Knowledge to Action: Addressing the social determinants of health to promote Aboriginal and Torres Strait Islander Social and Emotional Wellbeing

Abstract

Aboriginal and Torres Strait Islander cultures are one of the oldest living cultures in the world with philosophies, knowledges and practices that sustained culture and people through great adversity. One of these philosophies is Aboriginal and Torres Strait Islander social and emotional wellbeing, which encapsulates the holistic view of life and underpins Aboriginal and Torres Strait Islander ways of knowing, being and doing. Social and emotional wellbeing represents the interconnection of spirituality, connection to Country, family, community, mind and emotions and the body, and how these are essential to health and wellbeing. Social and emotional wellbeing also recognises historical, political and social factors which shape and impact health and wellbeing of individuals and communities. Ongoing colonial violence has undoubtedly contributed to Aboriginal and Torres Strait Islander communities experiencing adverse outcomes on all health and social measures. Indigenous knowledge and self-determination are key to improving health and wellbeing outcomes, and in a colonial context it is necessary to bring together Indigenous and non-Indigenous knowledge at the interface to understand and inform health systems, policy and practice. The social determinants of health, such as education, employment, housing and income, have proven complex in their contribution to health and social outcomes across the globe. Whilst many policies, plans, programs and initiatives have been implemented in an attempt to address unmet health and social needs, it has become increasingly evident that imposed solutions which are not self-determined are not the answer. Evidence-based understandings are necessary to implement holistic responses to social and emotional wellbeing addressing a range of cultural, historical, political, and social factors that shape health and wellbeing. This thesis outlines a PhD program of work which aimed to build foundational understandings on approaches to address social determinants of health and promote action on social and emotional wellbeing. An Indigenous methodology underpinned the mixed methods, iterative research design which included prioritising Indigenous ways of knowing, being and doing, insider approaches and Indigenous governance and leadership. Indigenous and non-Indigenous knowledges were integrated to describe community level outcomes for mental health and the social determinants of health. An enhanced scoping review methodology identified health programs addressing one or more social determinants. Practice-based evidence was generated from a developmental evaluation of an initiative addressing unmet social and cultural needs of Indigenous South Australians. Community-level outcomes emphasised significant unmet mental health and social needs for South Australian communities. Review findings highlight that few programs specifically addressed or provided coordinated action on the social determinants of health. A focus on emerging themes, complexity and reflective practice generated practice-based evidence for implementing strengths-based case management to identify unmet needs, engage in goal setting and broker connections with social and health services. This thesis outlines a range of innovative practice, methodological, and research considerations for promoting social and emotional wellbeing. Future initiatives need to consider system-level factors and measure the impact of holistic responses to expand the existing practice-based evidence that integrates the social determinants of health to promote social and emotional well-being.