The Public Health Bush Book is a resource for all community health care providers who want to strengthen their health promotion and disease prevention practice. It has been written specifically for teams who work with Aboriginal communities in the Northern Territory. The Public Health Bush Book is one response to the needs of staff for more support to do public health work and to do it well.
This resource emphasises brief and early interventions, disease and harm prevention and health promotion strategies. It focuses on strategies to address the direct causative or risk factors for ill health as outlined in the Aboriginal Health Policy (see Volume 2), namely misuse of alcohol and other drugs, inadequate environmental health and hygiene, and poor nutrition. It suggests how you can use these strategies, both when people present for treatment at the health centre and in the course of everyday life and work with an Aboriginal community. It will assist you to work in ways that recognise and reinforce the capacity of people to know what is needed and how to do something about these needs.
For experienced workers, it provides a useful check for evaluating current work practices and extending them. For the less experienced, it serves as a resource to guide efforts in developing sound public health practices.
The theory, principles and strategies presented in these two volumes have a strong basis in research and practice, both nationally and internationally. The principal approaches are based on the Ottawa Charter for Health Promotion (1986) and are described under ‘Key Concepts’.
Working in partnership, community development, participatory research, planning and evaluation, and education for health are the fundamentals for working in a health promoting way. These processes involve the transfer of skills and knowledge to community members. They are essential to strengthen people’s capacity to take control and improve their own health and well-being and need to be based on a two-way learning process.
THS staff have generously contributed case studies. Their stories show how they are:
The NT Aboriginal Health Policy is based on the National Aboriginal Health Strategy. The Policy was endorsed by the NT Cabinet in 1996. It provides a framework for the NT Government to address the unsatisfactory state of Aboriginal health. The principles of the policy are central to the way we all approach our work.
Principles of the NT Aboriginal Health PolicyImprovement of Aboriginal health status is a key priority of Territory Health Services. Improving access is creating the means for Aboriginal people to use a range of health services which includes local community health centres as well as special care services. Equity is the sharing of resources to ensure that an appropriate level of health service is provided for Aboriginal people. Health services must be available to Territorians at the rate it is needed to improve health outcomes. Culturally appropriate and effective health services are essential for Aboriginal people as a significant client group with specific needs. All non-Aboriginal health staff must undergo Aboriginal cultural awareness training. Increased participation of Aboriginal people in decision making and operational processes of the health system is essential. This must be based on mutual respect between Territory Health Services and stakeholders and their shared knowledge and experiences. Community control and responsibility for the provision of community based health care services is the preferred management model. Holistic view of health, as accepted by Aboriginal people, should underlie health service delivery. A two-way information flow underpins the effective delivery of health services and Aboriginal people's understanding of this process and their participation in decision making about it. Intersectoral action between all levels of government, Aboriginal organisations and Aboriginal communities is necessary to establish agreed priority needs, maximise use of resources, reduce duplication and assist coordinated action by different sectors. NT Aboriginal Health Policy 1996:8 |
How effective you are in your work will largely depend on your willingness to learn from and work in partnership with local Aboriginal people and Aboriginal colleagues.
Aboriginal culture has enabled people to live and thrive in challenging environments for over 60 000 years. If you are open to recognising, appreciating and understanding Aboriginal world views and health beliefs, your capacity as a health service provider will be greatly enhanced.
From experience...One of the main valuable points for anyone new starting is to listen and learn from the Aboriginal Health Workers. They are a most valuable resource and certainly prevent a lot of grief and conflict. They are a great buffer between the community and health centre staff and can teach so much if they know their advice and opinions are valued. RAN, East Arnhem District, 1996 |
There are written resources you can draw on to orient yourself to Aboriginal culture:
For Central Australia
For the Top End
- Taking Time for People: An Orientation Manual for People Working in the East Arnhem District by Jeannie Devitt (1995)
‘Big relationships’When new Balanda sisters come in to work among the Aboriginal Health Workers, the first thing that they want to learn is from us - we teach them what’s there and what’s to be done - we teach them about...[our] relationships to anyone (others). We teach them about the death of the families and how families could get together for that ceremony because we Aboriginal people have got big relationships. And that’s how Balanda sisters usually learn - slowly by slowly until they sometimes understand Yolngu way of life and culture... So there was no problem between us, the Aboriginal Health Workers and the Balanda sisters, everything is smooth - working together as a team. Burrayburray Dhurrkay, Senior Health Worker |
THS (in partnership with the Institute for Aboriginal Development) has also developed an Aboriginal Cultural Awareness Program (ACAP). If you have not participated in a cross cultural course, make inquiries as soon as possible. The recommended reference book for ACAP is Binan Goonj: Bridging Cultures in Aboriginal Health by Anne Eckermann, Toni Dowd, Mary Martin, Lynette Nixon, Roy Gray and Ena Chong (1992).
