Papers by Karen McPhail-Bell
BMJ Open, 2017
Introduction There is growing recognition among health researchers and funders that the wider ben... more Introduction There is growing recognition among health researchers and funders that the wider benefits of research such as economic, social and health impacts ought to be assessed and valued alongside academic
outputs such as peer-reviewed papers. Research translation needs to increase and the pathways to impact ought to be more transparent. These processes are particularly pertinent to the Indigenous health sector given
continued concerns that Indigenous communities are over-researched with little corresponding improvement in health outcomes. This paper describes the research protocol of a mixed methods study to apply FAIT (Framework to Assess the Impact from Translational health research) to the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI). FAIT will be applied to five selected CRE-IQI Flagship projects to encourage research translation and assess the wider impact of that research.
Methods and analysis Phase I will develop a modified programme logic model for each Flagship project including identifying process, output and impact metrics so progress can be monitored. A scoping review will inform potential benefits. In phase II, programme logic models will be updated to account for changes in the research pathways over time. Audit and feedback will be used to encourage research translation and collect evidence of achievement of any process, output and interim impacts. In phase III, three proven methodologies for measuring research
impact—Payback, economic assessment and narratives—will be applied. Data on the application of FAIT will be collected and analysed to inform and improve FAIT’s performance.
Ethics and dissemination This study is funded by a nationally competitive grant (ID 1078927) from the Australian National Health and Medical Research Council.
Ethics approval was obtained from the University of Newcastle’s Human Research Ethics Committee (ID: H-2017–0026). The results from the study will be presented in several peer-reviewed publications, through conference presentations and via social media.
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Journal of Australian Indigenous Issues, 2017
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Frontiers in Public Health, 2018
Continuous quality improvement (CQI) processes for improving clinical care and health outcomes ha... more Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.
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Croakey, 2018
Three delegates from the southwest Pacific nation of Kiribati spoke at a Practical Justice Initia... more Three delegates from the southwest Pacific nation of Kiribati spoke at a Practical Justice Initiatives event at the University of NSW in March 2018. In this blog post, Darryl Cronin (Indigenous research fellow, UNSW) and I summarise the event, and convey the challenge issued by the speakers. Please follow the link to read the article on the Croakey website.
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Croakey, 2017
Access here: https://croakey.org/a-place-to-call-home-housing-and-its-influence-on-health/
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Handbook of Research Methods in Health Social Sciences, 2017
This chapter provides a critical reflection on an ethnographic approach led by a non-Indigenous r... more This chapter provides a critical reflection on an ethnographic approach led by a non-Indigenous researcher in partnership with an Indigenous community-controlled health organization, and a team of Indigenous and non-Indigenous supervisors, advisors, critical friends and mentors. The chapter explores the way the three interrelated principles of Indigenist research informed the study, as a critical reflection of the methodology’s achievement of a decolonizing research agenda. The flow of Maiwah (the Brisbane River in Australia) provides a metaphor for the chapter’s diverse authorship. Maiwah’s tributaries, inlets and banks represent author voices at different points while the one River flowing represents coming together to form a broader collective story of the research that still respects the authors’ individual positioning. Maiwah’s flow also signifies the dialogical approach of the research – ‘tricky ground’ (Smith, 2005) for non-Indigenous researchers seeking to privilege Indigenous voices while remaining accountable to their own White privilege, particularly given that at its most basic level, research requires the 'extraction of ideas' from participants. Yet, the flow of Maiwah also shows us the possibilities of research, where in this case, researcher and participants together co-created new knowledge in support of their agendas. This process enabled both research outcomes and increased research capacity and confidence in the host agency and researcher. On this account, decolonizing research is perhaps more about relationship and devolving control over the process than it is about particular methods, and the respectful negotiation of epistemological meanings and representation of particular knowledges that can result.
