Professor Kate Senior

This paper will explain the concept of double perspective and the impact that this cultural understanding may have on the health of the Indigenous peoples of Scandinavia. In inter-cultural communication, one set of meanings may be discernible to the outsider while a whole extra set of restricted or underlying meanings are only accessible for those people who have the cultural knowledge to discern them. These different sets of meanings embody a double perspective. It is not dual perspectives on the same reality but rather seeing two separate but overlapping realities. We will discuss the layers of meaning which are involved in the interactions between public healthcare institutions, clinicians and staff, and Indigenous people including the Sámi. These interactions are influenced by the impact of colonization and the ongoing epistemicide of Indigenous thought. By realising the improved resilience that a double perspective brings to Indigenous peoples, an awareness of the inclusion and exclusion of Indigenous persons, cultures and histories should become established in public institutions and in everyday life. A double perspective carries Sámi resilience, and should be understood as a key to support individual health, and also the collective wellbeing of a people living on their traditional yet colonized land.

Research undertaken by outsiders into issues of concern to Aboriginal communities frequently ignores community culture and the knowledge embedded within Aboriginal communities. Methodologies are adopted which perpetuate the colonialist mindset of non-indigenous Australians leading to failed solutions to Aboriginal problems. This paper describes an Aboriginal-led community-based research project, exploring the role of Aboriginal Australians in caring for, and transforming, their own communities. It focuses on the roles that Information Systems can play when providing an accessible platform for Aboriginal voices. The authors conducted an in-depth case study of one Aboriginal Community Controlled Organisation (ACCO), the Illawarra Koori Men¿s Support Group (IKMSG). The research consisted of a social network analysis (SNA) of the inter-organisational links of the IKMSG; interviews and focus groups with members of the IKMSG and the co-design of their first website. The prominence of the IKMSG in the SNA maps suggests that its work in the community is highly respected and that the model produced by this research can act as a guide for success in other ACCOs. The findings have been used to develop a theoretical model of Aboriginal community engagement and intervention. This model can enable authentic outcomes to projects which address Aboriginal concerns and support the conduct of community-led research in Aboriginal communities.

In this article we visit a car junkyard in the small Arnhem Land outstation of Nalawan in the top end of Australia's Northern Territory. Using both a mobilities paradigm and recent theorizing of waste from the global south, we will argue through our ethnographic observations that the wrecked cars become mobile, reassembled, and reconceptualized in a range of surprising ways. Though now immobile, the stories they encapsulate continue to circulate and reverberate with the complexities and tensions of Indigenous mobilities.

The goal of this article is to explain the concept of double perspective and the impact this may be having on the health of Indigenous people. In inter-cultural communication, there are sets of meanings that are discernible to anyone, and an extra set of underlying meanings that are only accessible for people who have the cultural knowledge to discern them. These different sets of meanings embody a double perspective. We will discuss the double perspective involved in the interactions between public healthcare institutions, the clinicians and staff of these institutions, and Indigenous people. By realising the potential for improved resilience that a double perspective brings to Indigenous people, an awareness of the inclusion and exclusion of Indigenous persons, cultures and histories should become established in healthcare institutions and health research. A double perspective carries resilience, and as such it should be understood as a key to support individual health and the collective well-being of Indigenous people.

This article seeks to understand Indigenous Australian young people's relationships and their experiences of sexual intimacy. A cohort of Indigenous 16¿25-year-olds from urban, rural and remote communities were invited to participate in a collaborative method involving scenario-based body mapping. In these activities, young people discussed the range and complexity of their relationships and how constructions and interpretations of relationships contribute to both positive and negative experiences. These rich understandings provide important insights into adolescent sexuality as ¿multidimensional, socially constructed and negotiated'. However, they also point to the continued gendered power inequalities that subordinate young women's lives to the desires and control of young men.

Rates of sexually transmissible infections (STIs) in remote central Australian Aboriginal communities have been persistently high for over two decades, yet risk factors for STIs in these communities are not well understood. This qualitative study explored behavioural and contextual risk factors for STIs in young Aboriginal people in central Australia. The study identified that casual relationships between young people are common and that there is a strong association between travel, alcohol and casual sex, highlighting the ongoing need for comprehensive sexual health programs that are tailored to the specific social, cultural and interpersonal circumstances of young people in this setting.

