Dissertations / Theses on the topic 'Aboriginal and Torres Strait Islander people'

Background Globally, non-communicable diseases (NCDs) such as cardiovascular disease and diabetes represent an issue of epidemic proportion, responsible for tens of millions of premature deaths annually. NCDs are also responsible for reducing quality of life and causing detrimental social and economic effects. Disparities across population groups are evident. In Australia, NCDs were a leading cause of the total burden of disease in 2011. Aboriginal and Torres Strait Islanders have a shorter life expectancy and poorer health risk factors and outcomes than non-Indigenous Australians. Much of this gap in life expectancy has been attributed to preventable NCDs. Physical activity is a key modifiable cause of the excess burden of disease and mortality. Among Aboriginal and Torres Strait Islanders, there is a lack of evidence around the associations between physical activity and health and demographic factors and the impact of strategies to increase physical activity, compared to mainstream evidence. Aims This thesis aims to contribute towards building an evidence base around the association of physical activity on the health of Aboriginal and Torres Strait Islanders. The first aim is to examine cross-sectional associations between physical activity and a range of lifestyle, environmental and social factors among adults. Subsequently, the thesis identifies and describes physical activity patterns and influencing factors among adolescents. The third aim is to describe characteristics of physical activity programs targeting Aboriginal and Torres Strait Islanders. Lastly, the thesis aims to measure the effects of a community-based physical activity program. Methods The series of studies used a range of methods. The first study examined whether achievement of national physical activity recommendations was associated with healthy lifestyle behaviours, neighbourhood environmental characteristics and social support among Aboriginal and non- Aboriginal adults in New South Wales (NSW) (Chapter 2). The second study examined cross-sectional demographic, social, psychosocial and health correlates of physical activity among Aboriginal and non- Aboriginal adolescents in NSW (Chapter 3). The third study examined age related declines in physical activity among Aboriginal and non-Aboriginal young people and their variation by season, setting and type among Aboriginal and non-Aboriginal children from between 2007/8 and 2011/12 (Chapter 4). The fourth study reviewed the scientific and grey literature for physical activity programs targeting Aboriginal and Torres Strait Islanders operating between 2012 and 2015, described their characteristics and engaged with program coordinators to verify sourced information (Chapter 5). The final study examined the health and community impacts of the Indigenous Marathon Program (IMP) in a remote Torres Strait island community, using questionnaire and semi-structured interview mixed methods (Chapter 6). Results In Chapter 2, a similar proportion of Aboriginal and non-Aboriginal adults achieved national physical activity recommendations and factors relating to achieving recommendations were similar in both groups. However, neighbourhood features and social support were less favourable among Aboriginal adults. Among Aboriginal and non-Aboriginal adolescents, physical activity levels were similarly low but some correlates differed by Aboriginality (Chapter 3). Aboriginal girls were less active than boys, as were those whose mothers were unemployed. In Chapter 4, serial physical activity declines were found in a population of Aboriginal and non-Aboriginal young people over five years, but not across all seasons, settings and types. Chapter 5, identifies 110 programs that aimed to increase physical activity for health or broader social outcomes. Around half were found to collect process or impact evaluation data but this is underrepresented in the scientific literature. In Chapter 6, impacts of Indigenous Marathon Program were the adoption of running and broader healthy lifestyle factors in a remote community with a high initial level of community readiness. Barriers to running were both personal, cultural and environmental. Conclusion The findings from this thesis make a novel contribution to building an evidence base of associations between physical activity and the health of Aboriginal and Torres Strait Islanders. A number of factors associated with physical activity in adults and children are unique to Aboriginal and Torres Strait Islanders populations; other factors are similar to those experienced by mainstream populations. It is vitally important that physical activity programs that aim to improve health or social outcomes can determine their value through evaluation.

Abstracts – oral conference presentations Lukaszyk, C., Harvey, L., Sherrington, C., Close, J., Coombes, J., Mitchell, R., Moore, R., Ivers, R. Fallrelated injury hospitalisations for Aboriginal and Torres Strait Islander people aged 50+ in New South Wales, Australia, 15th World Congress on Public Health, April 2017, Melbourne, Australia Lukaszyk, C., Harvey, L., Sherrington, C., Close, J., Coombes, J., Ivers, R. Investigating hospitalisations due to fall-related injury for older Aboriginal and Torres Strait Islander people in New South Wales, Australia, 7th Biennial Australia and New Zealand Falls Prevention Conference, November 2016, Melbourne, Australia Lukaszyk, C., Coombes, J., Sherrington, C., Keay, L., Tiedemann, A., Cumming, R., Broe, T., Ivers, R. Preventing falls amongst older Aboriginal people: development and pilot evaluation of the Ironbark Program, 15th National Conference of Emerging Researchers in Ageing, October 2016, Canberra, Australia Lukaszyk, C., Approaches to preventing falls amongst older Aboriginal people, Travelling Rural Fall Prevention Network Forum, September 2016, Broken Hill, Dubbo, Australia, invited speaker Lukaszyk, C., Coombes, J., Sherrington, C., Keay, L., Tiedemann, A., Cumming, R., Broe, T., Ivers, R. Developing and trialling a culturally appropriate fall prevention program for older Aboriginal people, Australian Health Promotion Association, June 2016, Perth, Australia Lukaszyk, C., Coombes, J., Sherrington, C., Keay, L., Tiedemann, A., Cumming, R., Broe, T., Ivers, R. Approaches to developing a falls prevention program for older Aboriginal people, Australian Injury Prevention Network, November 2015, Sydney, Australia Lukaszyk, C., Coombes, J., Falls Prevention in Older Aboriginal People: Approaches to Program Development, Championing Falls in April Forum, April 2015, Sydney, Australia, invited speaker Lukaszyk, C., Coombes, J., Sherrington, C., Keay, L., Tiedemann, A., Cumming, R., Broe, T., Ivers, R. Falls prevention in older Aboriginal people: service audit and yarning circle discussions, Australian Injury Prevention Network, November 2014, Sydney, Australia Lukaszyk, C., Coombes, J., Sherrington, C., Keay, L., Tiedemann, A., Cumming, R., Broe, T., Mack, H., Ivers, R. The Ironbark Project: Fall Prevention in Older Aboriginal People in NSW, Australian and New Zealand Falls Prevention Conference, November 2014, Sydney, Australia Lukaszyk, C., Coombes, J., Sherrington, C., Keay, L., Tiedemann, A., Cumming, R., Broe, T., Ivers, R. Ironbark Project Service Audit on Fall Prevention in Aboriginal People, Emerging Health Policy Research Conference, October 2014, Sydney, Australia Abstracts – poster conference presentations Lukaszyk, C., Coombes, J., Keay, L., Sherrington, C., Tiedemann, A., Turner, NJ., Cumming, R., Broe, T., Hillmann, E., Ivers, R. Working together to develop and trial a culturally appropriate fall prevention program for older Aboriginal people. Lowitja Institute International Indigenous Health and Wellbeing Conference, November 2016, Melbourne, Australia Lukaszyk, C., Harvey, L., Close, J., Ivers, R. Investigating fall-related injury hospitalisations for older Indigenous people in Australia, 12th World Conference on Injury Prevention and Safety Promotion, September 2016, Tampere, Finland Lukaszyk, C., Coombes, J., Sherrington, C., Keay, L., Tiedemann, A., Cumming, R., Broe, T., Ivers, R. Developing and trialling a culturally appropriate fall prevention program for older Aboriginal people, RICH forum, March 2015, Multiple locations, Australia Workshops “Fall prevention for older Aboriginal people: lessons from the Ironbark Aboriginal Fall Prevention Project”, pre-conference workshop for the 7th Biennial Australia and New Zealand Falls Prevention Conference, Melbourne, November 2016 Awards Cross Cultural Public Health Research Award. May 2017. University of Sydney and University of Western Sydney. Postgraduate Research Support Scheme Travel Grant. October 2017. University of Sydney, School of Public Health. Postgraduate Research Support Scheme Travel Grant. October 2016. University of Sydney, School of Public Health.

This thesis investigates the representation of Aboriginal and Torres Strait Islander people(s) in mainstream Australian newspapers. It combines approaches from corpus linguistics and critical discourse analysis to examine factors such as terms of reference, prominent themes and salient discourses employed in this coverage. The data consists of a purpose-built corpus of articles containing mention of Aboriginal people(s) or issues published in the 12 major metropolitan dailies within a 3-month period in mid 2019. The analysis confirmed a number of previous findings, as well as identifying two previously unidentified discourses—those of economic success and non-agential cooperation—and the linguistic resources used to construct them. One particularly valuable contribution is the finding that the agency of Aboriginal participants in cooperative events is often undermined using prepositions, a part of speech regularly overlooked in both corpus linguistic and critical discourse analytic studies.

This thesis explored how six teachers of mathematics embedded Aboriginal and Torres Strait Islander Peoples’ Histories and Cultures into the core mathematics curriculum. Semi-structured interviews were conducted, then written transcripts were analysed through the use of Bernstein’s Theory of Pedagogic Discourse. Teachers shared their perspectives on how they have developed their cultural capabilities, and how this has informed culturally responsive teaching of mathematics. Recommendations are made for how to support in-service teachers with their personal cultural capabilities to authentically embed Aboriginal and Torres Strait Islander Peoples’ Histories and Cultures in mathematics curriculum.

Health research should inform culturally-appropriate, evidence-based primary healthcare (PHC), potentially enhancing social and emotional wellbeing (SEWB) among Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) Peoples. When conducting such research, scientific and ethical quality should be forefront. Aim To identify approaches and enablers to conducting high-quality, culturally-appropriate Indigenous-focused SEWB PHC research. Methods This thesis comprises three sections: firstly, two systematic reviews of the Indigenous-focused SEWB PHC research literature; secondly, an in-depth critical and reflective case study of an Indigenous-focused SEWB PHC research project entitled Getting it Right: the validation study (hereafter referred to as Getting it Right); finally, a process evaluation of Getting it Right using a grounded theory approach. Results Twenty-five research projects were included in the systematic reviews. Two were judged as high quality using scientific and ethical criteria. Research projects that were judged as ethical used culturally-sensitive approaches, focused on developing relationships and involved community members. These approaches also appeared to enable this research. Getting it Right had an adaptive protocol (where localised approaches were developed within certain requirements) and PHC services were reimbursed on a per participant basis. The research was evaluated as meeting scientific and ethical quality criteria. The process evaluation showed that the research was acceptable to most participating staff (n=36), community members (n=4) and participants (n=500). Many were willing to participate in research and speak about SEWB. Staff reported that the reimbursement provided to the service sufficiently resourced the research. Conclusion High-quality, culturally-appropriate Indigenous-focused SEWB PHC research can be facilitated by culturally-sensitive, flexible, collaborative and sufficiently-funded approaches.