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The potential for health promotion through social networking sites (SNSs) is widely recognized. H... more The potential for health promotion through social networking sites (SNSs) is widely recognized. However, while health promotion prides itself in focusing on the social determinants of health, its par-tiality for persuading individuals to comply with health behaviours dominates the way health promotion utilizes SNSs. This paper contributes to an understanding of collaborative ways SNSs can work for health promotion agendas of self-determination and empowerment in an Indigenous Australia context. An ethnographic study was undertaken with Deadly Choices, an Indigenous-led health promotion initiative. The study involved participant observation of interactions on Deadly Choices SNSs between Deadly Choices and its online community members. Deadly Choices provides an example of SNSs providing a powerful tool to create a safe, inclusive and positive space for Indigenous people and communities to profile their healthy choices, according to Indigenous notions of health and identity. The study found five principles that underpin Deadly Choices' use of SNSs for health promotion. These are: create a dialogue; build community online and offline; incentivise healthy online engagement ; celebrate Indigenous identity and culture; and prioritize partnerships. Deadly Choices SNSs empowers Indigenous people and communities to be health promoters themselves, which represents a power shift from health promotion practitioner to Indigenous people and communities and more broadly, an enactment of Indigenous self-determination on SNSs. Mainstream health promotion can learn from Indigenous health promotion practice regarding the use of SNSs for health promotion agendas.
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Access here: https://croakey.org/challenging-the-health-promotion-sector-to-acknowledge-and-apolo... more Access here: https://croakey.org/challenging-the-health-promotion-sector-to-acknowledge-and-apologise-for-colonial-practices/
Statistics regarding poor Indigenous health outcomes are common justification for mainstream health promotion intervention in Indigenous people’s lives. I won’t recount the statistics here; there is an abundance of material available describing Indigenous health inequalities.
Instead, I would like to highlight that these statistics provide another kind of evidence; that is, the lack of effective action to address Indigenous health disadvantage, including general failure to engage with the social, historical, political context of Indigenous Australians on their terms.
In this article, I call for acknowledgement of and apology for health promotion’s continued use as an apparatus of colonial control over Indigenous Australians, and make suggestions for ways to do things differently.
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In this article, I share with you a short reflection on my recent experience of hosting AHPA's Tw... more In this article, I share with you a short reflection on my recent experience of hosting AHPA's Twitter account. I do this to reflect on and improve my own Twitter practice, as well as to assist those of you already engaged in, or considering joining, Twitter.
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This report documents the methods and findings of consultations undertaken as part of the Can Get... more This report documents the methods and findings of consultations undertaken as part of the Can Get Health in Canterbury project (CGHIC). A brief analysis of the consultation data is represented by way of three tables and two diagrams in the results section, followed by a discussion for future considerations. The appendices include details the consultations as a separate document.
Please contact e.harris@unsw.edu.au for a copy of the full report.
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Australia is a world-leader in health promotion, consistently ranking in the best performing grou... more Australia is a world-leader in health promotion, consistently ranking in the best performing group of countries for healthy life expectancy and health expenditure per person. However, these successes have largely failed to translate into Indigenous health outcomes. Given the continued dominance of a colonial imagination, little research exists that values Indigenous perspectives, knowledges and practice in health promotion. This thesis contributes to addressing this knowledge gap.
An ethnographic study of health promotion practice was undertaken within an Indigenous-led health promotion team, to learn how practitioners negotiated tensions of daily practice. The study was strengths-based, informed by a theoretical framework that privileged Indigenous knowledges, perspectives and experiences, drawing on three theoretical tools: postcolonialism and critical race theory positioned the researcher and health promotion discipline; whilst cultural interface theory enabled the analysis to shift beyond a critique of the Western, to uncover the practitioners’ meaning-making in daily health promotion practice.
The practice revealed innovative, diverse, relationship-based approaches to health promotion that effectively shifted power from health promotion practitioner to Indigenous people and communities. Community choice and control were central to practice. Through a dialogical approach with Indigenous people and communities, Indigenous notions of health and healthy behaviours were embedded and Aboriginality was asserted as health promoting itself.
