Deficit Discourse and Strengths-based Approaches Changing the narrative of Aboriginal and Torres Strait Islander health and wellbeing William Fogarty, Melissa Lovell, Juleigh Langenberg and Mary-Jane Heron National Centre for Indigenous Studies, The Australian National University Deficit Discourse and Strengths-based Approaches Changing the narrative of Aboriginal and Torres Strait Islander health and wellbeing William Fogarty, Melissa Lovell, Juleigh Langenberg and Mary-Jane Heron National Centre for Indigenous Studies, The Australian National University © The Lowitja Institute & National Centre for Indigenous Studies, 2018 ISBN: 978-1-921889-55-4 First published May 2018 This work is published and disseminated as part of the activities of the Lowitja Institute, Australia’s national institute for Aboriginal and Torres Strait Islander health research, incorporating the Lowitja Institute Aboriginal and Torres Strait Islander Health CRC (Lowitja Institute CRC), a collaborative partnership funded by the Cooperative Research Centre Program of the Australian Government Department of Industry, Innovation and Science. 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Both a PDF version and printed copies of this report may be obtained from: www.lowitja.org.au The Lowitja Institute National Centre for Indigenous Studies PO Box 650, Carlton South The Australian National University Victoria 3053 AUSTRALIA 45 Sullivans Creek Rd Acton, ACT 2601 AUSTRALIA T: +61 3 8341 5555 E: [email protected] T: +61 2 6125 6708 W: www.lowitja.org.au E: [email protected] W: http://ncis.anu.edu.au Authors: William Fogarty, Melissa Lovell, Juleigh Langenberg and Mary-Jane Heron For citation: Fogarty, W., Lovell, M., Langenberg, J. & Heron, M-J. 2018, Deficit Discourse and Strengths-based Approaches: Changing the Narrative of Aboriginal and Torres Strait Islander Health and Wellbeing, The Lowitja Institute, Melbourne. Managing Editor: Cristina Lochert Editor: Brevity Comms Design and Layout: Dreamtime Creative ii | Deficit Discourse and Strengths-based Approaches Contents Acknowledgments v Acronyms v Executive summary vi Introduction 1 What is deficit discourse and why is it important? 2 Strengths-based approaches: A corollary to deficit? 4 Methodology and research design 6 Key method: Critical Discourse Analysis 6 Tool 1: Leximancer 7 Tool 2: NVivo 7 Strengths-based approaches and concepts in health 9 Asset-based approaches and resilience 9 Strength as ‘holistic health and cultural appropriateness’ 10 Strength and social determinants of health 11 Strengths-based counselling approaches 12 Strength through protective factors 12 Strength as empowerment 13 Strength, wellness and wellbeing 13 Strength through decolonisation 13 Strength as salutogenesis 14 Typology 14 Deficit Discourse and Strengths-based Approaches | iii Why use strengths-based approaches? 16 Justifications for using strengths-based approaches 16 Utilitarian justifications 16 Binary justifications 17 Strengths-based Indigenous health programs 18 Whānau Ora Framework 18 Deadly Kids Deadly Futures Framework 19 #IHMayDay 20 Indigenous Storybook WA 21 Ngangkari Program 22 Talking Up Our Strengths 23 AIMhi Stay Strong App 24 Differences in discourse between Australian and international literature 26 Figure 1: International thematic landscape of selected strengths-based literature 26 Figure 2: Australian thematic landscape of selected strengths-based literature 27 Conclusion 29 References 30 iv | Deficit Discourse and Strengths-based Approaches Acknowledgments The authors would like to acknowledge the For their various contributions to this report funding support from the Lowitja Institute that – including research support, editing, critical enabled this project to be carried out. Thanks are readings of drafts and helpful discussions – we also due to Lowitja Institute staff Dr Jill Guthrie, are grateful to colleagues at the National Centre for Ms Mary Guthrie, Ms Tahlia Eastman, Ms Luella Indigenous Studies (NCIS): Professor Mick Dodson, Monson-Wilbraham, Ms Aiesha Gierson, Dr Hannah Bulloch, Associate Professor Cressida Ms Leila Smith and Ms Cristina Lochert for Fforde, Ms Lauren Gibbs and Mr Ben Wilson. their support and enthusiasm for this project, Finally, thanks to the members of the NCIS Deficit and for their feedback as the work progressed. Discourse Research Group for their input and Thanks to Ngaanyatjarra Pitjantjatjara guidance: Professor Mick Dodson, Dr Laurie Bamblett, Yankunytjatjara (NPY) Women’s Council, Mr Scott Gorringe, Professor Patrick Sullivan, the Public Health Advocacy Institute WA and Dr Lisa Waller and Associate