This article provides a critical discussion of the social determinants of health framework and compares it with theoretical perspectives, such as that offered by assemblage theory, offering an alternative view of the complex interplay between human relationships and the structures around us. We offer an ethnographic perspective, discussing the lived experiences of the social determinants in an Indigenous community in a remote part of northern Australia.

Background: Despite abundant alcohol control regulations and measures in Thailand, prevalence of alcohol consumption has been relatively steady for the past decade and alcohol-related harm remains high. This study aims to explore, through the perspectives of key public health stakeholders, the current performance of regulations controlling alcohol availability and access, and the future directions for the implementation of Thai alcohol policy. Methods: Semi-structured interviews were conducted with public health stakeholders from three sectors; the government, academia and civil society. Their perceptions about the current alcohol situation, gaps in the current policies, and future directions of alcohol policy were discussed. Audio data were transcribed verbatim, systematically coded and analysed. Results: The three key concerning issues were physical availability, economic availability and commercial access, which referred to outlet density, taxation and pricing, and compliance to stipulated regulations, respectively. First, Thailand failed to control the number of alcohol outlets. The availability problem was exacerbated by the increased numbers of liquor licences issued, without delineating the need for the outlets. Second, alcohol tax rates, albeit occasionally adjusted, are disproportionate to the economic dynamic, and there is yet a minimum pricing. Finally, compliance to age and time restrictions was challenging. Conclusions: The lack of robustness of enforcement and disintegration of government agencies in regulating availability and access hampers effectiveness of alcohol policy. Comprehensive regulations for the control of availability of and access to alcohol are required to strengthen alcohol policy. Consistent monitoring and surveillance of the compliances are recommended to prevent significant effects of the regulations diminish over time.

In this paper we attempt to understand at least some of the complex and interacting forces ¿ cultural, biological, developmental and historical ¿ that influence adolescents¿ sexual behaviour in three remote Australian Aboriginal communities. We use the concept of ¿agency¿ only as a foil for our interpretation. Drawing upon ethnographic material, we focus on: ¿walkin¿ around at night¿, avoidance of arranged marriages and the exchange of sexual favours for drugs and money. Cognitive, evolutionary, and neuroscience enable us to illustrate the interpenetration of sociocultural and psychobiological factors in adolescent girls¿ behaviour: expectations about marriage, a desire for love, sexual urges, a brain that is highly responsive to peers and rewards, a disadvantaged and uncertain environment, and challenges to effective adult control.

The small, decentralised communities, known as outstations which satellite larger Indigenous Australian remote communities have often been conceptualised as places that are beneficial to health and well-being. This paper provides an exploration of the meaning of their outstation for one family and the benefits that this connection brings to them, which are expressed in a deep connection to the land, continuing relationships with ancestors and a safe refuge from the stresses of the larger community. We argue that the outstation provides a place for people to be in control of their lives and form hopes and plans for the future. These benefits are position in a context where the future liveability and sustainability of the outstation is both fragile and vulnerable.

Drawn from a sample of 88 Indigenous young people in five locations in urban and remote Northern Australia, this research utilised a combination of qualitative approaches to encourage young people to discuss their ideas about sexual relationships and violence. Indigenous youth discussed highly public displays of violence, as well as violence within intimate settings and the interrelationships between these two arenas. A key finding of this research was that young people described violence as an accepted part of their sexual relationships and this normalisation led to significant tensions in their experiences and management of their everyday relationships. While violence around young people's relationships in remote communities was reported to some extent as being controlled through both the public and controlled form they take, we found that the increasing mobility of young people from remote to urban locations due to education opportunities and the impact of social media can lead to more serious forms of violence and tension in the maintenance of young people's sexual relationships. This contributes new findings to the literature on Indigenous young people's experiences in relationship forming and management, an area that has received little attention in the academic literature.