The study’s findings converge with global health promotion discourse. This suggests that paradoxically, decolonising health promotion practice in Indigenous contexts requires we ‘do things differently’, while adhering to health promotion’s philosophical foundations of empowerment and control. The study proposes four interrelated principles for decolonising health promotion, informed by the practice observed. The study concludes that decolonising health promotion practice requires a radical reworking of practitioner relationships with Indigenous people and communities. Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian health promotion practice.
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Health promotion aspires to work in empowering, participatory ways, with the goal of supporting p... more Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people's autonomy, health promotion also imposes a particular, health promotion-sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion's paternalistic control over people, rather than people's control over their own health. Herein we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion 'interventions'. Moreover, the potential stigmatisation produced in any paternalistic acts 'done for their own good' cannot be assumed to have evaporated within the self-proclaimed 'empowering' narratives of health promotion. This issue's guest editor's call for health promotion to engage 'with politics and with philosophical ideas about the state and the citizen' is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion's central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion's broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion's general failure to reduce health inequalities experienced by Indigenous Australians.
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Mainstream health promotion has failed Aboriginal and Torres Strait Islander peoples, according t... more Mainstream health promotion has failed Aboriginal and Torres Strait Islander peoples, according to Karen McPhail-Bell, a PhD candidate at Queensland University of Technology.
In the article below, she argues that those working in the field could learn from strengths-based programs like The Institute for Urban Indigenous Health’s Deadly Choices. It offers lessons for all health promotion practice, she says.
Her challenge is timely, with the Public Health Association of Australia’s 43rd annual conference starting in Perth tomorrow (follow #PHAA2014 for Twitter news from the conference).
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Global Health Promotion, 2013
Introduction:
The Ottawa Charter is undeniably of pivotal importance in the history of ideas a... more Introduction:
The Ottawa Charter is undeniably of pivotal importance in the history of ideas associated with the establishment of health promotion. There is much to applaud in a charter which responds to the need to take action on the social and economic determinants of health and which seeks to empower communities to be at the centre of this. Such accolades tend to position the Ottawa Charter as ‘beyond critique’; a taken-for-granted ‘given’ in the history of health promotion. In contrast, we argue it is imperative to critically reflect on its ‘manufacture’ and assess the possibility that certain voices have been privileged, and others marginalized.
Methods:
This paper re-examines the 1986 Ottawa Conference including its background papers from a postcolonial standpoint. We use critical discourse analysis as a tool to identify the enactment of power within the production of the Ottawa health promotion discourse. This exercise draws attention to both the power to ensure the dominant presence of privileged voices at the conference as well as the discursive strategies deployed to ‘naturalize’ the social order of inequality.
Results:
Our analysis shows that the discourse informing the development of the Ottawa Charter strongly reflected Western/colonizer centric worldviews, and actively silenced the possibility of countervailing Indigenous and developing country voices.
Conclusion:
The Ottawa Charter espouses principles of participation, empowerment and social justice. We question then whether the genesis of the Ottawa Charter lives up to its own principles of practice. We conclude that reflexive practice is crucial to health promotion, which ought to include a preparedness for health promotion to more critically acknowledge its own history.
