Cultural determinants of health

This year, I have had the opportunity to work with Professor Kerry Arabena in a consulting role for the Lowitja Institute in a new and quite groundbreaking piece of research / advocacy for Indigenous studies about Cultural Determinants of Health with particular focus on Aboriginal and Torres Straits Islander people. This work has once again emphasized in my mind the value of cultural practices and knowledge of Indigenous populations around the world.

Cultural determinants of health play out across various domains. Research has focused on six of these in particular:

  • Connection to Country;
  • Cultural Beliefs and Knowledge;
  • Language;
  • Family, Kinship and Community;
  • Expression and Cultural Continuity; and
  • Self-determination and Leadership (Salmon et al, 2018)

CDoH

The language that is used in this context matters, because it determines not only what can be said about a particular topic but also what people are able to think, and what they hold to be true (Davis, 2019; Hall, 2001). Language determines the way we think about things, to the extent that language governs the meaning we are able to construct: “Discourse […] constructs the topic. It defines and produces the objects of our knowledge. It governs the way that a topic can be meaningfully talked about and reasoned about. It also influences how ideas are put into practice and used to regulate the conduct of others.” (Hall, 2001: 72). This confers language the power to determine reality in ways that is often subtle and difficult to detect. At the same time, the person or organisation using the language acquires power over the subject, and thus about the person or issue spoken about (Davis, 2019; Hall, 2001). Thus, the deficit discourse determines the way people think about Aboriginal and Torres Straits Islander people, culture, and relationships with mainstream society and government, including what people think about themselves, where the idea of deficit has become internalised (Davis, 2019). This can impact outcomes for Aboriginal and Torres Straits Islander people including mental and physical health.

Replacing a deficit discourse with a strength-based approach promises to emphasise the aspects of people’s culture and practices that make them strong and resilient and promote health, happiness and wellbeing (Rashid, 2015). Aboriginal and Torres Straits Islander history and culture, as we argue in this paper, holds important lessons for people’s health and wellbeing, which we discuss as the cultural determinants of health. Community relationships and family and kin networks, for example, can provide entry points to disseminate knowledge about health practices (Brough et al., 2004). Living on country and engaging in traditional methods for food production has been shown to have great health benefits (Salmon et al., 2018). As we hope to show, there are numerous ways in which engagement with cultural determinants of health can lead to better health outcomes. Incorporating cultural determinants of health more widely in policy promises to improve understanding of how to promote happy, healthy communities that will be valuable for Aboriginal and Torres Straits Islander communities as well as for the rest of the population (Salmon et al., 2018).

My contribution to this work has been to look into the literature around cultural determinants, as well as to think about the role a strength-based approach has on the way people discuss cultural determinants of health. In addition I contributed to the data visualisation around cultural determinants, including work with video footage from the roundtables held at the 2019 Lowitja conference in Darwin.

Brough, M., Bond, C., Hunt, J., 2004. Strong in the City: towards a strength-based approach in Indigenous health promotion. Heal. Promot. J. Aust. 15, 215–220. https://doi.org/10.1071/he04215

Hall, S., 2001. Foucault: Power, knowledge and discourse. Discourse Theory Practice. A Reader. 72, 81.

Davis, M., 2019. Indigenous Australian Identity in Colonial and Postcolonial Contexts. Palgrave Handbook Ethnography 1–18. https://doi.org/10.1007/978-981-13-0242-8_146-1

Rashid, T., 2015. Positive psychotherapy: A strength-based approach. Journal of Positive Psychology 10, 25–40. https://doi.org/10.1080/17439760.2014.920411

Salmon, M., Doery, K., Dance, P., Chapman, J., Gilbert, R., Williams, R., Lovett, R., 2018. Defining the Indefinable: Descriptors of Aboriginal and Torres Strait Islander Peoples’ Cultures and their Links to Health and Wellbeing. https://doi.org/10.25911/5bdbcdf5c89a7

 

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