The THS Aboriginal Cultural Awareness Program (ACAP)The program consists of four cultural awareness workshops complemented by three Learning Packages. These packages are taken back to the workplace between workshops. The first workshop is one day in length and the other three are each two days in length. While each of the sections of the program can stand alone, the workshops and the learning packages build on each other in order to expand and develop concepts, skills and approaches. ACAP management generally prefer staff to work through each of the four stages of the course even if individuals have had a lot of previous experience working with Aboriginal people. Experienced participants help the course because learning generally happens through discussion. Learning also takes place back in the workplace where people share meanings about important principles. The ACAP aims to:
Contacting the ACAP team You might contact your local ACAP team to:
Information provided by ACAP, Alice Springs |
ACAP Contact Details |
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Central Australia |
Top End |
| ACAP Staff Development Services Liebig Building, THS Alice Springs NT 0870 Phone: 8951 7594 or 8951 7728 |
ACAP Staff Development Services Block 4 Royal Darwin Hospital Casuarina NT 0810 Phone: 8922 7945 |
This section briefly describes the current understanding of public health, health promotion and primary health care. It draws attention to how these disciplines are related and what they mean for your practice. The key principles of equity, community participation and social justice underpin public health, health promotion and primary health care.
Most of us take for granted access to nutritious and safe food, availability of clean water, adequate sewerage disposal and housing, immunisation and sound public health legislation. These factors have been responsible for the substantial gains in health in western societies over the last 300 years. These factors, in turn, are the result of economic growth and development, universal education, improved status of women (including birth control), and an effective public health care system, emphasising preventive measures (Harper et al 1994; Smith and Douglas 1995).
Public health, like every other area of health care, is changing as our understanding evolves. Beginning in the mid 1980s, a new public health movement has resulted in a refocusing on the underlying determinants of health. There is also a renewed recognition that the public, professionals and governments need to work together for better health for all people. The Ottawa Charter for Health Promotion (1986) was the first document to state the five action areas for this ‘new’ public health: build healthy public policy; create supportive environments; strengthen community action; develop personal skills and reorient health services.
Today public health is described as "the organised response by society to protect and promote health and to prevent illness, injury and disability" (National Public Health Partnership 1997). Public health today aims to:
From The Solid Facts......People’s lifestyles and the conditions in which they live and work strongly influence their health and longevity. Medical care can prolong survival after some serious diseases, but the social and economic conditions that affect whether people become ill are more important for health gains in the population as a whole. Poor conditions lead to poorer health. An unhealthy material environment and unhealthy behaviour have direct harmful effects, but the worries and insecurities of daily life and the lack of supportive environments also have an influence. Wilkinson and Marmot (eds)1998:6-7 |
For health service providers, taking a public health approach means recognising that individual health behaviours (and therefore health outcomes) are influenced by family systems, knowledge and education, environmental conditions, belief systems and a whole host of economic, political, historical and cultural forces. The following diagram illustrates these influences.
Today public health practice includes a wide range of strategies to action at the individual, group and community levels. These strategies span:
Health promotion as a "process of enabling people to increase control over, and to improve, their health" (WHO 1986) operates along the continuum of practice - from community-wide strategies to clinical practice. So whatever your job, you can carry it out in a health promoting way, increasing the capacity of individuals, groups and communities to improve their own health.
The Declaration of Alma Ata (WHO 1978) provided the blueprint for Primary Health Care with an aim of achieving an acceptable level of health for all people: Health for All by the Year 2000.
| A definition Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals, and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination... WHO 1978:3 |
Since the Declaration was issued, Primary Health Care has come to mean a number of things. Primary Health Care is:
| The implementation of Primary Health Care is based on the
following principles: A Population Focus - looking at the influences on the health of a community, as well as the specific health problems of individuals. Cooperative Action - recognises that the actions of many public and private organisations in, for example, the fields of transport, education, housing and industry, impact on the health of the community. A cooperative approach is required. Community Participation - in the planning, organisation, operation and control of health care services and activities is important and promotes improvements in services and in the health of people themselves. Multiple Strategies - as many current health problems result from a number of factors, effective and lasting solutions require a variety of approaches. These will often involve a blend of treatment, prevention, health promotion and education. Community Health Accreditation and Standards Program, SA |