Alcohol use is common globally and the health risks from drinking are recognised. However, Indigenous Peoples who have been impacted by colonisation, trauma and racism, could be at greater risk of developing alcohol-related harms. One of these harms could be alcohol dependence, the strong internal drive to use alcohol with an inability to control use, prioritising alcohol and also physiological characteristics. The way alcohol dependence is interpreted or identified can be different across cultures and for Indigenous Peoples. The overall aim of this thesis was to identify the prevalence of alcohol dependence among Indigenous Peoples globally, and the associations of dependence in an Indigenous Australian community sample. Chapter 2 is a systematic review of the prevalence of alcohol dependence among Indigenous Peoples globally and examines how dependence is identified. Chapter 3 estimates the prevalence and describes the correlates of alcohol dependence in a representative community sample of Indigenous Australians. Chapter 4 identifies the associations between alcohol dependence with harms and getting help for drinking in a representative community sample of Indigenous Australians. This research reports that the prevalence of current alcohol dependence among Indigenous Peoples globally from similarly colonised countries varies widely and shows few tools have been validated for Indigenous Peoples. The prevalence in the representative community sample of Indigenous Australians is similar to the general Australian population. Dependent drinkers were more likely to report harms and more likely to get help for their drinking. Researchers, health professionals and clinicians do well to use Indigenous-specific survey tools or operationalise existing tools when trying to identify alcohol dependence among Indigenous Peoples. Accurate prevalence data can better inform treatment needs and unmet needs. Indigenous Australians need support and treatment options that are readily available, accessible and culturally appropriate. Identifying these needs could help with funding and resource allocation.

Alternative schools are an emerging model of education offered to young people who have been disenfranchised from conventional schooling opportunities. The body of literature on alternative schools in Australia has not identified how many Indigenous young people are engaged with alternative schools and how alternative schools are supporting Indigenous young people to remain engaged in education. It is well documented that Aboriginal and Torres Strait Islander people experience significant disadvantage including poorer educational outcomes than their non-Indigenous peers. This study seeks to contribute to improving educational outcomes for Aboriginal and Torres Strait Islander young people through exploring Aboriginal and Torres Strait Islander interactions with alternative schools in Queensland and investigating the practices of alternative school leaders in terms of how they are supporting Indigenous young people to remain engaged in education. Critical race theory informed the development of this study. An Aboriginal researcher sought to shift the focus of this study away from Indigenous young people to Principals; to explore their perspective of their own knowledge and practices in supporting Aboriginal and Torres Strait Islander young people at their school. Using survey methodology, a web-based questionnaire was developed to survey Principals’ providing data on alternative schools in Queensland including the demographics of the alternative school; self-reported knowledge of Indigenous cultures and communities and practices that support Aboriginal and Torres Strait Islander young people at their alternative school. There are nine key findings that emerged through the analysis of this study: key finding one is the high percentage of Aboriginal and Torres Strait Islander young people enrolled in schools surveyed; key finding two is there is a high percentage of Aboriginal and Torres Strait Islander staff employed in the schools; key finding three is the majority of the schools are located in low socio-economic areas; key finding four is the strong willingness of Principals’ in this study to engage in self-directed learning in relation to Aboriginal and Torres Strait Islander cultures; key finding five is the limited demonstration of understandings of Aboriginal and Torres Strait Islander cultures and communities; key finding six is the most prevalent practice of Principals’ in this study is the celebration of cultural events and cultural activities; key finding seven is the limited Principal engagement with Aboriginal and Torres Strait Islander young people, their families and the local community; key finding eight is the practice of alternative schools provides limited support and nurturing of Aboriginal and Torres Strait Islander young person’s cultural identity and key finding nine is that Principals’ are relying heavily on informal discussions with staff to know what their staff’s knowledge and skills are in relation to supporting Aboriginal and Torres Strait Islander young people. There are multiple implications that have arisen from this study. The data demonstrated high numbers of Aboriginal and Torre Strait Islander students and staff. The data also revealed that Principal’s demonstration of knowledge in relation to Indigenous cultures and communities was limited, as well as limited Principal engagement with Indigenous young peoples, families and communities. Therefore a major practical implication of this study is the urgent need for quality cultural learning opportunities for leaders of alternative schools to improve practices. Additionally, the implications of this study support an urgent need for further research on the role alternative schools are playing in supporting Indigenous young people to remain engaged in education.

This thesis examined the educational outcomes for Indigenous children enrolled in Queensland state (public) primary schools from the perspective of the collective and social impact of programs and services. The study used quantifiable data to show that the gap is not closing, regardless of an improvement in attendance, along with literacy and numeracy achievement levels, in certain regions of Queensland.

This thesis concerns the relationship between ideology, values, beliefs, politics, language, discourses, public policy and health outcomes. By examining the origins of federal health policy concerning Aboriginal and Torres Strait Islander Peoples 1972-2001 I have explored the idea that the way a problem is constructed through language determines solutions enacted to solve that problem, and subsequent outcomes. Despite three decades of federal policy activity Aboriginal and Torres Strait Islander children born at the start of the 21st Century could expect to live almost 20 years less than non-Indigenous Australians. Explanations for the gap include that the colonial legacy of dispossession and disease continues to wreak social havoc and that both health policy and structures for health services have been fundamentally flawed. The research described in this thesis focuses on the role of senior Federal politicians in the health policy process. The research is grounded in theory which suggests that the values and beliefs of decision makers are perpetuated through language. Using critical discourse analysis the following hypotheses were tested: 1. That an examination of the language of Federal politicians responsible for the health of Aboriginal and Torres Strait Islander Peoples over three decades would reveal their beliefs, values and discourses concerning Aboriginal and Torres Strait Islander Peoples and their health 2. That the discourses of the Federal politicians contributed to policy discourses and frames in the Aboriginal and Torres Strait Islander health policy environment, and 3. That there is a relationship between the policy discourses of the Aboriginal and Torres Strait Islander health policy environment and health outcomes for Aboriginal and Torres Strait Islander Peoples. The hypotheses were proven. I concluded that there was a relationship between the publicly-expressed values and beliefs of politicians responsible for health, subsequent health policy and resulting health outcomes. However, a model in which theories of discourse, social constructions of people and problems, policy development and organisational decision-making were integrated did not adequately explain the findings. I developed the concept of "policy imagination" to explain the discrete mechanism by which ideology, politics, policy and health were related. My research suggests that the ideology and values which drove decision-making by Federal politicians responsible for the health of all Australians contributed to the lack of population-wide improvement in health outcomes for Aboriginal and Torres Strait Islander Peoples in the late 20th Century.

This thesis critically compares the conceptualisation of disability in the public discourse between Indigenous people and New South Wales (NSW) government and non-government disability service agencies. This study explores intersections of the conceptualisations of disability at the Cultural Interface using the Occupational Justice Framework (Gilroy, 2009; Durocher, Gibson and Rappolt, 2014). This thesis consists of two sections. Section 1: Literature Review Section 2: Journal manuscript The first section of this thesis is the literature review. The literature review examines the low participation rate of indigenous people in disability services and the need for culturally appropriate disability services for Indigenous people. In order to ensure culturally appropriate services are provided for Indigenous people, the Western and Indigenous perspectives of disability need to be understood and each are discussed in turn in the literature review. The review initially discusses the Western conceptualisation of disability, followed by the Indigenous conceptualisation of disability. The review also explores how both Indigenous and Western perspectives on disability influence each other. The developments in disability conceptualisation throughout history are also discussed, followed by the current literature that led to the development of this study. The second section of this thesis is a journal manuscript. The journal manuscript explores the intersections and tensions between Indigenous people and NSW government and non- government disability service agencies regarding the conceptualisation of disability. The journal manuscript also examines the outcomes and implications of the findings.

The present study focussed on the information needs of the academic staff of Batchelor College.* It examined their access to and the provision of adequate and appropriate resources for the implementation of the Diploma and Associate Diploma level courses offered through the College. Batchelor College, an institute of tertiary education, is situated 100 kilometres south of Darwin, Northern Territory, Australia. The content and the modes of delivery of Batchelor College courses are specifically designed to be culturally and socially appropriate to Aboriginal people, particularly those from traditionally oriented and 'remote' communities. It can only be within this framework that informed and sensitive research can be conducted. The main purpose of the current study was to investigate the information needs of staff delivering higher education courses to 'remote' Aboriginal students of Northern Australia. Six distinct areas of study emerged: 1, to identify the information needs; 2, to analyse the information-seeking behaviour; 3, to assess the level of satisfaction with current information sources; 4, to identify inadequacies in the existing information seeking processes; 5, to identify constraints experienced; and 6, to explore how future information needs may be catered for. A mailed survey instrument was specifically designed and implemented, and it attracted a response rate of eighty-seven percent. The population under investigation was the academic staff of Batchelor College, and the variables of: 1, location; 2, sex; 3, academic school; 4, designation; 5, tenure; 6, length of service; and 7, educational background were studied in relation to the questions asked. Results of the survey were analysed using 'Mystat: Statistical Applications', (1990). Frequency distributions were computed to determine the number of respondents who selected each option. A number of questions that elicited a written response were analysed, as were the many extra comments staff members made throughout the survey. The study found that the academic staff of Batchelor College are most affected by the location variable. It appears that how staff members use, regard and value the information sources used to inform their academic practice is affected by where a staff member is located. That is, the more isolated a staff member was, both geographically and professionally, the more significant were the findings of use of information sources. The study concludes with considerations of future planning strategies that could improve the access to and use of information. The study also identifies areas for further research. * Batchelor College, an institute of tertiary education, is situated 100 kilometres south of Darwin, Northern Territory, Australia (see Appendix 3).

This thesis evaluates a chronic condition self-management program for Aboriginal and Torres Strait Islander people in urban south-east Queensland who have or are at risk of cardiovascular disease. Outcomes showed short-term improvements for some anthropometry measures which could be a trend for improvement in other anthropometry indicators over the longer term. The program was of particular benefit for participants who had several social and emotional wellbeing conditions. The use of an Aboriginal and Torres Strait Islander conceptual framework was critical in undertaking culturally competent quantitative research in this project.

