Mick Adams, Post Graduate Student, Master or Arts - Indigenous Research and Development. Centre for Aboriginal Studies. Curtin University of Technology. Perth Western Australia. September 1999

Improving Indigenous Men’s Health : A Cultural Perspective

Introduction.

My research attempted to explore ways of improving Aboriginal and Torres Strait Islander men’s health. The objectives of this study were (i) to undertake an analysis of the role of Aboriginal and Torres Strait Islander men in the management and maintenance of traditions, responsibilities and obligations as leaders, guardians and facilitators of health and well being in their community and family structures; and (ii) to assist stakeholders to formulate strategies to develop best practice models which have the potential to promote Aboriginal and Torres Strait Islander men’s health throughout Australia.

A statement made by an Aboriginal Elder at a health forum in the Northern Territory in 1993 has fostered the interest in my research. He stated that "Men have been dragging the chain while the women have been leading the way." This research has also been influenced by the concerns raised by the many Aboriginal and Torres Strait Islander men who say that women’s health has been high on the agenda while there are no similar agenda, resources or programs available to assist men. Men’s health has not had the same attention as women’s health.

The research advocates an approach to evaluate ways to improve Aboriginal and Torres Strait Islander men’s health, focusing particularly on the place of culture, traditional roles, responsibilities and the obligations of men in facilitating health improvement. It employed a collaborative approach to acquiring and recording information to ensure that the formulation of programs to address Aboriginal and Torres Strait Islander men’s health is done in a culturally appropriate manner. The research aim to empower Indigenous men by drawing on Aboriginal and Torres Strait Islander knowledge to provide both a cultural and a gender perspective, and to formulate strategies in order to develop best practice models.

The Issues

It was important to carryout this research because little has been achieved to enhance Indigenous men’s health and because it is carried out by an Aboriginal and Torres Strait Islander male. My position as an Indigenous researcher equips me to work in culturally appropriate ways in partnership with Aboriginal and Torres Strait Islander

Despite a huge investment in Aboriginal health in recent years the health status of Aboriginal and Torres Strait Islander men is still poor. A wide range of studies and reports (National Aboriginal Health Strategy 1989, Swan & Rapheal 1995, Burdekin 1993, Nagel et al…1996, Reid & Trompf 1991, RCIADIC 1991) indicate that the health of Aboriginal and Torres Strait Islanders is exceedingly poor in comparison to non-Indigenous Australians. The Queensland Department of Health Status Report (1996) on Aboriginal and Torres Strait Islanders indicates that Indigenous health is the worst of any social group in Australia. The Draft National Men’s Health Policy (1996:29) supports this finding, concluding that Aboriginal and Torres Strait Islander men have consistently poorer outcomes across the range of health indicators compared to the wider Australian community.

Most attempts to improve men’s health have been based on western medical approaches and have failed to achieve any substantive improvement. Aboriginal and Torres Strait Islander men experience a greater incidence of major illness such as diabetes, hypertension and cardiovascular disease, than the Australian population as a whole. In the report titled The Health and Welfare of Aboriginal and Torres Strait Islander Peoples (joint publication of the Australian Bureau of Statistics) Sir William Deane (1998:3) states that "A young man in this country (Australia) is at present almost three times more likely to die between the ages of 15 and 24 if he is an Aboriginal than if he is not." The Queensland Department of Health Status Report (1996:3) found that the life expectancy for Indigenous males in Queensland (56 years) is 19 years lower than the figure for all Queensland males.

The impact of colonisation has been instrumental in shaping, the behaviour, health and well-being of Aboriginal and Torres Strait Islander people today. Rowley (1974:7) suggest that policy makers and other non-Indigenous people have made insufficient allowance for the violent treatment of Aboriginal people. Rowley (1974:5) points out that Australian versions of history have generally paid little attention to the Aboriginal resistance to white settlement and its impact on Aboriginal people to the present day. Homicide, rape, and cruelty have been commonplace over wide areas and for long periods. Rowley suggests that historical studies of the interaction of the two racial groups have sanitised the role of settlers and government.

