Sandra M. Gifford

Longing to belong: Social inclusion and wellbeing among youth with refugee backgrounds in the first three years in Melbourne, Australia

For young people with refugee backgrounds, establishing a sense of belonging to their family and community, and to their country of resettlement is essential for wellbeing. This paper describes the psychosocial factors associated with subjective health and wellbeing outcomes among a cohort of 97 refugee youth (aged 11-19) during their first three years in Melbourne, Australia. The findings reported here are drawn from the Good Starts Study, a longitudinal investigation of settlement and wellbeing among refugee youth conducted between 2004 and 2008. The overall aim of Good Starts was to identify the psychosocial factors that assist youth with refugee backgrounds in making a good start in their new country. A particular focus was on key transitions: from pre-arrival to Australia, from the language school to mainstream school, and from mainstream school to higher education or to the workforce. Good Starts used a mix of both method and theory from anthropology and social epidemiology. Using standardized measures of wellbeing and generalised estimating equations to model the predictors of wellbeing over time, this paper reports that key factors strongly associated with wellbeing outcomes are those that can be described as indicators of belonging - the most important being subjective social status in the broader Australian community, perceived discrimination and bullying. We argue that settlement specific policies and programs can ultimately be effective if embedded within a broader socially inclusive society - one that offers real opportunities for youth with refugee backgrounds to flourish.

The Sources of Stress Experienced by Professional Australian Footballers

Abstract Previous studies looking at the sources of stress in sport have generally overlooked the unique experiences of professional athletes participating in team sports. This paper describes the results of a qualitative study aimed at identifying the sources of stress experienced by a cross-section of professional Australian footballers. Players from two Australian Football League clubs took part in the study involving in-depth, one-to-one interviews and focus group discussions. The results revealed that players identified sources of stress that went beyond those associated with the competitive event (such as poor performances) and included a lack of feedback, difficulty balancing football and study commitments, and job insecurity. The influence of both competition and non-competition sources of stress parallels previous research involving non-professional athletes and indicates that the entire sporting experience needs to be taken into account when developing stress management strategies.

Trying to keep a balance: the meaning of health and diabetes in an urban Aboriginal community

Although the predominant paradigm of epidemiological investigation continues to focus narrowly on the individual and on individual risk factors, there is a growing body of work that calls for a rethinking of the current epidemiological models. In this paper we illustrate the need for a more comprehensive epidemiological approach towards understanding the risks for diabetes, by exploring the lived experiences of diabetes and lay meanings of risk among Aborigines living in Melbourne, Australia. Ethnographic fieldwork was conducted within the Melbourne Aboriginal community in the state of Victoria over a 22-month period (1994-1996). Melbourne Aborigines see non-insulin dependent diabetes mellitus (NIDDM) as the result of living a life out of balance, a life of lost or severed connections with land and kin and a life with little control over past, present or future. The lay model regarding diabetes that is derived from the narratives of Melbourne Aborigines, consists of three levels of connectedness important in determining an individuals susceptibility not only to diabetes but to all disease--(1) family, (2) community and (3) society. This structure of interactive systems at successive levels from the individual to the population fits within the framework of an ecological paradigm. The strength of ethnography as applied to epidemiology is that it has the capacity to discover previously unknown components of a system at several different levels, and to build models to explain how these components interact. This framework, developed using an ethno-epidemiological approach, has application in other indigenous populations who have been dispossessed of their land, their pasts and their future. There is great potential to apply this approach to the major public health challenges presented by rapid global socio-cultural and environmental change that are impacting negatively on population health.

Place-making, settlement and well-being: The therapeutic landscapes of recently arrived youth with refugee backgrounds

This paper explores the relationship between place-making, well-being and settlement among recently arrived youth with refugee backgrounds in Melbourne, Australia. Drawing on qualitative data including photo-novellas and neighborhood drawings, we describe the ways youth negotiate connections to place in early resettlement. Within the context of broader research on health and place, we describe how recently arrived youth actively seek out places with qualities associated with restoration and recovery and through these engagements, work to create therapeutic landscapes on arrival. The findings have implications for understanding the contribution of place-making to well-being in the settlement process.

The Social and Cultural Context of Risk and Prevention: Food and Physical Activity in an Urban Aboriginal Community

One of the key public health challenges facing indigenous and other minority communities is how to develop and implement effective, acceptable, and sustainable strategies for the prevention of noninsulindependent diabetes mellitus (NIDDM). In this article, the authors describe how an ethnographic approach was used to contextualize the behavioral risk factors for NIDDM and applied to the development of a more meaningful and appropriate epidemiological risk factor survey instrument for an urban Aboriginal population in Australia. The overall research design comprised a mixture of qualitative and quantitative methods. The ethnographic study showed that the complex web of meanings that tie people to their family and community can and should be taken into account in any social epidemiology of health and illness if the findings are to have any effective and long-term potential to contribute to successful public health interventions targeting these behavioral risk factors.

