Public Health Association of Australia
In this NAIDOC Week 2021, the Public Health Association of Australia (PHAA) embraces First Nations Peoples’ cultural knowledge and understanding of Country as part of Australia’s national heritage.
This year’s NAIDOC theme, ‘Heal Country!’ resonates strongly with the PHAA team, as it calls for stronger measures to recognise, protect, and maintain all aspects of Aboriginal and Torres Strait Islander culture and heritage. Healing Country means finally resolving many of the outstanding injustices which impact on the lives of Aboriginal and Torres Strait Islander communities. As a peak representative body for the nation, we have as a core value a deep commitment to the physical and mental health and wellbeing of all our population, and especially those who have experienced the most disadvantage and discrimination.
As a part of our commitment to healing, this NAIDOC Week we are sharing extracts and articles from the Australian and New Zealand Journal of Public Health, which we hope will advance our healing journey.
Indigenous geographical health research
Despite a four-fold increase in research since 2010, a review of Aboriginal and Torres Strait Islander health research to reflect the geographical distribution of the Indigenous population of Australia has identified a worrying lack of research amongst urban Indigenous communities.
Led by Dr Warren Jennings, from the University of Queensland, 1,258 research papers were identified in a period from January 2013 to January 2018. Of those, 190 (15%) focused exclusively on Indigenous people living in urban areas; 563 (45%) in rural/remote areas; and 505 (40%) spanned urban and rural/remote areas. Despite similar burdens of disease, three times as many papers were published per 1,000 for rural/remote areas than urban areas. This, despite the 2016 Census showing an estimated 37% of Indigenous people in Australia lived in major cities.
The report concluded the persisting gap in research publications in urban compared with rural/remote Indigenous populations and burden of disease figures suggests that the problem of ‘Indigenous invisibility’ in the city remains. This gap traces its origins to racist assumptions and stereotypes of what constitutes a ‘real’ Indigenous person or community, worsened by the poorer identification of Indigenous people in urban settings, particularly in the health context.
The health of urban Aboriginal children
An excellent example of the type of research needed into urban Aboriginal health involved a survey of more than 400 carers of Aboriginal children who participated in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).
Those surveyed were asked to describe the single most important factor that would help their children to be healthy and well. Responses were analysed using thematic and content analysis.
The research identified 13 factors related to: loving family relationships, culturally competent healthcare, food security, active living, community services, education, social and emotional connectedness, safety, breaking cycles of disadvantage, housing availability and affordability, positive Aboriginal role models, strong culture, and carer wellbeing.
Aligning with holistic concepts of health, caregivers believe that a broad range of child, family and environmental-level factors are needed to ensure the health and wellbeing of Aboriginal children.
This study also highlights the importance of providing public health initiatives that enable equal access to the social determinants of health for carers of Aboriginal children. Affordable and adequate housing, food security, culturally appropriate healthcare, and family and community connectedness remain critical areas for targeted initiatives.
Barriers to quitting smoking
Daily smoking prevalence among Aboriginal and Torres Strait Islander people is falling, but at 39% it is still 2.8 times the prevalence of non-Indigenous Australians and is responsible for 12% of the total and 23% of the gap in the burden of disease.
A survey examined whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers.
Researchers analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking about the Smokes baseline survey (April 2012–October 2013) and the 759 who completed a follow-up survey a year later (August 2013–August 2014).
More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow-up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive.
The report concluded health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Rather, health staff should emphasise the benefits to mental health that come with successfully quitting smoking.
Impact of Rethink Sugary Drink advertising
An online survey tested the hypothesis that a culturally tailored sugar-sweetened beverage campaign designed specifically for the Victorian Aboriginal community will not only be valuable for Aboriginal Victorians but will also have cross-over benefits for non-Indigenous Victorians.
The results just published show 76% of Aboriginal respondents recalled seeing the advertisement compared to 56% of non-Aboriginal respondents. A high proportion of respondents (59% for Aboriginal, 55% for non-Indigenous) who had seen the advertisement correctly identified the sugar content of a 600mL drink. The perceived relevance of the advertisement was high (78% for Aboriginal vs. 47% for non-Indigenous), as was the response that it motivated action to improve health (82% vs. 50%).
The researchers concluded that the Aboriginal Rethink Sugary Drink campaign was successful in engaging both Aboriginal and non-Indigenous Victorians. Notwithstanding the study limitations, findings indicate that while Aboriginal people were more likely to recall seeing the Aboriginal-specific television advertisement and more likely to find it relevant and motivating, many non-Indigenous Victorians also responded favourably to the campaign. Overall, these results suggest that broadcasting Aboriginal social marketing campaigns on whole-of-population platforms is an acceptable and effective strategy for promoting nutrition messages for both the Aboriginal and non-Indigenous populations, as such campaigns can have cross-over appeal and deliver positive results across both audiences.
An unexpected and unintended finding of this evaluation was the stark difference between Aboriginal and non-Indigenous respondents with relation to feelings of guilt. More than one-third (36%) of Aboriginal respondents reported that the advertisement made them feel guilty, while only 5% of non-Indigenous respondents reported a guilt response.