Closing the Gap in Aboriginal health disparities: is there a place for Elders in the neoliberal agenda?
Terrance Cox A , Ha Hoang
A B , Jonathon Mond A and Merylin Cross A
A Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Launceston, Tas. 7250, Australia. Email: Terrance.Cox@utas.edu.au; jon.mond@utas.edu.au; Merylin.Cross@utas.edu.au
B Corresponding author. Email: Thi.Hoang@utas.edu.au
Australian Health Review 46(2) 173-177 https://doi.org/10.1071/AH21098
Submitted: 26 March 2021 Accepted: 22 September 2021 Published: 23 November 2021
Abstract
Objective In light of concerns surrounding neoliberal government approaches to addressing Aboriginal disadvantage, this project examined how Elders consider the Closing the Gap programs for improving community health outcomes.
Methods A participatory action research project was undertaken in collaboration with eight Elders from a remote Aboriginal community in Australia’s island state of Tasmania. The findings emerged from thematic analysis of individual interviews and yarning circles.
Results The Closing the Gap programs were seen by Elders as having instrumental value for addressing Aboriginal community disadvantage. However, the programs also represented a source of ongoing dependency that threatened to undermine the community’s autonomy, self-determination and cultural foundations. The findings emerged to represent Elders attempting to reconcile this tension by embedding the programs with cultural values or promoting culture separately from the programs. Ultimately, the Elders saw culture as the core business of community well-being and effective program delivery.
Conclusion The findings are reflective of tensions that arise when neoliberal policies are imposed on Aboriginal ways of knowing, being and doing. The Elders premised cultural well-being as the key determinant of Aboriginal community health.
What is known about the topic? Closing the Gap represents successive neoliberal policy responses of Australian governments to address ongoing Aboriginal disadvantage.
What does this paper add? Closing the Gap programs were recognised by Aboriginal Elders for providing the community with improved services, but also a threat to the community’s cultural foundations and self-determination. The findings illustrate ongoing tensions between neoliberal principles and Aboriginal cultural values.
What are the implications for practitioners? More effective Closing the Gap approaches require greater collaboration between policy stakeholders and community Elders.
References
[1] Butler TL, Anderson K, Garvey G, et al Aboriginal and Torres Strait Islander people’s domains of wellbeing: A comprehensive literature review. Soc Sci Med 2019; 233 138–57.| Aboriginal and Torres Strait Islander people’s domains of wellbeing: A comprehensive literature review.Crossref | GoogleScholarGoogle Scholar | 31200269PubMed |
[2] Dawson J, Augoustinos M, Sjoberg D, et al Closing the Gap: Examining how the problem of Aboriginal and Torres Strait Islander disadvantage is represented in policy. Aust J Soc Issues 2020;
| Closing the Gap: Examining how the problem of Aboriginal and Torres Strait Islander disadvantage is represented in policy.Crossref | GoogleScholarGoogle Scholar |
[3] Council of Australian Governments (COAG). Partnership Agreement on Closing the Gap 2019–2029. 2019. Available at: https://www.coag.gov.au/about-coag/agreements/closing-gap-partnership-agreement
[4] Bell K, Green J. On the perils of invoking neoliberalism in public health critique. Crit Public Health 2016; 26 239–43.
| On the perils of invoking neoliberalism in public health critique.Crossref | GoogleScholarGoogle Scholar |
[5] Jamieson L, Hedges J, McKinstry S, Koopu P, Venner K. How Neoliberalism Shapes Indigenous Oral Health Inequalities Globally: Examples from Five Countries. Int J Environ Res Public Health 2020; 17 8908
| How Neoliberalism Shapes Indigenous Oral Health Inequalities Globally: Examples from Five Countries.Crossref | GoogleScholarGoogle Scholar |
[6] Howard-Wagner D, Bargh M, Altamirano-Jiménez I. From new paternalism to new imaginings of possibilities in Australia, Canada and Aotearoa/ New Zealand: Indigenous rights and recognition and the state in the neoliberal age. In: Howard-Wagner D, Bargh M, Altamirano-Jiménez I, editors. The neoliberal state, recognition and Indigenous rights New paternalism to new imaginings. Canberra: The Australian National University; 2018. p. 1–42.
