While Indigenous and non-Indigenous Australians live in the same country geographically, we exist in different territories in terms of contextual social environments.  In 2008 the Council of Australian Governments pledged to close the health equality gap for Aboriginal and Torres Strait Islander peoples. The World Health Organisation (WHO) reported the health gap between Indigenous peoples and their counterparts to be the largest in the world (Markwick et al., 2014). While their aims were clear and thought-out, 14 years later we still see an increased gap in health. With $25.4 billion spent (Gardiner-Garden, 2012) on “closing the gap” in the last financial year, it appears money alone is not enough to solve the health care inequality with chronic diseases observed substantially more in Indigenous populations (Nash & Arora, 2021).

This approach is inadequately addressing important structural, cultural and political contributions to health (Verbunt et al., 2021). As reported in the Australian Institute of Health and Welfare (AIHW) report (2020), type 1 (11 and 12 cases per 100, 000) and gestational diabetes mellitus incidences (16 and 17 cases per 100,00) were similar to non-Indigenous counterparts (unlike type 2 diabetes). It’s more than genetics or predisposition. This is where consideration of the social determinants of health (SDoH) are crucial to defining Indigenous health differences.

When colonisation of Australia occurred, there was a deep disruption to Indigenous cultures as land was claimed from traditional owners, and with many forced to live in missions. The disruption caused separation from groups, tribal and family bonds and traditions, with many taken from known environments where the spirituality of their culture was based. Moving inland mob to coastal missions (Palm Island) and moving coastal mob to inland missions (Cherbourg) led to disrupted collection, storage, preparation, cooking and sharing of food. This was the first step to dislocating the most immediate relationship between person and food. It also broke their connection with their known environment. Social determinant factors are the association between individuals’ social positioning, income, education, occupational rank and their health (Braveman & Gottlieb, 2014).

History tells us that since white settlement and the removal of Indigenous peoples from their lands, there has been an increase in health disadvantage that can only be rectified using a social determinants of health approach building on autonomy and social participation.

Indigenous Australians view health holistically, and the SDoH extend beyond that of traditional biomedical definitions. These determinants concentrate on the physical, social, emotional, spiritual and ecological wellbeing for individuals and communities (Nash & Arora, 2021; Verbunt et al., 2021). These are operationalised through macro government structures like policy and societal values (Pearson et al., 2020). Indigenous Australians are among the most socially disadvantaged in the country, having objectively poorer SDoH.

However, Indigenous Australians also have added cultural determinants that weigh heavily like spirituality, family and connection to their land (Frier et al., 2021; Nash & Arora, 2021; Pearson et al., 2020). Those Indigenous peoples who still follow cultural practices including hunting, enjoy bush tucker and community events such as dance, lowered their risk of diabetes, indicating the real power of cultural practices for health and wellbeing.

To assist with returning a sense of control to those living with diabetes, Indigenous-run clinics with Aboriginal and Torres Strait Islander Health Workers and Practitioners must play a vital role in any model. Simply encouraging more exercise or a better diet unfortunately has a limited impact in the face of poverty and systemic disadvantage, employment, education and housing conditions. Barriers occur in many contexts, including patient-physician interactions and delivery of health services within a biomedical model. Our health education often pushes “personal responsibility” narratives which perpetuates prejudice and racist beliefs, reinforcing already low self-esteem (Markwick et al., 2014).

An Indigenous led long-term approach, co-designed with local communities to deliver whole-life holistic programs is fundamental to improving the health and well-being of Aboriginal and Torres Strait Islander peoples; from childhood, education, employment and social participation. This is integral to Closing the Gap on diabetes. 

By Trent Lyon

Exercise Physiologist

First Nations Health Unit