Marie McInerney writes:
Breaking down research and policy silos and challenging the impact of institutional racism and colonisation on Indigenous health research, policy and practice will be at the heart of “courageous conversations” at a major symposium in Brisbane over the next two days.
The 6th National Health and Medical Research Council (NHMRC) symposium on research translation will focus on Aboriginal and Torres Strait Islander health and bring together leading national and international Indigenous researchers to “join the dots” between research, policy and practice.
The two-day symposium is being co-hosted by NHMRC with the Lowitja Institute, the national Aboriginal and Torres Strait Islander health research institute.
Dr Tamara Mackean, a Senior Research Fellow in Indigenous Health at Flinders University and the George Institute for Global Health, said the NHMRC had “embraced” the partnership. Lowitja and the Indigenous-led scientific committee, which she co-chaired with Associate Professor Yvette Roe from the University of Queensland, had developed a “strong global Indigenous presence” in the program.
“So we’ve got the right kind of space, the right kind of coming together of different perspectives and disciplines to really grapple with what are at times quite complex problems but also the barriers to actually getting some of the research findings into policy, into practice and into systems,” she said.
Mackean said silos existed in non-Indigenous health research too but there were fundamental differences for Indigenous researchers in terms of “health and wellbeing as lived and understood by Aboriginal and Torres Strait Islander people and from the systems and practitioner perspective”.
Focus on innovation
Keynote speakers at the event today (Tuesday) will include Professor Ian Anderson, Deputy Secretary for Indigenous Affairs in the Department of Prime Minister and Cabinet, and Donna Ah Chee and John Paterson from the Central Australian Academic Health Science Centre.
On Wednesday, Dr Carrie Bourassa, a Meti researcher from Canada who was recently appointed as the Scientific Director of the Canadian Institute of Aboriginal Peoples’ Health, will speak on systemic racism and its impact on health, canvassing unethical research and the historical legacy of colonisation.
Her fellow international keynote Sir Mason Durie, one of Aotearoa New Zealand’s most highly respected academics, will speak about the potential for great innovation at the interface of different knowledge systems.
A panel session titled Courageous Conversations and featuring Dr Jaquelyne Hughes, Dr Ray Lovett, Prof Alex Brown, Dr Chelsea Bond and Dr Cass Hunter will look at how Indigenous health research still takes place within “an overarching system that is still inherently colonial”, Mackean said.
She expects it to be one of the standout discussions at the symposium.
“What is courageous is not just about Aboriginal and Torres Strait Islander people standing up and saying we want to have a conversation about what colonisation means within contemporary settings in terms of what we are all trying to do to improve health and wellbeing,” she said.
“It also allows for non Aboriginal and Torres Strait Islander people to really understand what is their place in this research space. And that starts to open up even more challenging ideas: issues of racism and whiteness and privilege.
“These are very difficult things. When you talk about them people automatically shut down, because they are foreign, they feel frightening, they feel bigger than Ben Hur.”
Road map and road blocks
The symposium comes soon after the release of the NHMRC’s Draft Road Map 3 to provide NHMRC’s strategic direction for Aboriginal and Torres Strait Islander health and medical research over the next ten years.
It includes a commitment to continue directing five per cent of its annual budget to Indigenous research and notes that community consultations viewed public health issues rather than medical advances “as particularly important”, it says.
The draft, which is open for comment until December 10, acknowledges the role of institutional racism “as a factor that impacts on health service delivery” and of the “ongoing importance of research into the social and cultural determinants of health as well as health system, service delivery and translational research”.
But the research event is also being staged as Australia has hit a roadblock on the path to self-determination, with the Turnbull Government’s rejection of a key element of the Uluru Statement from the Heart for a nationally recognised body to give Aboriginal and Torres Strait Islander people a Voice to Parliament.
One of the architects of the Statement, senior Indigenous health advocate Pat Anderson AO, is the chair of the Lowitja Institute, which last year hosted an international conference of Indigenous researchers in Australia.
The conference released a closing statement declaring that: “The right to self‐determination underpins the right to health.”
It called for Indigenous thinking, intellect, and wisdom to be valued and for the research process to be decolonised.
Both Mackean and leading non-Indigenous researcher Professor Fiona Stanley told Croakey that the Voice proposal has major significance for Indigenous health and health research.
