Indigenous health and well-being: wise and responsive practice in primary health care

Abstract

Introduction One of the common questions asked by students and even staff involved in nursing education has been: ‘Why do we need a separate topic/chapter/course on Indigenous health?’ While this should be self-evident considering where the greatest health challenges of our time lie, it is not always clear. Indigenous peoples in countries such as Australia and Āotearoa New Zealand, although diverse in languages, cultures and histories, often share a common experience of profound relevance to health professionals today – an experience of being colonised that had detrimental and ongoing impact on health and well-being. However, in spite of these common experiences, there is also a resilience and capacity among Indigenous peoples that provides the community/primary health care nurse with an opportunity to affect real change towards better health outcomes. This chapter introduces Indigenous approaches to health care that have relevance for the Australian and Āotearoa New Zealand contexts. Several of the principles for practice are readily transferrable to other culturally and linguistically diverse populations. The challenges are undeniably major, but the rewards are potentially transformative. Nursing training and education is most often located within mainstream, non-Indigenous settings. Health professionals who want to make a positive difference to the health outcomes of Indigenous clients should be equipped with knowledges and understandings which will facilitate effective engagement. Further, this chapter will examine the historical influences that have impacted on the health and well-being of Indigenous peoples in both Āotearoa New Zealand and Australia, and consider the need for adopting Indigenous approaches to health care practice and engagement such as cultural safety, cultural responsiveness and other cultural frameworks. Finally, it will examine the role of the community nurse in Indigenous primary health care. A note on terminology before proceeding: ‘In the Australian context, the term “Indigenous” is used to refer to Aboriginal and Torres Strait Islander peoples and, with due respect, these terms are used interchangeably and acknowledge the diversity of languages and cultures that characterise Australian indigeneity’ (Rigby & Jeeawody, 2014, p. 283). In Āotearoa New Zealand, Māori are the first Indigenous peoples who can trace their ancestry and genealogy ( whakapapa ) right back to those who arrived in the early canoe fleet migrations of the mid-1300s (Ministry for Culture and Heritage, 2005) from the Tahitian and Hawai'iki regions.