emotional Wellbeing (SEWB)

SEWB is integral to the holistic view of health held by many Indigenous Australian people. It encompasses the social, emotional, spiritual, and cultural wellbeing of the whole community, which is essential for the health and wellbeing of individuals.

The integrity of relationships between people and spiritual entities, and the clarity of connections between people and land, contribute significantly to the SEWB of Indigenous people (Garvey, 2008).

Domains of SEWB

The domains of SEWB include:

• Connection to Body
• Connection to Mind and Emotions
• Connection to Family and Kinship
• Connection to Community
• Connection to Culture
• Connection to Country
• Connection to Spirit, Spirituality, Ancestors

Social Determinants of SEWB

The social determinants of SEWB include:

• Housing
• Education
• Income
• Employment
• Food Security
• Transport
• Health
• Regional & Remote Location
• Racism

Colonialism

Colonialism relies on a stratified society where the colonizer is privileged and the colonized are deprived. It is a system of privilege that presumes a moral hierarchy of human worth (O’Sullivan, The Conversation, 2022).

Strengths of Aboriginal and Torres Strait Islander Peoples

Aboriginal and Torres Strait Islander peoples have great strengths, creativity, and endurance, along with a deep understanding of the relationships between human beings and their environment.

Definition of Health

Health for Aboriginal and Torres Strait Islander people refers to the social, emotional, and cultural wellbeing of the whole community, not just the physical wellbeing of an individual (National Aboriginal Health Strategy, 1989).

Referrals

Referral options include:

• Aboriginal Community Controlled Health Organisation
• Aboriginal Legal Service
• Aboriginal Housing Co-operative
• Aboriginal Community Liaison Officer (Police)
• Aboriginal Education Support
• Link-Up (Stolen Generations)
• Ngangkari (Traditional Healer)
• Elders
• Traditional Owners
• Local Aboriginal Land Council (LALC)

Closing the Gap

Closing the Gap requires non-Indigenous Australians to increase their knowledge, understanding, and respect of Indigenous cultures.

Population Statistics (2023)

• Estimated Australian Aboriginal and Torres Strait Islander population: 913,889.
• NSW has the highest number of Aboriginal and Torres Strait Islander people: 303,186 (33% of the total).
• The NT has the highest proportion of Aboriginal and Torres Strait Islander people in its population: 32%.

Mortality Statistics (2022)

• Age-standardised death rate for Aboriginal and Torres Strait Islander people (NSW, Qld, WA, SA, NT): 10 per 1,000.
• Life expectancy at birth (2020-2022):
  • Males: 71.9 years
  • Females: 75.6 years
  • Approximately 8-9 years less than non-Indigenous Australians.
• Median age at death (NSW, Qld, WA, SA, NT): 62.3 years.
• Deaths among Aboriginal and Torres Strait Islander children aged 0-4 years (2017-2021):
  • Total: 613
  • Aged 0-1 years: 518 (85%)
  • Aged 1-4 years: 95
• Leading causes of death (NSW, Qld, WA, SA, NT):
  • Ischaemic heart disease (IHD)
  • Diabetes
  • Chronic lower respiratory diseases
  • Cancer of trachea, bronchus, and lung
• Maternal mortality ratio (2012-2021): 17 deaths per 100,000 women who gave birth.
• Avoidable deaths (2017-2021): 7,766 deaths from avoidable causes among Aboriginal and Torres Strait Islander people aged under 75 years (NSW, Qld, WA, SA, NT).

Life Expectancy (2020-2022)

Life expectancy at birth in years, by Indigenous status and sex, selected jurisdictions, Australia:

Cardiovascular Health

• In 2018-19, around 15% of Aboriginal and Torres Strait Islander people reported having cardiovascular disease (CVD).
• In 2017-2021, in Qld, WA, SA and the NT combined, there were 1,750 new diagnoses of rheumatic heart disease (RHD) among Aboriginal and Torres Strait Islander people, at a crude rate of 75 per 100,000.
• In 2020-21, there were 16,986 hospital separations for CVD among Aboriginal and Torres Strait Islander people, representing 5.1% of all Aboriginal and Torres Strait Islander hospital separations (excluding dialysis).
• In 2022, IHD was the leading specific cause of death for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT.

