Challenging our own practices in Indigenous health promotion and research

Abstract

At the 2006 National Conference of the Australian Health Promotion, Māori academic and public health physician Dr Papaarangi Reid challenged us to critique our own practice and asked whether health promotion needs to be de-colonised. In this paper, one Indigenous and two non-Indigenous researchers working within the Aboriginal community controlled health sector reflect on ways in which research and health promotion interventions with Indigenous populations challenge or reinforce the very values that have led to the disadvantage, neglect and apathy experienced by Indigenous populations in the first place. While our practice is framed by the principles of Aboriginal self-determination and community control, we suggest that de-colonising is not so much about the need to invent new research methods nor to search for research methods in traditional Aboriginal culture; it is much more about values, processes and relationships. We recognise the need to challenge the deficit model in health promotion and research, and we do not want to inflict any more damage to the community, through reinforcing stereotypes, creating fear, or contributing to further bad press. We argue for adopting a methodology that shifts power and enables Indigenous people to frame research in ways they want it framed, and for taking a holistic approach and focusing on community strength and resilience.

Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity

“…For example, if health professionals seek more positive healthcare interactions with Aboriginal people at the interface, even in the presence of organisational barriers, they can focus on addressing personal ideology. The importance of health professionals self-reflecting, evaluating and increasing their self-awareness both personally and professionally has previously been acknowledged, for example a critique of one’s own practice [31], reflection on one’s beliefs, attitudes, values and worldviews [32–35], awareness of assumptions [33], knowledge of one’s limitations [36], preconceived ideas and stereotypes [37, 38] and motivation to work with Indigenous peoples [32] Health professional attitudes directly affect practice in Aboriginal health, for example physicians’ attitudes towards Aboriginal people affected the care they provided [39], demonstrating the importance of personal ideology as a contributor to experience. The presence of implicit biases about Aboriginal people, developed from past interactions, were also evident in health professionals, with some able to mitigate the negative effects of these when working at the interface, generally through self-reflection.…”

Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory

“…The providers assumed that Indigenous peoples had knowledge deficits (not knowing enough about arthritis as a disease or of the effectiveness of certain treatments), cultural deficits (not appreciating the value of an appointment), and resource deficits (transportation), among others. This frame borrows from the deficit model, placing the responsibility on individual limitations, and assuming weaknesses in individuals or communities [25]. This bias towards individual patient level rather than systemic solutions was reported in another study where providers who were asked about barriers to renal transplantation focused on language issues and cultural factors [26].…”

“…Stereotyping, bias and uncertainty have been found to contribute to health disparities for other minority populations, and were also linked to healthcare systems and the legal and regulatory processes surrounding health services [32]. The deficit model is actually detrimental to Indigenous peoples because it can reinforce existing apathy and neglect by providers [25]. Thus, utilization is better explained by biases, stereotyping and discrimination experienced.…”

‘We don't tell people what to do’: ethical practice and Indigenous health promotion

“…'We don't tell people what to do' has particular significance for health promotion in this post-colonial setting, requiring the devolution and sharing of power with participating communities. 40 This form of power sharing may contradict the healthy lifestyle agenda most often required of practitioners by their employers and funding bodies. 41 It may also require the realisation of an emancipatory health promotion practice capable of resisting entrenched individualism, which stigmatises those who 'fail' in their citizenry duty to 'be healthy'.…”