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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

This submission reflects the views of
Organisation Name: 
Ninti One & Centre for Remote Health, Flinders University
Personal Details
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Aboriginal and Torres Strait Islander people have consistently conveyed for decades and beyond that their approach to health is holistic, and that culture - grounded in connections to language, family and land – plays a key role in their wellbeing. This consistent message holds over time, and across the diversity of Aboriginal and Torres Strait Islander groups. However, national policy in Australia is yet to successfully honour Aboriginal cultural factors and their associated holistic worldviews. In his recent article, “We need transformative change in Aboriginal health”, Aboriginal academic, Professor Shane Houston states: “Holistic approaches rich in evidence-based thinking, emphasis on community control of health services, inter-sectoral collaboration and improved monitoring and accountability are themes that have repeatedly been highlighted in almost the same way despite the passage of almost a quarter of a century. So what is wrong with this?” (Houston S. Med J Aust. 2016;205(1):17-8). Building the evidence-base on approaches that are innovative, inclusive and holistic and, that particularly identify cultural determinants, has the potential to achieve transformative change. The Interplay Wellbeing Framework and ‘shared space’ model of working collaboratively (crc-rep.com/interplay) is a starting point for remote Australian Aboriginal communities, but is yet to be validated for other demographics.
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
‘Closing the Gap’ and related policies across all States and Territories These policies aim to reduce inequities across education, employment and health outcomes, but have not had the expected improvements on their own measures, prompting the need for a fresh approach. Policy approaches and their underlying assumptions have been challenged on many levels particularly for the lack of ownership or genuine involvement offered to Aboriginal people in the solutions process. Approaches to date are built from mainstream rather than Aboriginal values and goals, and assume that Aboriginal people will experience improved quality of life by adopting mainstream values and practices. Part of the challenge has been genuinely engaging community members and incorporating their values and priorities into policy. The major challenge is for the ownership, design and implementation of health strategies to maintain integrity of values and worldviews across Aboriginal and Torres Strait Islander communities, governments and researchers – whose partnerships and collaboration are necessary to achieve genuine change. Bridging worldviews with such vast differences in conceptual thinking and ways of working represents a substantial, but not impossible challenge. Transformative progress demands replacing the status quo for novel, inclusive and more empowering approaches.
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
By listening to the needs and values of Aboriginal and Torres Strait Islander people and building these and their involvement into the research goals, design and translation greatly improves the potential impact of the research. For example, this approach is/represents: a. Grounded in culture - honouring Aboriginal and Torres Strait Islander values and concepts of health b. Inclusiveness - through active participation and ownership of knowledge and practice by Aboriginal and Torres Strait Islander people and communities c. Empowerment – Working together collaboratively between communities, government and researchers to build a shared knowledge-base to achieve transformative change. This research expands on the concept of ‘social determinants of health’, bringing together rigorous research and community development. In taking a holistic approach, it builds an understanding of the many threads that must come together to improve health, with many broader benefits. As such evaluation of potential benefits is a priority. For example, a health economist has projected benefits of about $900 per year per person for investment in ‘Caring for country’ for a community with access to this opportunity (Campbell D et al Health Policy. 2011;99:83-9). This is an example of a holistic approach to health.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
‘Closing the Gap’ has afforded substantial investment with little impact recorded. Costs of providing Aboriginal health services are escalating with annual government expenditure in 2010-2011 tallying $8,190 per person and in the NT, $16,110 (Alford, 2014). Aboriginal wellbeing policy strategies to date have been criticized as ‘top down’, ‘one-size-fits-all’, focusing on disadvantage rather than strengths, and looking at education, employment and health separately rather than at the whole of system level. The lack of genuine involvement of Aboriginal and Torres Strait Islander peoples in the development and implementation of solutions targeting their own lives has received increasing attention. This holistic approach has the potential to enhance social, cultural and environmental values through services, where a single investment achieves outcomes across a range of portfolios – economy of scope (Campbell et al Rural Remote Health. 2008 Oct-Dec;8(4):1010). Building the knowledgebase on holistic approaches to Aboriginal and Torres Strait Islander health and wellbeing has the potential to identify and strengthen key pathways and areas for investment. For example, this knowledge can drive integrated approaches to monitoring and evaluation, policy, program and service delivery. This enables policy and program makers to optimize wellbeing cost-effectively.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
A key issue identified in the ‘Cultural Determinants of Aboriginal and Torres Strait Islander Health Roundtable’ conducted by the Lowitja Institute in 2014 (1) was the need to build an evidence base about the health impacts of culture, and particularly to define quantifiable cultural determinants. A literature review conducted by the Healing Foundation also identified the need for strong evaluation frameworks that are consistent with an Aboriginal and Torres Strait Islander world view (2). The remit of both of these organisations is primarily driven around improving Aboriginal and Torres Strait Islander health and wellbeing. In alignment with our literature review on this topic, both organisations recommend that approaches must be holistic, strength-based, quantifiable/evaluated, grounded in culture, build empowerment, accommodate cultural diversity and with local ownership (1,2,3). 1. Nguyen O, Cairney S. (2013) http://www.crc-rep.com.au/resource/CW013_InterplayLiteratureReview_TowardsWellbeingFramework.pdf. 2. Lowitja Institute (2014). http://www.lowitja.org.au/cultural-determinants-roundtable 3. McKendrick J et al The Healing Foundation. (http://healingfoundation.org.au/wordpress/wp-content/files_mf/1392087179ATSIHFLitreview.pdf

Page reviewed: 30 August, 2018