Sunday, February 14, 2010

Health Promotion in New South Wales, Australia

written by
Susanne Olsen & Paula Williams

(double click to enlarge all images on this site)

What is Health Promotion?

Health promotion is the process of enabling people to improve their health, by increasing their control over their health and the determinants of good health. It is essentially the effort to prevent disease and injury from occurring in the first place, as opposed to traditional health services, which treat disease and injury once it has occurred.

Unlike the traditional clinical care provided by health services, health promotion focuses on populations (or communities), as opposed to individuals. Often, health promotion requires the health system to work with non-health sectors, such as schools, child care, workplaces, local government, as they have a powerful influence over health.

Emphasis on providing the right information to the patient can reduce the chances of developing chronic illnesses such as heart disease, cancer and Type II diabetes. By making just a few small but important lifestyle changes, people can ensure better health and wellbeing for the future - and more time to enjoy the important things such as spending time with friends and family.

In Australia focusing on the state of NSW, the state government has written the State Plan which defines some of the key priorities for health promotion, this being improved health through reduced obesity, smoking, illicit drug use and risk drinking.

The following targets have been set for these priorities:
• Continue to reduce smoking rates by 1% per annum to 2010, then by 0.5% per annum to 2016.
• Reduce total risk (binge) drinking to below 25% by 2012
• Hold the proportion of people using illicit drugs to below 155
• Stop the growth in childhood obesity by holding childhood obesity at the 2004 level of 25% by 2010. Then reduce levels to 22% by 2016.

Health Promotion Aims:

Health promotion priorities are also described in the State Health Plan and Healthy People NSW. The State Health Plan is the NSW Government’s long term plan to deliver the best possible health care services to the people of NSW towards 2010 and beyond. It sets strong targets for better health service delivery across the public sector in NSW. The priorities in the State Plan are a result of extensive consultation with the community, business and stakeholder groups. More than 3,500 groups and individuals provided their views and local knowledge in the development of this Plan. Each local region in NSW, known as the Area Health Service, responds to the local priorities that were raised during the community consultations.

Organizational Partnerships in Health Promotion:

The types of organisations involved are the NSW Health Department and the Centre for Health Advancement within the Population Health Division. These organisations, address the main at risk groups and leads the health promotion activities to address smoking, overweight and obesity, and falls prevention in the elderly. From time to time the Centre also works on emerging issues, such as diabetes prevention, sun protection and child injury. For example:

Healthy People NSW:

Improving the health of the population sets the platform for population health action in NSW over the next 5 years and beyond. The plan builds on existing population health efforts in NSW, including Healthy People 2005, and identifies key issues that must be tackled to meet the challenges arising from the changing profile of our community, increasing prevalence of chronic conditions and the persistent threat of existing, novel and re-emergent infectious diseases.

Live Life Well is another awareness program to communities. Australians are living longer than ever before. To ensure people get the most out of life, it is important they look after themselves to remain healthy and happy for as long as possible. The overarching theme of the program is, to Live Life Well and to take positive steps to maximise your chances of living an illness free life.

A promotional website offers the public basic information and tools that will enable them to start making healthier changes to Live Life Well including quit smoking, eating better, being active, limiting your alcohol, maintaining a healthy weight, and managing stress.

Enhanced Primary Care Program: Health systems around the world have traditionally treated sick people, and now greater emphasis is placed on prevention. In 2004 the Federal Government introduced an incentive scheme for General Practitioners to refer their patients with chronic health disease to Allied Health Professions to provide a total care plan for their patient, called the Enhanced Primary Care Program . 11 Allied Health professions can be involved as part of the care plan. Some patients require up 2-3 professional consults dependent upon their underlying health issues, such as diabetes. For this patient a consult with the Diabetes Educator is important, as well as to the Dietician, Podiatrist and Eye Specialist.

Strict guidelines are in place as to who is eligible to receive assessments and treatments from the appropriate professional. Assessment and treatment is provided accordingly, but the consult is also an opportunity for the practitioner to educate their patient about their underlying health issues and empower them with greater knowledge to enable them to take charge of their health care program.

This greater knowledge often allay fears of horror stories they have heard about older family members, such as grandparents, who may have fallen victim to complications from infections resulting in amputations of the lower limb. As part of the intervention process professionals integrate a treatment plan. This process is in consultation between the practitioner and patient and reviews take place every 3 or 6 months and then annually, to monitor changes and hopefully overall improvement in their health status.

