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An Ethnography of Health Promotion with Indigenous Australians in South East Queensland

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An Ethnography of Health Promotion with Indigenous Australians in South East Queensland See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/292140373 "We don't tell people what to do": An ethnography of health promotion with Indigenous Australians in South East Queensland Thesis · December 2015 CITATIONS READS 0 36 1 author: Karen McPhail-Bell University of Sydney 25 PUBLICATIONS 14 CITATIONS SEE PROFILE Available from: Karen McPhail-Bell Retrieved on: 25 October 2016 “We don’t tell people what to do” An ethnography of health promotion with Indigenous Australians in South East Queensland Karen McPhail-Bell Bachelor of Behavioural Science, Honours (Public Health) Submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy School of Public Health and Social Work Queensland University of Technology 2015 Key words Aboriginal, Aboriginal Medical Service, Australia, colonisation, community controlled health service, critical race theory, cultural interface, culture, ethnography, Facebook, government, health promotion, identity, Indigenous, Instagram, mainstream, policy, postcolonial theory, public health, relationship, self- determination, social media, Torres Strait Islander, Twitter, urban, YouTube. ii Abstract Australia is a world-leader in health promotion, consistently ranking in the best performing group of countries for healthy life expectancy and health expenditure per person. However, these successes have largely failed to translate into Indigenous health outcomes. Given the continued dominance of a colonial imagination, little research exists that values Indigenous perspectives, knowledges and practice in health promotion. This thesis contributes to addressing this knowledge gap. An ethnographic study of health promotion practice was undertaken within an Indigenous-led health promotion team, to learn how practitioners negotiated tensions of daily practice. The study was strengths-based, informed by a theoretical framework that privileged Indigenous knowledges, perspectives and experiences, drawing on three theoretical tools: postcolonialism and critical race theory positioned the researcher and health promotion discipline; whilst cultural interface theory enabled the analysis to shift beyond a critique of the Western, to uncover the practitioners’ meaning-making in daily health promotion practice. The practice revealed innovative, diverse, relationship-based approaches to health promotion that effectively shifted power from health promotion practitioner to Indigenous people and communities. Community choice and control were central to practice. Through a dialogical approach with Indigenous people and communities, Indigenous notions of health and healthy behaviours were embedded and Aboriginality was asserted as health promoting itself. The study’s findings converge with global health promotion discourse. This suggests that paradoxically, decolonising health promotion practice in Indigenous contexts requires we ‘do things differently’, while adhering to health promotion’s philosophical foundations of empowerment and control. The study proposes four interrelated principles for decolonising health promotion, informed by the practice observed. The study concludes that decolonising health promotion practice requires a radical reworking of practitioner relationships with Indigenous people and iii communities. Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian health promotion practice. iv List of publications and presentations Publications relevant to the thesis but not forming part of it McPhail-Bell, K., Nelson, A., Lacey, I., Brough, M., Fredericks, B., & Bond, C. (under review). Maiwah as a framework for Indigenist research: Community control and decolonising health promotion research in Australia. In P. Liamputtong (Ed), Doing Cross-Cultural Research in Health and Social Sciences. Springer Publications. McPhail-Bell, K., Bond, C., Brough, M. and Fredericks, B. (2015). “We don’t tell people what to do”: Ethical practice and Indigenous health promotion. Health Promotion Journal of Australia, 26(3), 195-199. doi: 10.1071/HE15048p; McPhail-Bell, K. (2014). Deadly Choices: Better ways of doing health promotion. Croakey – the Crikey health blog. Crikey: Sydney. McPhail-Bell, K., Fredericks, B. & Brough, B. (2013). Beyond the accolades – A postcolonial critique of the foundations of the Ottawa Charter. Global Health Promotion. 