It’s time to move away from the deficit model that is implicit in much discussion about the social determinants of health, and instead take a strengths-based cultural determinants approach to improving the health of Aboriginal and Torres Strait Islander people. This is one of the messages from Ngiare Brown, Professor of Indigenous Health and Education at the University of Wollongong.

Professor Brown also stresses the importance of a focus on resilience, and the value of the Aboriginal Community Controlled Health sector as a national network for promoting cultural revitalisation and sustainable intergenerational change.

The summary below is taken from her presentation at the recent NACCHO summit

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Connections to culture and country build stronger individual and collective wellbeing

Professor Ngiare Brown writes:

Although widely accepted and broadly researched, the social determinants approach to health and wellbeing appear to reflect a deficit perspective – demonstrating poorer health outcomes for those from lower socioeconomic populations, with lower educational attainment, long term unemployment and welfare dependency and intergenerational disadvantage.

The cultural determinants of health originate from and promote a strength based perspective, acknowledging that stronger connections to culture and country build stronger individual and collective identities, a sense of self-esteem, resilience, and improved outcomes across the other determinants of health including education, economic stability and community safety.

Exploring and articulating the cultural determinants of health acknowledges the extensive and well-established knowledge networks that exist within communities, the Aboriginal Community Controlled Health Service movement, human rights and social justice sectors.

Consistent with the thematic approach to the Articles of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), cultural determinants include, but are not limited to:

•Self-determination;

•Freedom from discrimination;

•Individual and collective rights;

•Freedom from assimilation and destruction of culture;

•Protection from removal/relocation;

•Connection to, custodianship, and utilisation of country and traditional lands;

•Reclamation, revitalisation, preservation and promotion of language and cultural practices;

•Protection and promotion of Traditional Knowledge and Indigenous Intellectual Property; and

•Understanding of lore, law and traditional roles and responsibilities.

The power of resilience

The exploration of resilience is a powerful and culturally relevant construct.

Resilience may be defined as the capacity to “cope with, and bounce back after, the ongoing demands and challenges of life, and to learn from them in a positive way”, positive adaptation despite adversity or “a class of phenomena characterized by good outcomes in spite of serious threats to adaptation or development”

Resilience is important because:

• It is culturally significant – we are a resilient culture, surviving and thriving;

• Resilient people/communities are better prepared for stronger, smarter, healthier, successful futures and have better outcomes across the social determinants of health (education, health, employment);

• Resilient individuals are more likely to provide a positive influence on those around them and are better able to develop and maintain positive relationships with others – family, friends, peers, colleagues;

• Resilience promotes collective benefits – social cohesion, community pride in success, economic stability, and improved health and wellbeing.

There is a developing body of international work describing cultural continuity and cultural resilience.

Scholars such as Fleming and Ledogar propose dimensions including traditional activities, traditional spirituality, traditional languages, and traditional healing.

Further, Native American educators propose cultural protective factors and cultural resources for resilience such as symbols and proverbs from common language and culture, traditional child rearing philosophies, religious leadership, counselors and Elders.

(For example, Chandler, M. J. & Lalonde, C. E. (2008). Cultural Continuity as a Protective Factor Against Suicide in First Nations Youth. Horizons –A Special Issue on Aboriginal Youth, Hope or Heartbreak: Aboriginal Youth and Canada’s Future. 10(1), 68-72; Olsson 2003, Stockholm Resilience Centre; John Fleming and Robert J Ledogar, ‘Resilience, an Evolving Concept: A Review of Literature Relevant to Aboriginal Research’,  Pimatisiwin. 2008 ; 6(2): 7–23. Iris Heavyrunner et al 2003).

The cultural determinants of health and wellbeing may be seen to be wrapping around, or cutting across individual, internal, external and collective factors.

A ‘social and cultural determinants’ approach recognises that there are many drivers of ill-health that lie outside the direct responsibility of the health sector and which therefore require a collaborative, inter-sectoral approach.

There is an increasing body of evidence demonstrating that protection and promotion of traditional knowledge, family, culture and kinship contribute to community cohesion and personal resilience.

Current studies show that strong cultural links and practices improve outcomes across the social determinants of health.

There are certain services only NACCHO and ACCH sector can and should do – child protection; mental health; women’s business; and men’s health.

This is useful in assisting policy and resourcing decision-making dependent upon context, geography, demography and tailoring services to local needs and priorities

The ACCH sector provides a true national network and a vehicle for cultural revitalisation. A cultural determinants approach and cultural revitalisation drive sustainable intergenerational change.