Between the years of 2004-2008, 1.3 million consults for Podiatrists alone were registered at the cost of 62 million dollars. The uptake of this program has significantly increased within the past 18 months, as more Doctors implement the program with their elderly patients with chronic disease. The long term benefits will still need to be seen, as the return of investment on such programs cannot be appreciated in the short term. As with most countries around the world the health care budget is a burden on any government, and as the population continues to age, more people living longer, it is known that this will place a strain on the current system. Ref: Burns, Josh 2009

Happy Healthy Harold is a NSW State Government funded initiative in partnership with NSW Department of Education and Training (DET NSW) to cater to all schools K-12 the importance of health & wellbeing. The mobile unit visited all schools across the state to promote awareness of drug and alcohol, obesity and the importance of exercise, dental care, sexual education and hygiene including transmittable disease. Issues such as the importance of good handwashing techniques, youth at risk of alcohol and drug abuse, anger management and child abuse. Safety Houses and Neighbourhoods were promoted through recognised symbols and signage on the streets to help the first steps of intervention to dysfunctional families.

Evidence Based Health Promotion

One of the basic concept models of interventions in Australia is evidence-based practice. Basically the movement to develop 'evidence based practice' first began in the field of medicine and has now spread to all parts of the health sector and other public sector activities. It is now widely accepted that activities to improve health should be supported by sound evidence.

This particular model works at the most basic level where evidence involves 'the available body of facts or information indicating whether a belief or proposition is true or valid'. Evidence based public health and policy is an exercise in constructing realities and interventions within particular contexts. This is particularly good for policy-decision makers, whereby, evidence may be defined as 'anything that establishes a fact or gives reason for believing something'.

Evidence-based health promotion refers to the development, implementation, and evaluation of effective programs and policies in population health through application of evidence, including systematic appraisal of research and appropriate use of program planning models. From this perspective, health promotion practice is directly linked with evidence that demonstrates effectiveness.

Effective, high quality health promotion policy and practice depends on the availability of information from existing research and evaluation, statistical sources and expert knowledge. Evidence based practice relies on the findings of sound evaluation research to determine whether an intervention is likely to be effective. The following organisations are involved with the assessment and delivery of the effectiveness of health promotion and population health interventions.
1. Area Health Services and Community Based Hospitals and Health Centres
2. Allied Health Professional Associations, eg. Australian Podiatry Association (NSW), Diabetes Australia
3. Royal Flying Doctor Service
4. Divisions of General Practice
5. The Cochrane Collaboration. Preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care and population health interventions.

Examples of NSW organisational integration within the community to implement an intervention process are as follows:

1. Flood Cleanup Guidelines, Including Information on Mosquitoes

A natural disaster declaration covering a number of Local Government Areas (LGA) within Greater Western Area Health Service (Broken Hill) has been made due to the recent flooding from the Queensland cyclones in January /February 2010. The LGAs include: Broken Hill, Bourke, Brewarrina, Coonamble, Gilgandra, Walgett, Warrumbungle and Warren.

• Cleaning rainwater tanks inundated with floodwater
• Fact sheet procedure for restoring flood water inundated domestic swimming pools
• Food safety and vegetable gardens following floods
• Flood clean up guidelines
• Mosquitoes are a health hazard fact sheet
• Mental health support available

2. Greater Western AHS Chief Executive urged the community to take up free swine flu vaccine.

A proactive approach was taken by the Australian Federal Government prior to the Winter season of 2009, to provide free swine flu vaccines to all health professionals, as well as carers of sick and the elderly people.

The preventative measure was to offer the swine flu vaccine in response to the high incident outbreak in the Northern Hemisphere Winter outbreak. Previous winter flu season and reports indicated that H1N1 pandemic activity was high in Europe, the Middle East, Asia and North America with the transient population around the world potentially spreading the disease as they return home. People in the at risk group included: people with underlying chronic medical conditions, heart and lung disease, cancers, HIV, asthma, diabetes; people who are morbidly obese; Indigenous people and pregnant women.

During the initial stages of the rollout, the focus was on ensuring that people in at risk groups were offered the vaccine first. Vaccination was not restricted to this group but was available to anyone who wished to be vaccinated. The aim of the program was to provide free vaccination against pandemic (H1N1) 2009 influenza for all members of the community who wished to be vaccinated.

Vaccinations started on the 30 September 2009. The World Health Organisation, in collaboration with the national and state bodies, monitored the safety of the pandemic vaccine. Worldwide, millions of doses had been distributed and administered. Safety data suggested that the vaccine had no more side effects than that seen with seasonal influenza vaccine. Promotional material encouraged parents to protect their children against swine flu, with the vaccine available for all children aged 6 months and over. It also advised the importance to have an infant less than 6 months of age in your care vaccinated.

