Australasian Psychiatry
Volume 11 Issue s1 Page S34 - October 2003
doi:10.1046/j.1038-5282.2003.02017.x
Indigenous Populations, Social determinants of health, the 'control factor'
and the Family Wellbeing Empowerment Program
Komla Tsey, Mary Whiteside, Audrey Deemal and Teresa Gibson
Objective: To explore links between the social determinants of health, the
'control factor', and an Aboriginal empowerment program.
Methods: The evidence that rank or social status is one of the most
important determinants of health is briefly presented. This is followed by
a critique of the Australian policy and intervention framework for tackling
and reducing social inequalities. The concept of 'control' as an important
element in addressing social determinants of health is examined next and
the Family Wellbeing empowerment program is analysed to illustrate how the
concept of control might be operationalised at program or intervention
level. Implications for health practitioners are identified.
Results: By providing a safe group environment for participants to explore
sets of critical questions about themselves, their families and
communities, through the process of participatory action research, Family
Wellbeing has demonstrated its potential to 'enable' Indigenous people to
take greater control and responsibility for their situation. While program
participants first address personal and immediate family issues, evidence
is emerging of a ripple effect of increasing harmony and capacity to
address issues within the wider community
Conclusions: The social determinants of health are complex and
multilayered and so addressing them needs to involve multilevel thinking
and action. The control factor is only one element, albeit an important
one, and Family Wellbeing is providing evidence that 'control' can be
addressed in Indigenous settings. For empowerment programs to achieve their
full potential, however, there is a need to ensure that such programs reach
a critical mass of the target group. It is also imperative that
policy-makers and practitioners take a longer-term approach, including
properly resourced longitudinal studies to document and enhance the
evidence base for such interventions. As health practitioners it is vital
we consider our work within this broader context, creatively seek to
enhance linkages between services and programs, and support processes for
change or intervention at other levels.
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