Tim Senior is a GP at Tharawal Aboriginal Corporation in Airds, Australia.
The service I work in will have turned 40 years old by the time you read this. My service, and others like it, was set up by the local Aboriginal community, because they were being poorly served by the health services that existed at the time. Part of this was that the options offered seemed to operate on a narrow, very biomedical idea of health. So, in setting up these health services they wrote a definition of health that they would work to, and it’s superb. Let’s compare and contrast!
I imagine that most readers can recite the World Health Organization definition of health in their sleep:
‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’1
Now, I like this definition, as it encompasses the biopsychosocial, but it does make me realise that I’m not healthy, and perhaps I never can be. To be healthy I can’t have any disease or infirmity, and I need an extra sprinkling of wellbeing. It just makes me realise I’ve got a bit of back pain from the way I sit, and I’m feeling quite anxious about clinic tomorrow. Could I ever be healthy? Is health unattainable for me, indeed for all of us?
Here’s the Aboriginal definition of health established in 1989 by the National Aboriginal Health Working Party:
‘“Aboriginal health” means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community. It is a whole of life view and includes the cyclical concept of life-death-life.’2
The first thing that strikes me about this is that there’s no mention of disease at all. It’s quite possible to have a disease or infirmity and be healthy, as long as you are able to reach your full potential. That sounds like just the sort of work we are always doing as GPs.
This definition is clearly biopsychosocial too, but it seems so in a much more dynamic way — my health depends on the health of my community, and the health of my community depends on my health. Living in a way that is true to my culture is healthy. Death is even part of being healthy.
Working to this definition has practical outcomes. Treatments are directed at the individual, of course, to help people achieve their potential — so people do have medications for their diabetes or depression, and they do have psychology or a dietitian directed to their individual needs. But the service also set up programmes for treatments at the community level, such as cooking classes, subsidised fruit and vegetables, dance groups, art groups, youth groups, and housing support. If the community isn’t healthy, the individual can’t be healthy. Health is social and cultural as well as biological and psychological.
These ideas will be familiar to most GPs, but setting it out explicitly in a definition of health, like this, means clinicians and services can be set up to meet that definition. While these words express an intuitive understanding of Aboriginal people of what it is to be healthy, I suspect they’ve described it for all of us — a very human definition of health.
References
1. World Health Organization. Consititution. https://www.who.int/about/governance/constitution (accessed 5 Jul 2023)
2. National Aboriginal Community Controlled Health Organisation. Aboriginal Community Controlled Health Organisations (ACCHOs). https://www.naccho.org.au/acchos (accessed 5 Jul 2023).
Featured photo by Claudio Schwarz on Unsplash.
