The social and cultural context of risk and prevention: food and physical activity in an urban aboriginal community

One of the key public health challenges facing indigenous and other minority communities is how to develop and implement effective, acceptable, and sustainable strategies for the prevention of non-insulin-dependent diabetes mellitus (NIDDM). In this article, the authors describe how an ethnographic approach was used to contextualize the behavioral risk factors for NIDDM and applied to the development of a more meaning-ful and appropriate epidemiological risk factor survey instrument for an urban Aboriginal population in Austra-lia. The overall research design comprised a mixture of qualitative and quantitative methods. The ethnographic study showed that the complex web of meanings that tie people to their family and community can and should be taken into account in any social epidemiology of health and illness if the findings are to have any effective and long-term potential to contribute to successful public health interventions targeting these behavioral risk factors. Notions of health risk among Aborigines in Melbourne, Australia, living with diabe-tes, cannot be meaningfully separated from the social risks of disconnection from family, past, and land. Food, in particular, represents powerful symbolic connections to belong-ing and sense of place and past within the Melbourne Aboriginal community. The mean-ings that food and other related social activities have are central in maintaining and reaf-firming connections between individuals and the wider social context of everyday life. Noncommunicable diseases, such as diabetes and coronary heart disease, are now the leading causes of morbidity and mortality in Aboriginal Australians, contributing to a life expectancy between 18 and 20 years less than that of non-Aboriginal Australians.1,2 The Samantha Thompson is a lecturer at the Australian Centre for International and Tropical Health and Nutri