Mackean said Indigenous knowledge systems, embedded in enduring relationships with the natural environment, had “spawned amazing understandings, not just about health and wellbeing, but science, meteorology, conservation and land management”.
“If you recognise sovereignty you not only recognise sovereign rights but also recognise sovereign knowledges,” she said.
“At some point, be it researching around Indigenous health and wellbeing or policy making around Indigenous health and wellbeing or trying as a society to reconcile what it is to heal, at some point that conversation about sovereignty and proper recognition will be had.
“You can only meet problems borne of clashing knowledge systems by properly understanding the knowledge systems.”
On the Uluru Statement and Indigenous health
Q & A with Professor Fiona Stanley
Q: What are the health implications of the Voice proposal?
There are three major implications:
- Giving First Nations the power to influence the services and policies in health and other areas that influence health such as housing, environments, education, culture, etc results in much more effective services than those that are imposed. The latter mostly do not appreciate the First Nations history, intergenerational trauma and current circumstances and ignore really important local knowledge that could make considerable differences to use of services, their trust by First Nations peoples and their ability to prevent and treat diseases.
- Those communities and populations which have more power (examples below) also have fewer mental health problems, substance abuse, domestic violence and child neglect.
- Giving First Nations people a voice is, like renewables with climate change, more cost effective than not doing so, not only for health services, but for most aimed at wellbeing and welfare. If governments only care about financial bottom lines, a First Nations voice is the way to go.
Q: What are the implications of the Voice proposal for research translation?
Having a First Nations voice should include empowering First Nations researchers, policy makers and service providers to conduct their own research, analyse and interpret their own data and translate it into improved outcomes.
The recent Indigenous Data Sovereignty symposium at the University of Melbourne (Croakey ed: see this report from that symposium) presented evidence that when this happens, the outcomes are spectacularly better!
Most Indigenous health research conducted by First Nations researchers is very applied and usually answers the questions about what works and what doesn’t and what are the characteristics of Indigenous services that work. Such research is immediately translatable. Such research is done with passion and cultural integrity and means that not only will services be used, they will build pride and combat racism.
Q: Could you give any examples to illustrate the issues raised above?
Yes, there are a lot from both overseas and in Australia.
Two Canadian studies (British Columbia and Nunavit):
- Chandler and Lalonde studied all the tribal tracts across British Columbia and collected youth suicides over a 25-year period. There was huge variability in these rates, some tracts had the highest in the world and others had no suicides at all! The characteristics of those with low rates were a) Aboriginal controlled services; b) language; c) treaty or treaty negotiations even if they had failed; d) more women on council.
- In the Nunavit community they negotiated with Health Canada to bring back traditional birthing to this remote northern community which had high rates of substance abuse, domestic violence, suicide, child maltreatment, mortality rates, 60 per cent caesarean section rates with women being sent 600 kilometres south to have their babies.
With First Nations control of health services in close partnership with Canada Health, there was a dramatic turnaround in all these outcomes.
Australian examples include Aboriginal controlled health services (we do need better data on these) and other community based, data driven activities in Bourke (Maranguka Community Hub – also improved justice outcomes), Shepparton, Yorta Yorta Data Unit, Fitzroy Valley (June Oscar, Marilyn Carter, Maureen Carter, Olive Knight), and of course the Tiwi Islands chronic disease project. A range of projects run by First Nations researchers in Western Australia have preliminary data on using Indigenous knowledge and elders to vastly improve Aboriginal attendance for care etc.
Q: Are there any other comments you would like to make about the Voice proposal and the Uluru Statement?
Yes. Not only have we wasted millions of dollars on ineffective health and other services which fail to understand causal pathways, but these failed services have actually caused considerable harm (not just wasteful and useless which is bad enough).
Failure is usually attributed (insinuated) to First Nations people themselves rather than the inappropriate and inadequate services provided. This contributes further to the low self-esteem and mental health problems, as well as ensuring pathways to non-participation and incarceration. Giving First Nations a voice is urgent and important for all these and many other reasons. It is the most humane and cost effective solution to closing the gap but will take a huge change in the culture of federal, state and local government bureaucracies. Bring back ATSIC I say!
Summer May Finlay and Marie McInerney are covering the Symposium for the Croakey Conference News Service. Follow the discussions at #ResearchTranslation17, @WePublicHealth, @OnTopicAus, and @mariemcinerney.