Indigenous self-determination is a spectre haunting colonial settler states. Struggles for land, cultural rights and sovereignty challenge governments built on dispossession, plunder and genocide. As the neoliberal phase of capitalism and its push for greater resource extraction pushes the planet to ecocide, Indigenous communities and their environmental ontologies offer solutions to catastrophic ecological and social crisis. This comparative thesis examines campaigns for Indigenous sovereignty in Bolivia and Australia and briefly explores the topic of Indigenous-led answers to the climate crisis. This study is inspired by a visit to Bolivia in 2006 and a motivation to deepen an understanding around Indigenous struggles in Australia. Bolivia is a focal point for this research because its ‘government of the social movements’ (Achtenberg 2015, para 6) is an experiment in Indigenous emancipation. In Australia, Aboriginal activists Pat Eatock and Ray Jackson encouraged my research around local campaigns. Engaging and convincing, Aunty Pat and Uncle Ray lived by a ‘political commitment to take up the side of the oppressed and exploited’ (Kinsman 2008, para 4). A good deal of intellectual and activist work on Indigenous self-determination employs a contrastive framework. Drawing out similarities and differences across nation-state boundaries clarifies colonial strategies and strengthens a global solidarity response. However, there is a scholarship emphasis towards the global north due to the domination of imperialist narratives. This explains why self-determination studies within Australia do not feature research on Bolivia’s sovereignty model. The research fills a gap within scholarly texts, because, as yet, no comparison between Bolivian Indigenous resistance and Indigenous Australian struggles exists. Research road map This investigation starts with an introduction, delves into the research’s theoretical and methodological approach, divides into three chapters and concludes. Each chapter compares Bolivia and Australia’s three structural pillars that form the basis of Indigenous self-determination: land, cultural rights and self-governance bodies. The concluding chapter assesses and compares the strengths and weaknesses of First Nation struggles in each country. The research finds that Indigenous sovereignty battles have benefited from coalitions between Indigenous and socialist forces in ‘black-red’ alliances (coalitions between Indigenous, communists and socialist forces) (Townsend 2009, p.5). Finally, an emancipatory vision of Indigenous self-determination, based on battle models within Australia and Bolivia, is proffered. Theoretical framework and methodological approach This investigation fuses Indigenous cosmological tenets and a Marxist philosophical framework. It engages a participatory activist research methodology through engagement with and interviews from Indigenous and mestizo activists and scholars. The research finds commonality between Marxist philosophical foundations and aspects of Indigenous ontologies. Marxism was the theoretical child of Western liberal thought, which hosted a range of pro-colonial positions. In comparison, Karl Marx critiqued colonialism’s enslavement of Aboriginal people (Marx 1867 p. 531). Marx and Friedrich Engels developed Marxism’s philosophical and scientific tenets — dialectics and materialism - arguing the material world is primary and provable. Marxism’s dialectics notes ‘an interconnected, eternal motion existing within all phenomena’ (Engels 1873-1886, para 1) (Marx and Engels 1869, para 4) (Engels 1896, para 4, 5). That is, A equals A, and non-A. Dialectics is built upon in Indigenous Bolivian Aymara philosophies. Aymaran ‘trivalent logic’ is the Indigenous Bolivia’s hyper-dialectical cosmological tenet. Trivalent logic advances the Marxist dialectic, through adding one more recognised dimension. The Aymaran ‘plurivalence’ is neither formalistic nor absolutist. It is neither A nor B, but can be A, B, or C. Another commonality between Marxism and Indigenous cosmologies are their ecological positions. The emphasis on a communitarian ethic in both Marx’s writings and Indigenous approaches point to additional parallelisms. However, a key contrasting tenet of Marxism to Indigenous spirituality, is its scientific approach – it’s materialism. However, this study concludes that a Marxist approach and Indigenous cosmologies host more similar ideas and concepts than oppositional ones, and so fuses both frameworks. The participatory action research method situates this study within an empowerment frame. Colonisation attempts to silence Indigenous people. Therefore, this study features the judgements of Murri elder Ken Canning, active in the Sydney based Indigenous Social Justice Association, alongside Gumbaynggirr man Roxley Foley, and Zachary Joseph Wone, from the Kabi Kabi Nation of the Dundaburra clan. All the Bolivian interviewees, Enrique Castana Ballivian, Odalis Zuazo and Pablo Regalsky work within Indigenous communities, or publish articles about land management and Indigenous rights. Complications in comparisons This research uncovers a difficulty in comparing self-determination battles in Australia and Bolivia. Bolivia was colonised by Spain, Australia, by Britain. Bolivia holds the highest percentage of indigenous people of any nation in the Western hemisphere – 42% (Fontana 2013 para 3), (TeleSur 2015, para 2). Yet only 2.8% of the population identify as Indigenous in Australia (Australian Bureau of Statistics, 2017, para 1). Australia is a rich imperialist country, while Bolivia is part of the exploited, impoverished third world. However, this study reveals, Indigenous Australian and Bolivian communities confront common enemies. Imperialism’s profit motive targets homelands, kinships and organisations. In this, the two resistance struggles interlink. Struggles for land in Bolivia and Australia An examination of Bolivia and Australia’s land rights battles in the neoliberal phase uncover more differences than similarities. Bolivia’s struggles proved more powerful, ending with the election of President Evo Morales, who leads an Indigenous government. However, a constant between the two nations struggles was the critical role of the black-red alliances. In Australia, the modern land rights movement was sparked by Aboriginal labourers strike in 1946–1949, in the Pilbara, Western Australia - assisted by non-Aboriginal communist Don McLeod. Then, in 1966, Aboriginal communities in Gurindji led the longest strike in Australia’s history, winning nine years later. Frank Hardy, Communist Party member, was a critical ally in the struggle. Following these seminal fights, Aboriginal people have won some control over 33% of Australia’s land mass. In Australia’s neoliberal period, land rights were attacked. Firstly, through the Northern Territory (NT) Intervention in 2007, then in 2015, with attempts to close remote Aboriginal communities in Western Australia (WA) and South Australia (SA). The ‘Stop the NT Intervention’ movement was not successful, but mass protests in 2015, led by the #sosblakaustralia movement stopped the closures of remote communities. Both the Indigenous rights movement and black-red alliances have not been strong enough to assuage neoliberalism’s assault on land rights. While 33% of land in Australia has been re-won, in some form, to Aboriginal and Torres Strait Islander communities, the majority of land to Aboriginal and Torres Strait Islanders is in remote and arid lands. In comparison, Bolivia’s land rights movements and black-red alliances in the neoliberal phase proved incredibly hardy. On the back of strong movements: The Coca, Gas and Water Wars, Indigenous Aymara Evo Morales was elected in 2005. Sections of the government proposed a ‘communitarian socialist’ Bolivia and Morales’s agrarian revolution handed 9600 square miles of state-owned land to Indigenous communities. However, Bolivia’s pro-Indigenous land reform and pachamama (mother-earth) approach was questioned by a proposal build a highway through the Isiboro Secure National Park and Indigenous Territory (TIPNIS) in 2011. Various Non-Government Organisations (NGO) charged Morales with coercion and ignoring Indigenous wishes. On the other side of the debate, Vice-President Alvero Garcia Linera argued anti-government NGOs led a green imperialist intervention against the TIPNIS project. After withdrawing from the highway’s timeframe and consulting with communities, a number of TIPNIS opponents withdrew their opposition. Struggles for cultural rights in Australia and Bolivia Spanish and British colonial projects both attempted ethnocide against thirty-six Bolivian communities and five hundred distinct First Nations in Australia. Britain sought to physically eliminate Indigenous people, but when resistance proved too robust, they began a cultural war through protectionist policies and an assimilation wave. By comparison, Spain’s strategy was to attempt genocide against Indigenous Incas, then co-opt a layer of compliant Incan nobility to enslave remainder Indigenous population. In Australia, Aboriginal and Torres Strait Islander campaigning in the 1960s forced the end of assimilationist policies with Freedom Rides, the resilient Tent Embassy in Canberra and an urban expansion in Redfern leading a powerful cultural revival. In the neoliberal phase, governments in Australia are leading a second assimilation phase. A culture war decrying a ‘black armband’ view of history included the abolition of the national Indigenous self-governance body Aboriginal Torres Strait Islander Commission (ATSIC) and $534 million in cuts from Indigenous services in 2014. Despite these obstacles, communities fought off a government-funded ‘Constitutional Recognition’ campaign. However, school history textbooks continue to portray Australia in a colonial white frame. Language reclamation battles have only elicited incremental progress. Comparatively, under the Morales government, Bolivia’s Indigenous cultural rights have progressed. The Bolivian government established a ‘Vice Ministry for Decolonization’. The new constitution acknowledges thirty-six recognized indigenous peoples, compels universities to teach Indigenous languages and memorializes anti-colonial warriors. On increasing Indigenous identification, the government has received a set-back. However, on balance, the MAS government is advancing a decolonizing program. Struggles for self-governance Winning self-governance structures in an anti-colonial frame is critical for Indigenous self-determination. The research uncovers socialists have developed autonomy structures for minority governance that aid Indigenous self-governance projects. From the Russian Bolshevik federated structure model, to Bolivia’s plurinationalism and Indigenous native peasant autonomy structures (AIOCs), socialists have, and are experimenting with democratic structures that benefit to Indigenous and ethnic minorities. However, in Bolivia, there appears to be a retreat from an AIOC model, as Indigenous autonomies do not feature in the 2025 government strategy document. In Australia, British genocide policies weakened First Nations governance, but nation-wide resistance organisations developed from the 1920s. By the 1970s Aboriginal communities had won elected national representation and localised land councils. In the neoliberal phase ATSIC was established – but the government disbanded it in 2004. Militant, national alliances such as the Freedom Summit, Grandmothers Against Removal, #sosblak and Warriors of the Aboriginal Resistance (WAR) formed to fight land grabs and a re-assimilation push. The research discovers a weaker self-governance movement in Australia compared to Bolivia. Additionally, Australia’s socialist movement is more fragile– although a number of Aboriginal militants joined the Communist Party of Australia (CPA) in the 20th century. This study concludes that two organisations, Socialist Alliance and Solidarity, assist Aboriginal campaigns in the 21st century. Aboriginal activists stand as Socialist Alliance candidates in state and federal elections. Socialists in Australia only gather 1.5–5% in state and federal elections. However, three socialists at the local council level have been elected with 30–55% of the vote. In comparison, openly socialist Bolivian presidential candidate Evo Morales wins 65% of the national vote. Conclusions This comparative study discovers strong Indigenous self-determination battles and structures in Bolivia, and weaker ones in Australia. Australian Indigenous resistance offers a rich experience of decolonising lessons to Bolivia’s Indigenous struggles. Equally, Bolivia’s empowerment structures hold encouraging insights. This research concludes that neoliberalism’s strength, a small Indigenous population and the weakness of progressive forces, leave the battle for a pan-Aboriginal republic at an embryonic stage. In contract, Bolivia’s Plurinational project is empowering Indigenous people with land, cultural rights and governance structures. While under pressure due to its positioning in the global capitalist market, Bolivia’s revolution is building Andean capitalism and an Indigenous nationalist model, with a communitarian socialist trajectory. This tension of having to operate within imperialism, I contend, do not detract from Bolivia’s positive example of a Indigenous sovereignty model. The study concludes that vying for state power hosts contradictions for Indigenous self-determination battles. However, Bolivia’s example shows that building Indigenous power from within and separate from the state, has benefited the majority of its people. Black-red alliances have been critical in both Bolivia and Australia’s battles for land, culture and governance rights. Indeed, Bolivia’s Plurinational structures can be viewed as a continuation of a socialist democratic principle. Bolivia points to a pathway for Indigenous emancipation in Australia. A multi-national, pan-Aboriginal and Torres Strait Islander anti-corporate republic offers a powerful decolonising frame. Through songlines and memorias, heroic wars, embassies and sovereignty plans, these autonomist models are providing robust self-determination prototypes.

Australian research confirms that Aboriginal and Torres Strait Islander people experience high levels of social inequality, racism and injustice. Evidence of discrimination and inequality is most obvious within the criminal justice system where they are seriously over-represented. The Australian news media plays a large part in reinforcing Aboriginal and Torres Strait Islander inequality, stereotypes and racist ideology within specific situations such as the Northern Territory Emergency Response and the Redfern riots. This study widens the scope from how the media reports a single criminal justice event to how the media reports Aboriginal and Torres Strait Islander people’s interaction with the criminal justice system. The study relies on Norman Fairclough’s (2003) theory of critical discourse analysis to analyse critically 25 Australian online news media articles featuring Aboriginal and Torres Strait Islander people. Specifically, the study applies Fairclough’s (2003) three assumptive categories (existential, propositional and value). It identifies discourse reinforcing dominance and inequality within those media articles and reveals two major findings. The first significant finding is the unwillingness of any article to challenge or question the power structures that reinforce or lead to Aboriginal and Torres Strait Islander inequality. The second major finding involves three ideologies within the text communicating racism and inequality: neo-colonial, neo-liberal assimilation and paternalistic ideologies. The concern is that although the twenty-five news media articles appear neutral, the critical analysis reveals racist ideologies being communicated and an unwillingness to challenge the power structures that create these. This position suggests that racism is not just a problem of a bygone era—it is a contemporary issue continuing at a deeper level nestled in the underlying assumptions and ideologies found within news media discourse. These findings would bring awareness to the media’s discursive practices and generate further discussion and research to address the discursive structures responsible for perpetuating the systemic harm to Aboriginal and Torres Strait Islander people.