The processes of colonisation have taken away many responsibilities from Aboriginal and Torres Strait Islander men. The introduction of government policies has had a detrimental effect on the status of Aboriginal men. The establishment of missions and settlements restricted men from performing their traditional roles as land owners, educators, father figures, providers and decision makers, breaking their spirit and connection to the land. Thus, Bellear (1995:77) reports that men’s roles, in particular, have suffered due to the changes to traditional lifestyle and the disruption of family structures. Aboriginal and Torres Strait Islander men have been disempowered through the reduction of their authority and status, and also because of restrictions on their cultural activities and values. Aboriginal men who were members of the lost generation have been rendered dysfunctional by stress and have not been able to fulfil their traditional role. In many areas Aboriginal and Torres Strait Islander men have watched their women struggle to have their issues raised, recognised and addressed, while they sought their solace in alcohol, abuse and self-destruction (Adams 1997:1).

The Research Process

I believe that in order to address the issues raised above I needed to carry out a comprehensive research that included discussions with Aboriginal and Torres Strait Islander peoples. This research employed a qualitative approach to gathering information and recording Aboriginal and Torres Strait Islander men’s experiences of issues associated with their health and well-being (Marshall and Rossman, 1995). The research employed a systematic method of acquiring knowledge and appropriately empowering people. This investigative approach facilitates a holistic interpretation in accordance with Aboriginal Terms of Reference, thereby, enabling communities to have controlled ownership of the development and implementation of outcomes (Postgraduate Students MIRD, 1998).

The research encompassed an Aboriginal terms of reference (Osborne & Dick, 1994: 7; Kickett, 1992: 38) to include cultural knowledge, understanding and experiences that are associated with a commitment to Aboriginal ways of thinking, working and reflecting. Aboriginal Terms of Reference incorporates specific and implicit cultural values, beliefs and priorities, from which Aboriginal standards are derived, validated and practised. Aboriginal Terms of Reference principles and core values are issue-specific and context bound. That is, they recognise diversity, current realities and apply an Aboriginal worldview as a framework for research. This takes into account cultural and experiential knowledge, a commitment to Aboriginal ways of thinking, working and reflecting and to the empowerment, hopes, goals and aspirations of the research participants. Aboriginal Terms of Reference will change to suit the diverse range of cultural values, beliefs and priorities from within local settings or specific contexts (Osborne & Dick, 1994).

In the past Aboriginal people have been subjected to intrusive, damaging, disempowering and prolific research. It is difficult to estimate the extent of the harmful effects that such research may have had. Such harmful effects have been both direct and indirect in nature. Past methods of research have been imposed upon Aboriginal people by researchers who have retained control of the research project, who have failed to involve people in a collaborative effort and who have not shared information. This scenario is the one most likely to have a negative effect on any community and produce an outcome which is misinformed, could be rejected and may harm an individual or group.

Historically, research methodologies have been inappropriate, unaccepted and most time, degrading. The method of research have not consented with Aboriginal peoples, often exploiting the culture, knowledge and experience of Aboriginal people, giving nothing in return for the information received. That is, the information has been used for the researchers professional gain rather than the advancement of Aboriginal people and their communities. Bourke (1995, cited in Scougall 1997:54, Williams and Stewart 1992:20) reminds us that the history in Aboriginal and Torres Strait Islander communities is the history of something ‘done to’ Aboriginal and Torres Strait Islander people, not something which communities have initiated, constructed, controlled or benefited from. The appropriation of Indigenous knowledge has done little to enhance the lives of Indigenous people.

Scougall quotes Dodson (1994:4) by stating that mainstream knowledge of communities has primarily been the product of people who don’t live in them, but who nevertheless ‘have had a preoccupation with observing, analysing, studying, classifying and labelling Aboriginal and Torres Strait Islander people and their Aboriginality’. Scougall continues by saying the consequently the Aboriginal and Torres Strait Islander community experience of research has generally been less than positive. He quotes Attwood and Arnold (1992) by saying that too often community members have been reduced to the status of "inert objects who are spoken for by others, by Aboriginalists who claim that this knowledge is a representation of the real".

