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Symposium on Indigenous Health and the Contribution of Sociology
Symposium on Indigenous Health
This issue sees two new areas for discussion and debate. The first symposium arises out of the Health Sociology Day at Coriole in December 2000, specifically the paper given by Ian Anderson on the challenge to sociologists to engage in Indigenous health. Sherry Saggers, Dennis Gray, Peter d'Abbs and Chris Cunneen have taken up the challenge. All four have been in the field for several years as their research displays and as editors we were delighted at the way in which the papers intersect. Ian Anderson sets the scene for a structural analysis of the relationship between Indigenous health and the state by exploring the position of Aboriginal people prior to, and subsequent to the 1967 referendum. He notes the impact of organised medicine's resistance to nationalised health care in Australia and the impact this had on Indigenous people. This is not to deny the fact that some individual doctors offered free health care to Aboriginal people prior to 1973/1975 when the first community controlled medical services began their magnificent work.
A careful reading of Anderson's paper provides ideas and outlines for further sociological research. Anderson's own paper illustrates the value of a social and historical analysis of the Constitution and other legal and quasi-legal regulations as factors in the provision or lack of health care for Aboriginal people. While he notes the fact that state governments would have provided some care, much of this in remote areas would have been funneled through missionary institutions bringing other cultural and structural factors into the charitable provision of health care. It was an institutional response, but of a particular kind. In the post-referendum period the provision of health care shifted to state, federal and community controlled services. As Anderson notes little has been written on these various institutional responses to the health needs of Aboriginal people. Anderson raises questions about the impact of specific health professional groups and their professional structures on the kinds of health care provided. He mentions doctors, but the position of nurses is also pertinent, as is the professional relationship between these two groups and the impact this has on the social relations between both groups and Aboriginal health workers. The ebb and flow of power between these three providers of health care says much about the way Indigenous health and health beliefs and practices are constructed and understood.
Anderson points to the influence of policies of self-determination and the impact of community controlled health services. The ability of these services to resist incorporation, mainstreaming and budget cuts presents an intriguing account of a robust social movement. Contrary to 'popular myth' the continued growth of these robust organisations says much about the importance Aboriginal people give to equity and access to Western biomedical care and to shaping the way they wish to receive this care. The history of this movement and the many concrete services provided under this rubric is a refreshing anomaly in twenty-first century community health.
The three other papers deal with the present situation. Sherry Saggers and Brian Gray provide a forceful argument for state intervention and prohibition over access to alcohol. Their paper is persuasive and at a theoretical level illustrates the value of classical explanations of the issues. Peter d'Abbs provides a further sociological challenge by reminding us that social and behavioural changes require more than the imposition of laws and regulations from outside agencies. He brings further illumination to that fundamental principle: community control. D'Abbs' review of relevant research weighs up the relative strengths of anthropology (including ethnography), psychology, psychiatry, social epidemiology, social history and political science before arriving at a sociologically informed model of both causation and beneficial social change. He deals usefully with concerns that researchers working in this field should themselves be Indigenous Australians. Cunneen asks how successful was the Royal Commission into Aboriginal Deaths in Custody, shows its failures, notes the increase in punitive responses to crime in the community at large, but also illustrates the way in which the Commission shifted the cultural ground in positive ways.
Taken together, these four papers should indeed challenge sociologists about to embark on studies in the field of Indigenous health and illness. They span the sociological spectrum of theory and method and consider the merits of using classical structural analysis with or without approaches such as demography; critical ethnography; social constructionism; analysis of formal and informal medical texts; case studies of health policy, health intervention and health promotion programmes; and sociologically informed history, especially of Aboriginal political movements and their profound effects at national and local levels. We hope this symposium inspires sociologists to take the challenge further.
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