Building evidence about effective health promotion in Aboriginal and Torres Strait Islander communities

The genesis of this issue of the Australian Journal of Primary Health occurred in October 2013, at the inaugural Onemda VicHealth Koori Health Unit’s writers retreat at the Mount Eliza Business School (Victoria, Australia). At this gathering, Aboriginal and Torres Strait Islander academics from universities across Australia met with non-Indigenous researchers, editors and writers, all invested in the process of writing together. Over the course of the retreat, community people had a chance to reflect and write up their work, and students and academics had opportunities to build capacity together by participating in workshops, joint exercises and walks along the beach. Over dinner, we discussed the multiple ways in which we promoted health and well-being and what is possible through the active engagement of culturally sensitive researchers with people invested in community, innovations, capacity building and shared experience. What we quickly identified was that there is no simple term to express what we mean by ‘health promotion’. We know health is a universal human aspiration and a basic human right. We know there are people across Australia, including members of our Aboriginal and Torres Strait Islander communities, who may never achieve good health. We also know that there are many of us working to address the inequitable distribution of social determinants. Health promotion, we determined, is a complex interactive function of the ideas one has absorbed from others; others, in turn, whose ‘own’ ideas are a complex interactive function of the ideas they have absorbed, and so on. For some of us, such complexity is hard to tie down on a page through the act of writing. However, through the creative process of writing together, we identified some papers that we thought were worthy of publication so others could learn about the successes being discussed at this gathering. We are grateful to Ms Kate Silburn from La Trobe University (Melbourne, Vic., Australia) for putting us in touch with the editorial team at the Australian Journal of Primary Health. We also want to acknowledge the farsightedness of this team in dedicating a journal issue to health promotion with and by Aboriginal and Torres Strait Islander people.

In the pages of this special issue you will see health promotion represented as a synthesis of people with their families and communities, people with the natural world, people transforming their service delivery systems, building capacity within their organisations and changing the way mainstream communities interact with Aboriginal and Torres Strait Islander people. Others have developed key educational, practice-orientated and clinical tools and resources to engage people with their own and their community’s health and well-being. Other papers articulate the capacity of developments in Aboriginal and Torres Strait Islander people’s health promotion work to inform and strengthen health promotion efforts targeted at other population groups. All work represented in this special issue of the Journal has been undertaken by people who are committed to the work of health promotion, to its social purpose and to concepts of social justice and equity for all. Importantly, many papers start from a strengths-based position. A clear message from authors contributing to this special issue is that for too long Aboriginal and Torres Strait Islander people have been described as having problems that are too big and complex to be solved within communities themselves. Aboriginal and Torres Strait Islander people are starting to write back against these descriptions, changing the collective story of Aboriginal and Torres Strait Islander communities from one of deficit to one of strength and resilience.

This ‘writing back against the deficit position’ is in itself a health promoting exercise, a call to which culturally sensitive researchers are starting to respond. If there is one behavioural change that we would want as a result of this compilation it would be that researchers do not in the first sentence focus on our disadvantage; rather, we want them to focus on what is possible through a process of self-determination and of co-creating health and well-being. We took the responsibility of co-creating health and well-being seriously. First, participants at the writers retreat in Mount Eliza developed a call for papers and sent the invitation to participate through our networks. The editorial team, made up of Indigenous and non-Indigenous academics, maintained a strong commitment to ‘two ways together’. Second, we invested in a peer-review process that saw each paper reviewed by at least one Aboriginal and/or Torres Strait Islander reviewer and at least one non-Indigenous reviewer. This meant the review process supported the authors of the articles with both academic and cultural rigour. Finally, we are delighted that there are first-time authors in this issue of the Journal. Although health promotion work is innovative and inspiring, many Aboriginal and Torres Strait Islander people are employed in chronically under-resourced contexts, are time poor and are not actively encouraged and supported to showcase their work in academic journals. We are proud that there are a high proportion of practice and innovation papers in this special issue of the Journal. We remained true to the principles in Indigenous scholarship to support first-time authors write their articles as the primary authors. This has been a defining moment for some of the Aboriginal and Torres Strait Islander academics included in this issue. It means so much more to be a first author on your own merit than be acknowledged as a person whose work in communities generated academic accolades for others. There is a great sense of achievement when academics take the time to engage community-based Aboriginal and Torres Strait Islander researchers in the process of writing. We hope this provides encouragement for others to do the same, to truly partner Aboriginal and Torres Strait Islander people in academia, for there is much to celebrate, even in this time of despair.

Many of us consider the past 10 years to be the most disruptive in contemporary Indigenous affairs. The recent transformations triggered by the change of government at a national level and the resultant changes in policy, funding, educational and social service supports are seemingly without precedence during previous decades. Although it is easy to be discouraged, the papers in this special issue of the Journal speak to hope and of innovation, empowerment and an excitement for the future. Equally exciting are the large number of papers that have a Victorian focus, or are written by and for an urban audience. We are reminded of the ‘Urban is the New Black’ campaign started by Deadly Choices, itself a ‘writing back’ against the invisibility of Aboriginal and Torres Strait Islander people living in urban communities. We hope these articles give a strong voice to Aboriginal and Torres Strait Islander people living and working in urban contexts, whose authenticity is often called into question in public discourse.

The health promotion projects described in this issue look at tackling poor health through a range of strategies and interventions delivered not only through the primary health care sector, but also by addressing employment discrimination, through sporting clubs and events, in communities and at National Aboriginal and Islander Day Observance Committee (NAIDOC) events. As you will see, community is the context, the method, the focus, the intervention and, ultimately, the solution. Key themes explored in the breadth of these papers include social connectedness, enhancing the effectiveness of workplaces, enhancing the capacity for mainstream to effectively engage with ‘the other’, reducing racism and enhancing organisational systems. In addition, the complexity of the work has meant that all manner of people have crossed their disciplinary bounds, sometimes many times over. The multidisciplinarity of this issue of the Journal also makes it distinctive.

We hope you enjoy reading this special issue as much as we enjoyed putting it together. We are all the richer for co-creating this with authors and across the membership of our respective communities. We also hope that you reflect on the processes used in the development of these papers and consider adopting them into your practice, and your life. Start from strength, work with complexity, cultivate an appreciation for the contributions of a group and co-create a future together of which we can all be proud.