Elsevier

Health & Place

Volume 54, November 2018, Pages 210-220
Health & Place

“Here we are part of a living culture”: Understanding the cultural determinants of health in Aboriginal gathering places in Victoria, Australia

https://doi.org/10.1016/j.healthplace.2018.10.001Get rights and content

Highlights

  • Cultural determinants of health enhance individual and community identity, wellbeing and resilience.

  • Aboriginal Victorian gathering places provide safe spaces to practice and learn Aboriginal culture.

  • Gathering places encourage healing and wellbeing creating inclusive and empowering spaces.

  • Gathering places provide a sense of place, especially for people who have been marginalised.

  • Gathering places could be replicated to create safe and culturally competent services in other communities.

Abstract

This article provides an exploration of the cultural determinants of health, based on a research evaluation investigating a number of Aboriginal gathering places in Victoria (Australia). Gathering places are recognised as settings in which people practice and learn about local Aboriginal culture, history and place. Academic literature on gathering places is sparse. Thirteen gathering places were evaluated in this research. Each site is unique and has a specific story that connects it to the history and geography of the place in which it is located. Sixty-nine gathering place members participated in qualitative semi-structured interviews or focus groups. Using thematic analysis, the findings were divided into four key themes associated with cultural determinants of health (social networks; inclusiveness; empowerment; connections). These elements create a safe place to learn about culture and Country, and support an environment for strengthening identity, improving health and building resilience. The findings from this study highlight the benefits of using gathering places to explore the cultural determinants of health.

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.

References (98)

  • C.A.M. Richmond et al.

    The determinants of First Nation and Inuit health: a critical population health approach

    Health Place

    (2009)
  • M. Snyder et al.

    “To much moving… there's always a reason”: understanding urban Aboriginal peoples' experiences of mobility and its impact on holistic health

    Health Place

    (2015)
  • Anderson, I., Baum, F., Bentley, M., 2007. Beyond Bandaids: Exploring the Underlying Social Determinants of Aboriginal...
  • K. Arabena et al.

    Climate change: impact on country and aboriginal and Torres Strait islander culture

  • M.D. Auger

    Cultural Continuity as a determinant of Indigenous peoples' health: a metasynthesis of qualitative research in Canada and the United States

    Int. Indig. Policy J.

    (2016)
  • Australian Bureau of Statistics

    Population Characteristics, Aboriginal and Torres Strait Islander Australians, 2006 (Cat. No. 4713.0)

    (2010)
  • Australian Institute of Health and Welfare

    The Health and Welfare of Australia's Aboriginal and Torres Strait Islander People: An Overview 2011 (Cat. No. IHW 42)

    (2011)
  • Australian Institute of Health and Welfare, 2017. Aboriginal and Torres Strait Islander Health Performance Framework....
  • M. Bals et al.

    The relationship between internalizing and externalizing symptoms and cultural resilience factors in Indigenous Sami youth from Arctic Norway

    Int. J. Circumpolar Health

    (2011)
  • K.H. Basso

    Wisdom Sits in Places: Landscape and Language Among the Western Apache

    (1996)
  • K. Big-Conoe et al.

    Anishinable youth perceptions about community health: toward environmental repossession

    Health Place

    (2014)
  • G.M. Boulton-Lewis et al.

    Conceptions of health and illness held by Australian Aboriginal, Torres Strait Islanders, and Papua New Guinea health science students

    Aust. J. Prim. Health

    (2002)
  • J. Browne

    Grounded theory analysis: Coming to data with questioning minds

  • C.P. Burgess et al.

    Healthy country, healthy people: the relationship between Indigenous health status and “caring for country”

    Med. J. Aust.

    (2009)
  • B. Carson et al.

    Social Determinants of Indigenous Health

    (2007)
  • R.D. Chenhall et al.

    Living the social determinants of health: assemblages in a remote Aboriginal community

    Med. Anthropol. Q.

    (2017)
  • City of Port Phillip

    Where Do You Mob Want to Meet Up? A Scoping Report into Indigenous Concepts of Gathering and Place in the Urban South/Southern Metropolitan Region of Melbourne. Urban South Indigenous Gathering Place Report

    (2015)
  • J.W. Creswell

    Qualitative Inquiry and Research Design: Choosing Among Five Traditions

    (1998)
  • D. Crouch

    Leisure/tourism Geographies: Practice and Geographical Knowledge

    (1999)
  • B. Davis et al.

    Aminina Nud Mulumuluna (“You gotta look after yourself”): evaluation of the use of traditional art in health promotion for Aboriginal people in the Kimberley region of Western Australia

    Aust. Psychol.

    (2004)
  • Department of Health

    Koori Health Counts! Victorian Aboriginal Hospital Data 2009–2010

    (2011)
  • Department of Health

    Koolin Balit: Victorian Government Strategy Direction for Aboriginal Health 2012–2022

    (2012)
  • Department of Health

    Aboriginal Inclusion Framework

    (2013)
  • DHHS

    Evaluation Plan for the Koolin Balit Investment

    (2015)
  • E. Dietsch et al.

    Australian aboriginal kinship: a means to enhance maternal well-being

    Women Birth

    (2010)
  • A.M. Dockery

    Culture and wellbeing: the case of indigenous Australians

    Social Indic. Res.

    (2010)
  • J. Doyle et al.

    What makes us different? The role of Rumbalara Football and Netball Club in promoting indigenous wellbeing

    Aust. Community Psychol.

    (2013)
  • P. Dudgeon et al.

    Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice

    (2014)
  • C. Fiedeldey-Van Dijk et al.

    Honouring Indigenous culture-as-intervention: development and validity of the native wellness assessment

    J. Ethn. Subst. Abus.

    (2017)
  • B. Frederick

    ‘We don’t leave our identities at the city limits’: aboriginal and Torres Strait Islander people living in urban localities

    Aust. Aborig. Stud.

    (2013)
  • J.P. Gone et al.

    The Blackfeet Indian Culture Camp: Auditioning an alternative Indigenous treatment for substance use disorders

    Psychol. Serv.

    (2015)
  • V. Grieves

    Aboriginal Spirituality: Aboriginal Philosophy the Basis of Aboriginal Social and Emotional Wellbeing (Discussion Paper 9)

    (2009)
  • M. Guillemin et al.

    “We’re checking them out”: indigenous and non-Indigenous research participants' accounts of deciding to be involved in research

    Int. J. Equity Health

    (2016)
  • B. Heffernan et al.

    The History of Indigenous Identification in Victorian Health Datasets, 1980–2011: Initiatives and Policies Reported by Key Informants

    (2012)
  • M. Holmes et al.

    Law for country: the structure of Warlpiri ecological knowledge and its application to natural resource management and ecosystem stewardship

    Ecol. Soc.

    (2013)
  • D.R. Horton

    Aboriginal Australia [Map]

    (1996)
  • R. Hovey et al.

    Social-relational understanding of health and wellbeing from an indigenous perspective

    Int. J. Indig. Health

    (2014)
  • L.M. Hunter et al.

    Aboriginal healing: regaining balance and culture

    J. Transcult. Nurs.

    (2006)
  • J. Kingsley et al.

    Using a qualitative approach to research to build trust between a non-aboriginal researcher and aboriginal participants (Australia)

    Qual. Res. J.

    (2010)
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      The healing of trauma requires the establishment of an environment of safety (2002, p. 193). Kingsley et al. [149] investigated the importance of Aboriginal gathering places in Victoria, Australia. They conclude that Aboriginal gathering places provide a sense of safety and community, and that people are then willing to make themselves vulnerable and explore their thoughts, feelings and emotions [149].

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