Why health care in remote communities is not a ‘lifestyle choice’

March 20, 2015
Stop the forced closure of Aboriginal communities rally in Perth on March 17.

Prime Minister Tony Abbott’s recent comments on the “lifestyle choice” of Aboriginal Australians living in remote areas are troubling, especially given his self-anointed role of “Prime Minister for Aboriginal Affairs”.

I have been privileged to work in Aboriginal health, in a rural centre of South Australia, for a number of years. The simplistic notion that people live in remote regions purely due to a lifestyle choice is far from reality.

A core theoretical framework to explain health, from my occupational therapy profession, is the interaction of the person, environment and occupation. It is only when these three factors are interacting in balance that true health and wellbeing can be achieved. This model is pertinent to the issue of removing people from their ancestral lands.

Person refers to the specific skills, experiences, knowledge, motivations and cultural aspects of an individual.

Environment refers to the context in which living healthily can be performed. This can be broken up into cultural, socioeconomic, institutional, physical and social environments.

Occupation refers to self-directed meaningful tasks, such as social roles, self-care, employment, cultural roles, productivity and leisure.

Moving Aboriginal people will (and does) have significant impacts on their health and wellbeing. Relocation to a new environment produces many challenges, due to the disconnection with country, language, family, friends, kinship and all things familiar.

These common attributes of Aboriginal culture are key agents binding healthy communities together. It has been this way for thousands of years.

In reference to the model, when an individual is displaced, factors that make up person, environment and occupation will be thrown out of balance, thus healthy lifestyles will not be achieved.

I recently helped with the rehabilitation of a man from a very remote part of central Australia. His leg had been amputated. He felt like a fish out of water — person. He just wanted to go home to his family — environment. He was bored and found no relevance in the institution — occupation. All he wanted to do was to return to his country, where his life has balance and meaning. This is a very common scenario in Indigenous health.

Through necessity, many Aboriginal people accessing health services in regional centres or cities are from remote regions. Some people must live in a built-up environment due to lack of health services in their isolated homeland. The most common examples of this are individuals needing to access renal dialysis. Many have to pack up their lives so that they can, literally, stay alive.

People who have been relocated often struggle to integrate into a new land that is far from all that they know. Health and wellbeing often deteriorate. To introduce government legislation that will knowingly inflict this outcome seems extremely cruel and misguided.

Last week the Lowitja Institute issued a statement on the closing of Western Australian communities reporting, “grave concerns” with the proposal.

“There is a strong body of evidence in Australia that supports the link between land, culture and wellbeing. For example, evidence tells us that the effects of colonisation have limited Aboriginal and Torres Strait Islander people from having agency over their lives which is vital for health and wellbeing.

"The continuation of cultural practice, including land management is known to be protective of good health and social and emotional wellbeing. This brings into question the wisdom of removing people from land.”

Tony Abbott was born in London, England in 1957. He immigrated to Australia with his family in 1960. That was a lifestyle choice.

The first people of Australia have occupied this ancient land for an estimated 60,000 years, potentially the longest continual human culture on Earth. The desire of Aboriginal Australians to stay connected with their land and culture is not merely a “lifestyle choice”. But have we even bothered to ask them?

Read more: Rallies against community closures: 'There is no price on culture'

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