"Our bodies aren’t meant to live the whitefellas way”: Navigating Indigenous oral health in neoliberal Australia

Abstract

Aboriginal and Torres Strait Islander Peoples have a healthy oral health history. Intentional disruptions initiated during colonisation and sustained by neoliberalism and institutional racism have had devastating impacts on oral health, and general wellbeing. Despite concerted efforts to reduce the experiences of oral diseases for Aboriginal and Torres Strait Islander Communities, inequities persist and, in some cases, have worsened. Therefore, the research comprising this thesis broadly aimed to further our understanding of the complex circumstances contributing to the inequitable experience of oral health for Aboriginal and Torres Strait Islander Peoples through qualitative methodologies. This thesis is broadly divided into four sections and 16 chapters. Section A provides an introduction to this thesis. It its divided into two parts, the first provides a brief overview of Aboriginal and Torres Strait Islander oral health in Australia. The second part is a literature review comprised of two qualitative systematic reviews. Section B details the methodologies and study design of this thesis. Chapter 4 provides details related to the study design, methodological approaches, and theoretical frameworks. Chapter 5 provides the Candidate’s positionality statement. Chapter 6 details a methodological approach to research, termed Relational Yarning, that was conceptualised alongside the research comprising this thesis. Section C includes the results generated from the research undertaken during Candidature and includes six chapters. Chapters 7, 8, and 9 detail barriers, facilitators, and motivators related to establishing and maintaining oral health for Aboriginal and Torres Strait Islander families. Chapters 10 and 11 focus on exploring the impact of neoliberalism on Aboriginal and Torres Strait Islander oral health as well as global Indigenous wellbeing. Section D provides an overview of the research presented in this thesis and recommendations for future directions. Chapter 13 and 14 are commentaries regarding aspects of concepts deemed critical during previous sections of the thesis: self-determination, resistance to neoliberalism, and the need to progress a strengths-based narrative regarding Aboriginal and Torres Strait Islander oral health. Chapter 15 provides concluding remarks and recommendations. This thesis provides evidence and suggestions to enhance existing facilitators to establishing and maintaining oral health, as identified by Aboriginal and Torres Strait Islander families and Indigenous Communities, globally. Aboriginal Community Controlled Health Organisations (ACCHOs) have a strong history of supporting Aboriginal and Torres Strait Islander self-determination and subsequently, Community wellbeing. Any successful endeavour to further oral health equity for Aboriginal and Torres Strait Islander Peoples must privilege the leadership and expertise of ACCHOs and their workforce. There remains a need for structural changes that ensure adequate funding to comprehensively embed oral health promotion and programming in the service delivery of ACCHOs This thesis supports the notion of neoliberalism as a re-colonisation of Aboriginal and Torres Strait Islander Peoples, and indeed Indigenous Peoples globally, that is furthering health disparities through both insidious process of internalisation as well as generative mechanisms external to individuals. Critically, the strength of Aboriginal and Torres Strait Islander Communities continues to resist these processes.