The Australian Government's Chief Medical Officer indicated that while two doses of vaccine for children less than 10 years is recommended, one dose may still provide a good level of protection against pandemic influenza. General Practitioners and Aboriginal Medical Services have been administering vaccinations to the community. Over 73,000 doses of vaccine have been distributed in Greater Western AHS. People can access the following website for more information on H1N1 Influenza, through the NSW Health Pandemic Vaccination link at

3. Free Child Weight Management Program for local families

As obesity is becoming an increasingly important issue in our local community with almost 25% of Australian children currently overweight or obese promotional programs have been developed. The current trends indicate that by 2050 the incidence of child obesity will be closer to 50%. Based on this prognosis the NSW Parenting Program took the intervention communication strategy “What is it and who is it for?” implementing MEND (Mind, Exercise, Nutrition…Do it!). This is part of a national initiative offering free healthy lifestyle courses for children 7- 13yrs old who may not fit within the ideal weight range and their families.

4. The NSW Collaborative Centre for Aboriginal Health Promotion

The philosophy and underlying principles of the NSW Collaborative Centre. The NSW Collaborative Centre for Aboriginal Health Promotion is a joint initiative of NSW Health and the AH&MRC. The Centre is a major step forward in developing better practice health promotion approaches to improve Aboriginal health in NSW. The philosophy of the NSW Collaborative Centre for Aboriginal Health Promotion (CCAHP) is to improve the effectiveness of Aboriginal Health Promotion in NSW and throughout Australia. The Centre will ensure a strategic approach for Aboriginal health promotion as well as fostering leadership for Aboriginal health promotion at the NSW state level. The Centre will seek to achieve these goals through three key functions:

  • Gathering, reviewing and disseminating case studies of good practice in Aboriginal health promotion via a clearinghouse/website function that could be used nationally.

  • Providing training opportunities for the Aboriginal health promotion workforce to acquire necessary skills and knowledge in health promotion.

  • Increasing the skills of Aboriginal health personnel within local aboriginal Community Controlled Health Services and other local aboriginal community organisations for effective health promotion planning and implementation resourced by the NSW Aboriginal health promotion grants scheme.

5. Cervical Cancer Health Promotion Program for Indigenous Women

According to the recent National Health & Medical Research Council (NHMRC) cervical cancer is now an uncommon disease in Australia, and that mortality from the disease is one of the lowest in the developed world bettered only by Finland. However, this is only good news if you are one of the majority of Australian women who is not of Aboriginal or Torres Strait Islander origin.

Whilst it is important that women understand the meaning of an abnormal result, and that the need for colposcopy and possible travel to a distant centre for treatment in the event of an abnormality being detected, is explained clearly and in appropriate language to women before they consent to screening it is not however, always easy to explain this to the Indigenous female community. In addition the association between vaginal examinations and the diagnosis and treatment of sexually-transmitted infections such as syphilis is another reason why some indigenous women are fearful about cervical screening. Again, more education and information, appropriately and respectfully provided, is essential. It has been observed by many health workers that indigenous women in particular prefer internal examinations and Pap smears to be performed by another woman, hence the real effort that has gone into providing such services and training in Australia especially with the introduction of the Nurse practitioner and Aboriginal Health Worker. It has been suggested that indigenous women health workers might be trained to perform cervical screening and in North Queensland, NSW and WA many have undergone such training. However it has been reported that many women in smaller communities prefer intimate examinations done by women from outside the community, and therefore the value of such health worker training may lie more in educating their communities than in the actual provision of services. It would seem that the provision of more information about the reasons for performing Pap smears, and the consequences, both positive and negative, of screening programs, is pivotal to increasing the participation rates amongst indigenous women especially in QLD where incidences of cervical cancer mortality rate amongst indigenous women is now 10 times greater than the average national rate across Australia.