Objective: To explore the attitudes and opinions of public health experts in gambling and related unhealthy commodity industries towards the tactics used by the gambling industry to prevent reform and the advocacy responses to these tactics. Methods: In-depth interviews (30-60 minutes) with a convenience sample of 15 public health experts and stakeholders with a public health approach to gambling (n=10), or other unhealthy commodity industries (food, alcohol, tobacco, n=5). Results: Participants described the influences of political lobbying and donations on public policy, and industry framing of problem gambling as an issue of personal responsibility. Industry funding of, and influence over, academic research was considered to be one of the most effective industry tactics to resist reform. Participants felt there was a need to build stronger coalitions and collaborations between independent academics, and to improve the utilisation of media to more effectively shift perceptions of gambling harm away from the individual and towards the product. Conclusions and implications: Gambling industry tactics are similar to the tactics of other unhealthy commodity industries. However, advocacy initiatives to counter these tactics in gambling are less developed than in other areas. The formation of national public health coalitions, as well as a strong evidence base regarding industry tactics, will help to strengthen advocacy initiatives.

Ideas from evolutionary theory and a consideration of social and cultural factors are used to argue that teenage pregnancy in three remote Aboriginal communities represents a strategic response to current environments characterised by pervasive and sustained risk and uncertainty. Ethnographic studies of the communities find that these environments both provoke and enable the reproductive strategies of adolescent boys and girls but raise the question of the effects of father absent socialisation.

How well do young people understand their developing sexuality and what this means? This paper reports on findings from the Our Lives: Culture, Context and Risk project, which investigated sexual behaviour and decision-making in the context of the everyday life experience and aspirations of Indigenous and non-Indigenous young people (16¿25 years) in the Northern Territory, Western Australia and in South Australia. Using qualitative data, this paper focuses on what participating young people thought was necessary to improve the quality of sexuality education. Participants suggest that current forms of sexuality education are too clinical, didactic and unengaging, and are missing in relevant content. Young people requested more information on relationships, first sexual experiences and negotiating condom use. These requests indicate that young people realise that they need more knowledge in order to have healthy relationships, which conflicts with the popular belief that providing young people with open, honest information around sex will encourage them to have sex or increase sexual risk taking. Making sexuality education more of a priority and listening to the needs of young people could be a positive step towards improving sexual health and well-being.

There is a lack of comprehensive data available to measure the wellbeing of young people in the Northern Territory which means that programs and policies are developed largely without an evidence base negatively impacting on the relevance and sustainability of these programs. This paper argues that there is a need for a comprehensive survey to be conducted which addresses current gaps in data collection particularly in relationship to the measurement of wellbeing of young people. The need to measure wellbeing is discussed. The types of wellbeing measures and measurement frameworks which could be used are described and recommendations made for the development of a survey.

This paper examines young people's perceived vulnerability to sexually transmitted infections (STIs) and their efforts to create a sense of personal safety within an environment in which risks may be high and where STIs are highly stigmatised. The paper reports on findings from research involving both Indigenous and non-Indigenous 16- to 25-year-olds from remote, rural and regional Australia, including communities in the Northern Territory, Western Australia and South Australia. The study used qualitative methods, including body mapping and scenario based interviewing, to explore how young people made decisions about potential sexual partners and how STIs were understood within the context of young people's everyday social worlds. The paper has important implications for the design and implementation of sexual-health education programmes by documenting the stigmatisation of young people with STIs and the protective mechanisms peer groups employ to create perceptions of personal safety. © 2014 © 2014 Taylor & Francis.

Recently, social determinants of health frameworks are receiving some criticism in that they do not engage with questions related to individual subjectivity and agency as they relate to health decision-making behavior. This article examines the different ways in which people living in a remote Arnhem Land community in the Northern Territory of Australia, take responsibility for their own health and the extent to which they are able to prevent illness. A number of related sub-questions are explored relating to how people perceive their health and their role in health care in their community, including their engagement with the health clinic, traditional medicines, and the influence of sorcery on ill health and sickness. © 2013 by the American Anthropological Association.

