Health Psychology. Michael Murray
the street or stand near the hotel. Beyond is a glimpse of Sydney Harbour, with masts and rigging of sailing ships. The picture references the ‘grog culture’ of the early colonial years – ‘grog’ being a mid-eighteenth-century term meaning cheap alcohol. Two men gather round a bucket of ‘bull’, a cheap source of alcohol made by soaking and fermenting old sugar bags.
Indigenous health
There are about 370 million indigenous people from thousands of different cultures in all continents of the planet (United Nations, 2017). While indigenous communities cannot be encapsulated within a single definition, the United Nations (2009) used Martinez Cobo’s (1987) conceptualization of indigenous groups as:
peoples and nations which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them. They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions and legal system. (United Nations, 2009: 4)
Globally, indigenous peoples experience poorer health outcomes, reduced quality of life and higher mortality rates from specific diseases, such as heart disease, tuberculosis, cancer, respiratory disease, stroke and diabetes, than their non-indigenous counterparts. Indigenous populations are six times more likely to die from injuries and are disproportionately more affected by forced displacement caused by natural disasters, armed conflict and loss of their ancestral domains. They also have worse access to education, health care and social services. This trend can be observed among indigenous groups around the world, including those in North America (Ramraj et al., 2016), Australia (Marmot, 2016), New Zealand and the Pacific (Anderson et al., 2006), Latin America and the Caribbean (Montenegro and Stephens, 2006) and Africa (Ohenjo et al., 2006).
The alleged health profile of indigenous groups has been distorted by racism and racial stereotypes. This is illustrated by the alleged alcoholism rates of Australian Aboriginals (Box 6.1). Similar stereotyping occurs regarding the alcohol use of Native Americans. Direct comparisons to published alcohol consumption data from other US populations indicated that American Indians in two reservation samples may be less likely to use alcohol than are others in the USA. However, among American Indian drinkers, more alcohol was consumed per drinking occasion (Beals et al., 2003).
Governmental efforts aim to address inequalities that disadvantage indigenous communities, but in some instances these efforts are tokenistic or symbolic in nature. Living with a legacy of conquest and culture, they may even continue to subjugate indigenous people to unjust and unfair economic and educational systems (Fredericks et al., 2014). It is important to recognize indigenous ways of knowing and to value indigenous stories and narratives within their socio-cultural context to bring to the surface knowledge that is relevant, insightful and meaningful for community members. Participatory action research can be used to facilitate this process (see Chapters 7 and 16). Genuine participation, instead of tokenistic participation, can foster a sense of ownership for community members and can strengthen personal and community capabilities.
For example, Thompson et al. (2013) facilitated an arts-based participatory action research project to explore the experiences and meaning of physical activity in two remote Northern Territory communities in Australia. Semi-structured interviews were conducted with community members (n = 23) and supplemented by five commissioned paintings by community-based artists and ethnographic observations. Physical activities were often linked with work, diet, social relationships and being active ‘on country’. They also were associated with educating younger generations about indigenous traditions.
Culturally appropriate physical activities such as bush walking, dancing and art making contribute to health promotion of the community. It is important that indigenous beliefs, knowledge and traditions are considered in the process. Furthermore, social and political issues, including those that are related to racism and discrimination, need to be taken into account since these may compound experiences and access to health care and promotion (Denison et al., 2014).
Racism and health
Racism contributes to poor mental and physical health among migrants, ethnic minority groups and indigenous peoples. Research evidence suggests that everyday experiences of discrimination are related to stress that can potentially lead to chronic illnesses. Even after controlling for factors such as perceived neighbourhood unsafety, food insecurity and financial stress, these associations were consistent across various ethnic groups (Clark et al., 1999; Earnshaw et al., 2016b). Strong associations were also shown between racial discrimination and psychological distress (Halim et al., 2017). Anderson (2013) used data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship between stress symptoms from perceived racism and overall health (n = 32,585). The analyses suggest that stress from perceived racism can have substantial negative consequences that contribute to poor mental and physical health in adults. Among young people, Grollman (2012) used data from the African-American Youth Culture Survey (n = 1,052) to examine the prevalence, distribution, and mental and physical health consequences of multiple forms of perceived discrimination. Findings suggest that young people from disadvantaged backgrounds are more susceptible as a result of experiencing multiple forms of discrimination than their more privileged counterparts. As with the findings from the adult population, a systematic review showed that the relationship between perceived racial discrimination and mental health can be observed among children and young people from minority ethnic groups (Priest et al., 2013).
Health-limiting behaviours, such as poor diet, smoking and increased alcohol intake, can also manifest as a response to the chronic stress of racism. For example, low socio-economic status, racial discrimination and low acculturation (i.e., being immersed in African-American culture and communities) are known to be the major socio-cultural correlates of smoking among African-American adults (Landrine and Corral, 2014). Bermudez-Millan et al. (2016) also found that while lower income predicted lower physical activity as well as poorer sleep quality and medical adherence, racial discrimination was associated with increases in food intake and alcohol consumption.
Landrine et al. (2016) tested whether racial discrimination can negatively influence a person’s self-reported health and whether they will rate it in terms of social instead of health indicators. They surveyed 2,118 African-Americans and found that the majority of their respondents (81.8%) rated their health as good/excellent, while only a relatively small proportion (18.2%) rated it as poor/fair. They also found that racial discrimination did not contribute to poor self-reported health, even after controlling for demographic factors. Findings also indicate that self-reported health was associated with objective health and was more strongly linked in the low- than the high-discrimination group.
Imposing culturally insensitive health promotion activities may exacerbate the social exclusion that is already being experienced by minority ethnic groups. Ochieng (2013) conducted a qualitative study exploring the beliefs and perceptions of healthy lifestyle practices among African-Caribbean men and women. In-depth interviews were conducted with 18 participants from the north of England. Findings suggest that participants felt that messages around healthy lifestyle practices were not applicable to their everyday lived experiences since these often ignored issues related to their experiences of social exclusion, racism and ethnic identity. Health promotion programmes that use individualistic approaches are inappropriate for, and isolate, those from ethnic minority communities who practise more collectivist traditions to express their beliefs, values and identity. Thus campaigns that try to promote healthy lifestyles need to consider socio-economic and cultural contexts, including issues related to disadvantage, racism and marginalization, to enable African-American and other minority ethnic groups to incorporate these messages and practices into their everyday lives (see Chapter 16).