For the purposes of this discussion, the term “Indigenous” is used to represent Aboriginal and Torres Strait Islander peoples collectively, unless otherwise indicated. However it should be noted that these peoples have distinct cultural identities and differences between and within themselves.
What does the word ‘health’ mean to you? What does being ‘healthy’ mean to you?
Historically, ‘health’ and what constitutes being ‘healthy’ was mostly defined by the medical world, and reflected a biophysical (relating to anatomy and physiology, or ‘physical’ health) model. To be in ‘good health’ then was the absence of illness, disease, or injury. More recently, and mostly driven by the public, the concept of ‘health’ has also encompassed the mental and emotional state of a person, though recognition and adoption of this within medical care arguably still needs a lot of work. Some specific medical fields have further recognised that there are social determinants which influence a person’s health, and have broadened the biophysical model of care to a biopsychosocial (physical, mental, and social factors are interrelated) model of health. One example is the field of pain management, where understanding chronic, long term pain has revealed that factors such as mental health, living conditions, and socioeconomic status, for exmaple, can all contribute to a person’s perception and experience of pain.
Indigenous peoples worldwide commonly use an even broader definition of health. In 1989 the National Aboriginal Health Strategy defined ‘health’ within an Indigenous context as:
… not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole-of-life view and includes the cyclical concept of life-death-life.”
National Aboriginal Health Strategy (1989)
This definition is still used today when planning, implementing and reviewing strategies and programs to improve the health and wellbeing of Indigenous peoples, as evidenced in documents such as the Australian Government’s recently released National Aboriginal and Torres Strait Islander Health Plan 2021-20311. However, what some people don’t immediately recognise is that this isn’t just another way of defining the biopsychosocial model of health. It’s broader than that: it encompasses factors that traditionally are not considered within a non-Indigenous model of healthcare. Because of that, non-Indigenous peoples can struggle to understand why, despite the ongoing rhetoric, the allocation of specific funds, the specialised programs, etc., the health of Indigenous peoples only shows marginal (at best) improvement over time. There needs to be a better understanding that improving Indigenous health goes beyond providing more services and programs. It’s about recognising that many factors outside of the medical system impact and wellbeing.
To help understand that I’d like to take a deeper look at a couple of phrases within the definition.
“not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community”
Apart from recognising the biopsychosocial model within this phrase, there are two main concepts that I feel need to be recognised.
The first is “cultural wellbeing”. Culture is an inherent part of Indigenous peoples lives. It is the basis upon which everything else has context and meaning. Indigenous peoples have struggled to retain our culture due to practices and policies – some historical, some present day – that have limited, or in some cases destroyed, their ability to do so. This includes but is not limited to factors such as identity, language, connection to country, and traditional beliefs and practices including spirituality and lore. Preserving and propagating culture is a crucial component to improving Indigenous health.
The second is “wellbeing of the whole Community”. Indigenous peoples are community-centric, rather than individual-centric peoples. In other words, for me to be ‘in good health’, it’s not just about what is happening to me as an individual, but also what’s happening to my immediate and extended families, the community I come from, the community I live in (which may not be the same as the one I come from), and the broader community (Indigenous peoples in my State, my country, across the world, all humankind) as far as I choose to extend it. If my community is “sick”, then I am also “sick”, or at the very least at risk of becoming “sick”. Understand that “sick” might not be a disease, like Covid; it could be poverty, or poor employment or education prospects, or high rates of suicide or substance abuse, for example. This can be a very different concept from the non-Indigenous individual-centric or nuclear-centric ideal of health, and therefore hard for people to understand.
“achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community”
The first part of this, “achieve their full potential as a human being”, comes back to a concept I believe needs to be inherrent in all modals of healthcare: that all of us have a basic human right to attain an optimal level of health. Coming back to our expanded, Indigenous concept of health, my “full potential as a human being” would not just include the best physical and mental health I could enjoy, but also my ability to achieve the highest level of educaton I can, have meaningful and desirable employment opportunities, be free from prejudices and racism, know and be able to practice my culture, and live without fear of oppression or limitation of my social and human rights. It means I can live my best life at all times, and if we all can live our best lives, then our whole community becomes ‘healthy’.
When you understand these concepts, you understand that achieving ‘good health’ is not just about medical care; it’s about culture, social justice, housing and infrastructure, employment and education, community development, environmental issues, socioeconomics, politics and leadership, and a myriad of other factors. Failure to understand the interconnection of these factors, and the need to address all of them concurrently has been one of the biggest limitations in achieving significant improvement in Indigenous health and equity in health status with non-Indigenous peoples.
Having said that, I’d like to think that non-Indigenous people who understand these concepts will also realise that these ideas and values are also important to them, and their own health, and want to adopt them for themselves. Perhaps one day we will all have a global definition of health that reflects the ideals and values of all humankind.
References:
- Department of Health. (2021). National Aboriginal and Torres Strait Islander Health Plan 2021-2031: Canberra.
