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The effects of Aboriginal culture and

philosophy on indigenous health

by Anna Verhulst



























A thesis submitted in partial fulfillment of the requirements for the

Honours Programme in International Health


Maastricht University, 2013
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Where are my first-born, said the brown land, sighing;
They came out of my womb long, long ago.
They were formed of my dust—why, why are they crying
And the light of their being barely aglow?

I strain my ears for the sound of their laughter.
Where are the laws and the legends I gave?
Tell me what happened, you whom I bore after.
Now only their spirits dwell in the caves.

You are silent, you cringe from replying.
A question is there, like a blow on the face.
The answer is there when I look at the dying,
At the death and neglect of my dark, proud race

~ Jack Davis, 1970
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TABLE OF CONTENTS


Introduction

4
Definitions of used terms

5
Methods

6
Chapter 1: A brief colonial history of Australia

7
Chapter 2: Aboriginal health

9
Chapter 3: The impact of Aboriginal spirituality and culture on health care outcomes

11
Chapter 4: Traditional Aboriginal health beliefs

14
Chapter 5: The way forward

18
Summary

20
References

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4

INTRODUCTION

The indigenous people of Australia, the Aborigines, have occupied the Australian continent for at least
60.000 years. The Aboriginal people of Australia now make up 2.5-3.0% of the total Australian
population. [1]

Current reports show a depressing picture of the health among the Australian Aborigines, especially
when compared to that of the total Australian population. Life expectancy at birth is barely 60 years
for Aboriginal men, compared to almost 77 for all Australian males. [1] Infant mortality rates are
thrice as high for Aborigines than for the total Australian population.

The leading causes of death are diseases of the circulatory system, external causes of morbidity and
mortality (predominantly accidents, intentional self-harm and assault), neoplasms (cancer), endocrine,
metabolic and nutritional disorders (mainly diabetes), and respiratory diseases. [1,2] Consequently,
social outcomes also show a substantial disadvantage for the indigenous Australians.
A well-documented [2-5] cause of the current health status of Aborigines is the historical influence of
white society on the Aboriginal wellbeing. Although Australia’s colonial history and its legacy should
not be ignored, it is more functional to focus on the contemporary issues that are contributing to the
disparities in health status between Western and indigenous Australians.

Consequently, a more interesting and potentially much more useful insight can be gained when
examining the current health care outcomes of the Aborigines from the point of view of their own
philosophical beliefs on health and illness. [6-9] To illustrate this with a brief example: examining the
so-called Aboriginal model of causation [7] yields interesting insights. Aboriginal people display
preference for concrete knowledge, recognizably related to the immediate context of their lives. The
abstract concepts that shape the Western health services may thus be incomprehensible to the
Aborigines. For example, when asked about an injury, an Aboriginal patient may reply that it occurred
while they were at a relative’s house, rather than that it having occurred at a specific time. The
resulting impaired communication may be one of the factors that contributes to a suboptimal health
delivery.

The aim of this honours thesis is to study traditional Aboriginal health beliefs and describe how they
relate to health care delivery to the indigenous population of Australia. Brief attention will also be
given to the process of colonization of Australia, the current health status of the Aborigines and the
Aboriginal culture in general. This thesis will be concluded by putting forward suggestions towards
improving Aboriginal health, focusing on the impact of Aboriginal philosophy on healthcare outcomes.
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DEFENITIONS OF USED TERMS

To avoid any confusion with regards to used terminology in this thesis, one has assume the following
meaning when coming across terms henceforth mentioned.

‘Aboriginal’ will refer to the indigenous people of Australia, existing of both Aboriginal people living
on the Australian continent or the island state of Tasmania, and Torres Strait Islanders (living on the
islands north of the state Queensland). The noun used to correctly describe the Aboriginal people is
‘Aborigines’ (as opposed to the commonly used term ‘Aboriginals’). The term ‘Western’ will be used
to describe the ancestry and background of European people who discovered and colonized the
Australian continent from 1606 onward, and their descendants.