In this thesis 'Indigenous disadvantage' is examined through historical and contemporary discourses, including as a 'wicked' or intractable problem, within Australian Indigenous Affairs policy. Policies, programs and the views of policy actors working in Australian Indigenous Affairs were interrogated through themes of deficit and strength-based discourses. It is argued in this thesis that strength-based discourses which include genuine engagement and co-design with Indigenous Australians, can provide more meaningful and inclusive policy outcomes by challenging the current power structures that exclude and marginalise Aboriginal people and Torres Strait Islander people in policy development and implementation.

This program of research investigated the factors facilitating drink driving in Indigenous communities in Far North Queensland. Drink driving-related road crashes are a significant health burden for Indigenous people, as they die in road crashes at three times the rate of other Australians and are 30% more likely to be seriously injured. This research provided information to develop and pilot a culturally-specific program, 'Hero to Healing'. The main motivation to drink drive was related to 'kinship pressure; where drivers were pressured by family members to drive after drinking. The underlying responsibility for transporting family members was related to cultural values and involved responding to family needs as a priority. Exposure to older family members drink driving was considered to play a role in normalising the behaviour, leading to imitation into adulthood. The research highlighted the need to treat drink driving as a community issue, rather than an individual phenomenon.

This thesis details how the current health system consistently fails to incorporate Indigenous ways of knowing, being and doing. Using the Intervention Level Framework and the 3Es (enact, embed, and enable), the thesis demonstrates the ongoing coloniality and systemic racism of Indigenous public health policymaking and health systems in Australia. The research cogently demonstrates the need for greater self-determination and control of Indigenous affairs by Indigenous people, the necessity of privileging Indigenous voices, and Indigenous control, direction, and co-design a public policy-making, and the requirement to disrupt, deconstruct and decolonise Western knowledges and cultures of ways of being knowing and doing in order to move beyond colonial imperialist traumatic approaches to Indigenous public health policy which continue to this day. The research provides identifiable and concrete leverage points in the system which can be used to transform those racialized rules and norms to achieve sustainable transformational systemic, organisational and individual change such as legislation, statutory bodies and government commitments underpinned by the need to overcome deep-seated resistance to changing status quo mindsets and beliefs in order to address Indigenous oppression and disadvantage and implement Indigenous culture once it has been incorporated into a public policy. The findings fundamentally call for a turning away from white possessive logics and willingness to deeply listen with an open heart and open mind in genuine partnership with Aboriginal and Torres Strait Islander people so as to decolonise and Indigenise health systems and policy-making, including non-Indigenous people and governments being held to account and relinquishing power and control over Indigenous affairs in favour of localised place-based community-led approaches based on relatedness, connectivity, respect, reciprocity, reverence and responsibility.

This research explores the in-between space of intercultural collaboration between Aboriginal and Torres Strait Islander peoples and non-Indigenous peoples in Australia. Using critical and third space theories and a post-qualitative inquiry, I examine negotiations of cultural difference through articulated moments of intercultural collaboration in order to inform intercultural pedagogical practices. This research also explores how ideology, imbued through discourse, has the power to enforce or challenge cultural and social domination. This in turn creates cultural hegemony, a process whereby a particular social and cultural group has the power to influence the thoughts, expectations and behaviours of a particular society.

This thesis contributes to the decolonisation of health promotion by examining Indigenous-led health promotion practice in an urban setting. Using critical ethnography, the study revealed dialogical, identity-based approaches that centred relationship, community control and choice. Based on the findings, the thesis proposes four interrelated principles for decolonising health promotion and argues that Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian mainstream health promotion practice.

The current study consisted of two initiatives. The first initiative was to qualitatively explore the perceptions and attitudes of Career Advisers in New South Wales secondary schools regarding health career pathways for Aboriginal and Torres Strait Islander secondary school students. The second initiative was to explore strategies for raising awareness and stimulating interest in health career pathways for Aboriginal and Torres Strait Islander secondary school students. Fifteen Career Advisers from fifteen secondary schools across metropolitan and regional New South Wales participated in the study. At three separate data collection sites, and at the express request of the participant, the school Aboriginal Education Assistant also contributed primary data to the study. It was the express wish of Career Advisers at these schools that an Indigenous perspective be included in the study. At one data collection site, the Deputy School Principal also expressed the wish to be included in the study. In total nineteen participants contributed toward the study. Findings from the current study suggest that Career Advisers work within a challenging world-of-work context which is constantly changing in order to meet the demands of globalisation. Furthermore, it is evident that within this world-of-work context Aboriginal and Torres Strait Islander students face significant barriers and socio-economic disadvantage. This disadvantage severely impacts upon and restricts these students’ access to career education within the schooling environment. Additionally, the opportunity to engage with and foster lifelong learning in conjunction with ongoing career development is also negatively impacted upon. Other than with medicine and nursing, Career Advisers were found to have limited knowledge regarding both the diversity and range of allied health careers that are currently available to Aboriginal and Torres Strait Islander students. Career Advisers noted they work collaboratively with Aboriginal Education Assistants, who are a core component of the learning and teaching environment for Aboriginal and Torres Strait Islander students. In spite of the critical role they play in holistically integrating the schooling environment and the Aboriginal and Torres Strait Islander community, it was noted that of those schools that did employ Aboriginal Education Assistants, did so on a part-time or casual basis. It was also noted by some participants that despite the necessity for Aboriginal Education Assistants to be on staff in their school, and to be available to themselves and to Aboriginal and Torres Strait Islander students, there was no Aboriginal and Torres Strait Islander person employed in that capacity. Notwithstanding these significant challenges, research outcomes from the current study will recommend that Career Advisers and Aboriginal Education Assistants be supported in their roles. This is particularly important if they are to raise awareness and stimulate interest in health career pathways for Aboriginal and Torres Strait Islander students. Furthermore, it is recommended that additional research be conducted in order to determine how the Commonwealth Department of of Education Science and Training can best provide this support.

Chronic disease is the most significant contributor to the mortality gap between Australia’s First Nations people and the overall Australian population. This study explored chronic disease self-management and health literacy in First Nations adults living in remote Queensland. Key findings were poor communication by healthcare providers coupled with limited health literacy abilities of individuals were the major barriers to active engagement with managing chronic disease. Providing a supportive health literacy environment and the provision of appropriate health information delivered in a cultural safe way using clinical yarning, may assist with closing the gap in First Nations people.

This thesis is the first to comprehensively evaluate Acute Respiratory Illness with Cough (ARIwC) in urban, predominantly Aboriginal and Torres Strait Islander, children. It identified a community experiencing significant disadvantage and a concerning burden of ARIwC. Positive findings include the frequent presentation to primary health care, continuity of primary health care provider, and knowledge of when cough is abnormal; factors that are all critical to the success of interventions and further research to reduce the burden of disease.

Thesis (Master of Letters)--Central Queensland University, 1998.
"A dissertation submitted in partial fulfilment of the requirements for the Degree of Letters in History. Central Queensland University." Cover title.

For far too long, Aboriginal and Torres Strait Islander peoples' voices have been silenced. This study critically analyses the National Aboriginal and Torres Strait Islander Education Strategy 2015 through the lens of the Coolangatta Statement on Indigenous peoples' rights in Education. Focus is placed on how the Strategy addresses the rights of Aboriginal and Torres Strait Islander peoples in education when seeking to improve the educational attainment of Indigenous primary and secondary students. In turn, the representations of Aboriginal and Torres Strait Islander students, parents and communities are explored and established.

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.

During 1987 my essential beliefs about the nature of the world were challenged by a chance event which led to my arrival in Arnhemland. Working with Aboriginal people allowed me to see first hand the failings of Western ideas in Aboriginal education and health. This is how a 12 year collaboration with Aboriginal people began. The aim was to search for answers to the question, 'Why so many ideas that had been successfully used in the Western world, fail to meet the needs of aboriginal people? My experiences prior to 1995 had led me to believe that Both Ways, an education pedagogy developed in teacher education, was the best approach for empowering Aboriginal Health Workers. I believed Both Ways gave Aboriginal Health Workers a means to develop solutions to aboriginal health issues which valued and respected their aboriginal knowledge. I needed to describe and evaluate the practice of both ways with Aboriginal Health workers for the purpose of proving the benefit of this pedagogy for other educators in this field. This thesis describes how I came to think Both Ways was a good idea; how I defined Both ways; and how I put it into practice. It also provides a description of the issues raised in my critique of Both Ways and in my attempts to provide answers to these issues. Several years of collecting data, including records from action research group discussions, participant observation, interviews with peers and students, and formal evaluations left me with many concerns about Both Ways. As educators follow my journey of discovery I hope that they will recognise experiences and insights that they themselves have shared. The descriptions and discussions in this thesis will add significantly to the overall discourse about health worker education. Similarly, the exploration of ideas beyond Both Ways will add significantly to the overall body knowledge about the power relationships involved in teaching in a cross cultural setting
Doctor of Philosophy (PhD)

This study involves the analysis of one of the most recent Indigenous Education policies, the Aboriginal and Torres Strait Islander Education Action Plan 2010-2014 (MCEECDYA, 2011). It examines how the language used within policy positions Aboriginal and Torres Strait Islander peoples. Articulating Rigney's (1999) Indigenist Research Principles with Fairclough's (2001) Critical Discourse Analysis provides a platform for critical dialogues about policy decision-making. In doing so, this articulation enables and emphasises the need for potential policy revision to contribute to the Aboriginal and Torres Strait Islander struggle for self-determination.

During 1987 my essential beliefs about the nature of the world were challenged by a chance event which led to my arrival in Arnhemland. Working with Aboriginal people allowed me to see first hand the failings of Western ideas in Aboriginal education and health. This is how a 12 year collaboration with Aboriginal people began. The aim was to search for answers to the question, 'Why so many ideas that had been successfully used in the Western world, fail to meet the needs of aboriginal people? My experiences prior to 1995 had led me to believe that Both Ways, an education pedagogy developed in teacher education, was the best approach for empowering Aboriginal Health Workers. I believed Both Ways gave Aboriginal Health Workers a means to develop solutions to aboriginal health issues which valued and respected their aboriginal knowledge. I needed to describe and evaluate the practice of both ways with Aboriginal Health workers for the purpose of proving the benefit of this pedagogy for other educators in this field. This thesis describes how I came to think Both Ways was a good idea; how I defined Both ways; and how I put it into practice. It also provides a description of the issues raised in my critique of Both Ways and in my attempts to provide answers to these issues. Several years of collecting data, including records from action research group discussions, participant observation, interviews with peers and students, and formal evaluations left me with many concerns about Both Ways. As educators follow my journey of discovery I hope that they will recognise experiences and insights that they themselves have shared. The descriptions and discussions in this thesis will add significantly to the overall discourse about health worker education. Similarly, the exploration of ideas beyond Both Ways will add significantly to the overall body knowledge about the power relationships involved in teaching in a cross cultural setting

Influences on food and lifestyle choices for Aboriginal and Torres Strait Islander Australians: An Aboriginal perspective The care and management of chronic diseases and comorbidity impose a substantial burden on the Australian government, Aboriginal Medical Services (non-government primary health care organisations) and mainstream health services and systems. Nowhere is this burden more felt than upon Aboriginal and Torres Strait Islander Australian individuals, their families and communities. Most health research studies that have measured the burden of chronic disease tend to take only a partial view of the socio-economic consequences, focusing on measuring the burden on the health system of responding to an illness rather than apply a holistic perspective of the overall historical, political, social, cultural and emotional wellbeing (psychological distress) that impact upon Aboriginal and Torres Strait Islander peoples, their families and communities. The analytical framework applied in this thesis used mixed methods of research, study design, data collection and analysis in order to provide a holistic assessment of the population, socio-economic and cultural burden of disease. Research was undertaken in a number of different settings; including Aboriginal Medical Services and the Eora (TAFE) College. Responses provided by Aboriginal and Torres Strait Islander participants in the 45 and Up longitudinal cohort study were analysed. The framework incorporated features to assess the key dimensions of Aboriginal and Torres Strait Islander Health and incorporated a holistic definition of Aboriginal health: “Aboriginal health is not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole community in which each individual is able to achieve their full potential as a human being, and thereby contributing to the total well-being of their Community. It is a whole-of-life view that includes the cyclical concept of life-death-life”. (NACCHO 2013) The findings of all these studies highlight that there is a need to investigate further the resilience factors, relationships and psychological distress, which influence Aboriginal and Torres Strait Islander people’s food choices, diet patterns, risky behaviour and lifestyle choices.

