“Here we are part of a living culture”: Understanding the cultural determinants of health in Aboriginal gathering places in Victoria, Australia
Introduction
“Aboriginal culture, like any other, is not static… Any real attempt to respond to Aboriginal culture must be based on creating a social space in which the lived reality of Aboriginal culture can assert itself over and against the social construction of that reality by non-Aborigines” (Morrissey et al., 2007, p. 245)
There is a growing body of evidence exploring the influences of culture, social determinants, traditional practices and knowledge on health and wellbeing outcomes, especially in Aboriginal populations (Hunter et al., 2006, Carson et al., 2007, Oster et al., 2014, Rowan et al., 2014). This has led to the emergence of a field of inquiry focused on cultural determinants of health with evidence correlating Aboriginal peoples’ health and wellbeing with cultural identity and connection (Wexler, 2009, Wexler, 2014; Wren et al., 2015; Reid et al., 2016; Vance et al., 2017). Cultural determinants of health are defined by the National Institute of Aboriginal and Torres Strait Islander Health Research (Lowitja Institute, 2014, p. 2) as “promot[ing] a strength-based perspective, acknowledging that stronger connection to culture and country build stronger individual and collective identities, a sense of self-esteem, [and] resilience”. For Aboriginal people cultural connectedness and knowledge are determinants of health. This is not unique to Australia, with Auger (2016) and Bals et al. (2011) acknowledging cultural continuity, resilience, activities and languages as determinants of Indigenous health in North America and Norway respectively. Evidence from Australia (Davis et al., 2004, Dietsch et al., 2010) and internationally (Gone and Calf Looking, 2015; Wexler et al., 2015; Fiedeldey-Van Dijk et al., 2017) associates Aboriginal cultural healing programs with wellbeing improvements. Aboriginal Victorian health organisations have long emphasised the importance of culturally strengthening activities and holistic perspectives of health as fundamental to service delivery (Victorian Aboriginal Community Controlled Health Organisation [VACCHO], 2010), evident in settings like Aboriginal gathering places. However, there has been limited evaluation of these programs, and gaps exist in the literature on Aboriginal cultural determinants of health from a community perspective (Auger, 2016).
This paper aims to understand the cultural determinants of health for Aboriginal Victorian people attending gathering places. Gathering places are described as community hubs that promote the importance of culture to support positive health for Aboriginal Victorians (Department of Health and Human Services [DHHS], 2015). Gathering places broadly “aim to advance health and wellbeing outcomes through the establishment and utilization of culturally sensitive settings that encourage… active participation and determination of community life” (City of Port Phillip, 2015, p. 9). The terminology of ‘gathering places’ for Aboriginal Victorian people is somewhat contested. Some communities prefer ‘healing places’ or ‘community centres’ as they feel this is more representative of what such places do or provide. However, we elected to use ‘gathering places’ as the collective term to describe the sites we visited. Gathering places also conveys two important elements that can have cultural relevance in Aboriginal settings. The first element relates to the act of gathering, which can comprise of assembling, grouping, getting-together or meeting people. Further, in an Aboriginal community context gathering can take on slightly divergent meanings. For example, gathering can represent the collecting of traditional foods or bush tucker, as well as the coming together of groups for important cultural activities or ceremonies (Myers, 1986, Read, 1996, Holmes and Jampijinpa, 2013). The second element relates to the physical place, position, space, or site which conveys a sense of a rigid location. The importance of connection to Country, historical colonial contexts and sacred ceremonial sites can be further conceptualised when understanding Aboriginal meanings of ‘place’ (Rapoport, 1975, Pawu-Kurlpurlurnu et al., 2008, Lawson and Kingsley, 2018). Furthermore, there are numerous settings, particularly in Aboriginal community contexts, that could be described as ‘gathering places’ without using this terminology. For example, Aboriginal Victorian sporting clubs are health-promoting and culturally-strengthening and also include elements of community ‘gathering’ (Doyle et al., 2013, Thorpe et al., 2014). Aboriginal land management programs on Country provide another example as they bring community members together to practice culture, strengthen identity and improve self-esteem (Arabena and Kingsley, 2015). This study focuses on gathering places of different sizes, delivery and style. Gathering places include those that provide cultural programs on either a designated site, multiple shared community spaces, or a range of activities in different locations (Table 1).
Section snippets
Background
Tse et al. (2005) identified that, although traditional custodian groups differ in ‘cultural geography’, Aboriginal perspectives of health focuses on a holistic and a cyclic whole-of-life view, encompassing physical, social, spiritual and cultural determinants (National Aboriginal Health Strategy Working Party [NAHSWP], 1989). In this model, the past, present and future intertwine to impact on Aboriginal peoples’ health with a focus on the community rather than individual (Boulton-Lewis et al.,
Methods
Participatory and culturally-appropriate methodologies were utilised during this evaluation, as guided by Aboriginal and Torres Strait Islander community development and research protocols (NHMRC, 2003, Laycock et al., 2011; Victorian Department of Health, 2013). These protocols were incorporated into a research ethics application, which was approved by the University of Melbourne (Ethics ID: 1545520). The research team was carefully selected to ensure that the design would go beyond purely
Results
Themes from the evaluation were grouped into concepts relating to the cultural determinants of health. These concepts were established with the gathering place reference committees to understand what positive health outcomes meant for individuals and communities, rather than imposing researcher-determined measurements of ‘good health’. The research team drew on the Lowitja Institute (2014) definition of cultural determinants of health (involving strength-based approaches and connection to
Discussion
Gathering places are settings for connecting Aboriginal people from diverse backgrounds including Elders, youth and people from the Stolen Generations. This created a place for intergenerational/cross-cultural relationships, learning, healing and reconciliation. Such settings align well with the Indigenous model of health, which encourages a whole-of-life approach based on holism (NAHSWP, 1989). The findings emphasised that this safe learning space was especially important for Stolen Generation
Conclusion
After analysis and consultation, a number of factors that strengthen cultural determinants of health became apparent. This research reveals that gathering places reduce social isolation, provide opportunities to meet new people, reinforce family and kinship ties and strengthen culture and knowledge. This study speaks to the knowledge gap identified in the literature by addressing the link between gathering places and cultural determinants of health for Aboriginal Victorian communities. The
Acknowledgments
We are grateful for the assistance and support provided by Josie Atkinson, Kate Gilbert and Professor Kerry Arabena during the evaluation and Dr. Cecily Maller, Marissa Skovron and two anonymous reviewers during the review process. The late Dr. Kevin Rowley's expert advice was instrumental in designing the evaluation and we would like to acknowledge his contributions to this research. A special acknowledgment must be made to the participating Aboriginal gathering places for allowing this
Summary declaration of interest statement
This research evaluation was funded by the Department of Health and Human Services, Victoria (Australia) (Nos: C4043 and C4185). None of the authors have any competing interests to declare and all have approved the manuscript for submission. All identifiable information has been de-identified to ensure no conflict of interest for any person or organisation involved in this study. The content of this manuscript has not been submitted for publication elsewhere.
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