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METHODS

This thesis was written as an analysis of relevant literature to the subject of indigenous health in
Australia. The literature search included major health and education databases as well as several
internet search engines. Points of attention regarding the selection of literature were relevancy to the
subject, date of publishing and reliability of the source. Publication was not a requirement to be
included in the analysis. Sources composed by authors of Aboriginal descent, or authors directly
drawing upon Aboriginal sources, were given preference over those composed by Western authors,
especially where the subject of Aboriginal cultural and philosophical beliefs was considered.

Limitations
Finding literature on the subject of Aboriginal health beliefs was rather arduous. Firstly, many articles
and books on this subject go back in time as far as 1975. Some books were not available (online)
without paying a substantial financial fee, and many articles on the subject were not converted into an
online document at all. As a consequence, it was often not possible to refer to the original sources, but
instead having to refer to secondary sources quoting the primary source. On the occasions where this
was the only possibility, as many veritable secondary sources as possible were searched for.




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CHAPTER 1: A brief colonial history of Australia

In order to fully comprehend the problems Australia is currently facing with regards to Aboriginal
health, one should be aware of the colonial history of the continent, and one has to appreciate which
historical actions set in motion the events leading to the problems Australia is facing today.

The first Europeans to visit the continent of Australia were the Dutch in 1606, who made record of a
land they then referred to as Terra Australis Incognita, or ‘unknown southern land’. Between 1606
and 1770 numerous European ships sailed the Australian waters. However, the only party that showed
real interest in the vast continent, were the British. It was in 1770 that the English lieutenant James
Cook landed on the east coast of Australia, at what is known today as Botony Bay. [12]
From 1770 onwards gradual colonization of mainly the east coast of Australia took place. This process
offered the British a solution to their overcrowded prisons, shipping convicts from England off to the
new continent to use as laborers. The colonies experienced many difficulties in their quest to erect
self-sustainable settlements on the new continent. Most of the problems were caused by the vast lack
of food and supplies, which the British found hard to gather in the for them unknown and hostile land.

These problems were probably one of the main reasons for the British to approach the Aboriginal
inhabitants of Australia, who had been occupying the continent for at least 60.000 years. As far as is
currently known, the Aborigines migrated from south-east Asia when the sea level was much lower
than at present, and the oceans that needed to be crossed were much smaller. Initially, relations
between the colonizers and the Aboriginal people were generally hospitable, and based on mutual
understanding of the terms of trading food, tools and supplies. These relations became hostile as
Aborigines realized that the presence of the explorers threatened the land and resources upon which
they and their order of life depended. The first records of acts of resistance against the British
colonizers by the Aborigines date from 1790. These revolts were generally violent in nature, with
most casualties occurring on the side of the Indigenous people. [12]

However, it was not until the mid-1830s that the colonizers dealt with the question of land-ownership
by Indigenous people. Initially, treaties were signed to purchase land from the Aborigines, but these
treaties were effectively over-ridden by the British governor Richard Bourke, issuing a proclamation
stating that the land belonged to no-one prior to the British crown taking possession. Despite many
other people, including the House of Commons, recognizing the rights of landownership of the
Aboriginal occupants, the principle expressed in Bourke’s proclamation was applied frequently. It was
not until 1992 that a decision made in the ‘Mabo Case’ by the Australian High Court altered the
foundation of land law in Australia. Following the High Court decision, the Commonwealth
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Parliament passed the Native Title Act in 1993, enabling Indigenous people throughout Australia to
claim traditional rights to unalienated land. [13] The importance of land and land-ownership to the
Aborigines will be discussed into more detail in chapter 3.

In addition to this initial dispossession of land, numerous other crimes against the country’s
Indigenous people were committed. One example, out of the many available, is the removal of
Aboriginal and Torres Strait Islander children (‘the Stolen Generation’) by Western Australians, which
commenced in 1883 and went on until 1969. [14] It wasn’t until 2008 that the Australian government
issued an official apology for this incident. [15] As a result of this, and numerous other events of
conflict between Aborigines and Western Australians, colonial history can still be a sensitive subject
to be discussed in Australia.

Although today Aboriginal rights are becoming more recognized, prior damage done has already
resulted in Aborigines today being disadvantaged in a number of ways. Urbanization, alcohol and
substance abuse and poor nutrition among Aborigines can all be ascribed to the process of
colonization, and certainly play a significant role in today’s unsatisfying health status of the
Aboriginal people of Australia. It has even been suggested that healthcare in Australia is institutional
racist caused by, for example, funding inequity, differences in treatment regimens and cultural
barriers to Aboriginal use of healthcare services. [3] The next chapter in this thesis will examine the
current health status of the Aborigines in more detail.