[7] Yap M, Yu E. Expressions of Indigenous rights and self-determination from the ground up: A Yawuru example. In: Howard-Wagner D, Bargh M, Altamirano-Jiménez I, editors. From new paternalism to new imaginings of possibilities in Australia, Canada and Aotearoa/ New Zealand: Indigenous rights and recognition and the state in the neoliberal age. Canberra: The Australian National University; 2018. p. 93–112.
[8] Hampton R, Toombs M. Indigenous Australians and health: the wombat in the room. Melbourne: Oxford University Press; 2013.
[9] Martin K, Mirraboopa B. Ways of knowing, being and doing: A theoretical framework and methods for indigenous and indigenist re‐search. J Aust Stud 2003; 27 203–14.
| Ways of knowing, being and doing: A theoretical framework and methods for indigenous and indigenist re‐search.Crossref | GoogleScholarGoogle Scholar |
[10] Australian Government. Closing the Gap Report 2020. Available at: https://ctgreport.niaa.gov.au/sites/default/files/pdf/closing-the-gap-report-2020.pdf.
[11] Australian Government. Australian Statistical Geographical Classification – Remoteness Area. 2020. Available at: https://www.health.gov.au/health-topics/health-workforce/health-workforce-classifications/australian-statistical-geographical-classification-remoteness-area [verified 12 January 2020]
[12] Kendall E, Sunderland N, Barnett L, Nalder G, Matthews C. Beyond the rhetoric of participatory research in indigenous communities: advances in Australia over the last decade. Qual Health Res 2011; 21 1719–28.
| Beyond the rhetoric of participatory research in indigenous communities: advances in Australia over the last decade.Crossref | GoogleScholarGoogle Scholar | 21844284PubMed |
[13] Barlo S, Boyd W, Pelizzon A, Wilson S. Yarning as protected space: principles and protocols. AlterNative, Int J Indigenous Peoples 2020; 16 90–8.
[14] Bessarab D, Ng’andu B. Yarning about yarning as a legitimate method in Indigenous research. Int J Critical Indigenous Stud 2010; 3 37–50.
| Yarning about yarning as a legitimate method in Indigenous research.Crossref | GoogleScholarGoogle Scholar |
[15] Charmaz K. Special Invited Paper: Continuities, Contradictions, and Critical Inquiry in Grounded Theory. Int J Qual Methods 2017; 16 1–8.
| Special Invited Paper: Continuities, Contradictions, and Critical Inquiry in Grounded Theory.Crossref | GoogleScholarGoogle Scholar |
[16] Smith RL, Devine S, Preston R. Recommended methodologies to determine Australian Indigenous community members’ perceptions of their health needs: a literature review. Aust J Prim Health 2020; 26 95–103.
| Recommended methodologies to determine Australian Indigenous community members’ perceptions of their health needs: a literature review.Crossref | GoogleScholarGoogle Scholar | 32061267PubMed |
[17] Altman J. What future for Indigenous Australia: Economic hybridity and the neoliberal turn. In: Altman J, Hingston M, editors. Culture crisis: anthropology and politics in Aboriginal Australia. Sydney: University of NSW Press; 2010.
[18] Boot G, Lowell A. Acknowledging and promoting Indigenous knowledges, paradigms, and practices within health literacy-related policy and practice documents across Australia, Canada, and New Zealand. Int Indig Policy J 2019; 10 2
| Acknowledging and promoting Indigenous knowledges, paradigms, and practices within health literacy-related policy and practice documents across Australia, Canada, and New Zealand.Crossref | GoogleScholarGoogle Scholar |
[19] South Australian Health and Medical Research Institute (SAHMRI). South Australian Aboriginal Chronic Disease Consortium (The Consortium). Adelaide: South Australian Health and Medical Research Institute; 2021. Available at: https://www.sahmriresearch.org/our-research/themes/aboriginal-health/research-list [verified 7 September 2021]
[20] Baum F. The New Public Health, 3 edn. New York: Oxford University Press; 2008.
[21] National Aboriginal Community Controlled Health Organisation (NACCHO). Aboriginal health in Aboriginal hands. Canberra: NACCHO; 2020. Available at: https://www.naccho.org.au/ [verified 7 September 2021]