Professor Kerry McCallum. Curtin University for permission to use photographs. Acronyms CDA Critical Discourse Analysis CSOM Chronic Suppurative Otitis Media NCIS National Centre for Indigenous Studies OM Otitis Media Deficit Discourse and Strengths-based Approaches | v Executive summary This report explores strengths-based approaches that those experiencing the disadvantage are to shifting the deficit narrative in the Australian seen as the problem, and a reductionist and Aboriginal and Torres Strait Islander health sector. essentialising vision of what is possible becomes Studies, including a companion report to this one pervasive. Operating predominantly from a deficit entitled Deficit Discourse and Indigenous Health: or ‘ill-based’ approach provides only one side How Narrative Framings of Aboriginal and Torres to a multi-faceted story, and inhibits alternative Strait Islander People are Reproduced in Policy, solutions or opportunities that facilitate growth have identified a prevalent ‘deficit discourse’ and thriving. across Aboriginal and Torres Strait Islander health This report is the second in a two-part series policy and practice. ‘Discourse’, in this sense, examining deficit discourse, and responses to encompasses thought represented in written and it, in the Australian Aboriginal and Torres Strait spoken communication and/or expressed through Islander health field. The first, policy and practices. The term draws attention Deficit Discourse , draws on Critical to the circulation of ideas, the processes by and Indigenous Health Discourse Analysis to explore the extent and which these ideas shape conceptual and material patterning of deficit discourse in the academic, realities, and the power inequalities that policy and grey literature in this area. This report contribute to and result from these processes. builds on Deficit Discourse and Indigenous ‘Deficit discourse’ refers to discourse that Health by reviewing and analysing a growing represents people or groups in terms of body of work from Australia and overseas that deficiency – absence, lack or failure. It proposes ways to displace deficit discourse in particularly denotes discourse that narrowly health, or that provides examples of attempts situates responsibility for problems with the to do so. The most widely accepted approaches affected individuals or communities, overlooking to achieving this come under the umbrella term the larger socio-economic structures in which ‘strengths-based’, which seek to move away from they are embedded. the traditional problem-based paradigm and offer a different language and set of solutions to There is evidence that deficit discourse has an overcoming an issue. It is on these approaches impact on health itself — that it is a barrier to that we focus in this report. improving health outcomes. For example, Halpern (2015) argues that continual reporting of negative stereotypes and prevalence rates actually Research approach reinforces undesired behaviour. Accordingly, This report is the result of desk-based research, there are growing calls for alternative ways to carried out over six months at the Australian think about and discuss Aboriginal and Torres National University’s National Centre for Strait Islander health and wellbeing. Indigenous Studies. The research aims were to: Crucially, these should not be mistaken for calls to • Identify national and international methods deflate the realities of disadvantage in the socio- and approaches that are effective in economic circumstances faced by Aboriginal and changing the narrative used to talk about Torres Strait Islander Australians or to deny the Indigenous peoples’ health and wellbeing health conditions people experience. Discourses from a discourse based on deficit and ill- of deficit occur when discussions and policy health, to one of strength and resilience. aimed at alleviating disadvantage become so mired in narratives of failure and inferiority vi | Deficit Discourse and Strengths-based Approaches • Summarise the characteristics of successful holistic approaches, wellness and wellbeing, programs and initiatives and build the evidence strengths-based counselling approaches and of best practice and the benefits of strengths- positive psychology, decolonisation methodology, based discourse on Aboriginal and Torres Strait and salutogenesis. Islander peoples’ health and wellbeing. • Make recommendations of future actions Reasons for adopting strengths- to reframe discourse in the Australian based approaches Aboriginal and Torres Strait Islander health We found two broad, overlapping sets of context. justifications