22(2): 22-29. McPhail-Bell, K., Bond, C., & Redman-MacLaren, M. (2013) Skins for smokes and the use of cultural content and imagery. Queensland Health Promotion Quarterly, June, p. 8. Presentations relevant to the thesis but not forming part of it McPhail-Bell, K. & Appo, N. (2015, September). Deadly Choices social media: Empowering our people to create change. Population Health Congress: Hobart. McPhail-Bell, K. (2014, June). Deadly Choices or deadly choices? An ethnography of health promotion practice with Indigenous Australians. IUIH/Lowitja Symposium – Innovations in Urban Aboriginal and Torres Strait Islander Health: Closing the Gap. IUIH: Brisbane. McPhail-Bell, K. (2014, March). We have a lot to learn yet: A postcolonial lens in health promotion. AIATSIS National Indigenous Studies Conference – Breaking Barriers in Indigenous Research and Thinking. AIATSIS: Canberra. v McPhail-Bell, K. (2013, August). Panel speaker in: Potvin, L. and Larouche, A. (2013). Symposium: Towards a recognition of health promotion as a specific research domain. World Conference on Health Promotion. IUIHPE: Pattaya, Thailand. McPhail-Bell, K. & Bond, C. (2013, August). Culture in and culture of health promotion: Tensions at the interface of Australian Indigenous health promotion. World Conference on Health Promotion. IUIHPE: Pattaya, Thailand. McPhail-Bell, K. & Fredericks, B. (2013, August). Beyond the accolades: A postcolonial critique of the foundations of the Ottawa Charter. World Conference on Health Promotion. IUIHPE: Pattaya, Thailand. vi List of acronyms AAF Aboriginal Advancement Fellowship ABC Australian Broadcasting Corporation ABS Australian Bureau of Statistics AFL Australian Football League AHPA Australian Health Promotion Association AIDA Australian Indigenous Doctors Association AIHW Australian Institute of Health and Welfare AMS Aboriginal Medical Service ANPHA Australian National Preventative Health Agency ANTaR Australians for Native Title and Reconciliation APA Aboriginal Progressive Association ATSIC Aboriginal and Torres Strait Islander Commission CATSIN Congress of Aboriginal and Torres Strait Islander Nurses CCHS Community Controlled Health Service CDH Commonwealth Department of Health COAG Council of Australian Governments CRT Critical Race Theory CSDH Commission on Social Determinants of Health CTG Close the Gap CYWRT Cape York Welfare Reform Trial DAA Federal Department of Aboriginal Affairs EBM Evidence-based medicine GQT Good Quick Tukka HFA 2000 Health for All by the Year 2000 HLT Healthy Lifestyle Team HREC Human Research Ethics Committee HREOC Human Rights and Equal Opportunity Commission IAS Indigenous Advancement Strategy IDAA Indigenous Dentists’ Association of Australia vii IUIH Institute for Urban Indigenous Health MATSICHS Moreton Aboriginal and Torres Strait Islander Community Health Service MPSS Murri Places, Smoke-free Spaces NACCHO National Aboriginal Community Controlled Health Organisation NAHS National Aboriginal Health Strategy NBHP National Better Health Program NEAF National Ethics Application Form NFL National Football League NGO Non Government Organisation NHMRC National Health and Medical Research Council NHS National Health System NIRA National Indigenous Reform Agreement NRL National Rugby League NTEHP National Trachoma and Eye Health Program NTER Northern Territory Emergency Response PHC Primary Health Care PHM People’s Health Movement QAIHC Queensland Aboriginal and Islander Health Council QH Queensland Health QUT Queensland University of Technology RACO Royal Australian College of Ophthalmologists RCADIC Royal Commission into Aboriginal Deaths in Custody SDOH Social Determinants of Health SEQ South East Queensland SNSs Social Networking Sites SNTTS Say No To The Smokes programs TIGs Traditional Indigenous Games TVC Television Commercial WHO World Health Organization viii List of key terms Behavioural accounts of health Behavioural accounts of health are individualistic. This means such accounts operate at the individual level with a focus upon behaviour and risk factors (for example, smoking, alcohol consumption, exercise) (Baum & Fisher, 2014). Behavioural interventions tend to draw on theories of behaviour change and health behaviour, focusing on individual action and choice to improve health (Nutbeam & Harris, 2004). Colonisation Colonisation in Australia began with British imperialism to establish British control over land, resulting in dramatic change and destruction of Indigenous Australian peoples and their cultures (Dudgeon & Walker, 2015; Sherwood, 2010). Colonisation is both an historical and ongoing process and recognised globally as a determinant of Indigenous health (Commission on Social Determinants of Health, 2007; Smith, 2012). Decolonisation Decolonisation is a process that begins after recognition of colonisation (Sherwood, 2010). It is an approach and philosophy that accepts that research is not impartial and that as researchers and health professionals, we bring our own worldviews and perspectives (Sherwood, 2013a). Decolonisation requires the rewriting of history to include Indigenous
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