Indigenous people learn collaboratively and are very audio-visual communicators. They are traditionally educated by the elders through collaborative storytelling and image/pictures using dot- style art paintings. Currently, Central Australian Health Workers are using paintings by Margaret Lankin to represent important health and wellbeing document regarding cervical cancer and sexual diseases as one form of strategy to educate the local indigenous women. The painting tells a story about how important it is for women to have regular Well Women's checks. The traditional women supported each other and traditionally, older women taught the younger ones how to look after themselves and their country. Hence, the shapes in the painting represent the women sitting around together having a meeting. The one with the white dots is the lady from the screening place, who has come to talk about breast screening, cervical cancer and Well Women's screening. The circle with yellow, grey and brown dots is the screening place. Circles with white dots are the other communities involved in this big meeting. The footprints with white dots belong t
o the lady with all the knowledge she's going to pass on to the Aboriginal ladies there. The two ladies sitting in the circles are shamed. They sit there and wait to hear from the other ladies. The footprints with the yellow dots are the ladies who understand now what breast screening, cervical cancer and pap smears are, and how important it is to be screened. The yellow and white dots scattered over the painting are sending a strong message across to all women to be screened every two years. Read more...

Appendix A:
double click on image to view


• Happy Healthy Harold
• NSW State Health Plan 2007- A new direction for NSW Report 1/2/2007 /NSW Strategic State Plan
• Healthy People NSW: Improving the health of the population
• File link: Healthy People NSW: Improving the health of the population 12/2/2010
• Live Life Well
• NSW Aboriginal health promotion Link 14/2/2010:
• NSW Health Promotion evidence in Public Health Link 12/2/2009

Tuesday, December 22, 2009

Double click image to enlarge:

Visit HelpAge on older people and impacts to their health due to climate change

Sunday, December 20, 2009

Gender Gap in Retirement Schemes from a cross national perspective for single older women living in 21 C


This paper endeavours to expand on secondary comparative research data from a cross-national perspective the adequacy (or rather inadequacy) of some social benefits and retirement saving schemes among older single women and the effects it has on their economic status in today’s society. With extended periods in and out of the workforce to meet their caring responsibilities, women who have children are already disadvantaged in comparison with men in their income over time and in the superannuation entitlements they can accumulate. The ongoing effects of earning less than male counterparts and the difficulties in securing ongoing well-paid employment when returning to the workforce all contribute to the relative poverty of women (Parr, 2007; 2).

A survey of international patterns of pension provision relying on data from the 1990s finds that pension schemes financed by social security contributions are the most important source of support in old-age among developed countries. Reference (p6)
[1] Pension systems differ across European countries according to various characteristics. This paper will endeavour to build on the analyses using the comparative intragenerational redistributive performance of public pension transfers using data from the Luxembourg Income Study (2007).

This is a crucial time for Australian women. Social changes have seen women enter the traditional workforce in large numbers, while unpaid work in the home and caring responsibilities continue to be disproportionately undertaken by women. The review will polarize the findings regarding the economic position of single older women in 4 industrialized countries which have shown substantial differences, especially regarding the proportion of widows, divorcees, and never-married women experiencing poverty. It is anticipated that from the comparative study of these differences among the Australia, Germany, Sweden and Holland it will illuminate the role of different structural features of old-age security plans in limiting poverty.

[1] Department of Families, Housing, Community Services and Indigenous Affairs, Pension Review Background Paper (2008) p 6. At (viewed 9 February 2009);

Monday, November 9, 2009

Session 4 and 5

Double click on image to enlarge:

Conceptual Map 2009 by PWilliams colonisation,self determination cultural sensitivity and empowerment for Indigenous health workers 21C.

Thursday, November 5, 2009

Session3: Reflection

  1. a) After reviewing the two articles: Hart, M. (2007). Indigenous knowledge and research: the mikiwahp as a symbol for reclaiming our knowledge and ways of knowing; and Margot, L. & McKenzie, L. (2006). The wellness wheel: an aboriginal contribution to social work; consider and post your reflections on the following questions:

    b) i) What did you learn?

    Indigenous knowledge is a distinct knowledge and has contributed to wellbeing globally. Unlike westernised thinking the knowledge sits not in separate disciplines but rather is interrelated and are viewed together as a holistic knowledge which has these elements connected to the whole and contribute to the functionality of the Indigenous knowledge where nothing is divided or separated as a stand -alone subject. However, based on this fact it is not supported for its research and continued development by current society and academia. I learned that during colonial oppression the mikiwahp was developed as a symbolic imagery over its Indigenous people as a way of re-claiming their knowledge and traditional ways. The mikiwahp symbolises the balance of the poles tethered in a particular way to sustain a tepee and it has different viewpoints pending the position you view the poles. This relationship of the poles of the mikiwahp symbolises the knowledge which is about balance with nature and all living matter in a harmonious ‘aura’ of the combined energies around oneself. Therefore, local environmental issues causing any in balance to the relationship to all parts from the 'norm' would affect the energy or aura surrounding the wellbeing of that individual between the land animal, plants and the spirits. The latter especially as science and spirituality has no barrier. As an analogy it has a similar concept to human homeostasis which biologically manages the internal balance that acts as a regulator in the body to try to maintain the parameters at a constant level over possibly wide ambient environmental variations to maintain wellness. Basically the ways of learning this knowledge has both physical and spiritual methodologies of practice to guide oneself through the journey initiated by the creator. However, nowadays transmission of these teachings via Elders, are few and far between. Picturing Indigenous knowledge is very much based on your point of view what you perceive from your own perspective and immediate surroundings. This is why writing or speaking with different usage of language does not fully describe the knowledge as translation tends to develop a version of the knowledge that not necessarily is accurate. The teaching is very much context learning and experience comes before the theory. This is very similar to Carl Rogers who states ...experience is a harsh teacher it gives the practical first and the lesson after. (Using experiential learning in teaching)

