A remarkable story of a decades-long collaboration working for peace and reconciliation in the wake of a 1927 massacre on the Solomon Islands was shared at the recent Health Promotion Symposium 2023, where presenters also explored wide-ranging political, social, cultural, ecological and commercial determinants of health.
Marie McInerney writes:
In July 2018, leaders from the local Kwaio tribe and a group of Australians, including acclaimed scientist Tim Flannery, stood together, deep in the rainforest on the island of Malaita in the Solomon Islands.
It had taken them two days to walk into the mountains in torrential rain for a deeply private and sacred ceremony of reconciliation that had taken years of trust building and planning, and for which the Kwaio had waited nine decades.
No cameras or recordings were allowed as a senior Kwaio chief, a holder of sacred knowledge, called down the names of ancestral spirits and name after name of hundreds of Kwaio people who had died during or in the wake of a punitive expedition launched by Australian naval troops at the behest of the colonising British in 1927 in response to an uprising over tax.
The Malaita massacre, as it became known, caused ongoing problems for the Kwaio over decades, including sickness and death they could only explain as caused by the anger of ancestors.
Kwaio Chief Esau Kekeubata and Associate Professor David MacLaren from James Cook University, who have been working together on Malaita for 30 years, were instrumental in bringing about the landmark reconciliation ceremony.
Jointly delivering the Dr Eberhard Wenzel Oration at last week’s Health Promotion Symposium in Geelong, they said the ceremony has brought peace through respect for tribal ways, calming ancestral spirits and strengthening the Kwaio-led Baru Conservation Alliance.
The group works alongside Australian researchers across multiple pillars: conservation, health, education, agriculture, sanitation, management, reconciliation, and research.
“Peace and reconciliation have been a fundamental condition of my people’s health,” Kekeubata told the symposium, invoking the Ottawa Charter for Health Promotion in an address that set the tone and scope for many other discussions on the political, social, cultural, ecological and commercial determinants of health at the symposium.
MacLaren told the event that his work with the Kwaio people began three decades ago when, as a young medical scientist working in the Solomons, he met Kekeubata, then a village health worker, who invited the Australian to stay with his tribe and family.
It was easy, MacLaren said, to see that health services were almost non-existent for the Kwaio and that, where they did exist, they were culturally unsafe colonial and missionary expressions.
But while that was clear, MacLaren said he didn’t have the knowledge or intellectual frameworks to understand or address these historical and structural determinants of health, so he returned to Australia to undertake his PhD with Eberhard Wenzel as supervisor.
MacLaren’s 2007 dissertation concluded that, in seeking healthcare, Kwaio people were being forced to either relinquish fundamental precepts of culture and religion by entering the local missionary hospital or remain true to Kwaio beliefs and stay away.
“Many choose the latter. The result is considerable untreated acute and chronic illness and preventable death,” he wrote.
That’s been particularly the case with still unacceptable rates of tuberculosis (TB) among the Kwaio, with poor outcomes exacerbated by a healthcare system that demeaned them and required villagers to go into isolation in a culturally inappropriate hospital, a two-day trek at least from home, away from family and community for at least two months.
Now the Baru alliance is training young Kwaio conservation rangers to be village health workers, able to identify the symptoms of TB and to look after people who are on TB medication.
This new tribal model of healthcare, which they said has been an outstanding success, uses conservation maps to know where the TB patients live, mapping also their family members and tribal land — “grassroots methods for spatial epidemiology to know exactly where people live, what their ages are, what families they are from and who culturally is able to go talk to (them) …to negotiate taking specimens or taking medicine over different people’s tribal land”, he said.
Kekeubata also detailed other health programs being led by the Baru alliance, including making affordable menstruation pads for girls, who previously would miss school during their periods, and initiatives to improve food security
“Government and church people tell us it is too hard to work with the Kwaio people because of our customs, but we have our own solutions,” he said.
Asked after their Oration how they had built the trust needed for the 2018 reconciliation ceremony and ongoing work, Kekeubata highlighted the importance of proper dialogue and transparency at all levels. He expressed concern at the failure of the Voice referendum for Aboriginal and Torres Strait Islander people.
For MacLaren, what was important was a deep understanding of history and of the internal structures in Kwaio society, “so that when we engaged, we were confident that this was actually the correct way, that the right people were doing it and the right people were doing it for the right reasons”.
Also important was humility and committing to a respectful process of ‘ask, not tell’, he said, adding that a great Melanesian leader had told him early in my career “that the three Rs are important: respect, relationship and reciprocity”.