Brady (1992: 107) explains how this method has done very little to enhance Aboriginal people’s control of the research outcomes stemming from such research. Most research has been undertaken by non-Aboriginal people for reasons external to Aboriginal people’s need or interest, and has in most circumstances has been done on Aboriginal people. The inability to have input into, control over or ownership of the results of research has more often than not further disempowered Aboriginal people (Arbon, 1992: 99). Aboriginal and Torres Strait Islander people must be fully involved in research to continue the momentum set by those before us, and to identify new challenges and perspective’s to the research process and methodology (Arbon, 1992:99). It is essential that the project enact research processes that are ethical and appropriate from an Aboriginal perspective.

Whilst the main focus group is made up of Aboriginal and Torres Strait Islander men, processes for participation in this research project will include both men and women. Women are an integral part of the family structure and indeed men’s lives. They will be important participants in this research to identify issues and areas for improvement. If women are leading the way in Aboriginal and Torres Strait Islander health, than it’s only common sense to utilise their expertise. Their contribution will help destroy the negatives and replace it with positives. In pre-colonial traditional settings, Aboriginal and Torres Strait Islander gender issues were balanced in that men and women had equal responsibilities in maintaining the family structure. I believe that in order to improve men’s health you have to include the women.

The Consultation Process

To ensure a collaborative approach to gathering and recording information is included, this research was carried out in partnership with the Aboriginal and Islander Community Health Service (AICHS) in Brisbane. It focused on participants who utilise the service or who had some association with the service, for example Aboriginal Health Worker students, University students, funding bodies and other Aboriginal medical services’ staff. The AICHS covered a vast section of the south Brisbane region, providing a delivery of service to a mixed population of Aboriginal and Torres Strait Islander population. While much of the research concentrated within the area of service, it did at times venture out to other communities. These visits were not totally related to the research but it provided the opportunity to seek other people’s views on the research topic. This process also encouraged other men or stakeholders to discuss the topic of men’s health and to formulate ideas on how to address these issues. The process also invited other men to take the opportunity to tap into the program that was being administered by AICHS by utilising the Indigenous Men’s Health Co-ordinator, and of course, the researcher, to facilitate workshops that dealt with men’s health.

I believe that discussions on men’s health should not be separate from women’s health. This challenge highlights a holistic approach to the analysis of particular manifestations of illness with the basis of health and ill-health being seen to be very much in the family context and/or the domain of male and female relationship (Arbon, 1992:102). Men’s health, like women’s issues, has now been placed on the national, state and local agenda. This research was not established to debate gender issues, its aim was to consider negative processes and influences, such as government policies, genocide and racism, that have damaged the status and well-being of indigenous men and Aboriginal family structures and societies.

I believe that the plight of Aboriginal and Torres Strait Islander women have encouraged some men to look at taking appropriate measures to attend to their health. Women have been tireless in the struggle to improve the health and well-being of Aboriginal and Torres Strait Islander people. While attempts to improve the health of Aboriginal and Torres Strait Islander women have been on the national and political agenda for some time, and despite the huge amount of funding spent on Indigenous health a lot more work need to be done in this area.

Meetings were held with the women, giving them the opportunity to voice their opinion on men’s health. In addition women were invited to participate in the men’s health workshops. I was overwhelmed with the women’s approach and response to men’s health. I felt comfortable in consulting with the women, because I knew that they would have a lot to offer and that they were extremely conscience of the issues that were affecting the health of their menfolk. I also felt that, in addition to gathering the perspective of men, the women, in contrast, would be able to provide an additional perspective to the way they identified issues associated with men’s health.

As a researcher, I was open to and accepted criticism from both men and women about my method of cutting across cultural boundaries of mixing men’s business with women’s business. In most cases, while people suggested that it was unusual (not the done thing) they had no hesitation in contributing to the research. I welcomed both negative and positive response to my questions. I believed and promoted that negative responses were important, because they could be dealt with, and that positive responses were encouraging but not final and they too could be improved.

Conclusion.