    The medicine wheel is a wonderful planning tool to identify your position to wellness. It’s similar to doing a ‘swot’ analysis of your wellbeing. The circles of elements that affect your health and the environment are mapped to four steps. This is based on harmony which is ease of health as opposed to disharmony which is disease or illness. The North American aboriginal medicine wheel promotes well-being in all realms of human functioning ie. body, mind, heart and spirit. It is particularly useful as primary and preventative care methodology for health care workers because it can focus on intervention with the individual. Interestingly the spiral interconnectedness and interdependence reminds me of the cyclic weather patterns of the warm and cold fronts. The high pressure and low pressure of the Coriolis force depending where you are indicates cyclone or anticyclone. The North American aboriginal medicine wheel spiral flows anticlockwise starting from oneself to the outer spiral to universe. Ironically the low pressure found in the Northern Hemisphere spirals the same way ie. anticlockwise. It could be suggestive that it’s in harmony with Mother Earth which likewise rotates counter clockwise on its axis. Ideally the four cardinal directions in balance happen to be the four directions of the compass points- North, South East and West. Thus the wheel provides unity from all sides to guide an individual’s spiritual, mental, physical and emotional well-being.

    ii) What will you do with this knowledge?

    I think I will build on my own knowledge and share my knowledge through networks and forums. Cognitively, I will identify in my mind what strategies knowing now what I know and how I can help connect with other indigenous customs and ways of thinking and even non aboriginal people as to the benefits of these teachings. There are many ways of passing on life teachings and whilst the indigenous knowledge teachings has uniqueness from group to group. They also have similarities to many other people’s cultures. The current teaching and learning using experiential and context learning is being used more and more today. There are synergies with Indigenous ways especially about being collaborative and connected in the 21st Century. These methods are now forming new teaching paradigms and new pedagogies . For example George Siemen’s from Manitoba University talks about Connectivism, networking community and social collaborative learning. This is how knowledge was shared amongst the Indigenous communities and it was a social interaction and it was about networking listening and speaking. Symbolism of traditional ways balance and harmony can be potentially revived if we take the time to include our indigenous people in our everyday teaching with the wonderful educational technologies where we can see, hear and interact 'live'. But more so collaborate across many borders in real time in real places across many different spaces.

    iii) What is your responsibility to the teacher(s)?

    There are many complimentary teaching philosophies that will augment and bridge the Indigenous knowledge to help develop their place in academia whereby there is a valid nexus between teaching and research in their approaches to teaching and learning with Indigenous knowledge paradigms. One needs to research and promote Indigenous knowledge as being distinct and relate it to today’s context, time and space. Importantly, how these traditional ways have been around since time immemorial and some of the climate change issues could very well be addressed using the strategies of traditional knowledge. The Indigenous knowledge like all knowledge is invaluable and needs to be captured, shared and networked across all teaching paradigm methodologies. Experiential education is elusive, often paradoxical, and it is multifaceted with ethical, aesthetic, spiritual, physical social and psychological dimensions, even cosmic dimensions. Psychological mountain climbing may be the right phrase for what we mean by experiential education. Anyway as Aristotle once stated...The things we have to learn before we do them, we learn by doing them.

    In conclusion, as a teacher of teachers I will add it to my wisdom and personal knowledge bag to use as teaching tool for connecting with Indigenous students or staff from Cree backgrounds and maybe understand the other subtle ways of Indigenous groups about their indigenous knowledge in Objibway or Inuit or First Nation People. There are many teaching paradigms and philosophies to be aware of and Academia in the western society should know that there is no separation of faculties and discipline but a holistic circle of learning that sits in concentric circles within and about connecting and interrelating to all things just as the Indigenous teaching has known. I am currently involved with a university wide approach with key stakeholders nationally with my University about Indigenous teachings and research and we are very excited about coordinating this for the future!

