School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton St, Nedlands, Perth, Western Australia, 6009, Australia.
Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, Northern Territory, 0811, Australia.
Soc Sci Med. 2021 May;277:113829. doi: 10.1016/j.socscimed.2021.113829. Epub 2021 Mar 9.
In common with colonized Indigenous people worldwide, many Australian Aboriginal people experience inequitable health outcomes. While the commitment and advocacy of researchers and health practitioners has resulted in many notable improvements in policy and practice, systemic and structural impediments continue to restrain widespread gains in addressing Indigenous health injustices. We take Rheumatic Heart Disease (RHD), a potent marker of extreme health inequity, as a case study, and critically examine RHD practitioners' perspectives regarding the factors that need to be addressed to improve RHD prevention and care. This study is an important explanatory component of a broader study to inform new clinical practices, and health system strategies and policies to reduce RHD. A decolonising, critical medical anthropology (CMA) analysis of findings from 22 RHD practitioner in-depth interviews conducted in May 2016 revealed both practitioners' perceptions of health system shortcomings and a sense of hopelessness and powerlessness to transform existing health system inequities, the negative impacts of which were subsequently confirmed in a separate study of RHD patients' lived realities. We reveal how biomedical dominance, normalized deficit discourses and systemic racism influence the current policy and practice landscape, narrowing the intercultural space for productive dialogue and reinforcing the conditions that cause disease. To counter biomedical approaches that contribute to existing health inequities in health care, we recommend localized, strength-based, community-led research projects focused on actions that use critical decolonizing social science approaches to achieve system change. We demonstrate the importance of integrating biological and social sciences approaches in research, education/training, and practice to: 1) be guided by Indigenous strengths, knowledges and worldview, and 2) adopt a critical reflexive stance to examine systems, structures and practices. Such an approach facilitates productive cross-cultural dialogue and social transformation; providing direction and hope to practitioners, enhancing their knowledge, skills and capacity and improving Aboriginal health outcomes.
与世界各地被殖民的原住民一样，许多澳大利亚原住民的健康结果并不公平。尽管研究人员和卫生保健从业者的承诺和倡导已经导致政策和实践方面取得了许多显著的进步，但系统和结构性障碍仍然限制着在解决原住民健康不公方面取得广泛进展。我们以风湿性心脏病 (RHD) 作为一个案例研究，风湿性心脏病是极端健康不平等的有力标志，并批判性地审查了 RHD 从业者对于需要解决哪些因素以改善 RHD 预防和护理的观点。这项研究是更广泛研究的一个重要解释性组成部分，旨在为减少 RHD 的新临床实践、卫生系统战略和政策提供信息。对 2016 年 5 月进行的 22 名 RHD 从业者深入访谈的结果进行去殖民化、批判性医学人类学 (CMA) 分析，揭示了从业者对卫生系统缺陷的看法，以及对改变现有卫生系统不平等的绝望和无力感，这些负面影响随后在对 RHD 患者生活现实的单独研究中得到了证实。我们揭示了生物医学主导地位、规范化缺陷话语和系统性种族主义如何影响当前的政策和实践格局，缩小了富有成效的跨文化对话的空间，并加强了导致疾病的条件。为了应对导致医疗保健中现有健康不平等的生物医学方法，我们建议开展本地化、以实力为基础、以社区为主导的研究项目，重点关注采取批判性去殖民化社会科学方法来实现系统变革的行动。我们展示了在研究、教育/培训和实践中整合生物和社会科学方法的重要性，以：1）以原住民的优势、知识和世界观为指导，2）采取批判性反思立场来审查系统、结构和实践。这种方法促进了富有成效的跨文化对话和社会转型；为从业者提供方向和希望，提高他们的知识、技能和能力，并改善原住民的健康结果。