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CHAPTER 2: Aboriginal health
Analyses by the Australian Bureau of Statistics (ABS) and Australian Institute of Health and Welfare
(AIHW) show that in recent years there have been improvements in the areas of education, attainment,
labour force participation, unemployment, home ownership and income for Indigenous Australians. [1]
Yet, the health status of the Indigenous population is, and has always been, poor in comparison to that
of the Western Australian population. Relevant data to support this statement has been collected from
various sources [1, 10, 11] and the main findings have been summarized in table 1.

Table 1: Indigenous health indicators

A study researching the Indigenous health gap, assessed the amount of DALYs (Disability-Adjusted
Life-Years) and found that it exists of a total of 56455 DALYs, meaning that the total burden of
disease for the Indigenous population is more than twice as high as for the total Australian population.
The gap is apparent for almost all diseases, at all ages, in men and women and in remote and non-
remote areas. Non-communicable diseases explains 70% of the health gap and tobacco, obesity,
physical inactivity, high blood cholesterol and alcohol are the main contributing risk factors. [10]

Aboriginal population Total Australian population

Relative rate
(a)

Total burden of disease
(b)

(DALYs)
95 976 39 521 2.4


Life expectancy
I
(years)
Male
Female

59
65

77
82

0.8
0.8

Infant mortality
(d)

(deaths/1000 livebirths)
15.7 4.8 3.3


Self-assessed health:
fair or poor (%)
29 15 1.9


Self-reported psychological distress:
high or very high (%)

27 13 2.1

(a) Relative rate is defined as Indigenous status divided by the status of the total Australian population. (b) In 2003. Numbers adjusted for the
total number of people within the population. DALY: Disability-Adjusted Life-Years; a measure of overall disease burden, expressed as the
number of years lost due to ill-health, disability or early death. (c) Life expectancy at birth for the period 1996–2001. (d) Period 2003-2005
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The other displayed health indicators, being life expectancy, infant mortality, self-assessed health and
self-reported psychological distress also demonstrate that in terms of health status, the Aboriginal
population is expressly impaired in comparison to the total Australian population.

These great disparities in health experienced by the Indigenous people shows that there is a large
potential for health gain for this population. The gap in health status between Aboriginal and Western
Australians can be ascribed to many contributing factors, of which the process of colonization of the
Australian continent is the most commonly mentioned. Even though past events cannot be reversed,
the colonial history and its ‘legacy’ in terms of health disparities should not be ignored. However,
looking at contributing factors to problem that are still present in the current situation would yield
much more in terms of actual solutions. Some of the key factors are Aboriginal cultural and
philosophical values, and in particular their beliefs of health and illness. Hence, the next chapters will
focus on Aboriginal culture and philosophy, and how these factors affect Aboriginal health.


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CHAPTER 3: The impact of Aboriginal spirituality and culture on
health care outcomes
One should take into account that Aboriginal history and cultural values are not documented in the
same way as Western beliefs are. Aboriginal history was never written down, but passed on orally
from generation to generation. [16] Therefore, most information on Aboriginal culture and philosophy
is based on accounts of Aboriginal history that have been interpreted by Western people. It is
important to be aware that most literature describes Western interpretations of Aboriginal culture,
rather than straightforward facts.

In addition, there’s really no such thing as ‘the’ Aboriginal culture. The Aborigines are a very diverse
ethnicity, consisting of hundreds of different distinct groups living all across the Australian continent.
Not only are there many different Aboriginal languages and dialects, but their cultural and
philosophical beliefs are also dependent on their natural surroundings and present landmarks.

Keeping the prior in mind, general highlighted aspects of Aboriginal culture can give valuable insights
in their cultural, spiritual and philosophical beliefs. Additionally, they provide at least partly insights
in the genesis of some of the health problems Aborigines are currently experiencing.

