NACCHO Aboriginal health :Culture is an important determinant of health: Professor Ngiare Brown at NACCHO Summit

Ian Ring

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


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:


•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.

NACCHO member of new alliance calling for action on social determinants of health:


A collaboration of health, social service and public policy organisations has today called on governments at all levels to consider how the legislative decisions they make will affect the health of the nation and address increasing health inequity across Australia.

Social Inclusion Minister Mark Butler will officially launch the Social Determinants of Health Alliance at Parliament House this morning, welcoming the formation of a group that will seek to share the knowledge its members have gained working with those most affected by inequity to bring about fundamental change to how governments address the health of Australians.

“Over many years, there has been growing evidence about the role of the social determinants of health – the everyday conditions in which people are born, grow, live, work and play – in predicting the ongoing health of a person, but the response in Australia has been slow,” said Professor Fran Baum of Flinders University, who sat on the World Health Organisation’s Commission on the Social Determinants of Health. “This alliance is saying ‘enough is enough’ and ‘it’s time for action’.”

Australian National University Professor Sharon Friel was head of the Commission on the Social Determinants of Health’s science secretariat. She said the current Senate Inquiry into Australia’s response to the WHO report Closing a gap in a generation  creates an opportunity for progress to be made.

“There is some good work going on in Australia, but in a piecemeal fashion,” Professor Friel said. “We need an explicit policy framework and we need systematic analysis of what is happening around the country, and what is working. We may be underselling what is happening, but there’s currently no real way of knowing that.”

Professor Stephen Duckett, health program director at the Grattan Institute, said truly addressing health inequity requires a recalibration of how politicians, policy makers and health professionals think about disease.

“When we look at a condition like diabetes, prevalence is better explained by where you live than behavioural risk factors such as smoking or exercise,” he said.

Lin Hatfield Dodds, the chair of the Australian Social Inclusion Board, said Australia is lucky to have internationally renowned experts on the social determinants of health and “An advisory body like the Social Inclusion Board has much to gain from the insights that can be offered by those experts and by the new Alliance. I welcome its formation and launch today, and what it could mean for Australians’ health.”

NACCHO social determinants contact

James Lamerton

Senior Policy Advisor – Health Reform

Phone: 07 5471 7142 Mobile: 0409117526


Current members of the Social Determinants of Health Alliance include the Australian Council of Social Service, Australian Health Care Reform Alliance, Australian Health Promotion Association, Australian Nursing Federation, Catholic Health Australia, Centre for Health Equity Training Research & Evaluation, CRANAplus, Doctors Reform Society, HealthWest Partnership, Heart Foundation, Indigenous Allied Health Australia, NACCHO, People’s Health Movement Oz, Public Health Association of Australia, Ragg Ahmed, Sane Australia, Society of St Vincent de Paul, St Vincent’s Health Australia and Tasmania’s Social Determinants of Health Advocacy Network.

Workshop to guide the development of an issues paper on social determinants of Indigenous health

You are invited to participate (in person or by teleconference) in a workshop to guide the development of a Closing the Gap Clearinghouse issues paper that will be prepared in coming months. The issues paper focuses on the social determinants of Indigenous health and falls under the health COAG building block for overcoming Indigenous disadvantage.

The title of the issues paper is What works? A review of actions addressing the social and economic determinants of Indigenous health [62KB PDF] by Dr Katy Osborne and Professor Fran Baum, Flinders University.

The purpose of the workshop is for the authors to meet with key policy makers to discuss content and coverage of the issues paper, and to identify the main government programs and research and evaluations relating to the topic.

The workshop will initially focus on the project proposal for the issues paper that is hyperlinked above. It will then include a discussion about the major policy priorities and how the issues paper can meet the research needs of governments and service providers.


Friday 8 February 2013

11.00 am – 12.30 pm (AEDT)


Australian Institute of Health and Welfare, Traeger Court, off Thynne Street, Bruce, ACT

Teleconference facilities will be available for those outside Canberra to participate.


If you would like to participate in the workshop, please RSVP by Wednesday 6 February 2013 to

Please feel free to circulate this invitation to any colleagues that you think might be interested in contributing.

Written comments on the project proposal are also welcome by Friday 15 February 2013