Introduction The cultural determinants of health centre an Indigenous definition of health, and have been linked to positive health and wellbeing outcomes. There is growing evidence for the importance of the cultural determinants of health; however, to date, no high-level overview of the evidence-base has been provided. Synthesising existing literature on cultural determinants of health for Aboriginal peoples in a single manuscript will highlight what we know, and what needs to be explored in future research. It will also contribute to global efforts to capture the evidence of cultural determinant approaches amongst Indigenous populations. We therefore endeavoured to identify cultural determinants and highlight their impact on Aboriginal health and wellbeing outcomes, and outline the relationship and interconnection of different cultural determinants of health. Methods An overview of reviews was conducted. Medline (Ovid) and Scopus were searched using terms related to ‘cultural determinants of health’ and an ‘Aboriginal definition of health’. The database search was complemented by a web-based search of grey literature. Nine reviews were retrieved and included in our overview. Results Family/community, Country and place, cultural identity and self-determination were strongly identified across reviews as having a positive impact on the health and wellbeing outcomes of Aboriginal peoples. Family/community and Country and place were found to be components of ‘culture’ that shaped cultural identity. Self-determination was outlined as a requirement for Aboriginal peoples to pursue their cultural, social, and economic rights. Discussion/conclusions Cultural determinants are associated with health benefits for Indigenous peoples. A causal framework, developed to discuss the relationship and interconnection of the cultural determinants of health, demonstrates that cultural identity at an individual-level is important to benefiting from other cultural determinants of health. While self-determination and connection to culture and community-controlled organisations are integral factors to increase Aboriginal resilience and resistance and improve health and wellbeing outcomes. Further research is required to shift towards a multi-level understanding of the cultural determinants of health and to develop an Indigenous-led evidence-base around causal pathways. Such a shift would ensure priorities important to Indigenous peoples are captured in policy and practice.

No abstract

The provision of therapeutic residential care offers opportunities for traumatised children and young people to build relationships through establishing a safe and nurturing environment that can facilitate healthy recovery. For the Aboriginal child and young person demonstrating symptoms of trauma, cultural connections have been severed, relationships broken and there can be an overwhelming sense of abandonment. Aboriginal children's experiences of trauma go beyond the individualistic or familial and incorporate pervasive intergenerational trauma. This means that healing for Aboriginal children requires a therapeutic response embedded within an Aboriginal cultural framework. This paper presents the approach undertaken by an Aboriginal community organisation in developing a therapeutic residential care programme for Aboriginal children in their care. The model developed has implications for all therapeutic care programmes.

The toxic environment that is colonized Australia has broken many of the traditional circles of care for Indigenous children and created a service system which waits for Indigenous families to become dysfunctional before there is any response. The Victorian Aboriginal Child Care Agency (VACCA) encourages an approach to Indigenous children and families which is culturally respectful, culturally appropriate and framed according to the need to respect self-determination and human rights. VACCA has developed early childhood and family welfare policies which identify how cultural-strengthening works as a preventative measure to address risk factors for Indigenous children. With the ongoing reforms to Child and Family Welfare arising from the Children, Youth and Families Act, the Victoria State Government in Australia has an historic opportunity to lead the nation in creating an Indigenous-led child and family service system which focuses on issues of prevention and early intervention. The new Act prioritizes cultural and community connection in the best interest principles for Indigenous children, recognizes self-determination and requires generalist children’s welfare services to be culturally competent. The only way to ensure that every Indigenous child is effectively cared for is by developing the capacity of Indigenous communities to look after their own by strengthening Indigenous organizations and agencies. It is Indigenous agencies who are best placed to deliver innovative programs which are culturally embedded and carefully targeted to restore the circles of care for Indigenous kids. Aculturally competent service system is what is needed to ensure better outcomes for Indigenous children.