Register      Login
Health Promotion Journal of Australia Health Promotion Journal of Australia Society
Journal of the Australian Health Promotion Association
RESEARCH ARTICLE

‘We don’t tell people what to do’: ethical practice and Indigenous health promotion

Karen McPhail-Bell A C , Chelsea Bond A , Mark Brough A and Bronwyn Fredericks B
+ Author Affiliations
- Author Affiliations

A Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia.

B Central Queensland University, Bruce Highway, North Rockhampton, Qld 4702, Australia.

C Corresponding author. Email: karenmcphailbell@gmail.com

Health Promotion Journal of Australia 26(3) 195-199 https://doi.org/10.1071/HE15048
Submitted: 29 May 2015  Accepted: 6 October 2015   Published: 25 November 2015

Abstract

Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people’s autonomy, health promotion also imposes a particular, health promotion-sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion’s paternalistic control over people, rather than people’s control over their own health. Herein we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion ‘interventions’. Moreover, the potential stigmatisation produced in any paternalistic acts ‘done for their own good’ cannot be assumed to have evaporated within the self-proclaimed ‘empowering’ narratives of health promotion. This issue’s guest editor’s call for health promotion to engage ‘with politics and with philosophical ideas about the state and the citizen’ is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion’s central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion’s broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion’s general failure to reduce health inequalities experienced by Indigenous Australians.


References

[1]  World Health Organization (WHO). The Ottawa charter for health promotion. Ottawa: WHO; 1986.

[2]  Carter SM, Rychetnik L, Lloyd B, Kerridge IH, Baur L, Bauman A, et al (2011) Evidence, ethics, and values: a framework for health promotion. Am J Public Health 101, 465–72.

[3]  Carter SM (2014) Health promotion: an ethical analysis. Health Promot J Austr 25, 19–24.
Health promotion: an ethical analysis.Crossref | GoogleScholarGoogle Scholar | 24739775PubMed |

[4]  Carter SM, Kerridge I, Sainsbury P, Letts JK (2012) Public health ethics: informing better public health practice. N S W Public Health Bull 23, 101–6.
Public health ethics: informing better public health practice.Crossref | GoogleScholarGoogle Scholar | 22738618PubMed |

[5]  Wardrope A (2014) Relational autonomy and the ethics of health promotion. Public Health Ethics 8, 50–62.

[6]  DeMaria AN (2013) The nanny state and ‘coercive paternalism’. J Am Coll Cardiol 61, 2108–9.
The nanny state and ‘coercive paternalism’.Crossref | GoogleScholarGoogle Scholar | 23603230PubMed |

[7]  Yeo M (1993) Toward an ethic of empowerment for health promotion. Health Promot Int 8, 225–35.
Toward an ethic of empowerment for health promotion.Crossref | GoogleScholarGoogle Scholar |

[8]  Australian Bureau of Statistics (ABS). Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012–13. Canberra: ABS; 2013.

[9]  Australian Government. Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Department of Health and Ageing; 2012.

[10]  McPhail-Bell K, Fredericks B, Brough M (2013) Beyond the accolades: a postcolonial critique of the foundations of the Ottawa Charter. Global Health Promot 20, 22–9.

[11]  Jones-Roberts A, Phillips J, Tinsley K (2014) Creating a sustainable health promotion workforce in Australia: a health promoting approach to professionalisation. Health Promot J Austr 25, 150–2.
Creating a sustainable health promotion workforce in Australia: a health promoting approach to professionalisation.Crossref | GoogleScholarGoogle Scholar | 25027656PubMed |

[12]  Buchanan D (2008) Autonomy, paternalism, and justice: ethical priorities in public health. Am J Public Health 98, 15–21.

[13]  Tengland P-A (2012) Behavior change or empowerment: on the ethics of health-promotion strategies. Public Health Ethics 5, 140–53.

[14]  Goldberg DS (2012) Social justice, health inequalities and methodological individualism in US health promotion. Public Health Ethics 5, 104–15.
Social justice, health inequalities and methodological individualism in US health promotion.Crossref | GoogleScholarGoogle Scholar |

[15]  Liberman J (2013) Plainly constitutional: the upholding of plain tobacco packaging by the High Court of Australia. Am J Law Med 39, 361–81.

[16]  Australian Institute of Health and Welfare (AIHW). Australia’s health 2014. Cat. no. AUS 178. Canberra: AIHW; 2014.

[17]  Clough AR, Robertson JA, MacLaren DJ (2009) The gap in tobacco use between remote Australian communities and the Australian population can be closed. Tob Control 18, 335–6.
The gap in tobacco use between remote Australian communities and the Australian population can be closed.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MrhtVCqtw%3D%3D&md5=87b0c2eecf550752ffb0ddabff2db0beCAS | 19633148PubMed |

[18]  Baum F (2007) Cracking the nut of health equity: top down and bottom up pressure for action on the social determinants of health. Promot Educ 14, 90–5.
Cracking the nut of health equity: top down and bottom up pressure for action on the social determinants of health.Crossref | GoogleScholarGoogle Scholar | 17665710PubMed |

[19]  Bond CJ (2005) A culture of ill-health: public health or Aboriginality? Med J Aust 183, 39–41.