    Foot Notes:

    SWOT - Strength,Weakness,Opportunities,Threats

    Coriolis force- The main force which causes air masses to turn is called the Coriolis force. It is due to the equatorial regions moving faster than the polar regions as the earth rotates. The net result of the Coriolis force is that in the southern hemisphere, winds around low pressure systems or cyclones move clockwise and winds around high pressure systems or anticyclones move anticlockwise. (An intense cyclone is called a ‘tropical cyclone’ or sometimes a ‘hurricane’ or ‘typhoon’.) In the northern hemisphere they go the other way round, so if you are reading material written in England or the USA you need to remember that they will talk about these things going the opposite way to the way they go in Australia.

    Cyclonic Rotation Circulation (or rotation) which is in the same sense as the Earth's rotation, i.e. counterclockwise (in the Northern Hemisphere)

Saturday, October 24, 2009

Session 2 Health and Wellbeing in the North

Reflection on Health and Well-being in the North

Consider the diversity in livelihoods in time from traditional customs to today's ways.

Subsistence/Traditional Harvesting

For one aboriginal peoples' traditional harvesting has greatly diversified. By this I mean their traditional maintenance as to what they were culturally brought up as the accepted standard of living that would keep the community alive and reasonably healthy. These standards would depend on their roles in the community their gender, their age as an elder or matriarch/patriach.These standards were heavily dependent on seasonality, game migration, hunting access and the environment with it's provisions for shelter against the long winters. In contrast the long winters and short summers have a totally different focus to the conditions of those inhabitants living say in the southern regions. Namely the extreme sub zero temperatures that humans can survive on the frozen ice and endure effects of the cold winds and all its elements physically and mentally must have on the human body. Hence, the need for different requirements to sustain those extreme conditions and a different mindset and belief to endure that lifestyle. The sources of fat requirements versus carbohydrate need and procurement of different vitamins, minerals and omega oils are far more essential elements for nutrition than temperate zone inhabitants such as our European settlers would need. In fact latterly, this type of dietry intake would be quite detrimental. European and western food is biochemically suitable to those cultures who traditionally prepare and consume them. However, in the Arctic individuals don't have a varied choice and food is very much driven by seasonal changes, flora and fauna dynamics. The need for special dietry food such as seal, polar bear, fish for sustenance is important to sustain the arctic climate and the cyclic winters of the circumpolar North.

Nutrition and dietry intake is climate driven

The introduction of western food has interfered with the indigenous makeup of long traditional eating habits for which their body has been accustomed enzymatically, biochemically to adjust to the environments subsistence offering in the remote regions. As hunting practices change and environments alter so do roles. Cultural traditions are very much driven by the environment. For which the Indigenous people were familar with and became very accustomed to maintain their standard of living. So when they were forced to migrate their subsistence shrank. They were suddenly living in an unfamiliar environment where their diet, spirit and their role in community changed dramatically. The focus was now not so much on the old ways of survival but of another kind of survival the assimilation into European- westernised custom.

New dwelling, new ways but traditional pride, mind and spirit remains dormant

Indigenous people are now ubiquitous across Canada . Hence, there is a diversity of livelihoods across georaphical areas and this is dependent on seasons and climate extremes if in the far North compared to the South. They are not just concentrated in one specific region, reservation or township. Their lives have been changed by colonisation and so too their bodies and minds have had to adapt to new roles, new food, new locations and new technology. The infrastructure caters little for these cultures and hence their role in society is drammatically different to their pre-colonsation structure. The 21st century has made little allowance to these cultures' improvement since the 18th Century. Yet their roles continue to be submissive to ordinary society and marginalised against the dominant culture of westernisation. Many have the role of lowly paid workers, such as industry areas and outposts eg mines or quarries or roadworks. Others work in retail stores as lowly paid casualised workforce with long hours to make sufficient money to support their families. Indigenous culture is about functionality of an entire unit no one person keeps his own property but shares for the whole community such as his big catch of the day or hunt. Now they live in overcrowded dwellings some are too uneducated to manage a westernised job. There traditional practices are less taught by the elders to the new generation who's outlook on life is of constant confusion, inequity and loss of traditional cultural pride. They succumb to poor nutrition and acquire diabetes to non traditional food with an intolerance not only to sugar but alcohol and substance abuse.

