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McPhail-Bell, Karen(2014)We have a lot to learn yet : a postcolonial lens in health promotion. InAIATSIS National Indigenous Studies Conference - Breaking Barriers inIndigenous Research and Thinking : 50 Years On, 2014-03-26 - 2014-03-28. (Unpublished)

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Health promotion has failedIndigenous AustraliansAustralia is a world leader in health promotion and ranks highly for life expectancy and health expenditure per person. However, health promotion has failed Indigenous Australians, who suffer grossly disproportionate rates of disadvantage against all measures of socio-economic status, including health.

Mainstream health promotion has been unable to effectively engage with the social, cultural and political context of Indigenous Australians. Instead, we often see a preoccupation with individual risk factors and associated behavioural and lifestyle interventions. A narrative of mainstream health professionals promotes how to live better, healthier lives, with the expert voice privileged while the voice of those “being empowered” is silenced. (Photo 1)

Key points 

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Community‐driven concepts of health and engagement The Deadly Choices model of health promotion opens a space for dialogue with community about health by asking, “What’s your deadly choice?”. Deadly Choices includes healthy lifestyle but also spans across social determinants of health (e.g. education, employment, family).

Deadly Choices uses innovative engagement strategies. Sport is one such vehicle, with an emphasis upon participation and inclusion, to build role models (Photo 7). Social media is also an important tool for dialogue and interaction, leading to increased participation and engagement (Photo 5). Community events, leadership camps, ambassadors, media and many other techniques are used together to promote social choices and build a strong community.

The Deadly Choices team endeavours to embed quality improvement, striving to “always be better”.

Karen McPhail‐Bell, Queensland University of Technology

Branding: Culture is cool The community co-constructs the Deadly Choices brand. Merchandise is key for strengthening the brand, with jerseys and hoodies sought after by the community but available only by earning it: by making a deadly choice. (Photos 7-9)

Deadly Choices is positive and frames Indigenous identity as health-producing; this is a counter-narrative to a mainstream public health view of culture as illness-producing. The brand is one that community can relate to regardless of location or affiliation, with Deadly Choices a package for purchase. (photos 4 & 6)

Deadly Choices and health promotion The Institute for Urban Indigenous Health (IUIH) represents a partnership between local Aboriginal Medical Services. IUIH’s Deadly Choices program and campaign is an umbrella for its health promotion activities. Deadly Choices is about building strong leaders among Aboriginal and Torres Strait Islander communities to encourage healthy lifestyles and to create a healthy future together. (Photo 4)

Being a leader means making Deadly Choices, which could range from a healthy lunch to studying for a dream job to looking after each other.

Distributive leadership In the Deadly Choices model of leadership, everyone can be a leader. The team focuses on building leaders to be “distributed” throughout the community, as role models. Official Indigenous ambassadors are also utilised. (Photo 6).

The team uses leadership as a unique model of health promotion and resource for behaviour change. This form of leadership is different from Western interpretations of leadership but also draws on such concepts where useful. IUIH’s diverse preventative health team also endeavours to be leaders themselves. (Photo 3)

Community‐led responses workbut lessons must be sharedA call exists for health promotion with an Indigenous lens, developed from a perspective of decolonisation. Little research exists about how to do this, particularly within an urban context. There is also little research that values an Indigenous perspective in health promotion.

Researchers can learn from practitioners who operate at this interface. Therefore, my research describes actual health promotion practice with urban Indigenous people that acknowledges Indigenous perspectives.

My research uses an ethnographic approach with participant observation to become intimately familiar with a group of people by being intensely involved with them. (Photo 2)

Photo 7: Sport was used as a vehicle emphasising participation and inclusion

Photo 4: Deadly Choices – More than a campaign, it is a counter-narrative to traditional public health narratives of deadly risk

Photo 1: Illustration by Julie Haysom for W.Foley’s poster on dietary advice (2004)

Photo 9: Community programs were run, such as GoodQuick Tukka

Photo 6: A dialogue exists with community about what Deadly Choices are, such as familyPhoto 3: The mix of the team has been key for innovation

Photo 5: Social media has been a meetingground for engagement

Photo 8: Deadly Choices jerseys have to be earnedand hold value in the community

Photo 2: Ethnography involved me observing &participating with health promotion workers online &offline

ContactKaren McPhail-BellE: karenmcphailbell@gmail.comM: 0421 061 403

AcknowledgmentsInstitute of Urban Indigenous Health Ass/Prof Mark BroughDr Chelsea BondProf Bronwyn Fredericks

• The two-way communication in Deadly Choices between community and health promotion practitioners shares power between those involved. This contrasts traditional, expert-driven health promotion approaches.

• The Deadly Choices narrative of strength and identity is an empowering foundation for health promotion practice.

• Engagement strategies that are innovative and tailored to community can be fun and effective.

• Health promotion that centres Indigenous knowledge and perspectives brings lessons that can benefit mainstream health promotion (not just for Indigenous populations).