The pervasive health and social disadvantage faced by Aboriginal and Torres Strait Islander peoples is an acknowledged part of Australian society. The contemporary data reveal striking inequalities between Indigenous and non-Indigenous Australians in most measurable aspects of wellbeing across the life cycle. This reflects a postcolonial history of marginalisation and exclusion from mainstream society, dispossession of traditional lands, forced separation from family and kinship networks, and racism. Despite an increased awareness and disapproval of these inequalities in health, the inequalities persist.The lack of progress in the face of public disapproval and progressive government support underscores the fact that we still do not adequately understand the fundamental causes of Indigenous ill health and disease. A small body of research in Australia has highlighted that socioeconomic status (SES) accounts for a portion of the gap in health but this does not imply that they account for health differences within Indigenous population groups. A robust international literature has consistently shown that socioeconomic factors influence population health. These factors reflect the way in which society is ordered according to wealth, prestige, power, social standing or one’s control over economic resources, and their pattern of association with health has almost always depicted better health for those who are better off— that is, the health of population groups normally follows a gradient pattern. Despite the ubiquity of this observation in the empirical literature, there is uncertainty as to whether it applies to Aboriginal and Torres Strait Islander populations in Australia.Accordingly, this thesis has aimed to assess the pattern of socioeconomic disparities in the health and development of Indigenous populations in Australia, with a specific focus on children. The three key objectives were to: • Describe the developmental status of Indigenous children and the mechanisms that influence this status; • Determine the pattern of association between socioeconomic factors and physical and mental health outcomes; and • Reveal the significant differences (and similarities) in the socioeconomic pattern of child health between Indigenous and non-Indigenous populations, and articulate these in terms of their direction, shape and magnitude.The objectives of the study were primarily assessed using a quantitative analytic framework applied to four existing population-representative datasets: the 2008 National Aboriginal and Torres Strait Islander Social Survey, the 2000–2002 Western Australian Aboriginal Child Health Survey, the 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey. Simple univariate and cross-tabulation data were used to describe population characteristics, while the relationships between socioeconomic indicators and health outcomes were assessed using a range of regression techniques. Multilevel models are an important feature of this study, and have enabled a more accurate estimation of the effects of individual and area-level measures of SES on health. Generalised Additive Models were used to account for the possible non-linear nature of associations between continuous SES variables and physical health outcomes, with results presented as non-parametric spline curves. The mechanisms linking SES and mental health were explored using a stepwise approach to the regression analysis. All data in all chapters were weighted to reflect population benchmarks.The findings highlighted that there were significant socioeconomic disparities in the health of Indigenous children in Australia, although the direction, shape and magnitude varied, by both socioeconomic measure and health outcome. While the socioeconomic patterns of Indigenous child health are not universal, they are more consistent for mental than physical health. In addition, the thesis has shown that both conventional and alternative notions of SES can influence health patterns. The largest disparities in child physical health were observed for area-level SES indicators, while housing characteristics and area-level SES both had a strong direct effect on child mental health.The thesis has demonstrated that the patterns of socioeconomic disparities in child health differ markedly in Indigenous and non-Indigenous populations—at least in non-remote settings. It was not uncommon for the magnitude of disparity to be larger in the Indigenous population. These findings lend support to the notion that socioeconomic factors have a differential impact on the health of Indigenous and non-Indigenous populations. The implication of this for policy is that a single approach to stimulating socioeconomic conditions will not have equal benefits to child health outcomes in Indigenous and non-Indigenous populations. While the evidence here underscores the validity of the well-worn edict that “one size does not fit all” in Indigenous health policy, it also reinforces the need to examine health disparities within and across Indigenous and other population groups in order to better inform policy and practiceCollectively, the results have provided clear evidence that socioeconomic factors matter to both the physical and mental health of Aboriginal and Torres Strait Islander children. The diversity of findings implies that SES factors are one facet of the unique and complex set of factors that influence Aboriginal child health and wellbeing.This thesis has made several original contributions to the literature on social inequalities in Indigenous health in Australia and the broader field of social determinants of health. It is one of the few studies internationally to explicitly look at the socioeconomic patterning of health in an Indigenous population, and the first to examine these patterns among Indigenous children using population-representative data. In doing so, the study has begun to bridge the knowledge gap on social inequalities in Aboriginal health in Australia, and will facilitate a better grasp of the complex underlying mechanisms that determine Aboriginal health.For policy, this knowledge can lead to more effective government decision-making in terms of targeting social determinants of health that are of particular significance for Aboriginal populations. It is hoped that the findings of the thesis can provide directions for future research and insights to policy that will, ultimately, increase the pace of change toward health equity in Australia.

This thesis focuses on non-Indigenous educators’ work around embedding Indigenous perspectives in early childhood education curricula. In place of reporting examples of ‘good’ educational practice, the study questions how whiteness and racism continue to operate in diversity work that is seen to be productive and inclusive. The thesis argues for a more comprehensive framework for embedding Indigenous perspectives in before-school contexts to support educators’ efforts. New strategies for professional development are also suggested to support changes in disciplinary knowledge and pedagogy.

This thesis explores the physical activity experiences of Aboriginal and Torres Strait Islander mothers from a health promotion viewpoint, in which the determinants of physical activity can be understood. Although regarded as highly inactive subgroup of the population, little is known about the influence the determinants of health have on Aboriginal and Torres Strait Islander mothers’ physical activity participation. Therefore it is difficult to understand how future interventions could be developed to improve physical activity levels and probably explains why so few exist. The central argument of this thesis was that standardised, ‘one size fits all’ approaches, targeted at the majority are ineffective if they did not address the needs of specific groups and populations. Physical inactivity is a serious public health issue for all Australians, in particular the Aboriginal and Torres Strait Islander population, who suffer the greatest burden of disease. Hence, efforts to close the gap are needed by promoting physical activity, which is noted as the second most modifiable risk factor to chronic disease. In order to do this a comprehensive understanding of the factors that influence participation is needed. Whilst limited information that documented the physical activity determinants of Aboriginal and Torres Strait Islander mothers was available, the influences of the broader determinants were examined. The World Health Organization’s social determinants of health were used as framework to understand the various influences that impacted Aboriginal and Torres Strait Islander women’s lives. The purpose of this initial investigation was to contextualise physical activity behaviour. At this point however, it was discovered that the evidence base of the broader Australian maternal population was also relatively small. Therefore, pilot work was conducted to strengthen the knowledge and approach that would be taken in the main study.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Public Health
Griffith Health
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The Big Slap is a decolonised constructivist grounded theory study that explains the meaning of university education to mature-age Aboriginal and Torres Strait Islander university graduates in the context of age, life-stage, history, culture, socioeconomic status, race and place. It situates these meanings within the larger social structures that shaped the graduates’ lives and pays particular but not exclusive attention to the experiences of mature-age Aboriginal and Torres Strait Islander university graduates who lived and worked in remote regions of Australia. This study was developed in response to the identification of a defeatist discourse in the peer-reviewed and grey literature around the potential societal worth of mature-age Aboriginal and Torres Strait Islander university students. We noted an especially negative representation in the grey literature around the aspirations, capabilities and potential of Aboriginal and Torres Strait Islander students from remote regions. This discourse was starkly at odds with the positive representations of younger Aboriginal and Torres Strait Islander university students from regional and urban areas, and mature-age university students in general. It also conflicted with my experiential knowledge of the characteristics and contributions of mature-age Aboriginal and Torres Strait Islander university graduates, many of whom lived and worked in remote regions. The findings of this study provide a far more nuanced appraisal of the potential and actual societal worth of mature-age Aboriginal and Torres Strait Islander university students and graduates. They also challenge the ideological construct of Australia as a ‘post-racial’ society. These findings produced The Big Slap substantive grounded theory, which explains the relationship between two dynamic, interrelated and antithetical forces: the transformative potential of university education for mature-age Aboriginal and Torres Strait Islander graduates, and the ways in which structural racism in the graduates’ workplaces and communities acted to suppress that potential while protecting white innocence and preserving white power and privilege. The realisation that the meritocratic ideal promised by university education was largely a myth destabilised the graduates’ critical hope and disrupted their optimistic orientation toward a changed future. Nonetheless, the graduates demonstrated a determined resistance to the oppressive project of structural racism. They retained their transformative potential and remained committed to deploying it to the extent possible in the service of family and community wellbeing. The Big Slap offers a unique contribution to the fields of Aboriginal and Torres Strait Islander university education, graduate employment outcomes, and associated workplace organisational behaviour. It disrupts the defeatism in the literature around the potential societal worth of mature-age Aboriginal and Torres Strait Islander university students, including those who live and work in remote regions of Australia. It also exposes the presence and effects of structural racism in the graduates’ workplaces and explains its relationship to pervasive and persistent global ideologies of racial superiority and inferiority. Finally, The Big Slap challenges the Australian government and non-government sectors to enact structural change that genuinely and respectfully accommodates mature-age Aboriginal and Torres Strait Islander university students’ and graduates’ aspirations and capabilities, and potential and actual contributions to society.

