Literature review of the interplay between education, employment, health and wellbeing for Aboriginal and Torres Strait Islander people in remote areas

The availability of timely, comprehensive and good quality data specifically relevant to remote Aboriginal and Torres Strait Islander notions of health and wellbeing has been a significant obstacle to understanding and addressing related disadvantage in a meaningful way. This literature review for the CRC-REP Interplay Between Health, Wellbeing, Education and Employment project explored existing wellbeing frameworks at global and local levels that are relevant to Aboriginal and Torres Strait Islander people in remote Australia.Current government frameworks that collect data about Aboriginal and Torres Strait Islander people often produce a narrative that describes deficit, disadvantage and dysfunction. The frameworks include the Aboriginal and Torres Strait Islander Health Performance Framework, the Overcoming Indigenous Disadvantage Framework, the Australia Bureau of Statistics Aboriginal and Torres Strait Islander Wellbeing Framework and the National Aboriginal and Torres Strait Islander Social Survey. These frameworks gather statistical information for the purposes of policy analysis and program development and therefore use indicators that are important to policy. Increasingly, government frameworks are including holistic measures of health such as cultural health, governance and the impacts of colonisation.This literature review has identified the need to develop a wellbeing framework that not only accurately represents education, employment, health and wellbeing and the interplay between these and other factors, but that also recognises the strengths and resilience of Aboriginal and Torres Strait people as well as reflecting their worldviews, perspectives and values. For example, a definition of ‘wellbeing’ that highlights the importance of physical, social, emotional, cultural and spiritual influences at the level of the individual and the community has been endorsed by Aboriginal and Torres Strait Islander groups and governments alike and sustained for over 20 years. Accordingly, this literature review has been organised along these topics.In addition, the literature suggests that optimal wellbeing occurs when there is strong cultural identity in combination with control, achievement and inclusion at a wider societal level, such as through successful engagement in education and employment. Listening to Aboriginal and Torres Strait Islander people to learn of their conceptual thinking, knowledge and understanding, and responding to their priorities and ideas are crucial parts of the policy equation to improve outcomes across education, employment, health and wellbeing. The challenges in developing an appropriate wellbeing framework, then, are ensuring the active involvement and participation of the Aboriginal and Torres Strait Islander people.One example of how this has worked is provided by the Community Indicators Victoria Project, which used local-level data to address issues that the local community identified as important. A focus on strengths is also important, and is exemplified in the Social and Emotional Wellbeing Framework of the National Aboriginal and Torres Strait Islander Health Council and National Mental Health Working Group. Various existing programs – such as ‘Caring for Country’ – can be adapted to capture data about connection to country, for example, and how that impacts on physical and mental health. Critically, the core domains of education, employment and health need to be extended to include activities and concepts that Aboriginal and Torres Strait Islander people consider important to these areas.Recommendations for the development of a wellbeing framework are proposed here, derived from information available in the literature. Rather than being definitive, these recommendations provide a starting point for consultation and adaption towards establishing a wellbeing framework and operational system for collecting and analysing long-term health and wellbeing data for Aboriginal and Torres Strait Islander people in remote Australia as part of the research conducted by CRC-REP

Racism as a determinant of social and emotional wellbeing for aboriginal Australian youth

Objective: To explore the associations between self-reported racism and health and wellbeing outcomes for young Aboriginal Australian people. Design, setting and participants: A cross-sectional study of 345 Aboriginal Australians aged 16–20 years who, as participants in the prospective Aboriginal Birth Cohort Study, were recruited at birth between 1987 and 1990 and followed up between 2006 and 2008. Main outcome measures: Self-reported social and emotional wellbeing using a questionnaire validated as culturally appropriate for the study’s participants; recorded body mass index and waist-to-hip ratio. Results: Self-reported racism was reported by 32% of study participants. Racism was significantly associated with anxiety (odds ratio [OR], 2.18 [95% CI, 1.37–3.46]); depression (OR, 2.16 [95% CI, 1.33–3.53]); suicide risk (OR, 2.32 [95% CI, 1.25–4.00]); and poor overall mental health (OR, 3.35 [95% CI, 2.04–5.51]). No significant associations were found between self-reported racism and resilience or any anthropometric measures. Conclusions: Self-reported racism was associated with poor social and emotional wellbeing outcomes, including anxiety, depression, suicide risk and poor overall mental health

