Indigenous mental health promotion: process, politics, paradox and practicalities

[Extract]The burden of ill health confronting Aboriginal and Torres Strait Islander communities in Australia is now well recognised. Rates of nearly every major cause of ill health are higher, with indigenous life expectancy nearly two decades less than for the non-indigenous population. Not only is indigenous health poor by comparison to non-indigenous Australians, it is also poor by comparison to the indigenous populations of New Zealand, the United States and Canada where the last decades have seen significant reductions in the gaps between indigenous and non-indigenous life expectancy. By contrast, the gaps in Australia persist. In Australia, indigenous health initiatives have largely focused on treatment, and health promotion has only recently been placed on the agenda. In 1996 the NHMRC Health Advancement Standing Committee reviewed health promotion in indigenous Australia, identifying four principles essential for indigenous health advancement: 1. acknowledgment by non-indigenous Australians that Aboriginal people and Torres Strait Islander people have a right to their history, including the effects of colonisation on the health of Aboriginal people and Torres Strait Islander people today; 2. the inclusion of Aboriginal and Torres Strait Islander communities and individuals in allleve1s of decision making which affect their lives in general and their health in particular, through a community development approach; 3. the need for any initiatives to promote the health of Aboriginal people and Torres Strait Islander people to be integrated with culturally effective, high quality, accessible primary health-care services; and 4. the need for indigenous and non-indigenous Australians (and their organisations) to encourage the development of partnerships to improve Aboriginal and Torres Strait Islander health (NHMRC 1996, p. xi). These principles foreground social and historical context and are consistent with the now widely accepted holistic construction of indigenous health. Since the NHMRC report, indigenous health promotion has attracted significantly more interest including, for instance, a special issue of the Health Promotion Journal of Australia in 1998