Teresa Gibson

Social Determinants of Health, the ‘Control Factor’ and the Family Wellbeing Empowerment Program

Objective: To explore links between the social determinants of health, the ‘control factor’, and an Aboriginal empowerment program. Methods: The evidence that rank or social status is one of the most important determinants of health is briefly presented. This is followed by a critique of the Australian policy and intervention framework for tackling and reducing social inequalities. The concept of ‘control’ as an important element in addressing social determinants of health is examined next and the Family Wellbeing empowerment program is analysed to illustrate how the concept of control might be operationalised at program or intervention level. Implications for health practitioners are identified. Results: By providing a safe group environment for participants to explore sets of critical questions about themselves, their families and communities, through the process of participatory action research, Family Wellbeing has demonstrated its potential to ‘enable’ Indigenous people to take greater control and responsibility for their situation. While program participants first address personal and immediate family issues, evidence is emerging of a ripple effect of increasing harmony and capacity to address issues within the wider community Conclusions: The social determinants of health are complex and multi-layered and so addressing them needs to involve multilevel thinking and action. The control factor is only one element, albeit an important one, and Family Wellbeing is providing evidence that ‘control’ can be addressed in Indigenous settings. For empowerment programs to achieve their full potential, however, there is a need to ensure that such programs reach a critical mass of the target group. It is also imperative that policy-makers and practitioners take a longer-term approach, including properly resourced longitudinal studies to document and enhance the evidence base for such interventions. As health practitioners it is vital we consider our work within this broader context, creatively seek to enhance linkages between services and programs, and support processes for change or intervention at other levels.

Adapting the ‘Family Wellbeing’ empowerment program to the needs of remote Indigenous school children

Objective: To adapt the Family Wellbeing empowerment program, which was initially designed to support adults to take greater control and responsibility for their decisions and lives, to the needs of Indigenous school children living in remote communities.

The role of empowerment in setting a foundation for social and emotional wellbeing

Abstract Empowerment and community participation are major strategies, worldwide, for alleviating poverty and social exclusion, thereby reducing health disparities. In Australia, a lack of control, or mastery, has long been widely acknowledged as one aspect of a broader experience of powerlessness that needs to be addressed to reduce the current preventable Indigenous burden of disease and close the health disparity gap. Yet, it is hard to find empirical research examining the nature and attributes of empowerment and how to operationalise and evaluate these in the context of promoting Indigenous health. This paper synthesises the findings of a five-year Family Wellbeing empowerment study aimed at enhancing the capacity of Indigenous Australian people in Cape York, far north Queensland, to take greater control over the issues affecting their health and wellbeing. Documenting and analysing empowering strategies over time can help us to better understand the process of empowerment and ways in which change is generated at multiple levels. The study confirmed existing evidence that the process of empowerment is lengthy, taking years to achieve change beyond the individual level. It also highlighted the importance of initial engagement and personal capacity building, in socially and economically vulnerable communities where people experience relative powerlessness, as a critical foundation for improving the health of the broader community.

Listening, sharing understanding and facilitating consumer, family and community empowerment through a priority driven partnership in Far North Queensland

Objectives: This paper provides an example of a mental health research partnership underpinned by empowerment principles that seeks to foster strength among community organizations to support better outcomes for consumers, families and communities. It aims to raise awareness among researchers and service providers that empowerment approaches to assist communities to address mental health problems are not too difficult to be practical but require long-term commitment and appropriate support. Methods: A collaborative research strategy that has become known as the Priority Driven Research (PDR) Partnership emerged through literature review, consultations, Family Wellbeing Program delivery with community groups and activities in two discrete Indigenous communities. Progress to date on three of the four components of the strategy is described. Results: The following key needs were identified in a pilot study and are now being addressed in a research-based implementation phase: (i) gaining two-way understanding of perspectives on mental health and promoting universal awareness; (ii) supporting the empowerment of carers, families, consumers and at-risk groups through existing community organizations to gain greater understanding and control of their situation; (iii) developing pathways of care at the primary health centre level to enable support of social and emotional wellbeing as well as more integrated mental health care; (iv) accessing data to enable an ongoing process of analysis/sharing/planning and monitoring to inform future activity. Conclusion: One of the key learnings to emerge in this project so far is that empowerment through partnership becomes possible when there is a concerted effort to strengthen grassroots community organizations. These include social health teams and mens and womens groups that can engage local people in an action orientation.