Diabetes

• In 2021, 5.9% of Aboriginal and Torres Strait Islander people reported having diabetes as a long-term condition.
• In 2019-20, there were 4,835 potentially preventable hospitalisations of Aboriginal and Torres Strait Islander people for a principal diagnosis of diabetes.
• In 2022, diabetes was the second leading specific cause of death for Aboriginal and Torres Strait Islander people in NSW, Qld, SA, WA and the NT.
• In 2018, endocrine disorders accounted for 3.3% of total disease burden among Aboriginal and Torres Strait Islander people. Of this, 87% was attributed to type 2 diabetes.

Social and Emotional Wellbeing (including mental health)

• In 2018-19, 80% of Aboriginal and Torres Strait Islander males over 18 years of age reported feeling calm and peaceful all/most of the time and 87% felt happy all/most of the time.
• In 2018-19, 78% of Aboriginal and Torres Strait Islander females over 18 years of age reported feeling calm and peaceful all/most of the time and 88% felt happy all/most of the time.
• In 2018-19, 31% of Aboriginal people and 23% of Torres Strait Islander people aged 18 years and over reported high or very high levels of psychological distress.
• In 2018-19, 25% of Aboriginal people and 17% of Torres Strait Islander people, aged two years and over, reported having a mental and/or behavioural condition.
• In 2018-19, anxiety was the most common mental or behavioural condition reported by Aboriginal and Torres Strait Islander people aged two years and over (17%), followed by depression (13%).
• In 2021-22, there were 25,440 hospital separations with a principal diagnosis of International Classification of Diseases (ICD) ‘mental and behavioural disorders’ identified as Aboriginal and Torres Strait Islander.
• In 2022, 212 Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT died from intentional self-harm.
• In 2018, mental and substance use disorders accounted for 23% of total disease burden among Aboriginal and Torres Strait Islander people. Of all disease groups, mental and substance use disorders made the highest contribution to total burden.

Our Profile (2012-13)

• 48% of Aboriginal people or their relatives had been removed from their natural family.
• People who had been removed were more likely to experience high or very high psychological distress (35%) than those who had not (29%). This was also seen among those who had relatives removed (34%) compared to those who had not (26%).
• Although Aboriginal people access health and mental health services at a higher rate than the non-Indigenous population, there is likely to be many Aboriginal people who need services but do not access them, with underutilisation largely attributed to cultural inappropriateness.
• The lack of Aboriginal staff in health services compounds the barriers to accessing treatment, with greater involvement from Aboriginal communities in services significantly improving initiation and engagement to services.
• Aboriginal and Torres Strait Islander peoples were perceived as having high needs in relation to health, with participants highlighting the impact of intergenerational trauma on their communities and the associated impact on physical and mental health. Intergenerational trauma was thought to contribute to a range of other health and social problems including drug and alcohol use, family dysfunction and domestic violence.
• In general, the health system is failing as a result of this gap. Instead of preventing people entering the acute system, it is in effect channelling people to acute services due to a lack of clinical care. People experiencing moderate to severe physical and mental illness, including those with complex needs, are becoming increasingly unwell and their symptoms are often escalating to the stage where they need admission. This was perceived by most participants as costly, ineffective and low-quality care.
• Aboriginal and Torres Strait Islander peoples were identified as a priority population group in HNECCPHN. For Aboriginal people, mental disorders and substance use disorders are leading causes of burden of disease, and psychological distress is experienced at higher rates than for non-Indigenous people. Young Aboriginal people were hospitalised for mental and behavioural disorders at higher rates than the non-Indigenous population.