For many aboriginal people the focus of day to day activities has changed from planning , a hunt or gathering the fruits and berries in order to prepare for the sudden seasonal changes. Caring and teaching their traditional livelihood traits and to help occupy those long winters with activities such as story telling, handycraft,art and spiritual teaching and healing to the family has slowly faded into the past. Today those activities are replaced by western television and radio. There is very little role taken in planning their livelihood as a whole community approach to welfare. Rather, their needs have changed from survival in the wilderness where their body's no longer need to brace the climatic variances as when they had to hunt in the extrem cold, endure long winters. Now they have man made environments and shelter which controls the climate all year round by electricity and gas and fuel driven snow-mobiles to visit stores stocked with preserved food and take- away, and gas stations selling 24/7 alcohol and cigarettes all year round.


The needs are now reversed but the ways are still there but dormant and unpracticed due to marginalisation of these cultures to westernised standard of living and a new subsistence that has been dictated by colonization and western civilisation.

Friday, October 23, 2009

Session 1 Conceptualisation: Question 1:

What ways of promoting health and well-being and dealing with health problems were available pre-colonization? How were these viewed by outsiders?


Table of events during colonisation
Table 1: Aboriginal health

Firstly, we must be clear about the timelines when we discuss colonisation in Canada in the mid 18th century. Whilst European settlers was occuring around 18th and 19th century there was however, not much alteration to customs and tradition regarding promoting health and wellbeing at the onset of colonisation. It wasn't until, effects of colonisation started taking their toll with the onset of European diseases to the aboriginal people where their pre knowledge of health was impossible to combat for foreign disease. At the time of contact with Europeans, Aboriginal people were in good health – a fact that is well documented in historical documents and through the findings of paleo-biology efforts (Royal Commission on Aboriginal Peoples, 1996). After the contact period, however, many Aboriginal people became ill and died from infectious diseases that were foreign to them, such as influenza, polio, measles, smallpox and diphtheria.

Their modus operandum with customs and cultural ways was up until then mainly 'business as usual'. It wasn't really until the period between 1700-1800 AD that these customs and traditions became under attack with government restrictions Policies, Acts and Treaties that marginalised their very existence. As far back as the 18th and 19th centuries, agreements with representatives of the British Crown were initiated and sought by Aboriginal leaders to address the worsening health status of their people brought on by “new” infectious diseases and poverty. Many treaties for example; – Treaty 6 (1876), Treaty 8 (1899), Treaty 10 (1906);and Treaty 11 (1921) –were signed by both the federal government and First Nations, stating that the Crown would provide health care to the First Nations people to reimburse them for the use of their land and resources. However, as we know this was speculative as these so called 'Treaties' between Aboriginal and European nations were negotiated and concluded through a treatymaking process that had roots in the traditions of both societies. These were the means by which Europeans reached a political accommodation with the Aboriginal nations to live in peaceful co-existence and to share the land and resource of what is now Canada (RCAP, Vol. 1, 1996.)

For example, First Nations people hold the view that health care is a treaty right that was affirmed in the treaty-signing process and, as such, is legally binding to this day. Furthermore,because of the special relationship that was established through these agreements, Aboriginal people believe that the provision of health care falls under federal jurisdiction as opposed to being a provincial/territorial matter.

Pre colonisation strategies

The Elders and Shaman of Inuit cultures for example played an important role in promoting the health and well-being of their people by teaching the life-sustaining qualities of the local plants and animals in conjunction with spirituality. Indigenous Peoples have varied perspectives and belief systems. In Canada there is a great diversity within Aboriginal groups in regard to their traditional teachings. For example:

  1. The Cree concepts of miyupimaatisiiun ‘being alive well’
  2. The Ojibway (Anishinabe) Medicine Wheel Approach
  3. The Inuit cosmology and shamanism

Teaching for many Indigenous groups was passed on from generation to generation and was conducted orally to earn a form of trust through face to face interaction. The Elders would instruct about life and the learner would listen they would not be able to write but to focus on the teachings. Body language and use of the five senses were important information processes to understand the ways their creator wanted them to behave and believe in their life journey. Listening with your whole being requires a different attention span to today’s learners. Traditional teachers are now becoming fewer. If the language is scribed or recorded it won’t be passed on and shared in that language it will be a different version that is passed on to that generation and hence, is not the true teachings. This is because the language carries the teachings.Pre-colonization taught that the journey is the teaching not the destination. Rather, life is a path and is the road given by the creator where the individual finds their true identity, dignity and inner goodness along the way. Each person contributes to the collective wellbeing. It is not about one’s own well-being it’s very much about community one’s surrounding and the collective intelligence as one entity with the relationships that connect around it as with the ‘Medicine Wheel’. The medicine wheel depicts a circle where the Ojibway believe they are a traveller in this circle, thus everything is cyclical. This so called Circle cycle promotes wellbeing at all levels of society . The centre of the circle is Mother Earth which is the core of the circle. The wheel is multidimensional which connects into other directions relations past and present and future where all is connected. The teaching and wellbeing pre-colonization was the individual’s own effort to work at the balance to attain one’s well-being that was important and the key to health and well-being was ideally balance.