3.1 Spirituality: Dreamtime, perception of land and Aboriginal law

Indigenous spirituality derives from the philosophy that all elements, animate and inanimate, in the
world are connected, which is often referred to as the holistic notion of life. [17] The idea of creation
forms the basis of this philosophy, described as the time (the ‘Dreamtime’) when powerful creator
spirits (the ancestors) produced the origins of the modern world. To the Aboriginal people, the
creation stories provide the chart to all life as it exists today.

‘’Imagine a pattern. This pattern is stable, but not fixed. Think of it in as many
dimensions as you like – but it has more than three. This pattern has many threads of
many colors, and every thread is connected to, and has a relationship with, all of the
others. The individual threads are every shape of life (…). The pattern made by the
whole is in each thread, and all the threads together make the whole. Stand close to the
pattern and you can focus on a single thread; stand a little further back and you can see
how that thread connects to others; stand further back still and you can see it all – and
it is only once you see it all that you can recognize the pattern of the whole in every
individual thread. The whole is more than its parts, and the whole is in all its parts.
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This is the pattern that the ancestors made. It is life, creation spirit, and it exists in
country.‘’ [18]

Even though these creation stories may differ for each area in terms of accents and essence, they all
contain the same core elements: the creator spirits are responsible for all the features of the land and
the entire natural word and continue to live in forms that are visible only to ‘those with the ability to
see’. [17] Aboriginal spirituality does not include a concept of after-life. Life itself is sacred, and
mortality simply derives from the process of living life to its fullest.

While the Western perception of landownership is that of procession, economic importance and gain
of capital, the Aborigines regard it as a responsibility towards their ancestors to maintain good
connections with the land. The spiritual connection they have to both specific sacred places and the
land in general, was initiated at the time of creation, and must be maintained in order to preserve the
order of life. The forced dispossession of Aboriginal land during the process of colonization has been
mentioned as a factor contributing to stress-related disorders among the indigenous population. [6]

Maintenance of the relationships between the Aboriginal community and the creator spirits is of the
utmost importance, and is accomplished by performing rituals and by living up to the Aboriginal law.
The principal value under Aboriginal law is the sovereignty of individual persons and groups. This
means that it is not accepted to intervene in someone else’s business, unless a significant connection
exists, for example through marriage. The law serves to avoid conflicts and to maintain peace. Any
disputes that arise are settled by negotiation about the extent of satisfactory retaliation for the affected
party.

3.2 Culture: concept of identity, gender issues and shame

In Aboriginal culture, personal identity is derived from kinship, ritual, and spiritual relationships and
responsibilities. This results in a concept of identity that isn’t as much understood as the identity of
one individual, but is always extended to the identity of the group. Still, this does not mean each
individual person does not have an unique status, because no two people have identical consanguinity,
spiritual connections to ancestors or ritual responsibilities. [6]

Aborigines experience ‘shame’ when they lose the protection and anonymity normally provided by the
group. This can happen in situations where the person is forced to act in a way that is not in line with
social or spiritual obligations, in cases of individual recognition (for either praise or blame) or at
occasions where one does not know the rules for doing the right thing. [6, 7] In those cases, shame is
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experienced as a very powerful emotion, and when evoked in a medical setting, it can greatly impair
the co-operation of the Aboriginal patient.

The role of men and women in Aboriginal society is very different. Each have their own business: men
are engaged in activities such as hunting, managing conflicts and maintenance of responsibilities
towards the land, while women are concerned with the processes of menstruation, pregnancy,
childbirth and contraception. Both genders have their own private ceremonies, and food taboos
(especially during certain times in women’s cycle) are common. [6] Aboriginal law prohibits men
from interfering with women’s business, and vice versa. In this context, Aboriginal law also applies to
Western Australians, in the sense that a male Western doctor should not ask a female Aboriginal
patient about issues regarded by the Aboriginal community as ‘women’s business’ (ditto for a female
Western doctor asking a male Aboriginal patient about ‘men’s business’). Doing so is likely to give
rise to the earlier described emotion of shame in the Aboriginal patient. Surveys show that ‘feeling
uncomfortable’, ‘not being able to see a doctor of the same sex’ and ‘difficulties communicating with
medical staff’ were among the main key problems in accessing health services in Aboriginal
communities. [27]

