Cultural determinants of health for Aboriginal and Torres Strait Islander people - a narrative overview of reviews.

INTRODUCTION: The cultural determinants of health centre an Indigenous definition of health, and have been linked to positive health and wellbeing outcomes. There is growing evidence for the importance of the cultural determinants of health; however, to date, no high-level overview of the evidence-base has been provided. Synthesising existing literature on cultural determinants of health for Aboriginal peoples in a single manuscript will highlight what we know, and what needs to be explored in future research. It will also contribute to global efforts to capture the evidence of cultural determinant approaches amongst Indigenous populations. We therefore endeavoured to identify cultural determinants and highlight their impact on Aboriginal health and wellbeing outcomes, and outline the relationship and interconnection of different cultural determinants of health. METHODS: An overview of reviews was conducted. Medline (Ovid) and Scopus were searched using terms related to 'cultural determinants of health' and an 'Aboriginal definition of health'. The database search was complemented by a web-based search of grey literature. Nine reviews were retrieved and included in our overview. RESULTS: Family/community, Country and place, cultural identity and self-determination were strongly identified across reviews as having a positive impact on the health and wellbeing outcomes of Aboriginal peoples. Family/community and Country and place were found to be components of 'culture' that shaped cultural identity. Self-determination was outlined as a requirement for Aboriginal peoples to pursue their cultural, social, and economic rights. DISCUSSION/CONCLUSIONS: Cultural determinants are associated with health benefits for Indigenous peoples. A causal framework, developed to discuss the relationship and interconnection of the cultural determinants of health, demonstrates that cultural identity at an individual-level is important to benefiting from other cultural determinants of health. While self-determination and connection to culture and community-controlled organisations are integral factors to increase Aboriginal resilience and resistance and improve health and wellbeing outcomes. Further research is required to shift towards a multi-level understanding of the cultural determinants of health and to develop an Indigenous-led evidence-base around causal pathways. Such a shift would ensure priorities important to Indigenous peoples are captured in policy and practice.

'Healing through culture': Aboriginal young people's experiences of social and emotional wellbeing impacts of cultural strengthening programs.

BACKGROUND: Cultural connection for Aboriginal young people promotes wellbeing, resilience and healing. There is little research on the social and emotional wellbeing (SEWB) impacts of cultural strengthening programs for Aboriginal young people, especially research that includes the perspectives of young people. There is even less research that includes the experiences of Aboriginal young people who have been in out-of-home care. OBJECTIVE: The current study sought to address these research gaps by exploring the SEWB impacts of cultural strengthening programs by amplifying the voice of Aboriginal young people, including those who have been in out-of-home care. PARTICIPANTS AND SETTING: Aboriginal young people involved in an innovative cultural strengthening program, the Narrun Yana art collective, established by the Victorian Aboriginal Child Care Agency (VACCA). Also participating was VACCA's Team Leader of Children and Youth Programs, thus providing both experiences of participating in and of organising cultural programs. METHOD: A qualitative phenomenological approach was taken. Data consisted of semi-structured interviews with the team leader and two young people and written responses to the interview questions from one young person. RESULTS: Lived experience provided evidence that cultural strengthening programs; help strengthen SEWB, including connection to self, relationships, community and culture; contribute to building resilience in the context of intergenerational trauma, cultural loss and racism; and encourage help-seeking, both informal support and accessing mental health services. Young people also viewed participating in the research as worthwhile. CONCLUSIONS: Findings highlighted the importance of Aboriginal young people having opportunities to; connect to culture through participation in cultural strengthening programs, and engage in the design of these programs.

Questioning the ethics of evidence-based practice for Indigenous health and social settings in Australia.

Australian government planning promotes evidence-based action as the overarching goal to achieving health equality for Aboriginal and Torres Strait Islander populations. However, an inequitable distribution of power and resources in the conduct of evidence-based practice produces a policy environment counterintuitive to this goal. This context of contemporary evidence-based practice gives legitimacy to 'expert practitioners' located in Australian governments and universities to use Western guidelines and tools, embedded in Western methodology, to make 'evidence' informed policy and programming decisions about Aboriginal and Torres Strait Islander populations. This method for decision making assumes a positional superiority that can marginalise the important perspectives, experiences and knowledge of Aboriginal Community Controlled Organisations and their processes for decision making. Here we consider the four steps of an evidence review: (1) developing a review question; (2) acquiring studies; (3) appraising the evidence and (4) assessing the evidence, as components of wider evidence-based practice. We discuss some of the limitations across each step that arise from the broader context within which the evidence review is produced. We propose that an ethical and just approach to evidence-based review can be achieved through a well-resourced Aboriginal community controlled sector, where Aboriginal organisations generate their own evidence and evidence is reviewed using methods and tools that privilege Aboriginal and Torres Strait Islander ways of knowing, doing and being.

Indigenous ontology, international law and the application of the Convention to the over-representation of Indigenous children in out of home care in Canada and Australia.

This paper explores the efficacy of the United Nations Convention on the Rights of the Child (Convention, UN General Assembly, 1989) through the lens of the over-representation of First Nations children placed in out-of-home care in Canada and Aboriginal and Torres Strait Islander children in Australia. A general overview of Indigenous worldviews frames a discussion on the coherence of international human rights law and instruments, including the Convention, account for Indigenous Peoples' ontologies. The authors argue that the United Nations Declaration on the Rights of Indigenous Peoples (UN General Assembly, 2007) and a new theoretical framework published by the Pan American Health Organization (2019) on health equity and inequity are useful tools to augment the Convention's coherence with Indigenous ontologies. The paper discusses how the Convention can be applied to structural and systemic risks driving the over-representation of First Nations and Aboriginal and Torres Strait Islander children in out of home care in Canada and Australia. These two countries are included as First Nations and Aboriginal and Torres Strait Islander peoples in these countries have both had significant impact in advocating for their children despite experiencing similar barriers including contemporary colonialism. The advocacy work of the First Nations Child and Family Caring Society in Canada and the Victorian Aboriginal Child Care Agency in Victoria, Australia are discussed. The paper ends by outlining some of the challenges ahead that include the need to meaningfully recognize Indigenous self-determination and equitable funding and resources to enable the actualization of self-determination. Further research contrasting international human rights instruments with Indigenous ontologies could help inform possible amendments to international human rights treaties and general comments.