Student Corner

Aboriginal health

David Hains
First year nursing student, University of South Australia, SA

PP: 128 - 130

Abstract

Improving the health of Australian Aborigines remains a challenge for health care professionals. Understanding the meaning of the term health is central to this issue.

There are cultural differences that must be considered, and here the traditional Aboriginal view of health is compared with that of the World Health Organisation.

Article Text

Introduction

The health of Aboriginal Australians has long been a thorn in the side of health care professionals in this country. While Australia is considered 'The Lucky Country' for some, this is not reflected by current Aboriginal health statistics. Since the European invasion, the health status of the Aboriginal people, who were arguably one of the healthiest races in the world, has declined to such an extent that it is now on a par with many people who live in third world countries (McIlraith, Reid & Franklin 1982).

Health can only be defined in relation to a person's own values, which will, of necessity, reflect the cultural background of that person (Potter & Perry 1991). White Australian health professionals in general, and nurses in particular, need to understand the meaning of health within a traditional Aboriginal culture, in order to respond appropriately to the health needs of Aboriginal people. The aim of this paper is to discuss the Aboriginal view of health and compare it with that of the World Health Organization.

Traditional Aboriginal meaning of health

Within Aboriginal societies there is no direct equivalent for the word 'health' as it is known in Western society. In a traditional Aboriginal society health encompasses all aspects of life, '(n)ot just the physical well-being of the individual, but the social, emotional, and cultural wellbeing of the whole community' (National Aboriginal Health Strategy Working Party 1989). Dignity, self-esteem, justice and control over the physical environment are an important part of a healthy life.

Rose (1992), in her study of the Aboriginal people of the Victoria River Valley in the Northern Territory, describes health as punyu, a complete state of being, encompassing person and country. Punyu...

is variously translated as good, strong, healthy, happy, knowledgeable ('smart'), socially responsible (to 'take care'), beautiful, clean, and 'safe' both in the sense of being within the Law and in the sense of being cared for. (Rose 1992: 65)

According to Mobbs (1991), punyu is developed through a relationship of mutual care between body, land and spirit. Rose (1984) agrees with this mutual relationship when she states that punyu is not just being alive, but also contributing to life; '(w)hen people and country (are) both punyu the flow of energy keeps both strong, healthy, and fruitful'.

For the traditional Aboriginal, the most important aspect of peoples' health is their relationship with the land. Mobbs (1991) describes this by stating that health begins and ends with the land and all of its indigenous inhabitants, people, plants and animals. The social and legal systems of the Aboriginal people are based on their relationship with the land. Aboriginal law is built upon the relationship of 'country to country, country to plant and animal species, people to country, people to species, (and) people to people' (Rose 1992).

The bond between the traditional Aboriginal people and their land envelops their total social structure. Their religious, social and physical needs are bound up in the love, conservation and celebration of their country (Mcllraith et al 1982). Nathan and Japanangka (1983) describe this Aboriginal view of life and health as holistic, animistic and sacred. European invasion has had a disastrous effect on this relationship.

European invasion

It is widely accepted that when Captain Arthur Phillip arrived in Australia in 1788, the health of the Aboriginal people was generally better than that of the British (Staggers & Gray 1991, Mcllraith et al 1982). In the two centuries that have since passed, there has been a dramatic improvement in the health status of the white population in Australia and Britain but a catastrophic decline in that of the Aboriginal population of Australia (Franklin & White 1991).

According to Staggers and Gray (1991), from the outset, the British Government denied any prior ownership of Australia by the Aborigines, and therefore in British law, there were no obstacles to the acquisition of land for European purposes. At the time, British policy was to give Aboriginal people the full status and legal rights of British subjects. However, policies were generally abandoned when they impeded the desires of the European settlers, for example, in the acquisition of more farming land.

Franklin and White (1991) explain that the subsequent decline in the health of the Aboriginal people was due to three reasons. First the introduction of new diseases, second the forceful removal of their ancestral land, and third the substitution of a healthy lifestyle with a poor diet and living conditions. In addition there was physical confrontation, murder and rape. The result has been, and continues to be, physical and psychological illness and spiritual despair.

Staggers and Gray summarise this: '(w)ithin a few years of European settlement most of the necessary conditions for the maintenance of good Aboriginal health were absent.' (1991)

WHO view of health

In the preamble to the Constitution of the World Health Organization (WHO), written in 1946, health is defined as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (Moodie 1973). This definition is familiar to white Australians who work within the health care sector. It contains no mention of spiritual needs, nor any link between people's health, and the land, plants and animals. Forty years later, WHO (1986) identified the basic needs of all human beings as peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. These were said to be prerequisites for health, and it is here that a mention is made of the relationship between the environment and people's health. This is still very different from the spiritual bond of the traditional Aboriginal people with particular animals and plants that live in their homelands.

WHO implies that health is fundamental right of each individual, and that people should have the opportunities and resources to enable them to achieve their fullest health potential- a state of complete physical, mental and social well-being (WHO 1986). This view is accepted within the mainly white health care sector in Australia. Current health services however do not appear to deliver health, and this is obvious to nurses, doctors and Aboriginal people who have worked in Aboriginal communities (Reid 1982). While western health care may be successful in alleviating short term problems, it has shown that it is ineffective in resolving the long term problem which western culture.

Political, economic, social, cultural, environmental and biological factors can each be favourable or harmful to health in any society. Individuals cannot achieve their fullest health potential unless they have some control over the factors which determine their health. Where traditional Aborigines view life and health as being a part of the environment, WHO sees the environment as an external condition to which one must adapt in order to achieve good health.

Implications

The re-occupation of traditional homelands is seen by many Aborigines as their only hope for the future. This would allow Aborigines to be in the 'correct' relationship with the land, and therefore able to restore their health (Committee of review on environmental and public health within the Anangu Pitjantjatjara Lands 1987). This is borne out by Waterford who states

that the whole complex of ill-health can be altered only by Aboriginals themselves, and that the mechanism for achieving this alteration is the giving back to Aborigines of control over the factors that determine health: the whole living environment. (1982: 8)

In order to re-establish the concept of punyu, Aboriginal people must be given the opportunity to maintain their traditional relationship with the land. This would allow restoration of physical, social and spiritual harmony and therefore health. The mutual exchange of energy between land and people would again be possible.

Although in theory the return of control over the land to the Aboriginal people may be the single most important factor in improving their health, few would argue that this is possible on a large scale. While it is currently up to the politicians and lawyers to sort through the confusion brought about by Mabo, there are other issues to be addressed.

Conclusion

The question that needs to be asked is 'What is the meaning of health for each person and each community?' While there will very likely be some minor differences between the individual answers from within groups of black and groups of white Australians, there are significant differences between the meaning of health in the two cultural groups. The concept of health within a traditional Aboriginal society needs to be understood by all health care professionals, in order that the bond between Aboriginal people and the whole living environment can be appreciated. The World Health Organization definition of health which is understood by white Australians is not a good representation of the meaning of health for Australia's indigenous people.

A positive outlook about finding solutions for Aboriginal people is maintained by the Healthy Aboriginal Life Team, who believe that Aboriginal people will become strong and healthy again, just as they were in the past, when they were happy and free from sickness (1991). The concept of punyu must be understood, and kept in mind as solutions to Aboriginal health problems are sought by all those involved in health care. The common goal is to see Aboriginal people healthy again, and a mutual understanding of the meaning of health, is the beginning step towards a healthier future for the traditional owners of Australia.

Note: This paper is published with the approval of the Aboriginal Health Council of South Australia. The author wishes to acknowledge the help of members of the Council in supplying much of the literature consulted.

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