Contemporary Indigenous Cultures of Care: Are they compatible with prevailing Australian models of chronic disease self-care?

Abstract

The notion of a Culture of Care was invented by Australian cultural studies maven Michael Hurley in the early 2000s “as a way of conceptualising the relations between health service providers, the people taking treatments, their social and support networks, international media relays, community-based treatments media and the development of practices of self-care amongst people living with HIV/AIDS” [Hurley, 2002: np]. Specifically, A culture of care “refers to the everyday social spaces created when self-care practices are actively supported and relayed amongst and by people (i) affected by the presence of a disease, and/or (ii) sharing or negotiating a community of interests“ [Hurley 2002: 23]. I developed the concept further in 2002, arguing, “The cultures of care that have grown up around HIV positive men and their interactions with both clinic and community need to be understood as systems of meaning, as systems of shared history and values that extend beyond the clinical sphere, beyond the intensely permeable boundaries of the HIV positive gay community, out into the wider gay community, and its spaces and practices.”[Willis 2002: 22] In a later paper the same year, I extended the concept further by looking at other core elements of cultures of care, as evidenced by Aboriginal people as well as gay men: rationalities or logics of practice; transposable dispositions and habitus; symbolic systems; and decision circuits. Culture- of-care was a useful framework to explore and understand the complex interactions between individuals and their health conditions, their family and community, and the health system. It placed individual health decision-making and actions within a social and cultural framework.

Does it remain a useful construct when thinking about how the health system currently thinks about chronic disease – for example, self-management of diabetes, or of cardiovascular disease risk (hypertension/hyperlipidaemia/hyperglycaemia). How we understand self-care these days is through the lens of Positive Psychology ™ constructs, notably self-efficacy, locus of control, explanatory style, self-management, and social support. Self-care is a narrowly individualistic framework for understanding health decision-making and action.

In this talk I will unpack both of these frameworks for understanding health decision-making and action by examining them in light of two examples of Aboriginal people’s management of chronic disease from my experience as a medical anthropologist – remote-dwelling Aboriginal’s people’s management of end-stage renal failure in the 1990s, and the community-controlled model of care used by clinics within the Institute for Urban’s Indigenous Health in contemporary Brisbane. I am working towards characterising contemporary Indigenous cultures-of-care, and through them to critique the narrow individualism of current models of chronic disease self-care.

About the Presenter

Jon Willis is a medical anthropologist and social epidemiologist specialising in Indigenous and public health. Jon Willis is an Associate Professor in the Aboriginal and Torres Strait Islander Studies Unit at the University of Queensland, and Research Director of the University of Queensland Poche Centre for Indigenous Health. He has had a strong interest in Indigenous Australian health since his undergraduate training as an anthropologist at UNSW in the early 1980s. He worked for the Pitjantjatjara people of Central Australia from 1985-1997 as an applied anthropologist, and was responsible for the conduct and/or management of many research projects, including research into Indigenous uses of the built environment, the provision of community-based care and support to older people, and the investigation of native title for the protection of Aboriginal cultural heritage. He has given expert evidence in several native title cases, and served on several Ministerial Advisory Committees at State and National levels. He has a PhD from the Australian Centre for International and Tropical Health and Nutrition, focussed on Pitjantjatjara men’s practices of masculinity and sexual risk.