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ABSTRACT For just $5.29 Australians can now purchase “Skins” from local, independent grocers to c... more ABSTRACT For just $5.29 Australians can now purchase “Skins” from local, independent grocers to cover their cigarette packet with the Aboriginal or Torres Strait Islander flag. We argue that this use of cultural content and copyright[1] imagery on cigarette packets negates health promotion efforts, such as Australia’s recent introduction of plain packaging laws and the subsequent dismissal of a legal challenge from the tobacco industry. Aboriginal and Torres Strait Islander people smoke over twice the rate of non-Indigenous Australians (ABS 2010). Health promotion practitioners working to reduce these smoking rates face the challenge of the broader historical and cultural context of smoking behaviour. In response, health promotion efforts have endeavoured to shift, displace and resist the notion that unhealthy behaviours, such as smoking, are inherently part of Aboriginal and Torres Strait Islander culture. Some examples of this approach include Queensland Health’s Smoke-free Support Program (Smoking: It could cost us our culture), the Institute for Urban Indigenous Health’s Deadly Choices campaign and other initiatives beyond Queensland (for example, Adams et al 2010; Basinkski and Parkinson 2001). Brady (2002) has noted how throughout colonial contact, Europeans have exploited Aboriginal addiction to nicotine and therefore as health practitioners, we are concerned about what may be the continued exploitation of Aboriginal and Torres Strait Islander people for economic gain. We also note that Skins are available with the Australian flag and are concerned that more broadly, cultural and national pride is being manipulated by these companies. In other words, the sale of products that appropriate cultural content and copyright imagery for the purpose of enhancing the appeal of cigarettes is cause for alarm for us. As a practice, health promotion endeavours to secure equal opportunity and resources to enable people to achieve their full potential in life. Thus, we raise this issue for your awareness and welcome your analysis, comments and suggestions for action. We are also working on possible responses with advocacy organisations. Acknowledgement: The authors would like to acknowledge the contributions of Arika Errington (NACCHO) to this article. References: Adams K, Liebzeit A, Jakobi M. (2010). “How’s your sugar?: A deadly website for you, your family and your community.” Aboriginal and Islander Health Worker Journal, Aug;34(5):2. Australian Bureau of Statistics (2010). “The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, October 2010.” Journal ABS Cat No 4704.0(Issue) http://abs.gov.au/ausstats/abs@.nsf/mf/4704.0/ Basinski D, Parkinson D. (2001). “’We saw we could do it ourselves’: Koorie Cultural Regeneration Project.” Australian Journal of Primary Health;7(1):111-5. Brady, M. (2002) “Health inequalities: Historical and cultural roots of tobacco use among Aboriginal and Torres Strait Islander people” Australian and New Zealand Journal of Public Health 26(2): 120-124 [1] We note that both the Aboriginal and Torres Strait Islander flags are copyrighted materials and therefore must be reproduced in accordance the provisions of the Copyright Act 1968 or with the permission of the artists, respectively Harold Thomas and the Island Coordinating Council.
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Pacific health dialog, Jan 1, 2007
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Medicine, Jan 1, 2007
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Strategic planning and intersectoral collaboration have been identified as important processes fo... more Strategic planning and intersectoral collaboration have been identified as important processes for attaining sustainable and successful health outcomes. However, little evidence of the effectiveness of this exists in practice. Therefore, there is a requirement for evaluation of existing programs. This study examines the development and initial implementation processes of the Queensland Skin Cancer Prevention Strategic Plan 2001-2005 (QSCPSP). The study has two aims: (1) to develop a process evaluation model for assessing the effectiveness of the planning and preliminary implementation processes of the QSCPSP, and (2) to apply this model to the QSCPSP. By implication, information gathered from this will inform future strategic planning and intersectoral collaboration processes for health promotion. The study's process evaluation model consists of four elements: (1) program reach, (2) program acceptability, (3) intersectoral collaboration, and (4) program integrity. Sub-criteria e...
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Recently, I returned from a 3 month adventure in Geneva where I was a World Health Organization i... more Recently, I returned from a 3 month adventure in Geneva where I was a World Health Organization intern. This proved to be an incredible experience that I would like to share with you. My internship was with the School Health and Youth Health Promotion team (SHP), which currently sits within the Department of Chronic Disease and Health Promotion. My project involved synthesising the evidence and range of regulatory responses regarding the impact of alcohol marketing on young people. This project both informed the activities of SHP and will form part of a soon-to-be-published WHO monograph. The assignment I was responsible for was highly stimulating, particularly because it gave me the opportunity to approach health promotion as a WHO staff member and thus learn more about the WHO's perspective on the area. I also found that working at the WHO was a fantastic networking opportunity; I met with many WHO staff I had previously only read of and discussed their program areas, their ex...
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Conference Presentations by Karen McPhail-Bell
This presentation provides an overview of the history of Can Get Health in Canterbury and a brief... more This presentation provides an overview of the history of Can Get Health in Canterbury and a brief example of how it has translated to action to address health inequities in Canterbury, NSW.