The Indigenous community of Wadeye in the Northern Territory, Australia has been described as a community 'under siege from continual gang violence' (Rioting flares again at Wadeye. The Australian 7 August. www.theaustralian. news.com.au/story/0,25197,22195888-2702,00.html; Gang violence plagues Wadeye. ABC News 1 December. http://www.abc.net.au/news/2008-12-01/gang-violence- plagues-wadeye/224208; Wadeye worst in 50 years. NT News 2 November. http://www.ntnews.com.au/article/2012/11/02/314788-ntnews.html). The gangs appear to have emerged in the early 1980s and are generally defined through youth aligning themselves along cultural, clan and family affiliations into groups with contemporary Americanised gang characteristics, symbolic links with heavy metal music and clearly defined turf boundaries. Although they do engage in some relatively minor drug (predominately cannabis) distribution for profit, the rationale for these groups appears to be either as a provocative and offensive structure, or at other times as a defence mechanism. Despite the portrayal of gangs as the focus of criminal activity in the community, there has been little research to explore the relationship between the gangs and the criminal profile of the community. Nor has there been research that examines gang activity from the perspective of the members or within a broader community context. Without this level of understanding, it is very difficult to design interventions that meet the needs of youth in the community. This paper presents data from a survey of young people who were involved in gangs in Wadeye and interviews with gang members who were incarcerated in Darwin Correctional Centre. © Australian Institute of Criminology 2013.

Purpose - The purpose of this paper is to improve current evaluation designs for Indigenous Australian residential alcohol and drug treatment centres, by understanding the context of treatment in this modified TC context. The aim of the research is to present an analysis of the key features of treatment associated with four Indigenous Australian alcohol and drug treatment centres, as expressed by staff working in these centres. Design/methodology/ approach - Ethnographic observations were made at each site between 2008 and 2009 with the first author attending treatment groups, education sessions, staff meetings and other events. The first author conducted informal conversational discussions with all programme staff and board members. In addition, 23 staff and 15 board members participated in a semi-structured interview with an emphasis on gaining views on the essential elements of residential alcohol and drug treatment, potential barriers to effective treatment delivery and "what works" in residential treatment. Findings - A number of key themes emerged, including the importance of the flexibility of programmes to include a wide variety of treatment approaches, the importance of culture (although defined differently) in the delivery of appropriate service, provision of safe spaces that allow for clients and staff interaction, the potential for improvement in the provision of effective client case management, the need to reduce job-related stress through staff professional development and organisational culture change and the need to address the difficulties experienced in the provision of effective aftercare. Originality/value - Currently, there is very little evidence related to Indigenous Australian approaches to the treatment of alcohol and drug misuse. The paper contributes to the understanding of the key features of treatment delivery, as identified by staff employed in drug and alcohol residential treatment. This understanding is vital so that government agencies can provide appropriate funding to areas of need for treatment services. © Emerald Group Publishing Limited.

This article describes the application and adaptation of body mapping as a tool for exploring sexual health and sexual decision making among young people aged 16-25. It argues that while body mapping engaged youth to discuss general health issues, young people were reluctant to engage with issues related to sexual health, due to feelings of shame and fear of stigma. Sexual health case scenarios were developed and used in conjunction with body-mapping exercises. The use of scenarios was an effective way to explore sensitive information, while protecting young people from revealing any specific identifiable information about themselves. In this article, we suggest that utilizing a combination of methodological approaches (the visual body maps and written case scenarios) in sexual health research with young people has the potential to enhance and enrich the quality of the data, and allow for a safe and enabling environment. This is particularly important where long-term fieldwork might be difficult or constrained. © 2013 by the American Anthropological Association.

This study investigated the quality of life (QoL) of clients in an Indigenous Australian residential alcohol and drug treatment center. Qualitative and quantitative data were collected from a random sample of Indigenous clients utilizing the Self Evaluated Individual Quality of Life-Direct Weight tool. The findings from this study provide support for the inclusion of QoL as important in understanding the recovery process from substance misuse. A discrepancy was found between the self-reported aspirations of clients and the focus of the treatment provided, and recommendations were provided for inclusion of new areas in the education provided to the clients of this service. Copyright © Taylor & Francis Group, LLC.