Sabo and Gordon (1995:17) reveal that health seems to be one of the most clear-cut areas in which the damaging impact of traditional masculinity is evident. In following Sabo and Gordon’s lead I agree that the studies in the area of men’s health will only become meaningful through the participation and influence of women. I am mindful of the women’s positions and did not want to promote the division between men and women. Lorder (1994) in Sabo and Gordon (1995:16) explains that men need personal change, but this needs to be done without changing the political, economic and ideological structures of the gender order.

The worldview of Aboriginal health incorporates a holistic perspective. Therefore, in order to improve men’s health, the research should not only highlight gender issues, it must also incorporate the negative processes, such as government policies, genocide and racism, that has damaged the status and well-being of Indigenous men and Aboriginal family structures and societies.

The challenge was to develop a process, which incorporated active participation for both Aboriginal and Torres Strait Islander men and women to become involved in. I believed that the key motivator was to reconcile the family unit through initiatives of empowerment, self-determination and by addressing the health and well-being of men and women. From this starting point the concept of men taking control of their health, responsibilities and obligations could be encouraged from a community perspective.

In my attempts to address Aboriginal and Torres Strait Islander men’s health I use this philosophy:

If the man is unwell, he can not provide for his family, therefore the family suffers. If the family suffers, then they draw on resources from the community, the over use or dependence of the community causes it to dysfunction, which becomes unhealthy.

If the man is well, he can provide for the family, therefore if the family is provided for, they will be nourished. If the family is satisfied then they need not draw on resources from the community, therefore the community stays healthy and all will function to their fullest potential (Adams 1997).

References:

Adams, M. (1997) "Men have been dragging the chain while women have been leading the way". A study into the delivery of service accessible to the needs of Aboriginal and Torres Strait Islander men’s health. (unpublished paper as part of Bachelor of Applied Science Aboriginal Community Management and Development), Centre for Aboriginal Studies, Curtin University of Technology, Perth, Western Australia.

Bellear, R. (1995) "Men’s Business" article in the Proceedings from the National Men’s Health Conference, Compiled by the Commonwealth Department of Human Services and Health, Australia Government Publishing Service, Canberra ACT.

Burdekin, B. (1993) Human Rights & Mental Illness, Report of the National Inquiry into the Human Rights of People with Mental Illness, Australian Government Publishing Service, Canberra ACT.

Commonwealth Department of Human Services and Health, (1995) The Proceedings from the National Men’s Health Conference Australia Government Publishing Service, Canberra ACT.

Deane, Sir William. (1998) "The Health and Welfare of Aboriginal and Torres Strait Islander Peoples" (joint publication of the Australian Bureau of Statistics), in Aboriginal Health, Issues in Society, Volume 87, The Spinney Press, Australia.

Denzin, Norman K. (1989) Interpretive Interactionism, Applied Social Research Methods Series Volume 16, SAGE Publication.

Dodson, P. L, (1991) Royal Commission Into Aboriginal Death In Custody, Regional Report of Inquiry into Underlying Issues in Western Australia, Volume 2, Australian Government Publishing Service, Canberra.

Healy, K. (1998) Aboriginal Health, Issues in Society, Volume 87, The Spinney Press, Australia.

Marshall, C., & Rossman, G. (1995) Designing Qualitative Research (second edition), SAGE Publications.

Nagel, T., Mills, R. & Adams, M. (1996) Summary of Findings - Evaluation of Urban Mental Health Service Delivery to Aboriginal People, Territory Health Services, Darwin NT.

National Aboriginal Health Strategy Working Party, (1989) A National Aboriginal Health Strategy, Australian Government Printing Service.

Queensland Health (Department of) (1996) Aborigines and Torres Strait Islanders Status Report, Health Information Centre.

Reid. J., & Trompf. P, (1991) The Health Of Aboriginal Australia, Harcourt Brace Jovanovich Group, Australia.

Rowley, C.D. (1974) The Destruction of Aboriginal Society, Penguin Books, Australia.

Stringer, Ernest T. (1996) Action Research: A Handbook for Practioners, SAGE Publication.

Swan, P., & Rapheal, B. (1995) "Ways Forward" National Consultancy Report on Aboriginal and Torres Strait Islander Mental Health Part 1 & 2, Australian Government Publishing Service, Canberra ACT.

email Mick at adamsm@miwatj.com.au