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Uploads
Papers by Karen McPhail-Bell
outputs such as peer-reviewed papers. Research translation needs to increase and the pathways to impact ought to be more transparent. These processes are particularly pertinent to the Indigenous health sector given
continued concerns that Indigenous communities are over-researched with little corresponding improvement in health outcomes. This paper describes the research protocol of a mixed methods study to apply FAIT (Framework to Assess the Impact from Translational health research) to the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI). FAIT will be applied to five selected CRE-IQI Flagship projects to encourage research translation and assess the wider impact of that research.
Methods and analysis Phase I will develop a modified programme logic model for each Flagship project including identifying process, output and impact metrics so progress can be monitored. A scoping review will inform potential benefits. In phase II, programme logic models will be updated to account for changes in the research pathways over time. Audit and feedback will be used to encourage research translation and collect evidence of achievement of any process, output and interim impacts. In phase III, three proven methodologies for measuring research
impact—Payback, economic assessment and narratives—will be applied. Data on the application of FAIT will be collected and analysed to inform and improve FAIT’s performance.
Ethics and dissemination This study is funded by a nationally competitive grant (ID 1078927) from the Australian National Health and Medical Research Council.
Ethics approval was obtained from the University of Newcastle’s Human Research Ethics Committee (ID: H-2017–0026). The results from the study will be presented in several peer-reviewed publications, through conference presentations and via social media.
Statistics regarding poor Indigenous health outcomes are common justification for mainstream health promotion intervention in Indigenous people’s lives. I won’t recount the statistics here; there is an abundance of material available describing Indigenous health inequalities.
Instead, I would like to highlight that these statistics provide another kind of evidence; that is, the lack of effective action to address Indigenous health disadvantage, including general failure to engage with the social, historical, political context of Indigenous Australians on their terms.
In this article, I call for acknowledgement of and apology for health promotion’s continued use as an apparatus of colonial control over Indigenous Australians, and make suggestions for ways to do things differently.
Please contact e.harris@unsw.edu.au for a copy of the full report.
An ethnographic study of health promotion practice was undertaken within an Indigenous-led health promotion team, to learn how practitioners negotiated tensions of daily practice. The study was strengths-based, informed by a theoretical framework that privileged Indigenous knowledges, perspectives and experiences, drawing on three theoretical tools: postcolonialism and critical race theory positioned the researcher and health promotion discipline; whilst cultural interface theory enabled the analysis to shift beyond a critique of the Western, to uncover the practitioners’ meaning-making in daily health promotion practice.
The practice revealed innovative, diverse, relationship-based approaches to health promotion that effectively shifted power from health promotion practitioner to Indigenous people and communities. Community choice and control were central to practice. Through a dialogical approach with Indigenous people and communities, Indigenous notions of health and healthy behaviours were embedded and Aboriginality was asserted as health promoting itself.
The study’s findings converge with global health promotion discourse. This suggests that paradoxically, decolonising health promotion practice in Indigenous contexts requires we ‘do things differently’, while adhering to health promotion’s philosophical foundations of empowerment and control. The study proposes four interrelated principles for decolonising health promotion, informed by the practice observed. The study concludes that decolonising health promotion practice requires a radical reworking of practitioner relationships with Indigenous people and communities. Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian health promotion practice.
In the article below, she argues that those working in the field could learn from strengths-based programs like The Institute for Urban Indigenous Health’s Deadly Choices. It offers lessons for all health promotion practice, she says.
Her challenge is timely, with the Public Health Association of Australia’s 43rd annual conference starting in Perth tomorrow (follow #PHAA2014 for Twitter news from the conference).
The Ottawa Charter is undeniably of pivotal importance in the history of ideas associated with the establishment of health promotion. There is much to applaud in a charter which responds to the need to take action on the social and economic determinants of health and which seeks to empower communities to be at the centre of this. Such accolades tend to position the Ottawa Charter as ‘beyond critique’; a taken-for-granted ‘given’ in the history of health promotion. In contrast, we argue it is imperative to critically reflect on its ‘manufacture’ and assess the possibility that certain voices have been privileged, and others marginalized.