In this thesis I propose to address what are, in my view, significant educational problems: how to tease out and analyse those principles, concerning equity and social justice, which underlie a particular program of teacher education. I want to discuss the kinds of principles, issues and considerations which have to be faced when designing such a program as the Diploma of Teaching (Early Childhood Education) for Aboriginal and Torres Strait Islander students at James Cook University. The issues I will address are these: (a) The extent to which the notion of equality of educational opportunity is being addressed in the provision of teacher-education programs in Queensland in general, and James Cook University in particular; (chapter 1). (b) Ways in which the Diploma of Teaching (Early Childhood Education) p r o g r am aims to produce teachers able to act as agents of bi-cultural transmission; (chapters 2 and 3). (c) The value, usefulness and desirability of James Cook University setting up a teacher-education program specifically for Aboriginal and Torres Strait Islander students from geographically remote communities, thus increasing the participation rates of Aborigines and Islanders in teacher-education programs; (chapters 4 and 5). This process of analysis has led me to structure the thesis around three dimensions: (i) The historical context of the program; (ii) The program as one response to the problems faced by educational institutions in meeting the educational needs of Aboriginal people; (iii) A basis for the next phase in the development of new programs of teacher - education for indigenous students living in remote communities. This is a qualitative research project, based on my interpretation of available documentation, my use of relevant literature, and my own involvement as planner of, and teacher in the program. It is not a quantitative research project. The structure of the thesis has, as its introduction, an analysis of the extremely complex situation which exists at James Cook University. This analysis leads to a search for a set of principles to provide the theoretical underpinning of the program, which in turn leads through a combination of theory and practice to the "praxis" of the program as a model of equity and educational practice in teacher-education. The thesis is concluded by the presentation of the current stage in the development of a program for teacher-education students in remote communi ties. The conceptual framework for my thesis has been developed through my determination to increase my understanding of the complexities of developing teacher-education programs for indigenous students at James Cook University. The thesis is developed through case study techniques including: personal observation and recording of my work as Program Planner; a situational analysis of the historical background, leading up to the development of the Diploma of Teaching (Early Childhood Education) ; a discussion of the stages through which the development team proceeded with intentionality and empathy towards its task of constructing a specific program of teacher-education; and my use of existing literature to comprehend the educational and social problems which the program attemted to alleviate. Throughout my thesis the specificity of the "case", and the eclectic position I have adopted, have acted as boundaries of my conceptual framework. My thesis attempts to show that the "case" of the development of teacher-education programs for Aboriginal and Torres Strait Islander students at James Cook University, although an idiosyncratic instance , is valuable as illumination , if not for generalisation, and thus has a credibility and usefulness. The characteristics of the case-study method are frequently more appropriate to expansion is than reductionist activities, and I have tried to show how the different perspectives of Aboriginal and non-Aboriginal people, together with the beliefs, attitudes and values of such different interest-groups as university academics, Commonwealth and State Education Department bureaucrats, and teachers and parents in schools, have emphasised both the importance of questioning assumptions and the importance of critical, experiential understanding.

In Australia, over-representation of Aboriginal and Torres Strait Islander children in child protection systems is increasing. The legacy of the stolen generation has led to grief, sadness and loss of identity for many people, and major disparities in health, education, employment and housing means that Aboriginal and Torres Strait Islander families are more susceptible to child welfare interventions in the present and future. This makes it imperative that responses for these families are more effective, in order to achieve socially just outcomes. As well, Australia’s growing multicultural society has increased demand for services provided to people from diverse cultural backgrounds to recognise the impact and importance of culture and to respond effectively. Cultural competency, which focuses on developing knowledge, skills and values for cross cultural practice, has gained momentum. It aims to enhance the ability of workers to provide culturally relevant and effective responses to people from different cultural backgrounds. However, ensuring that practices in the human services are culturally appropriate, culturally safe, salient, and effective, has proved elusive.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Human Services and Social Work
Griffith Health
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The literature identifies a number of underlying issues that impact on the consumer protection of Aboriginal and Torres Strait Islander people. These issues arise from locational (remoteness), historical (protection and assimilation policies enacted through the colonial process) and cultural factors (rooted in tradition, customs and relationships to people and place). These factors act as a unique combination of circumstances which require a specific approach to consumer protection – one that addresses these issues and redresses 'advantage' and 'disadvantage' and 'power' and 'vulnerability'. A significant gap in the literature is an understanding of the role of culture in consumer transactions involving Aboriginal and Torres Strait Islander people; how to address locational issues; and the enduring historical impact of colonisation on the consumer behaviour of Aboriginal and Torres Strait Islander people. This thesis aims to contribute to this knowledge gap. The case law points to a particular need to look at options such as increased regulation in respect of matters such as unconscionable conduct, and misleading and deceptive conduct. It also indicates a greater need for access to legal education and community awareness about the consumer protections available to them and how best to exercise these legal rights especially for Aboriginal and Torres Strait Islander people living in remote Australia – to address locational 'disadvantage'. These issues will be explored in depth throughout this thesis including through an analysis of the data collected from semi-structured interviews. Literacy, numeracy, commercial acumen and financial literacy also appear to impact on Aboriginal and Torres Strait Islander consumers in the same way they did 25 years ago, as evidenced by the analysis in Chapter 2 of the case law over this period. Inequality experienced as a result of socio-economic factors will continue to place Aboriginal and Torres Strait Islander consumers at a 'disadvantage' for as long as this inequality (gap) remains. Positively, there is one area in which change is occurring; this is in respect of young Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander consumer 'vulnerability' within the new generation has in some ways decreased as a consequence of generational differences and generational change within the Aboriginal and Torres Strait Islander population. The influence of culture and Aboriginal and Torres Strait Islander values (such as relationality) is strong and continues to contribute to Aboriginal and Torres Strait Islander consumers' 'vulnerability'. There are challenges present in the consumer protection law that negatively impact on an Aboriginal and Torres Strait Islander person's ability to make informed decisions relate to interpretation and enforcement processes. Rather, the weight of the data together with an analysis of the case law leads to the conclusion that the law is sufficient but that problems lie in the broader themes of discrimination, socio-economic disadvantage and access to justice. Addressing Aboriginal and Torres Strait Islander consumer 'vulnerability' and 'disadvantage' cannot be attended to by the consumer protection laws alone, nor simply by consumer watchdogs, courts, financial counsellors and lawyers working independently from one another. A combination of all of these is required, pieced together within a broader strategy for improving all aspects of the lives of Aboriginal and Torres Strait Islander people.

Research Doctorate - Doctor of Philosophy (Phd)
The limited available data shows Aboriginal and Torres Strait Islander Peoples have disproportionately high rates of diabetes-related foot disease, and experience amputation up to 38 times more frequently than non-Indigenous Australians. The high rate of diabetes-related foot disease in this population results in reduced quality of life, elevated hospitalisation rates and associated expenditure, and significantly contributes to preventable deaths. The reasons for higher rates of diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples are complex, with a lack of available culturally safe care, low socioeconomic status and poor engagement with Western health services significantly contributing to the current catastrophic outcomes. To effectively address diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples, a better understanding of the extent of the problem is required, and, there needs to be improved access to culturally safe foot care through better service provision and a more culturally capable health workforce. This thesis had the overarching aims of establishing the foot health of Aboriginal and Torres Strait Islander Peoples in the local Central Coast community, and developing methods to improve access to, and delivery of, culturally safe foot care. This thesis investigated, via systematic review, the current state of diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples and the availability and effectiveness of foot care services to reduce diabetes-related foot complications in this population. The reviews demonstrated there is a lack of nationwide data relating to diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples, and, that most data focuses on amputation rates, with little information available regarding specific types of diabetes-related foot complications. Nevertheless we found Aboriginal and Torres Strait Islander Peoples had between a 3 to 6 fold increased likelihood of both foot ulcer and minor or major amputation, and, that these occurred at a younger age. Furthermore, we found no evidence of state- or nation-wide foot health programs for prevention of diabetes-related foot disease in Aboriginal and Torres Strait Islander Peoples. Existing services were localised and there was little evaluation of the acceptability of these programs, levels of community engagement or impact on foot disease. Subsequently through an extensive community consultation process we used an effective co-design approach to develop a foot care service embedded in an undergraduate podiatry program. Key design elements included; integrating ongoing community consultation; involvement of Aboriginal health workers and practitioners connected to their local community; recognising the role of community in cultural capability training of health students; and, creating a flexible and accessible care model that is aligned with the community foot care priorities. To conduct a comprehensive evaluation of the foot care service model, we used culturally appropriate methods to determine the Aboriginal and Torres Strait Islander perspective of program success through research yarns and customised surveys, as well as service utilisation data. These data demonstrated that service elements including yarning circles and group appointments, as well as student placements, increased participant engagement with, and ownership of the clinic. Increasing accessibility to the clinic was flagged as a mechanism to further increase engagement. In addition, student placement in a culturally safe clinic significantly improved students’ understanding of multiple aspects of cultural capability (e.g. understanding of culture, history, and their interrelationship with health and health care delivery), and level of confidence with providing culturally appropriate and safe foot care. In summary this research highlights the devastating impact of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and the importance of a co-designed approach to delivery of culturally safe foot health care, as well as the central role of immersive experiences for developing a culturally safe future podiatry workforce.

This thesis tells a story of the lands belonging to the Darumbal people located in the coastal region of Central Queensland, Australia, through the lives of a select number of young people connected to the Country as either Traditional Custodians or as members of other Aboriginal and Torres Strait Islander groups who have relocated to this area. In particular, the research examines how ten young Aboriginal and Torres Strait Islander people experienced school and how they leveraged those experiences to transition into family and community roles as young leaders. The thesis concludes that participants actively pursued a process of ‘belonging and becoming’. School spaces were appropriated to facilitate their desire for ‘belongingness’ and skills, abilities and aspirations were developed consistent with the goal of ‘becoming’ the future of their families and communities. Their recent experiences of completing Year 12, working and studying on Darumbal country informed post-school pathways that are simultaneously professional and cultural by necessity. The findings illustrate the environment which young Aboriginal and Torres Strait Islander people studying and working on Darumbal country have identified as valuable in their pursuit of belonging and becoming at the core of their identities. Whilst this research examines a very specific group of young Aboriginal and Torres Strait Islander people in a particular location the learnings from this study could offer an insight into other groups of young Aboriginal and Torres Strait Islander people living on other Aboriginal and Torres Strait lands; and potentially extended to other First Nations’ people elsewhere.