Listen to this interview with Chief Esau Kekeubata and Associate Professor David MacLaren, and also some more reading: Remarkable reconciliation ceremony in the Solomon Islands paves way for future partnerships.
Systems thinking, privilege and power, and ethics in action
The two-day Australian Health Promotion Association symposium, held in Geelong on the traditional lands of the Wadawurrung people, was the first dedicated gathering of the health promotion community since before the pandemic.
It sought to focus on big picture issues in health but also to follow through to the practice level with challenges, tools and examples to prompt action in practitioners’ own sphere of influence.
That included through a focus on systems thinking and on broader concepts of prevention — beyond trying to manage the latest new harmful tobacco or alcohol product to thinking about tax and corporate governance issues and digital disinformation in a landscape where harmful social media platforms were described recently by a US Senator as “the new tobacco”.
Keynote speaker Dr Becky White encouraged the sector to build its capacity to address infodemics — the overabundance of information, accurate and otherwise, in a digital and physical space, as well as information voids — which posed so many risks during the COVID-19 pandemic.
“We need to better understand prevention in this area, not just mitigation…The moderation [of platforms] is important, but we need things to happen before that,” White said, highlighting the work of the not for profit Internews and the Africa Infodemic Response Alliance (AIRA) in helping to build healthy information environments.
Watch this interview with Dr Becky White.
The closing plenary, led by political economist Katherine Trebeck, who will be AHPA’s Thinker in Residence next year, focused on global and local efforts to build an economy that is fit for people and planet. See this Twitter/X thread of the discussion.
The symposium also heard multiple calls to interrogate privilege and power, whether that’s held by harmful corporate actors or the responsibility of the health profession itself to step up on the climate crisis or on racism as a health determinant.
Deakin University researcher Khalid Muse said health promotion needs to question whether much-promoted community mobilisation of minority groups in the field is always empowering or ethical, or does it actually “devolve responsibility”.
Mobilisation isn’t a quick fix, it takes long-term capacity building and capability, and an interest in dismantling oppressive systems, he said during his panel session.
“What I’ve seen often is a lot of organisations and people who are calling for community mobilisation are actually not willing to create space for these communities, whether it be at their events, in their workplaces or within conferences and spaces like this,” Muse said to strong applause.
He urged everyone to reflect on their own power and privilege when they are calling for community mobilisation: “to look at the people around you, who’s in the room: if you’re working on vaping, are there young people in the room? If you want to mobilise community so you can use their lived experience, is that ethical and are those people actually represented in leadership within your organisation?”
Some other takeaways from #hpsymposium2023 follow.
Be a good human: be brave and know your history
The political and cultural determinants of health also came together in the symposium’s opening keynote address by Emma Rawson-Te Patu, President-Elect of the World Federation of Public Health Associations, the first Indigenous woman to hold the position.
The need for bravery — “a word that’s not used enough” — was also at the heart of her call to action to fellow health promotion professionals.
In working in health equity and with Indigenous peoples, she urged her profession to be brave (especially when it becomes uncomfortable), to make space and share power, to take the time for Indigenous people to know and trust them, to examine ego, and be generous, authentic and kind.
She also warned about enduring non-Indigenous obstacles to equity that echoed much of the misinformation surrounding the Voice referendum campaign.
Her list includes fear of loss by non-Indigenous people in favour of ‘unfair Indigenous gain’,, the “mistaken understanding that if you give more resources to Indigenous initiatives somehow the rest of the community is missing out”, and the fear of being held responsible for historical injustice.
“We know you weren’t there, but if we say to you what the issues are, how to fix them, and they’re not actioned, then you’re responsible for that,” she told non-Indigenous colleagues.
“Ultimately it’s about being a good human,” she said.
Reflecting that the failure of the Voice referendum showed the need for more historical literacy in Australia, Rawson-Te Patu also talked about cultural devaluing in the recent election campaign in Aotearoa New Zealand, including where a Maori Party leader’s tribal facial marking was defaced on multiple placards.
Asked about the political implications of the change of government, Rawson-Te Patu said the incoming Nationals plan to scrap the landmark Maori Health Authority, which was established last year as one of a number of good and brave policy acts by the former Labour Prime Minister Jacinda Ardern.
While still a work in progress, the Authority offers “truly authentic treaty-based partnership” on Maori health equity, she said, adding that it may have inbuilt legislative protection and strong community support that could save it yet.
But, she said, in the face of such setbacks, communities and campaigners could look beyond their own national processes to international mechanisms, like the United Nations, that might advance rights in different ways and beyond political cycles.
Watch this interview with Emma Rawson-Te Patu.
