NSW Health resources health promotion, prevention and early intervention initiatives that address Aboriginal-determined priorities and are delivered by or in partnership with the ACCH sector.
Preventing illness and injury where possible and detecting and treating illnesses and injuries early in their progression, both protects the wellbeing of Aboriginal families and communities and reduces pressure on healthcare services. The higher burden of chronic disease experienced by Aboriginal people means there is a critical need to acknowledge the links between how Aboriginal people experience healthcare settings, learn about health and wellbeing, and make decisions about their own health. This will support proactive approaches to health promotion, prevention, and early intervention.
Effective approaches to health promotion, prevention and early intervention take a holistic approach to people, processes, activities, settings and structures, and the dynamic relationships that operate between them.
Initiatives, or their customisation, are best determined locally through partnerships between Aboriginal communities, healthcare providers, and policymakers.
Social and emotional wellbeing is a strengths-based and holistic concept that centres upon the indivisible relationships between individuals, family, community, land, culture, spirituality and ancestry.
This is the foundation of health for Aboriginal people99 and is itself a crucial element of health promotion, prevention, and early intervention.
As the historical and ongoing impacts of colonisation have fractured these connections for many Aboriginal people, initiatives to support improved social and emotional wellbeing through a trauma-informed and healing-centred lens are therefore critical to preventing and effectively treating illness and injury100.
As climate change and natural disasters accelerate in speed and severity, environmental health–the ways in which our physical, chemical and biological environments affect our health and wellbeing–is becoming a more prominent policy focus. Aboriginal peoples’ deep cultural connections to Country, including both lands and waters, means environmental health is particularly vital to the prevention of illness and injuries.
Health promotion, prevention and early intervention approaches to public health collectively aim to reduce the incidence and severity of all types of illness and injury–including mental ill-health, social and emotional wellbeing challenges, communicable diseases, chronic diseases, and accidental injury–with the ultimate goal being to reduce the mortality associated with any given condition.
Health promotion focuses on enabling people to be in control of their health by ensuring they have access to the knowledge and tools required to lead long and healthy lives. Specifically, health promotion aims to foster protective factors and provide the information and opportunities to make healthy choices that can help prevent ill health before it occurs, aid in the early identification of risk factors or symptoms, and/or reduce the long-term impacts of illness or injury by seeking effective treatment pathways as early as possible101.
Strategies to foster good social and emotional wellbeing are examples of health promotion, as they can aid in early identification and support for individuals at risk, thereby preventing the escalation of mental health issues.
Health promotion is a critical element of preventing and effectively managing chronic diseases, given chronic illness is so closely interlinked with the social determinants of health102.
Prevention –or preventive health –focuses on detecting and responding to risk factors and promoting protective factors that prevent the development of health concerns, including through an early life approach where children access preventive care to avoid disease progression and comorbidities later in life.
Early intervention focuses on identifying, diagnosing, treating and managing health and wellbeing issues to reduce their severity and/or slow their progression over time.
Creating trust is key to engagement of Aboriginal people in health promotion, prevention and early intervention initiatives. Initiatives will be more effective when the following are considered, understood and reflected in initiative design: the social and historical context of colonisation, systemic racism and intergenerational trauma; the ongoing social, political, economic and environmental factors that impact Aboriginal people; the protective role of culture; and the importance of communities being able to self-determine their health and wellbeing priorities103.
“To achieve outcomes, we need to shift focus from sickness, illness and disease, to an intervention and prevention focus.” ACCHO representative, Advisory Committee member
“To achieve outcomes, we need to shift focus from sickness, illness and disease, to an intervention and prevention focus.”
“For young people, knowing what’s out there to access, what NSW Health can offer us, is really important.” Youth (urban) consultation participant
“For young people, knowing what’s out there to access, what NSW Health can offer us, is really important.”
Health promotion, prevention and early intervention initiatives are resourced commensurate with need and reflect priorities and implementation approaches that are determined by Aboriginal people.
Culture acts as a protective factor for Aboriginal peoples’ social and emotional wellbeing and has done so for thousands of generations. However, many Aboriginal people carry deep and lasting experiences of personal and intergenerational trauma, including disconnection from culture and kinship networks, as an ongoing legacy of colonisation and the fight against systemic oppression104. Nationwide, surveys indicate Aboriginal people experience both self-reported psychological distress and diagnosed mental health conditions more frequently than non-Indigenous people105, and racial discrimination continues to play a significant causal role in these figures106.
The health system, along with broader wraparound services and supports, therefore needs to embed trauma-informed and culturally grounded approaches to mental health and social and emotional wellbeing, which support Aboriginal people and communities to heal. In NSW, the relevant overarching policy framework is the Aboriginal Mental Health and Wellbeing Strategy 2020–2025, which aims for all Aboriginal people in NSW to have access to support services that provide the best opportunity for proactive promotion of social and emotional wellbeing and effective, timely treatment of mental health conditions. In directing NSW Health organisations on planning and delivering culturally safe, accessible, responsive and flexible mental health and wellbeing care for Aboriginal people and communities, it is designed to support non-Indigenous organisations, teams and people to work respectfully in partnership with Aboriginal services and communities107.
“We have a facility here specifically for Aboriginal and Torres Strait Islander people. Their success rate is astronomical. It’s fantastic and it’s so good to see people completing this program. It’s set away out in the bush... and they have a weaving course and connecting and doing those cultural things that we’ve lost. I think everyone could really benefit from having that, but having that as a specific rehabilitation centre has been really wonderful for our community.” Youth (regional) consultation participant
“We have a facility here specifically for Aboriginal and Torres Strait Islander people. Their success rate is astronomical. It’s fantastic and it’s so good to see people completing this program. It’s set away out in the bush... and they have a weaving course and connecting and doing those cultural things that we’ve lost. I think everyone could really benefit from having that, but having that as a specific rehabilitation centre has been really wonderful for our community.”
For support services to most accurately reflect Aboriginal lifeways, wellbeing models and healing methodologies, it is important that services are designed and implemented by Aboriginal people with personal experience of living with mental ill-health and psychological distress. The numerous benefits that embedding lived experience can have on service delivery and client outcomes are well known: ‘needs are better met when people with lived experience are involved in designing and evaluating policies and services’108. Aboriginal people will, therefore, feel safer and more engaged if social and emotional wellbeing services are designed with rather than for them.
Aboriginal cultural determinants of health and lived experience expertise are institutionally embedded in social and emotional wellbeing promotion and care systems, which deliver community-driven trauma informed solutions in responding to social and emotional wellbeing priorities determined by Aboriginal people.
Environmental factors that create disproportionate health risks to Aboriginal people and communities include extreme weather events, poor air and water quality, housing that functions poorly and/or does not adequately meet the needs of larger family structures, and food insecurity109. These risks must be tackled with effective, cohesive and culturally safe responses that empower communities to create health-supportive environments and reduce risk factors for illness, social or mental ill-health, or injuries. Therefore, Aboriginal peoples’ priorities, needs, and cultural and environmental knowledges must be centred, and decisions made in genuine partnership between communities, health services and other relevant public sector organisations.
Involvement of Aboriginal people and organisations in the co-creation and delivery of environmental health responses focused on priorities that are determined by Aboriginal people is standard practice across the health system.