3.3 Communication: the importance of contextual, concrete knowledge

In Aboriginal communication, there is a definite preference for contextual and concrete knowledge. [6]
This means that events are associated with concrete circumstances in their surroundings, which is in
contrast to the Western abstract way of defining time. For example, when asked about the timing of an
event, an Aboriginal would answer: ‘when the sun rose’ (rather than: ‘at six o’clock’) or ‘when I was
at my aunt’s house’ (rather than: ‘five days ago’). These differences in features of Aboriginal and
Western communication can be a contributing factor to impaired communication between (Western)
health staff and the (Aboriginal) patient, especially when asking after the onset and subsequent course
of symptoms. ‘Difficulties communicating with medical staff’ was found to be one of main reasons for
the Aboriginal patient to not seek medical treatment. [27]


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CHAPTER 4: Traditional Aboriginal health beliefs

While the previous chapter focused on general aspects of Aboriginal culture and their indirect effect
on healthcare outcomes, this chapter will focus directly on Aboriginal health beliefs. Before the
Australian continent was colonized by the British, the Aborigines had lived for centuries depending on
their own system of medicine. Just like their spiritual philosophy, their approach to health care is a
holistic one, where social, physical en spiritual aspects of health and life are recognized. [19, 22, 23]
Even though Aboriginal attitude towards treatment has changed during the process of colonization,
their thoughts on the cause of illnesses have not changed much. [7, 19, 20] These traditional beliefs are
deeply rooted in the Aboriginal way of thinking and function as means of coping. When confronted
with the Western thoughts on health and illness, it can be expected be a barrier to improving health
outcomes. [21]

4.1 The Aboriginal model of causation

The importance of adhering to Aboriginal law, has been touched upon in Chapter 3. Other than the
arousal of shame when breaking the law, Aborigines also believe that not adhering to the law can
induce supernatural intervention, ultimately causing serious illness. [7] In this way, illness functions as
a mechanism of social control to prevent community members from breaking the law, or neglecting
their obligations to the group and their ancestors.

While death and illness is accepted as the natural course of life in infants and in the elderly, injuries
and disease in previously healthy adults can from an Aboriginal point of view only be explained by
mythical force. In addition to breaking taboos, disturbing sacred sites by unskilled or uninitiated
persons may evoke sorcery from the spirits bound to that site. Finally, sorcery as retaliation or
punishment in cases of conflict is applied by sorcerers (who often also fulfill the role of traditional
healers), and is seen as the cause of illness when several family members get sick sequentially. [7] In
this sense the role of the traditional healer is that of the Western physician, therapist, priest, coroner
and judge combined. [23]

In the Aboriginal philosophy this model provides the answer to the ultimate cause of the event [7], and
explanation as to why one person is affected by illness and another is not. It gives an explanation for
the ultimate cause (breach of Aboriginal law), the effective causes (spirits or sorcerers) and the final
outcome (sickness, injury or death). [24, 25] While Western medical medicine draws upon rather
abstract theories regarding sickness and health, the Aboriginal model is more concrete and contextual,
the importance of which has been highlighted in Chapter 3.3. Western health staff have been reported
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to experience problems with Aboriginal patients not taking responsibility for sickness, disease or
substance abuse [7, 23], because of confusion about the cause of their condition. At the same time,
Aboriginal families have been reported to feel that Western medical staff are not forthcoming about
the true cause of death of their family member [23], and turn to their traditional model of causation for
an explanation. Additionally, they sometimes delay visiting a medical clinic when suffering from
illnesses, because they believe they suffer from sorcery [26], and not something Western medicine can
cure.

‘’The Aboriginal discourse of blame and the Western discourse of responsibility both
seek to ascribe meaning to a death, but the social function of assigning responsibility
may be different. Western people are familiar with the concept of learning from a
death to prevent another in future; this presupposes a cultural priority of avoiding
death. Whilst this priority may be shared by many Aboriginal people, the assigning of
responsibility may also be shaped by the need to avoid social conflict and preserve
traditional laws.’’ [23]

Differences in causal attribution can thus be considered as a factor contributing to impaired
communication between the indigenous population and Western health staff, and consequently as a
negative influence to health outcomes among Aborigines.