Planetary health is dire but we also need hope
The symposium’s plenary session on planetary health came on the day that a global team of climate scientists made dire headlines across the globe, reporting that “life on planet Earth is under siege. We are now in an uncharted territory”.
In the audience was a health researcher living in regional Victoria who had been directly impacted by the 2019-20 Black Summer bushfires. Earlier this month her community had been hit by both fires and flood on the same day, she said, prompting discussion on how rural communities can engage in climate advocacy and the mental toll of the climate crisis.
Another delegate spoke about how the Black Summer bushfires had at least raised hopes of real climate action, only to be washed away as the world grappled with COVID-19 instead and asking how hope for real action can be maintained.
Keynote speaker Professor Tony Capon, Director of the Monash Sustainable Development Institute, talked about the importance to him of hope amid the fear, playing a 2012 video on the Anthropocene, which “paints a fairly dark picture but also finishes with a positive message about human creativity and the fact that we can respond to these challenges”.
“Some would argue it’s too late. But I remain hopeful and I think anybody that works on these big issues has to remain hopeful,” he said, later urging hospitals and health services to shift to more sustainable food purchasing so they could also use their substantial purchasing power to “drive and accelerate” a broader transition across the agri-food sector.
Capon and fellow panellists Adjunct Professor Fiona Armstrong and Dr Rebecca Patrick co-authored a 2021 article in a VicHealth/MJA publication, concerned that health promotion practice has been slow to incorporate ecological determinants of health for a range of reasons, leaving it “relying on behaviour change interventions and narrow systems of measuring health outcomes, while ignoring ecological issues”.
Having Georgia Langmaid on the panel offered an illustration of a shift they were driving. An early career practitioner, she is Executive Support Officer for Victoria’s South East Councils Climate Change Alliance.
Langmaid’s takeaway message was that health promotion practitioners don’t have to be technical experts in planetary health, but they need to be brave and take the leap into climate action, because their communities are having to face the challenges head on. “And I think it’s our responsibility to help guide them and adapt,” she said.
Armstrong, former CEO of the Climate and Health Alliance, elevated the challenge. “You may not feel like it, but if you’re in this room you’re rich and privileged and it’s our responsibility as rich and privileged people to act on behalf of the species who cannot speak and the people who are not rich and privileged in our country and everywhere else,” she said.
“Mosquitoes do not have front groups, and mosquitoes do not have lobbies”
VicHealth CEO Dr Sandro Demaio reprised this famous quote from nearly a decade ago by then World Health Organization head Margaret Chan on the commercial determinants of health and how the vectors of disease have changed immeasurably.
Not only do they cause harm, but the purveyers of tobacco, alcohol, unhealthy food and other harmful products have lobby groups, are in Canberra in much larger numbers than the health sector, are well resourced, and unlike mosquitoes in malaria outbreaks do sue governments for taking public health action, Demaio
But while the products change, the practices are remarkably similar, Demaio said, with the tobacco/vaping industry able to do a “rinse and repeat”, particularly given the current generation of politicians in Canberra were not there when Australia’s leading plain packaging laws were brought in, so have not seen the industry playbook in action.
Anticipating a big fight in the coming months as the Federal Government seeks to tighten tobacco/vaping laws, Demaio said the health sector can’t keep playing Whack A Mole, trying to dispose of one harmful product after another.
Rather “we need to really start thinking at a systems-based level”, he said, pointing to the recent publication by VicHealth, Melbourne University and The Lancet that aims to create a normative framework for the commercial determinants.
For his VicHealth colleague Bonnie Matheson, learning about the commercial determinants has been a revelation: discovering the need to go beyond harmful products and industries to harmful practices, from tax to workplace issues, and therefore for health promotion to be talking to a new set of stakeholders: investors, shareholders, company boards. See this interview with Matheson.
But it’s not just about evil forces, the session heard.
The sector also needs to understand the capacity of the commercial determinants to benefit health through positive business ventures, like two featured at the symposium: the Aboriginal-led Ngarrimili and the work of Common Ground, a Victorian regenerative agricultural enterprise which is one of VicHealth’s Future Healthy Food Hubs partners.
But, warned Common Ground CEO Felicity Jacob, such enterprises also have to get political: unlike, for example, the fossil fuel industries, there are few subsidies for their work so it can be enormously difficult for smaller scale operators to be sustainable.
“It’s relying on the small players and individuals at the moment to make the right choice, but we have to get the system to support the right choice,” she said, quoting an old adage: “The wolf that wins is the one that you feed.”
Bookmark this link to track Croakey Conference News Service coverage of the event and also see #hpsymposium2023 on X/Twitter.