Methods:
This paper re-examines the 1986 Ottawa Conference including its background papers from a postcolonial standpoint. We use critical discourse analysis as a tool to identify the enactment of power within the production of the Ottawa health promotion discourse. This exercise draws attention to both the power to ensure the dominant presence of privileged voices at the conference as well as the discursive strategies deployed to ‘naturalize’ the social order of inequality.
Results:
Our analysis shows that the discourse informing the development of the Ottawa Charter strongly reflected Western/colonizer centric worldviews, and actively silenced the possibility of countervailing Indigenous and developing country voices.
Conclusion:
The Ottawa Charter espouses principles of participation, empowerment and social justice. We question then whether the genesis of the Ottawa Charter lives up to its own principles of practice. We conclude that reflexive practice is crucial to health promotion, which ought to include a preparedness for health promotion to more critically acknowledge its own history.
Conference Presentations by Karen McPhail-Bell
outputs such as peer-reviewed papers. Research translation needs to increase and the pathways to impact ought to be more transparent. These processes are particularly pertinent to the Indigenous health sector given
continued concerns that Indigenous communities are over-researched with little corresponding improvement in health outcomes. This paper describes the research protocol of a mixed methods study to apply FAIT (Framework to Assess the Impact from Translational health research) to the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI). FAIT will be applied to five selected CRE-IQI Flagship projects to encourage research translation and assess the wider impact of that research.
Methods and analysis Phase I will develop a modified programme logic model for each Flagship project including identifying process, output and impact metrics so progress can be monitored. A scoping review will inform potential benefits. In phase II, programme logic models will be updated to account for changes in the research pathways over time. Audit and feedback will be used to encourage research translation and collect evidence of achievement of any process, output and interim impacts. In phase III, three proven methodologies for measuring research
impact—Payback, economic assessment and narratives—will be applied. Data on the application of FAIT will be collected and analysed to inform and improve FAIT’s performance.
Ethics and dissemination This study is funded by a nationally competitive grant (ID 1078927) from the Australian National Health and Medical Research Council.
Ethics approval was obtained from the University of Newcastle’s Human Research Ethics Committee (ID: H-2017–0026). The results from the study will be presented in several peer-reviewed publications, through conference presentations and via social media.
Statistics regarding poor Indigenous health outcomes are common justification for mainstream health promotion intervention in Indigenous people’s lives. I won’t recount the statistics here; there is an abundance of material available describing Indigenous health inequalities.
Instead, I would like to highlight that these statistics provide another kind of evidence; that is, the lack of effective action to address Indigenous health disadvantage, including general failure to engage with the social, historical, political context of Indigenous Australians on their terms.
In this article, I call for acknowledgement of and apology for health promotion’s continued use as an apparatus of colonial control over Indigenous Australians, and make suggestions for ways to do things differently.
Please contact e.harris@unsw.edu.au for a copy of the full report.
An ethnographic study of health promotion practice was undertaken within an Indigenous-led health promotion team, to learn how practitioners negotiated tensions of daily practice. The study was strengths-based, informed by a theoretical framework that privileged Indigenous knowledges, perspectives and experiences, drawing on three theoretical tools: postcolonialism and critical race theory positioned the researcher and health promotion discipline; whilst cultural interface theory enabled the analysis to shift beyond a critique of the Western, to uncover the practitioners’ meaning-making in daily health promotion practice.
The practice revealed innovative, diverse, relationship-based approaches to health promotion that effectively shifted power from health promotion practitioner to Indigenous people and communities. Community choice and control were central to practice. Through a dialogical approach with Indigenous people and communities, Indigenous notions of health and healthy behaviours were embedded and Aboriginality was asserted as health promoting itself.