[20]  Cribb A. Why ethics? What kind of ethics for public health? In Peckham S, Hann A, editors. Public health ethics and practice. Bristol: The Policy Press; 2010. pp. 17–31.

[21]  Thomas D. Reading doctors’ writing: race, politics and power in Indigenous health research, 1870–1969. Acton: Australian Institute of Aboriginal and Torres Strait Islander Studies, Aboriginal Studies Press; 2004.

[22]  Denness C (2013) The ethics of paternalism in Aboriginal policy. Eureka Street 23, 49–52.

[23]  Aboriginal and Torres Strait Islander Commission. Information sheet: social justice and human rights for Aboriginal and Torres Strait Islander peoples. Sydney: Human Rights and Equal Opportunity Commission; 2003.

[24]  Australian Health Promotion Association (AHPA). Core competencies for health promotion practitioners. Maroochydore, Qld: AHPA; 2009.

[25]  American Public Health Leadership Society. Principles of the ethical practice of public health version 2.2. Washington, DC: Public Health Leadership Society; 2002.

[26]  Brough M (2001) Healthy imaginations: a social history of the epidemiology of Aboriginal and Torres Strait Islander health. Med Anthropol 20, 65–90.
Healthy imaginations: a social history of the epidemiology of Aboriginal and Torres Strait Islander health.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FptFKksA%3D%3D&md5=a51a7189423c43722bb3c4e654417a2aCAS | 11820767PubMed |

[27]  Gillor G (2011) The program effectiveness review as a case study of the relationship between the Aboriginal community-controlled health services movement and the state, 1980–1982. J Aust Indigenous Issues 14, 151–69.

[28]  Parsons M (2010) Defining disease, segregating race: Sir Raphael Cilento, Aboriginal health and leprosy management in twentieth century Queensland. Aborig Hist 34, 85–111.

[29]  Bond C. ‘When you’re black, they look at you harder’: narrating Aboriginality within public health. Brisbane: University of Queensland; 2007.

[30]  Bond C, Brough M. The meaning of culture within public health practice: implications for the study of Aboriginal and Torres Strait Islander health. In Anderson I, Baum F, Bentley M, editors. Beyond bandaids: exploring the underlying social determinants of Aboriginal health. Papers from the Social Determinants of Aboriginal Health Workshop, July 2004, Adelaide, SA. Darwin: Cooperative Research Centre for Aboriginal Health; 2007. pp. 229–38. Available from: http://www.lowitja.org.au/beyond-bandaids [Verified 29 October 2015].

[31]  Bolt R. Urban Aboriginal identity construction in Australia: an Aboriginal perspective utilising multi-method qualitative analysis. Sydney: University of Sydney; 2010.

[32]  Jordan DE (1986) Aboriginal identity: the management of a minority group by the mainstream society. Can J Native Stud 9, 271–311.

[33]  Fanon F. A dying colonialism. New York: Grove Press; 1965.

[34]  Bond C, Brough M, Spurling G, Hayman N (2012) ‘It had to be my choice’. Indigenous smoking cessation and negotiations of risk, resistance and resilience. Health Risk Soc 14, 565–81.

[35]  Ogwang T, Cox L, Saldanha J (2006) Paint on their lips: paint-sniffers, good citizens and public space in Brisbane. J Sociol 42, 412–28.

[36]  McDonald E, Slavin N, Bailie R, Schobben X (2011) No germs on me: a social marketing campaign to promote handwashing with soap in remote Australian Aboriginal communities. Glob Health Promot 18, 62–5.
No germs on me: a social marketing campaign to promote handwashing with soap in remote Australian Aboriginal communities.Crossref | GoogleScholarGoogle Scholar | 21721304PubMed |

[37]  Tsey K, Every A (2000) Evaluating Aboriginal empowerment programs: the case of Family WellBeing. Aust N Z J Public Health 24, 509–14.
Evaluating Aboriginal empowerment programs: the case of Family WellBeing.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FntFamsw%3D%3D&md5=576bcae0013670a2ca1d0d12ef58b89eCAS | 11109688PubMed |

[38]  National Aboriginal and Islander Health Organisation (NAIHO). The NAIHO experience: evolving to the NAIHO congress. National Aboriginal and Islander Health Organisation; n.d.

[39]  NSW Health. Principles for better practice in Aboriginal health promotion: the Sydney consensus statement, NSW Health 2002. Sydney: NSW Department of Health; 2004.

[40]  Pyett P, Waples-Crowe P, van der Sterren A (2008) Challenging our own practices in Indigenous health promotion and research. Health Promot J Austr 19, 179–83.

[41]  World Health Organization (WHO). Global strategy for health for all by the year 2000. Geneva: WHO; 1981.

[42]  Thompson L, Kumar A (2011) Responses to health promotion campaigns: resistance, denial and othering. Critical Public Health 21, 105–17.

[43]  Stanner, WEH. The Boyer lectures 1968: after the Dreaming. Sydney, NSW: Australian Broadcasting Commission; 1969.