4.2 Categorization of illness and injuries

Supernatural intervention has already been mentioned in the previous paragraph as the main cause of
illness as perceived by Aborigines. However, there are some other distinct categories that are used to
explain changes in health. [7]

The first one is the category of natural causes, that are part of everyday life and generally cause a state
of weakness (loss of appetite, pain, headache) that is limited in duration. Causes in this category are
negative emotions (such as envy, shame or anger), dietary factors and physical assault and injury.
Affected persons are not referred to as much as ‘ill’ or ‘sick’, but rather as ‘weak’ – which endorses
the notion that it is a temporary situation.

The second category is that of environmental causes, such as excessive heat and cold. For example, in
some Aboriginal populations, the position of the moon is said to evoke epilepsy or fitting in children.

Finally, the third category is the Western influence, which covers all conditions that are only known to
the Indigenous population since the process of colonization. Among the illnesses attributed to Western
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influence are alcohol and substance abuse, diabetes, cancer and many infectious diseases such as
measles en smallpox. Many of these diseases may indeed be caused by Western influence, but others
(such as cancer) may just not have been recognized as such by the indigenous population previous to
colonization.

Preventing disease in Aboriginal communities is directly linked to the Aboriginal model of causation
and etiology of disease. Preventive efforts to guarantee a healthy state of mind and body are associated
with socially accepted behavior and with steering clear of places, persons en objects that are regarded
as perilous. [7] Again, this ensures that rules and laws within the Aboriginal community are adhered to.

The difference in disease etiology between Western medicine and Aboriginal health beliefs may
contribute to impaired communication. In addition, an Aboriginal patient may not consider himself ill,
but may attribute his symptoms as a natural consequence to changes in his environment. He might also
regard his illness as something a Western doctor, not being part of the Aboriginal community and not
being in contact with the ancestor spirits, cannot comprehend and thus cannot cure, which will stop the
Aboriginal patient from seeking Western medical assistance in the first place. Finally, when there is
disagreement between doctor and patient about the cause of the disease, it may be hard to come to an
agreement with regards to treatment or preventive options.

4.3 Aboriginal medical treatment: bush medicine and traditional healers

As can be expected of people who took care of their own health for thousands of years without
Western intervention, Aborigines know their own traditional medicine. In Western terms, this is often
referred to as ‘bush medicine’: the use of substances directly from available natural surroundings (the
most frequently used sources are plants and animals) as a medical application. Many of these
applications are used for particular symptoms, without considering the underlying cause. Although the
use of bush medicine is decreasing, this seems to be mainly because Western medicine is easier
accessible, rather than an absence of trust in its competence. [7, 26]

While basic knowledge about bush medicine is present in all Aboriginal adults, traditional healers are
highly respected because of their specific ability to heal not only physical, but also spiritual illness. [7,
26]. Traditional healers, mostly the elderly, hold an unique position in the Aboriginal community and
if illness is thought to be of spiritual origin, an Aboriginal will only expect to be able to be cured by a
traditional healer. Their shared philosophy and language with their patients and the anticipation of
relief from the patient, results in a close connection between healer and patient. [7] Add to this the
element of being treated in a well-known and safe environment, and it is understandable why an
Aboriginal patient may prefer a traditional healer to a Western doctor.
17

As has been pointed out in Chapter 4.1 and 4.2, confusion or disagreement (between doctor and
patient) about the cause of the disease, may be a reason for Aboriginal patients to refrain from seeking
Western medical treatment. [26]

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CHAPTER 5: The way forward

The previous chapters have led to the identification of some aspects of Aboriginal philosophy and
health beliefs that have an impact on the health care delivered to them by Western health staff. This
final chapter will conclude by proposing policies that could be implemented in order to enhance health
care delivery to Aboriginal Australians, and ultimately improve Aboriginal health.
As has been described in chapter 1, the colonial history and the wrongs done to the Aboriginal
community may be a barrier to general communication and collaboration between the two
communities. However, even though this may impair the start of shared projects, in the end a
successful cooperation will inevitably lead to an improved intercultural relationship in general.

5.1 Education of Western health staff

As the previous chapters show, many of the identified problems in Aboriginal healthcare derive from
cultural disparities. Key points such as gender issues, induction of shame and the importance of
contextual means of communication could be addressed by educating Western health staff accordingly.
Both in-service training for practicing health staff and integration of Aboriginal culture in the medical
curriculum in Australia could potentially be of great benefit to the Aboriginal community.