This paper explores the aspirations of a group of young women in a remote Aboriginal community in the Northern Territory of Australia. It examines how their hopes and expectations are influenced by the reality of their everyday lives and the extent to which they are able to influence the course of their lives and become agents for change in their own communities. As with adolescents in lower socio-economic groups, the majority of young women in River Town have not developed life goals or clear strategies of how to achieve these goals. The choices that young women have are constrained by their narrow range of experience, which is characterized by early pregnancies and the potential threat of male violence. However, young women have articulated specific domains where they are able to control and structure their lives. This paper discusses the experiences of young women in this remote Aboriginal community. © 2012 Copyright Taylor and Francis Group, LLC.

The human ethics issues surrounding the conduct of health science research have been the subject of increasing debate among biomedical and social science researchers in recent years. Ethics procedures in health-science research are typically concerned with protecting anonymity and confidentiality, and are tailored to work that primarily uses quantitative methodologies. For qualitative research in the health social sciences, a different set of ethical issues often arises in the research process. This article examines three case studies of qualitative researchers working with Indigenous Australian communities, focusing on the researchers' experiences with ethics committees and how they approached a range of ethical issues arising in the course of their research. Key issues include: obtaining informed consent for participant observation; the evolving nature of qualitative research; the difficulties in foreseeing changes in approach; and the distinction between the research team and the researched in participatory action research. © RAI 2011.

This paper reports the findings from a pilot study in which the Schedule for Individual Quality of Life (SEIQoL-DW) was used to determine how 15 at-risk Indigenous Australian male youths aged between 14 and 19 conceptualised their quality of life. The youths, who were referred with problems associated with drug and alcohol misuse and criminal activity, were attending a diversionary program run by an Indigenous organisation in the Northern Territory, Australia. Quality of life was measured before and at the end of the nine-day programme in order to evaluate outcomes. Program staff found the SEIQoL-DW to be particularly useful in identifying culturally specific quality of life domains, allowing interventions to focus on improving the life areas that were of particular value to individuals as well as recognizing any deficits in their understanding the options available to them. While a control group was not used, mean SEIQoL-DW scores increased significantly over the course of the program. © 2010 Springer Science+Business Media B.V./The International Society for Quality-of-Life Studies (ISQOLS).

The subject of mental health has been discussed for some time in the literature on Australian Aboriginal peoples, although the volume of this work has been relatively small. This literature can be separated into two main approaches. The first has been concerned with documenting and analyzing disorders that are culturally specific to a particular group. The second, more recent body of literature understands mental health issues as resulting from a combination of factors related to the effects of colonization, such as loss of land, poverty, and the destruction of families. This literature is often aimed at diagnosis and the provision of appropriate services for Indigenous people without a comprehensive ethnographic understanding of the cultural specificities of certain mental health disorders. Although mental health problems are discussed, such as suicide, depression, and anxiety, little analysis is undertaken of how such states are locally experienced and understood. This paper reports the complexities involved in understanding mental health from the perspective of youth in a remote Aboriginal community in northern Australia. We argue that it is necessary to understand mental health within the broader context of the lives of Indigenous youth and, in particular, the interaction between their marginalization from participating in the opportunities that globalization offers with issues related to poverty, substance misuse, and specific cultural beliefs. © 2009 M.E. Sharpe, Inc. All rights reserved.

Objective: The aim of this paper is to describe the implementation of the Community Safety Research Project (CSRP) focusing on violence prevention among Aboriginal communities in western NSW in order to examine how practice converges with contemporary ethical guidelines. Method: A comparison was made of key project elements with the principles outlined in existing ethical guidelines, outlining the concrete issues that need to be confronted in practice. Results: The approach being pursued is consonant with the principles of contemporary guidelines; the results of the first phase qualitative study inquiring into workers' perceptions of violence revealed some differences in the understanding of violence between Aboriginal and non-Aboriginal workers, with some ethical implications. Conclusions: Ethical approaches to research among Aboriginal communities include, but extend well beyond, the principle of avoiding harm. A comprehensive approach to ethical research requires significant ongoing expenditure of effort and resources with implications for project development, management and funding. © 2009 Informa UK Ltd.