The health inequalities between Indigenous and non-Indigenous Australians, and the benefits of physical activity in the prevention and treatment of chronic diseases are well known. Yet, little research has been conducted on physical activity and health outcomes for Aboriginal and Torres Strait Islander people. The Australian physical activity guidelines, recommend that adults should accumulate 150-300 minutes per week of moderate activity or 75-150 minutes of vigorous activity or equivalent combinations of both. Currently, 47% of Aboriginal and Torres Strait Islanders in non-remote locations are sufficiently physically active, 0.9 times that of non-Indigenous Australians. The purpose of this thesis was to investigate ways to improve the health of Indigenous Australians through a physical activity program. The first major aim (Study 1) was to synthesise previous evaluations of physical activity interventions implemented with Indigenous people in Australia and New Zealand and, based on this, to identify gaps in the literature and to recommend an agenda for future research in this field. The second aim (Study 2) was to assess the reliability and validity of the Fitbit Flex for measuring physical activity levels, as this device would be used in the succeeding study. The Fitbit Flex was selected as the comparative device as it is a waterproof accelerometer that can be worn 24 hours a day as a wristband, which may be more convenient for users and was hypothesised to lead to higher compliance in wearing time than the waist worn Actigraph GTX3+. The third aim was to implement and evaluate an 8-week community-tailored physical activity program in a rural and regional setting. The quantitative part of the evaluation of the program (Study 3) involved assessing changes in functional capacity for exercise, physical activity and various health outcomes. In a qualitative study (Study 4) barriers and enablers to participating in the program were examined. Study 1: The systematic review was registered with the PROSPERO network and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of the literature identified 13 studies which met the inclusion criteria. Due to the heterogeneity of the data and the contexts in which they were collected a meta-analysis was not feasible, so a narrative synthesis of the results was conducted. Only six studies measured physical activity objectively (n=2) or via self-report (n=4) and only five studies measured a component of fitness such as strength or sub-maximal aerobic capacity. There was no clear evidence that the interventions had increased activity levels in the shortterm. However, 11 out of 13 studies reported improvements in fitness and other physical activity-related health outcomes such as reductions in weight and blood pressure. Study 2: A gap identified in the systematic review (Study 1) was the lack of objective measurements of physical activity, where only two out of the 13 studies had used pedometers. Therefore, in Study 2 the Fitbit Flex, a novel accelerometer, was validated against direct observation and a research-grade accelerometer (Actigraph GTX3+) under laboratory and free-living conditions. The validity of the Fitbit Flex was found to be dependent on the type of activity, where the number of steps taken during jogging and stair stepping were more accurate, compared to slow walking activities which were undercounted. The Fitbit Flex had overall moderate validity, was deemed more cost-effective and, due to the lower participant burden was expected to lead to higher compliance in wearing time. Consequently, the Fitbit Flex was selected as the method for objectively measuring activity levels of the participants in the planned physical activity program (Study 3). Study 3: In line with the recommendations from the systematic review, objective measures of activity with the Fitbit Flex were attempted in the evaluation of the physical activity intervention (Study 3). The primary outcome measure for the community-tailored 8-week physical activity program was the change in functional capacity, which was assessed by the six-minute walk test (6MWT). The physical activity program was implemented in both a rural (n=12) and regional community (n=22) in Far North Queensland. An attempt was made to use a wait-listed control group, however, the intended site withdrew shortly before the intervention was to begin due to a lack of staff availability. Due to an insufficient number of participants and therefore lack of statistical power, the original plan to run the evaluation with a waitlisted control group had to be replaced with a pre-post study design. An intention to treat analysis was undertaken due to low program attendance. In the rural community, there was a 50% attrition rate, where six of the 12 participants completed follow-up assessment. There was a significant improvement in the 6MWT distance from 467.3 metres±56 to 557.8 metres±108 (p=0.01) and significant decreases in body fat (34.98±6.6% to 30.61%±6.92, p=0.009) and hip circumference (106.6cm±4.0 to 104cm±5.3, p=0.005). Attendance to the program was low. Eight participants did not attend a single training session, and four attended an average of seven out of 26 sessions. Six sessions were cancelled due to rain which affected the implementation of the program. In the regional city, 18 of the 22 participants attended post-program assessments. There was an increase in the 6MWT distance, but this was not clinically significant (p=0.287). There were no significant reductions in weight (p=0.25), BMI (p=0.19) or body fat percentage (p=0.85). Significant reductions were measured in waist circumference (from 99.11cm±11.95 to 96.07cm±11.46 (p=0.006) and hip circumference (from 105.41cm±11.32 to 101.97cm±8.83 (p=0.019)). Reductions in both systolic (p=0.0002) and diastolic blood pressure (p=0.0002) were also evident. No significant improvements in pathology markers, such as HbA1c or cholesterol, were evident. Unfortunately, the objectively measured physical activity data could not be used for the evaluation of the intervention due to poor compliance in wearing the Fitbit Flex accelerometres. Self-reported daily minutes of moderate to vigorous physical activity increased from 28.2 minutes ± 13.3 to 40 minutes ± 20.2 (p=0.09), but this was not significant. Study 4: After observing low attendance to the physical activity program, a qualitative evaluation was undertaken to better understand the factors that were influencing the attendance rate. Semi-structured interviews were conducted with twelve participants at the follow-up health assessments for Study 3. The interview guide was loosely based on the Health Belief Model. It was theorised that individuals would be more likely to voluntarily engage in the physical activity program if their current behaviour is perceived as a threat to their health. The findings from the interviews confirmed that despite low program attendance, there were positive attitudes and high levels of motivation towards the physical activity program. The enablers to participation were the inclusion of family members, no financial cost and a good relationship with the principal investigator, which was strengthened by the community-based participatory approach to the program design. Barriers to program attendance were mostly beyond the control of the individuals, such as sorry business, needing to travel away from the community and lack of community infrastructure. Conclusion: The purpose of this thesis was to investigate ways to improve the health of Indigenous Australians through a physical activity program. Based on the findings from the systematic review of the literature and the validation study, an 8-week physical activity program was implemented. The results of the program suggest that those who participated in physical activity during the study period had improvements in clinical health outcomes. However, more consideration of community-specific barriers and enablers is needed prior to implementation of programs to understand how they will affect attendance to the program. More work is needed to better understand how to improve participation rates in physical activity programs for Aboriginal and Torres Strait Islander people in rural and regional settings.

Research Doctorate - Doctor of Philosophy (PhD)
Aboriginal and Torres Strait Islander peoples hold a unique position in Australian society, yet they are the most disadvantaged group in the community. This disadvantage is a direct result of the effects of European invasion and the systematic exclusion of Aboriginal and Torres Strait Islander peoples from many institutions of Australian society, such as social security, industrial relations and education systems. The unemployment rate for Aboriginal and Torres Strait Islander peoples is three times the national average, the highest unemployment rate of any group in the Australian labour market. Participation rates, skills, qualifications and income are all well below those of the non-Indigenous population. Since 1967, successive Commonwealth governments have attempted to correct these past policies by being proactive in promoting Indigenous education and employment, and by putting policies into place to redress the disadvantage that Indigenous peoples face. This thesis considers a range of employment issues that relate particularly to Aboriginal and Torres Strait Islander peoples’ employment. While noting some of the employment strategies utilised by governments, the particular focus of the thesis is with the strategies pursued by private-sector organisations to manage diversity and to reduce labour market disadvantage for Aboriginal and Torres Strait Islander peoples. By exploring these strategies, the thesis aims to identify what works and what does not work. In so doing, the thesis presents an original contribution to knowledge as the first study to examine private-sector attempts to redress labour market disadvantage for these peoples. In addition, the research will provide the basis for formulating and evaluative framework for Aboriginal and Torres Strait Islander employment.

Research Doctorate - Doctor of Philosophy (PhD)
Aboriginal and Torres Strait Islander people, hereinafter respectfully referred to as Aboriginal people, a have a rich heritage and diverse cultures. They have a strong connection to their community and country. However, Aboriginal people have suffered long-lasting effects from colonisation, dispossession of land and racism with devasting impacts, particularly for health outcomes. In Australia, Aboriginal people have up to three-fold higher rates of chronic disease compared to non-Aboriginal people. Given the high risk of frequent avoidable admissions and unplanned hospital readmissions for people with chronic diseases, it is not surprising that Aboriginal people also have higher rates of these types of hospitalisations compared to non-Aboriginal people. High rates of avoidable admissions and unplanned readmissions reflect sub-optimal community healthcare and poor hospital care. However, little research has explored these types of potentially unnecessary hospitalisations for Aboriginal people with chronic disease in Australia’s most populous state of New South Wales (NSW). This thesis explores frequent avoidable admissions and unplanned readmissions among Aboriginal people by focusing on three key aims. The first was to examine the prevalence and trends of frequent avoidable admissions and unplanned readmissions of Aboriginal and non-Aboriginal people residing in NSW, utilising linked hospital administrative data. International research examining the factors associated with unplanned readmissions in general populations indicate the importance of factors such as chronic disease management, a regular general practitioner, good health literacy and medication adherence. Therefore, the second aim of this thesis was to identify perceptions of Aboriginal people regarding potential contributors to chronic-disease-related unplanned readmissions. In-depth interviews were conducted with a sample of Aboriginal people who had been readmitted to hospital. Telephone follow-up has been used alongside other intervention components, such as tailored discharge planning and patient education, with the aim of reducing unplanned readmissions in surgical and general medicine patients. The final aim of this thesis was to examine the potential impact of telephone follow-up in reducing unplanned readmissions rates for patients with chronic disease. This involved a systematic review of the research literature on the impact of telephone follow-up, and an evaluation of a program utilising telephone follow-up for Aboriginal people. The implications of the findings of this work are discussed in relation to hospital and community health service practices and state-wide data monitoring. Further explorative research and a community-led multicomponent telephone follow-up enhancement intervention are proposed.

My MAE was undertaken at the South Australian Health and Medical Research Institute (SAHMRI), during 2018-2019. My studies focussed on the health and wellbeing of adolescent and young Aboriginal and Torres Strait Islander peoples, with the exception of my outbreak project. My studies included: Analysis of public health dataset - A retrospective study of South Australian adolescents aged 10-24 years utilising data from the Integrated South Australian Activity Collection dataset. The aim of the study was to assess leading causes and trends in hospital separations among adolescents in South Australia (SA) between 2006 and 2015, by sex, age groups and Aboriginal status. Counts and proportions of leading causes of separation were calculated as age-standardised rates and negative binominal regression was used to assess trend over time. Epidemiological study - Let's Talk About It 2019, an online survey of sexual health, knowledge, behaviours and access to health services for sexually transmitted infections (STI) and bloodborne viruses (BBV), amongst young South Australians aged 16-29 years, both Aboriginal and Torres Strait Islander and non-Indigenous. Descriptive analysis, univariate and adjusted logistic regression models were used to determine whether socio-demographic characteristics and sexual risk behaviours were associated with specific behaviours. Evaluation of a public health surveillance system - The preliminary evaluation of the ATLAS Aboriginal and Torres Strait Islander Sexual Health Surveillance Network - a national sentinel surveillance system within Aboriginal community-controlled health services (ACCHS). The evaluation of ATLAS involved a document review, stakeholder interviews and analysis of ATLAS data using the Centers for Disease Control and Prevention (United States of America) Updated Guidelines for Evaluating Public Health Surveillance Systems. I assessed the following attributes: acceptability, simplicity, flexibility, data quality, representativeness, timeliness, stability, and usefulness. Outbreak investigation - An epidemiological investigation and a retrospective case-control study of an outbreak of Salmonella Havana in alfalfa sprouts, in Adelaide. The outbreak was conducted during June and July 2018 with colleagues from SA Health. Investigations identified the most likely source to be alfalfa sprouts. Public health action lead to a consumer level recall of all alfalfa sprout products and public health alert. Teaching - This chapter outlines two teaching sessions, (i) a teaching session to first year MAE scholars, on a Single Overarching Communication Outcome (SOCO) in relation to the communication of a public health message; and (ii) a Lessons From the Field to my fellow scholars, on 'Conducting research with Aboriginal and Torres Strait Islander communities'.