The spirit played an enormous role in the healing process with an almost 'gestalt' mind, body and soul. This holistic healing approach was very related to the spirits of the environment such as the animals and the land sea and sky.

Ostensibly, during the pre colonization days these cultures identified and held in high regard those things mentioned in the environment that sustained them. This belief still exists but the marginalisation and shrinkage of their land has prevented many of their ways in sustaining this cultural holistic belief in healing. Particularly, the surrounding land and resources eg. plants and species and fauna that held special medicinal properties for them since time immemorial. Elders understood the remedies in these plants which determined the culture of the people living there in that particular location. For example, when Inuit babies and adults suffer ear ache, they would use seal fat as an antibiotic to relieve the ear ache. However, if they are now being relocated to a reservation that has no access to animal fat this type of remedy can not be used. Just like ointments are used today, animal fat can be used as well. Both men and women in the community gather the plants and mosses used to heal various ailments. Labrador tea leaves are boiled and the liquid mixed with seal fat to make an ointment. Leaves from the bearberry plant can be boiled and drunk to ease a stomachache. Purple saxifrage flowers and leaves can be eaten or made into a tea. Mosses are used as wicks for the traditional oil lamp (qulliq), or for diapers or sanitary napkins.

The community also deals regularly with mental-health problems and social issues. Individual interventions, often provided with the help of a shaman or respected elder, are done discretely to avoid hurtful gossip and to preserve the stability of the community. Emotional and spiritual wellness is promoted by a strict set of rules that governs the behaviour of each person and establishes each individual's relationship with the community. The importance of family, both for personal and community integrity, is strongly taught in the cultural upbringing of the young ones.

Aboriginal hunters would suffer severely from snow blindness the traditional herbs and animals would be applied. For example once a man was snow blinded, his eyes would be swollen they would turn to lice by fastening the lice with a piece of human hair right in the middle and the lice which was usually taken from people’s feet, this would remove the pus from the eye. This to the Europoean outsiders could be viewed as 'pagan' and such non Christian acts could be suggestive by the pious community as 'witch doctor-like' practices as a need to be changed in so called 'modern civilisation'.

Outsiders perspective on these strategies

European, and Christian missionaries were largely responsible for the upheavel of aboriginal cultural customs. Their once holistic healing and well being practice in balance with nature and their environment was to be disrupted by many unavoidable factors that would be detrimental to their future wellbeing as an indigenous race of people. The relocation and preventory cultural practices were the downfall of cultural health and sustainable wellness for these cultures. European colonisation viewed these cultures as primitive, uneducated and in need of indoctrinating their traditional old ways with new modern westernized ways. Colonisation brought a plethora of diseases that these cultures would not have a hope in curing let alone understanidng in one life time , and so there was no choice but to succumb to a greater problem and that was fear of extinction and being wiped out hence the treaties were the Outsiders way of compromise. Unfortunately, Europeans had a dichotomous outlook on the Indigenous groups and so this opinion divided many of the established health care systems from 'them' and 'us'. Hence, many of today's social and health care services have been shaped from social welfare policies originating from treaties and acts of colonization.

We see historically and in cases today that Indigenous People have inequitous rights to health and welfare such example is the disparate health system to Metis and Inuits and other indigenous cultures is not consistent federaly across Canada. Healing focuses on the person, not the illness. In his statement to the Royal Commission on Aboriginal Peoples a non-Aboriginal doctor, David Skinner, testified that “It is our belief that because our white man’s medicine is very technical-oriented, very symptom-oriented, very drugs- and surgery-oriented, that it lacks something that Native medicine has, which we desperately need but don’t practise: spirituality.


In many of these things we are talking about social welfare assistance to issues such as family violence, alcohol abuse, trauma, suicide — I support Skinner's belief that the Native public health nurses, Native nurses, Native doctors should have that in their approach as well — a spiritual component. The path toward healing must start in the past if it is to lead to wellness for the Inuit in the future.