Australian women's experiences of living with hepatitis C virus: Results from a cross‐sectional survey

Background: Of the estimated 160 000 Australians currently infected with the hepatitis C virus (HCV), over one‐third are women and very few have received clinical treatment, with most managing their illness in non‐specialist settings. Little is known about the experiences of women living with HCV in the general community. The present study provides the results from the first comprehensive social survey of Australian womens experiences of living with HCV.

“Eyes Wide Shut”: Narratives of Women Living with Hepatitis C in Australia

ABSTRACT Hepatitis C is the leading notifiable infectious disease in Australia and in the last few years, the number of new diagnoses among young women is beginning to outnumber men. For many, infection with hepatitis C virus (HCV) results in a chronic condition, which, in addition to a range of symptoms, carries with it the stigma attached to injecting drug use. Despite the growing prevalence of HCV, womens health has barely begun to address the gender specific impact of this illness on women. We report the results of a qualitative study of young womens experiences of living with HCV with a specific focus on the meaning of this condition and its impact on their lives. In 1999–2000, twenty-five in-depth interviews were conducted with women between the ages of 18 and 43 years, who were current or past injecting drug users and who had been diagnosed with HCV. One focus group discussion was held with health workers who provide treatment and care to this population. A number of key issues were identified that women believed impacted negatively on their lived experiences of HCV. Of most concern was the meaning of HCV and the social stigma attached. Stigma coupled with the lack of knowledge and awareness among health professionals and the high cost of treatment contributed to womens reluctance to seek support and care. HCV has yet to be taken up by the womens health movement as a key issue, especially for young women and we argue that this trend needs to be reversed.

Narratives of sexual health risk and protection amongst young people from refugee backgrounds in Melbourne, Australia

Young people with refugee backgrounds face many challenges when making their lives in a resettlement country and their sexual and reproductive health needs are often overlooked. This paper reports on sexual health literacy amongst recently arrived young refugees settling in Melbourne, Australia. Qualitative methods were used to explore how resettled youth access, interpret and implement sexual health information, with a particular focus on how social contexts shape attitudes and understandings. Focus group discussions and in-depth interviews were conducted with 142 participants aged between 16 and 25 years. Findings reveal that while young people had some knowledge of HIV and AIDS, knowledge of other STIs was limited. Importantly, narratives about risk and protection were informed by concerns for maintenance of social wellbeing. Sexual health promotion should be an explicit component of early resettlement services for youth with refugee backgrounds and strategies need to take account of the pre-migration and resettlement contexts.

The change of life, the sorrow of life: Menopause, bad blood and cancer among Italian-Australian working class women

This paper explores the discourse of menopause, health and illness among 20 middle aged Italo-Australian working class women living in Melbourne. Using the methods of interpretative anthropology and the perspectives of critical feminist theory, I argue that womens discourse about health and illness is one way in which they express feelings of loss over the fertility of their youth, ambivalences about their lives in Australia, and grief over a life left behind in Italy. These losses are experienced physically and expressed metaphorically through conditions of bad blood and nerves and are perceived to contribute to their vulnerability to a range of diseases including cancer. For these women, the change of life is experienced as the end of life and their fear of cancer is representative of their fears of social and physical death. Cancer is also seen to be a disease more common in Australia and is used as a metaphor for expressing anxieties relating to feelings of placelessness, of being disconnected from ones roots, and anxieties about becoming old and dying far from “home.”

Australian health policy on access to medical care for refugees and asylum seekers

Since the tightening of Australian policy for protection visa applicants began in the 1990s, access to health care has been increasingly restricted to asylum seekers on a range of different visa types. This paper summarises those legislative changes and discusses their implications for health policy relating to refugees and asylum seekers in Australia. Of particular concern are asylum seekers on Bridging Visas with no work rights and no access to Medicare. The paper examines several key questions: What is the current state of play, in terms of health screening and medical care policies, for asylum seekers and refugees? Relatedly, how has current policy changed from that of the past? How does Australia compare with other countries in relation to health policy for asylum seekers and refugees? These questions are addressed with the aim of providing a clear description of the current situation concerning Australian health policy on access to medical care for asylum seekers and refugees. Issues concerning lack of access to appropriate health care and related services are raised, ethical and practical issues are explored, and current policy gaps are investigated.