This thesis presents a collection of applied epidemiological studies and is primarily focused on health risk behaviours and preventive health programs. The studies included: - a cross-sectional analysis of data from two national Aboriginal and Torres Strait Islanders surveys. The study examined estimates of smoking prevalence by Indigenous Regions, 2012/13 and 2014/15; - a pre- and post- study of a local Aboriginal-developed tobacco control campaign in Central Australia. The study examined change in smokers and ex-smokers knowledge, attitude and behaviours to tobacco use, 2016-17; - a retrospective cohort study of Aboriginal Community Controlled Health Services which examined if outcomes in smoking were associated with targeted Indigenous tobacco control funding, 2014-2017; - a clinical audit to identify and provide recommendations to improve the pathways available to help identified smokers quit, in six Aboriginal Community Controlled Health Services in Queensland 2017; - an evaluation of the Royal Flying Doctors Service Monitoring System for an obesity-prevention program, the Healthy Living program, delivered in remote communities in South Australia 2007-2016; and, - an outbreak investigation of gastroenteritis following Melbourne Cup luncheons in the Canberra, November 2016. In all but one study, I examined data availability, collection and analysis to support program evaluations. Although, Australian national survey data for the Aboriginal and Torres Strait Islander population are the most comprehensive source on health risk behaviours, the data’s utility for evaluating regional program level activities and campaigns is challenged by small sizes and data restrictions. In my study of regional smoking prevalence, I noted that wide confidence intervals meant that changes over time at a regional level could not be detected. Further, cross sectional analysis is restricted to comparing changes in sub-populations, jurisdictions or regions over time rather than an analysis of changes in individuals over time. As such, these analyses do not allow the attribution of exposures, including exploring what program specific activities and campaigns lead to changes. In response to the national data limitations, managers and implementers of individual programs are opting to develop their own studies, monitoring and evaluation systems. In my pre- and post- study of smokers in Central Australia, I observed improvements in participants’ knowledge of smoking health risks and increased numbers of ex-smokers. I have recommended that next phase of Australian Government’s Tackling Indigenous Smoking evaluation needs to better examine which program specific exposures in tobacco control led to: the de-normalisation of tobacco use in communities; increased quit attempts; reduced uptake of smoking; and, the overall declines in smoking prevalence. I also examined the RFDS Monitoring System, a program monitoring system established to track changes in participants due to community-based health promotion activities. Local surveys/sentinel surveillance and program monitoring can help to improve program reporting and evaluations, is responsive to local data requests and builds health service capabilities. However, the system for ongoing data collection at an individual program level can also be compromised because of lack of comparability across sites/activities, limited budget, inadequate definitions of sampling frames, lack of standard operating procedures for data collection and the onus on nontechnical staff to analyse data. Australia needs an enhanced data collection system for preventive health that supports both local and regional data needs, while remaining comparable at a national level.

This thesis explores the contribution that racial discrimination laws have made and might make to addressing race discrimination against Indigenous Australians, who still experience this problem at disproportionately high levels despite introduction over four decades ago of racial discrimination legislation in Australia. The research investigates whether this legislation has failed to make appropriate contributions to reduction of race discrimination because of problems associated with Indigenous access to justice. It demonstrates that Aboriginal and Torres Strait Islander peoples are using processes of dispute resolution in this area to a limited degree, relative to the extent to which they encounter race-based discrimination. Informed by Indigenous methodologies, the research employs a mixed method design: utilising historical, qualitative and quantitative social science and legal approaches. This provides opportunity for distinctive analysis of the current limitations associated with Indigenous access to justice in the area of race discrimination. Also identified is whether Aboriginal and Torres Strait Islander peoples see value in enhancing Indigenous access to justice through race discrimination law and how this might be achieved. The thesis presents evidence that indicates that access to justice is seen, including by Aboriginal and Torres Strait Islander peoples, as an important right in itself and as essential to the assertion of all other rights, encompassing the right to equality or non-discrimination. It is argued, however, that to be effective the concept of access to justice must be appropriately expanded to incorporate Indigenous perspectives on 'justice' and how this might be attained. Formal equality of access to justice can lead to discriminatory outcomes, including limitations in terms of the extent to which Indigenous people are able to draw benefit from race discrimination law. The thesis also argues that Indigenous people do not see the law as providing a complete solution to the problem of race discrimination. Key non-legal strategies are identified, including those that empower Indigenous people to respond to discrimination without recourse to the law and that place responsibility for reduction of race discrimination targeting Indigenous people upon the wider community and government. The research makes a novel contribution to analysis of the effectiveness of race discrimination law in Australia. By prioritising Indigenous historical and contemporary perspectives throughout, it presents new perspectives on race discrimination law and access to justice for Aboriginal and Torres Strait Islander peoples.

This thesis presents a collection of applied epidemiological studies within an Aboriginal and Torres Strait Islander social, health and well-being context. I have applied mixed method approaches to epidemiological knowledge and methods to meet the required Masters of Philosophy in Applied Epidemiology (MAE) competencies. A social and cultural determinants of health framing was applied to the evaluation of a social health program, epidemiological study and data analysis study. Field work was undertaken with Aboriginal communities in the evaluation, epidemiological study and outbreak investigation and were underpinned by community engagement and community based participatory research models. The studies include: 1. Cross-sectional analysis of data from the Footprints in Time: Longitudinal Study of Indigenous Children (LSIC). The study explores the prevalence of community leadership aspirations and other future aspirations for children aged 9 to 12 years participating in Wave 8 of the LSIC study. Descriptive and analytical analyses were included to examine the association between leadership aspirations and key demographic factors: age, sex and remoteness. Additionally, I explored other self-reported aspirations for children with community leadership aspirations to further unpack leadership from a holistic perspective. I applied qualitative inquiry with LSIC key informants to contextualise the findings. An important feature of the study includes comparisons being made within an Aboriginal and Torres Strait Islander cohort, as opposed to comparisons between Indigenous and non-Indigenous people; 2. Outbreak investigation of mumps in an Aboriginal community in Queensland (Qld). The outbreak investigation took place in Yarrabah, March 2018 and was in partnership with Gurriny Yealamucka Health Service Aboriginal Corporation. The study included field epidemiology, advocacy and community engagement models of practice. Building relationships with the Aboriginal Health Workers (AHWs) was key to the study. The AHWs contributed to adaptation of a public health questionnaire and facilitated cultural brokerage between myself and the community to administer the follow-up questionnaire. I identified gaps between public health and primary health care practice and recommended practical strategies to help strength the relationship; and 3. Process evaluation of a Commonwealth funded program, Stronger Communities for Children (SCfC) was undertaken with a remote community in the Northern Territory, January to June 2018. A partnership between the ANU, Palngun Wurnangat Aboriginal Corporation, Kardu Lurruth Ngala Purrungime committee and community members guided the study. An epidemiological study was a component of the evaluation and included administering an adjusted survey instrument to collect data from the SCfC participants on cultural participation. Building community relationships was key and required a number of field visits to the community where I facilitated workshops with the main stakeholders to ensure community voice remained at the center of the study. Community input directed the study design, adaptation of the survey instrument, and development of the logic model and community researcher manual.

The Australian Institute of Aboriginal Studies (AlAS) was set up to record Aboriginal and Torres Strait Islander cultures before they disappeared forever. Proposed by Liberal parliamentarian WC Wentworth in 1959, the Commonwealth Government established it in 1961 and made it permanent through an Act of Parliament in 1964. This history focuses on its first thirty years, ending in 1989, the year the Institute came under a new Act, which introduced changes to its character and governance. In the 1960s, the Institute's focus was on 'traditional' Aboriginal and Torres Strait Islander cultures and most research took place in remote Australia. Aboriginal and Torres Strait Islander people had no input into the Institute's activities other than as 'informants'. By 1989, they were involved in all facets of the Institute's operations including its governance. Informed by the work of Michel Foucault on power/knowledge and truth and on governmentality, and in the context of the broader political and social environment, this thesis will explore the history of AlAS to identify the factors, both internal and external, that led to the changes. It will address the Institute's relationship with the Academy (including the conflict between academic disciplines within AlAS), and the ideological battles for its control between academics; Aboriginal people and the Academy; and Aboriginal and non-Aboriginal scholars and the government. It will seek to explain how a relatively powerless group of Aboriginal people (with the help of their non-Aboriginal supporters) managed, over time and in the face of the power of the Academy, to control the Institute.

Ideas that are migrating from Canada are already guiding advocates who seek greater judicial and constitutional recognition of Aboriginal and Torres Strait Islander peoples. However, there is a need for a conceptual framework through which to approach the lessons that can be learned from Canada in this area. Inspired by The Migration of Constitutional Ideas, an edited work by Sujit Choudhry, in this thesis I argue that by thinking about the migration and transplantation of foundational ideas and by differentiating between four ‘modes’ of migration (arguments of counsel, judicial determinations, academic critique and constitutional reform deliberations), it is possible to better understand some of the processes that are at play. In particular, by adopting the terminology of the ‘migration’ and ‘transplantation’ of ‘foundational’ ideas, I aim to demonstrate that it is dangerous to transplant foundational ideas, whether derived from the common law or constitutional law, without other ideas (particularly in relation to implications) also migrating. This thesis is a response to two distinct but related topics: ‘Topic 1 — The Potential for Judicial Recognition of Indigenous Self-Government Rights: The Migration of Foundational Ideas from Canada to Australia’ and ‘Topic 2 — Constitutional Recognition of Aboriginal and Torres Strait Islander Peoples, the Race Power and an Anti-Discrimination Guarantee: Contemplating Canadian Approaches to Equality’. Through these two topics I examine two of the recognised modes of recognition — judicial and constitutional — and focus on two discrete types of recognition — self-government and non-discrimination — and the lessons that can be learned from Canada. In response to the first topic I consider the extent to which foundational ideas are migrating from Canada to Australia in the field of Indigenous self-government rights and whether these ideas could be used in Australian courts. In response to the second topic I consider the extent to which Canadian experiences may assist when exploring the potential implications of prohibiting discrimination in the Australian Constitution and when examining the various options that are available. As far as the migration of foundational ideas from Canada is concerned, in Topic 1 my starting point is to consider what could be learned from the Canadian jurisprudence in order to understand the ideas that have migrated or could potentially migrate to Australia. In contrast, in Topic 2 I start with an appraisal of the lack of recognition of Aboriginal and Torres Strait Islander peoples in the Australian Constitution and the perceived problems with s 51(xxvi) (the ‘race power’), and in so doing I consider what benefits (modified) Canadian transplants may offer, if any.

My placement as a Master of Philosophy in Applied Epidemiology (MAE) scholar was with the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS); later based at the National Centre for Epidemiology and Population Health (NCEPH). In meeting my Masters requirements I conducted an epidemiology project using mixed methods entitled ‘A community perspective of Burdekin rot’ - based on the anecdotal reports of ‘Burdekin rot’ and the perceived higher incidence of cancer (and death) in the Burdekin community. Analysis of cancer incidence and geographic level analysis of Queensland Cancer Registry data was conducted for the period 2003-2012 to ascertain whether cancer rates and mortality rates vary between the Aboriginal and Torres Strait peoples and the general population within each Statistical Division (SD) of Queensland. Qualitative interviews were conducted to understand the experiences of Aboriginal and Torres Strait Islander peoples living in the Burdekin region in terms of cancer diagnosis, treatment and treatment outcomes. I conducted a cross sectional study and analysis of the 2010 Australian Capital Territory (ACT) Inmate Health Survey to determine if contact (phone and visits) was associated with lower levels of psychological distress. Comparisons of proportions between a range of exposure variables and the outcome variable of psychological distress were conducted to further examine any association between mild to severe psychological distress. Further, as a team member within NCEPH in collaboration with Qld Health I assisted in an outbreak investigation primarily with undertaking hypothesis generating questionnaires for an outbreak of Salmonella Saintpaul cases in Qld. Case information was provided by Qld Health including case pathology reports. My role in the outbreak included case interviews, data analysis comparing current data to Qld S. Saintpaul data 2006-2014 and preparing a brief for OzFoodNet in terms of a possible multi-jurisdictional outbreak of S. Saintpaul. My final project to meet study requirements was the evaluation of the Queensland Cancer Registry specifically concerning the completeness of Aboriginal and Torres Strait Islander status data. A teaching component of the MAE program core competency was fulfilled via a group teaching session on measurement bias to the 2015 MAE cohort. Also, developing and conducting a Lesson from the Field (LFF) component on cultural awareness and appropriate community engagement and partnership when conducting research with Aboriginal and Torres Strait Islander peoples.