Decolonising Public Health: Applying epidemiology and Indigenous worldview to how health and well-being is considered by Aboriginal and Torres Strait Islander people

Abstract

This thesis presents a collection of applied epidemiological studies within an Aboriginal and Torres Strait Islander social, health and well-being context. I have applied mixed method approaches to epidemiological knowledge and methods to meet the required Masters of Philosophy in Applied Epidemiology (MAE) competencies. A social and cultural determinants of health framing was applied to the evaluation of a social health program, epidemiological study and data analysis study. Field work was undertaken with Aboriginal communities in the evaluation, epidemiological study and outbreak investigation and were underpinned by community engagement and community based participatory research models. The studies include: 1. Cross-sectional analysis of data from the Footprints in Time: Longitudinal Study of Indigenous Children (LSIC). The study explores the prevalence of community leadership aspirations and other future aspirations for children aged 9 to 12 years participating in Wave 8 of the LSIC study. Descriptive and analytical analyses were included to examine the association between leadership aspirations and key demographic factors: age, sex and remoteness. Additionally, I explored other self-reported aspirations for children with community leadership aspirations to further unpack leadership from a holistic perspective. I applied qualitative inquiry with LSIC key informants to contextualise the findings. An important feature of the study includes comparisons being made within an Aboriginal and Torres Strait Islander cohort, as opposed to comparisons between Indigenous and non-Indigenous people; 2. Outbreak investigation of mumps in an Aboriginal community in Queensland (Qld). The outbreak investigation took place in Yarrabah, March 2018 and was in partnership with Gurriny Yealamucka Health Service Aboriginal Corporation. The study included field epidemiology, advocacy and community engagement models of practice. Building relationships with the Aboriginal Health Workers (AHWs) was key to the study. The AHWs contributed to adaptation of a public health questionnaire and facilitated cultural brokerage between myself and the community to administer the follow-up questionnaire. I identified gaps between public health and primary health care practice and recommended practical strategies to help strength the relationship; and 3. Process evaluation of a Commonwealth funded program, Stronger Communities for Children (SCfC) was undertaken with a remote community in the Northern Territory, January to June 2018. A partnership between the ANU, Palngun Wurnangat Aboriginal Corporation, Kardu Lurruth Ngala Purrungime committee and community members guided the study. An epidemiological study was a component of the evaluation and included administering an adjusted survey instrument to collect data from the SCfC participants on cultural participation. Building community relationships was key and required a number of field visits to the community where I facilitated workshops with the main stakeholders to ensure community voice remained at the center of the study. Community input directed the study design, adaptation of the survey instrument, and development of the logic model and community researcher manual. Show more