Objective: To test an evaluation framework designed to evaluate implementation of the North Queensland Indigenous communities between August and December 2005. Setting: Both communities are located in CapeYork, North Queensland. Community A has an estimated population of around 600 people; Community B has an enumerated population of 750, although health centre records indicate a higher number. Participants: Process evaluation involved health centre staff in both communities; clinical audits used random samples from the adult population (each sample n = 30); ethnographic fieldwork was conducted with resident population. Main outcome measures: Health centre scores and qualitative findings using a System Assessment Tool; clinical audits - extent to which scheduled services recorded; selected primary health performance indicators; qualitative ethnographic findings. Results: On almost all indicators, implementation of NQICDS had progressed further in Community A than in Community B; however, some common issues emerged, especially lack of linkages between health centres and other groups, and lack of support for client self-management. Conclusions: The evaluation framework is an effective and acceptable framework for monitoring implementation of the NQICDS at the primary health centre level. © 2008 The Authors Journal Compilation © 2008 National Rural Health Alliance Inc.

Objective: To examine marijuana use by youth in a remote Aboriginal community in Northern Australia over a 5-year period. Design: Participant observation, structured and unstructured interviews. Setting: Remote Indigenous Australian community. Participants: Young Aboriginal people and adult community members. Mainoutcome measure: Emergent themes of the attitudes towards marijuana use among remote Indigenous residents are reported. Results: Restrictions in the availability of alcohol and petrol have led to increased use of marijuana with serious social and community consequences. Conclusions: Efforts to control licit substances, such asalcohol, in remote communities need to be addressed in the context of understanding of the dynamics of alcohol and drug use in totality as well as interventions that address underlying structural and social inequalities. © 2008 The Authors Journal Compilation © 2008 National Rural Health Alliance Inc.

In Australia, Indigenous young women are more likely to become pregnant while in their teens than non-Indigenous young women. Factors such as poverty, educational outcomes and unemployment play a major role; however, there is little understanding of the attitudes of young women themselves with regards to pregnancy. This paper explores young women's decisions regarding their sexual relationships and pregnancy in a remote Australian Aboriginal community, called River Town. It focuses on young women's motivations to pursue sexual relationships and the information about sex and male behaviour to women that informs their decision-making. 'Walkin' about at night' is the term that River Town residents use to describe the nocturnal activities of adolescent females. The focus of this activity is for a young woman to find and maintain a relationship with a boy. Although it is considered by the young women to be one of the most exciting parts of their lives, it carries with it the risk of pregnancy and sexually transmitted disease. Young women are very aware of the first of these risks, if not the second, as teenage pregnancy is the norm in the community. © 2008 Taylor & Francis.

This paper identifies the challenges in researching the impact of a rural palliative care service on its patients, carers and providers in the context of the National Palliative Care Strategy. It describes the use of an anthropological method to overcome problems of acceptability and respondent burden and to enable the elaboration of meaning and valuation by participants. It uses the Griffith Area Palliative Care Service as a case study to illustrate the problems of such research and the value of the anthropological method over more conventional research and evaluation approaches. It makes recommendations about how to assess the outcomes of services such as palliative care where the focus of care is complex, individual and family, and the outcomes go far beyond what can be measured with the medical model.

While there is a growing literature on how health services research can inform health policy decisions, the practical challenge is for health services researchers to develop an effective interface with health policy-making processes and to produce outputs that lead to outcomes. The experience of the Centre for Health Service Development at the University of Wollongong, Australia, is used to illustrate the issues so commonly described in the literature and to reflect on our experience of trying to remain viable while producing relevant and valid research. A case study in a specific policy area - namely, the development of case-mix classifications and information systems to inform policy and funding in the subacute and non-acute hospital and community care sectors - is used as a practical example of the research-policy interface. © The Royal Society of Medicine Press Ltd 2003.

Divisions of General Practice were set up to improve links between GPs and consumers, to develop a population health perspective in general practice, and to improve patient care. The Illawarra Division of General Practice established a consumer consultative committee as part of a broader strategy to achieve these objectives. An interview study with committee members indicates the difficulties experienced in this task and the persistence of two cultures. Various options are identified by which consumer participation might be improved as means of fostering better links, improved care and a population health perspective amongst GPs. The first step is a more sophisticated understanding of the strengths and weaknesses of current consultative arrangements.