The content and design of these trainings should preferably be established by a combined effort of
Western and Aboriginal experts in this field, to ensure both quality content and co-operation of both
cultures.

5.2 Promoting enrolment in (bio)medical and nursing studies of Aboriginal students

Doctors that are closer to patients in terms of shared culture and philosophy are more likely to develop
a good working relationship with their patient (as becomes clear when examining the status of
traditional healers) and is essential in providing adequate treatment. This is why, in addition to
improving education among Aborigines in general, there should be a promotion of enrolment in
(bio)medical and nursing studies by students of Aboriginal descent.

A way to achieve this, would be by means of providing financial support and scholarships to
Aboriginal students. Both subsidies paid directly to the student as well as the financial rewarding of
universities for enrolling Aboriginal students, could prove to contribute to a higher number of
(bio)medical and nursing staff of Aboriginal descent.

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5.3 Establishing partnerships between the Western and the Aboriginal community

In order to create a firm foundation for future projects, to ensure collaboration of all parties and to
improve communication between the different cultures, more (medical) partnerships between the
Western and the Aboriginal community should be established.

One way to accomplish this would be by organizing an Aboriginal community worker system. In this
system, trained community workers of Aboriginal descent would function as the direct link between
the ill Aboriginal and the Western medical system. They would identify common health problems and
common risk factors (especially those mentioned in chapter 2) among Aborigines early and refer them
for medical treatment, and provide preventive care (targeted at vulnerable individuals such as pregnant
women). Because they would primarily be part of the Aboriginal community (their job as community
worker being part-time only), Aboriginal individuals would be more inclined to trust their judgment
than that of Western health workers.

Another way to achieve closer cooperation, would be by integrating Aboriginal traditional healers in
the Western medical system. They could, for example, be present during medical sessions of
Aboriginal patients with Western doctors, or could have their own consultation hours in the Western
hospital and be included in peer-discussions. This would indeed require some forbearance of both
parties in terms of disagreements on previously mentioned models of health and illness, but if
members of both cultures would strive to make the partnership work, the potential benefits would be
numerous.

Firstly, it would greatly increase the trust of the Aboriginal patient in the medical system, both directly
(because their ‘own’ doctor is included in the process of decision-making) and indirectly (because
cooperation of the traditional healer with Western doctors implies their trust in and acceptance of the
Western medical system), which subsequently would improve adherence of the patient to subscribed
therapy. Secondly, it would improve communication between patient and doctor (the traditional healer
would double-function as a skilled interpreter), which would improve accurate diagnosis and reduce
frustration in both doctor and patient. Finally, it would improve willingness of young Aboriginals to
become involved in the medical system because of the example set by their (often highly respected)
elderly, which would create a positive feedback loop for the proposal lined out in chapter 5.2.

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SUMMARY

The total burden of disease for the Indigenous population is more than twice as high as for the total
Australian population, of which non-communicable diseases explain 70% of the health gap and
tobacco, obesity, physical inactivity, high blood cholesterol and alcohol are the main contributing risk
factors. Even though the roots of the Aboriginal health problem can be found in the colonial legacy of
the continent, some of the key factors at least partly contributing to the problem are Aboriginal
cultural and philosophical values, and in particular their beliefs on health and illness.

Aspects of Aboriginal culture that can be seen as contributing factors to the health, are their spiritual
connection to the land and the forced dispossession of this land during colonization, gender issues and
the concept of shame. With regards to traditional Aboriginal health beliefs, the Aboriginal model of
causation, categorization of illness and injuries, and trust in traditional healing are factors that should
be taken into account.

Consequently, solutions for the Aboriginal health problem should be aimed at improving intercultural
communication. This could be done by education Western health staff on Aboriginal culture and
philosophy, by increasing the amount of students of Aboriginal descent enrolled in (bio)medical and
nursing studies and by creating medical partnerships between the Western and the Aboriginal
community.





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REFERENCES


1. Australian Bureau of Statistics and Australian Institute of Health and Welfare (2008). The
health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. ABS
Catalogue No. 4704.0 AIHW Catalogue No. IHW 21

2. Anderson I, et al. Indigenous health in Australia, New Zealand, and the Pacific. The Lancet
367 (2006), 1775–1785

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