Indigenous land management as primary health care: qualitative analysis from the Interplay research project in remote Australia

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: For Indigenous Australians, health transcends the absence of disease, and includes the health and wellbeing of their community and Country: their whole physical, cultural and spiritual environment. Stronger relationships with Country and greater involvement in cultural practices enhance the wellbeing of Indigenous Australians, and those in more remote regions have greater access to their Country and higher levels of wellbeing. However this does not translate into improvements in clinical indicators, and Indigenous Australians in more remote regions suffer higher levels of morbidity and mortality than Indigenous people in non-remote areas, and other Australians. The Interplay research project aimed to explore how Indigenous Australians in remote regions experience high levels of wellbeing despite poor health statistics, and how services could more effectively enhance both health and wellbeing. Methods: Indigenous Australians in remote regions, together with researchers and government representatives developed a wellbeing framework, comprising government and community priorities: education, employment and health, and community, culture and empowerment respectively. To explore these priorities Indigenous community researchers recruited participants from diverse Indigenous organizations, including Indigenous land management, art, business development, education, employment, health and municipal services. Fourteen focus groups and seven interviews, involving 75 Indigenous and ten non-Indigenous service providers and users were conducted. These were recorded, transcribed and analyzed, using thematic analysis, based on the wellbeing framework. Results: Research participants highlighted Indigenous land management as a source of wellbeing, through strengthened identity and empowerment, access to traditional food sources, enjoyable physical activity, and escape from communities where high levels of alcohol are consumed. Participants described how collaboration and partnerships between services, and recognition of Indigenous languages could enhance wellbeing, while competition between services undermines wellbeing. Indigenous land management programs work across different sectors and promote collaboration between services, serving as a source of comprehensive primary health care. Conclusions: Developing primary health care to reflect distinctive health needs of Indigenous Australians will enhance their health and wellbeing, which includes their communities and Country. Indigenous land management consolidates aspects of comprehensive primary health care, providing both clinical benefits and wellbeing, and can provide a focus for service collaboration.Cooperative Research Centre for Remote Economic Participation (CRC-REP, hosted by Ninti One Limited). Vincent Fairfax Family Foundation, through the Royal Australasian College of Physician

Oral health and social and emotional well-being in a birth cohort of Aboriginal Australian young adults

Background: Social and emotional well-being is an important component of overall health. In the Indigenous Australian context, risk indicators of poor social and emotional well-being include social determinants such as poor education, employment, income and housing as well as substance use, racial discrimination and cultural knowledge. This study sought to investigate associations between oral health-related factors and social and emotional well-being in a birth cohort of young Aboriginal adults residing in the northern region of Australia's Northern Territory. Methods: Data were collected on five validated domains of social and emotional well-being: anxiety, resilience, depression, suicide and overall mental health. Independent variables included socio-demographics, dental health behaviour, dental disease experience, oral health-related quality of life, substance use, racial discrimination and cultural knowledge. Results: After adjusting for other covariates, poor oral health-related items were associated with each of the social and emotional well-being domains. Specifically, anxiety was associated with being female, having one or more decayed teeth and racial discrimination. Resilience was associated with being male, having a job, owning a toothbrush, having one or more filled teeth and knowing a lot about Indigenous culture; while being female, having experienced dental pain in the past year, use of alcohol, use of marijuana and racial discrimination were associated with depression. Suicide was associated with being female, having experience of untreated dental decay and racial discrimination; while being female, having experience of dental disease in one or more teeth, being dissatisfied about dental appearance and racial discrimination were associated with poor mental health. Conclusion: The results suggest there may be value in including oral health-related initiatives when exploring the role of physical conditions on Indigenous social and emotional well-being.Lisa M Jamieson, Yin C Paradies, Wendy Gunthorpe, Sheree J Cairney and Susan M Sayer

Caring for country and the health of Aboriginal and Torres Strait Islander Australians

Schultz R and Cairney S. Caring for country and the health of Aboriginal and Torres Strait Islander Australians. Med J Aust 2017; 207 (1): 8-10. © Copyright 2017. The Medical Journal of Australia - reproduced with permission