The study’s findings converge with global health promotion discourse. This suggests that paradoxically, decolonising health promotion practice in Indigenous contexts requires we ‘do things differently’, while adhering to health promotion’s philosophical foundations of empowerment and control. The study proposes four interrelated principles for decolonising health promotion, informed by the practice observed. The study concludes that decolonising health promotion practice requires a radical reworking of practitioner relationships with Indigenous people and communities. Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian health promotion practice.
In the article below, she argues that those working in the field could learn from strengths-based programs like The Institute for Urban Indigenous Health’s Deadly Choices. It offers lessons for all health promotion practice, she says.
Her challenge is timely, with the Public Health Association of Australia’s 43rd annual conference starting in Perth tomorrow (follow #PHAA2014 for Twitter news from the conference).
The Ottawa Charter is undeniably of pivotal importance in the history of ideas associated with the establishment of health promotion. There is much to applaud in a charter which responds to the need to take action on the social and economic determinants of health and which seeks to empower communities to be at the centre of this. Such accolades tend to position the Ottawa Charter as ‘beyond critique’; a taken-for-granted ‘given’ in the history of health promotion. In contrast, we argue it is imperative to critically reflect on its ‘manufacture’ and assess the possibility that certain voices have been privileged, and others marginalized.
Methods:
This paper re-examines the 1986 Ottawa Conference including its background papers from a postcolonial standpoint. We use critical discourse analysis as a tool to identify the enactment of power within the production of the Ottawa health promotion discourse. This exercise draws attention to both the power to ensure the dominant presence of privileged voices at the conference as well as the discursive strategies deployed to ‘naturalize’ the social order of inequality.
Results:
Our analysis shows that the discourse informing the development of the Ottawa Charter strongly reflected Western/colonizer centric worldviews, and actively silenced the possibility of countervailing Indigenous and developing country voices.
Conclusion:
The Ottawa Charter espouses principles of participation, empowerment and social justice. We question then whether the genesis of the Ottawa Charter lives up to its own principles of practice. We conclude that reflexive practice is crucial to health promotion, which ought to include a preparedness for health promotion to more critically acknowledge its own history.
While the potential for health promotion through social media is widely recognised, little research regarding its use in health promotion exists. Lessons can be learnt from the Indigenous health sector, which leads with innovative social media for advocacy, health promotion and community development.
Methods
An ethnographic study was undertaken with Deadly Choices. Multiple Deadly Choices social media platforms were examined in fieldwork. This spanned formal social media interactions, such as competitions and incentives for engagement, and informal interactions involving unprompted community engagement with Deadly Choices social media.
Results/discussions
The study found that Deadly Choices social media platforms provide powerful tools for creating a safe, inclusive and positive space for community members to profile their healthy choices, according to Indigenous notions of health and identity. Using social media, Deadly Choices has facilitated a culture shift in its rapidly enlarging online community, to be one of pride and strength in being a healthy leader. While not the only mechanism for community engagement, the competition incentives – particularly the Deadly Choices merchandise – remain important. Indigenous and non-Indigenous people alike appear to embrace Deadly Choices social media, where retweets and reposts provide tangible evidence of Deadly Choices practitioners listening to and supporting the community’s healthy choices.
Conclusions/implications
Social media enables Deadly Choices practitioners to share ownership of the Deadly Choices brand and therefore, of the meaning of Indigenous health and healthy behaviours. In doing so, Deadly Choices social media repositions Indigenous identity as health promoting, and empowers Indigenous people and communities as leaders and health promoters.
Key message
Deadly Choices uses social media as a tool for empowering Indigenous people to take control over their health. Through social media, power is shared between health promotion practitioner and community, which upholds health promotion principles while resisting the deficit labels of public health regarding Indigenous Australians.
To complement this call, this paper presents findings of an ethnographic study of Indigenous health promotion practice, undertaken from a postcolonial and critical whiteness framework. These findings provide a narrative of strength and innovative approaches, highlighting the value of Indigenous knowledge. These findings also contradict the biomedical tendency to construct culture as illness-producing. More broadly, this study’s findings entail important lessons for health promotion to consider, if it is to move beyond the rhetoric, to truly increase people’s control over their health.