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On transforming conversations around Indigenous health – #IHMayDay

One of the clear themes from the recent #IHMayDay Twitter-fest was the value of changing the questions asked and the stories told about the health of Aboriginal and Torres Strait Islander peoples.

Arising out of some of those discussions, Mikaela Jade and Ruth Mirams, co-founders of the consultancy, Paramodic, write about four questions they have found to be transformative.

***

Start really closing the gap with these four questions

Mikaela Jade and Ruth Mirams write:

In the day’s most unsurprising news, Indigenous people throughout Australia (and the world) face poorer health outcomes than non-Indigenous people.

Health is defined the state of being free from illness or injury. So why, when we talk about Indigenous health, does the conversation so often focus on the ‘illness and injury’ part of the definition, and not the ‘free from’.

This frames the conversation focusing on the gap, and not on closing it. Health problems are human problems.

If we let people define the health problems in our communities as ‘Indigenous problems’, we let them put us in a box, and we don’t hold them to account for the difference in health outcomes between Indigenous and non-Indigenous Australians.

We were given a gift in Canada, which helped turn a community around from a desperate situation, and we want to share it with you. We hope you can use it to change outcomes in your community, as we have.

First, let us introduce ourselves. Mikaela is a Cabrogal woman and an environmental scientist and former government officer with experience with the Australian Bureau of Statistics conducting research on how to change the practices of an entire sector.

Ruth is a chemist, with peer-reviewed publications and a PhD in health research. We now run a science innovation company called Paramodic which dedicates 50% of its time and resources to working pro bono for Indigenous digital projects. We work towards actually closing the gap, not just talking about it.

Last January, we spent an incredible day on the Rama reservation in Canada with Mark and Christine Douglas, two incredible Chippewa elders. Our deepest thanks to our friend Kathy Manners who made this experience possible, and shared with us that day.

The 22 January 2013 was one of those days where you live a lifetime in a day. We will forever remember that day, it has changed our lives, and we will never be the same people. You can hear us talk more about that day at TEDxCanberra 2013.

Mark and Christine have an amazing love story, that spans culture and time, but is not our story to tell. When Christine married Mark and moved to the Rama reservation, the Chippewa people were in a desperate state. Warriors were turning inward. Alcoholism and unemployment were rife. People were hopeless and desperate. A strong and proud culture was breaking down.

As a trained psychologist, and now a member of the Rama community, Christine wanted to use her skills to do what she could for her people. So she carefully developed a survey with many questions, to gauge the sentiment of the people and what solutions could be.

Christine was a human-centred designer before the title became cool, and she went into the community to field test her questions. Wow did they change!

With the wisdom of Seven Generations of Ojibwe knowledge, a survey became just four questions. These questions are one of the most precious gifts we have ever been given. They have changed how we approach research.

More than that though, they have changed our lives. They change the way we do business, the way we work with people of all cultures and walks of life.

In the wake of Indigenous Health May Day, let’s talk about how these questions radically reframe the way we look at the pressing issues in Indigenous health, how we approach research and how we relate to each other in our every day lives.

But first, without further ado, let us share the gift Christine gave us with you – what we call ‘The Mnjikaning Questions’!

Mnjikaning questions

  • What are you most proud of?
  • What are you most afraid of?
  • What is your most pressing need?
  • What can you do to help?

Why we value these questions – and what they can do for you

Question 1 sets a radically different tone. Rather than focusing on the problems, it brings the focus to pride (but don’t misunderstand us, there are very real problems and they are serious, pressing and desperate).

It invites the person answering to be a whole person – not just the persona you think you see. Are you most proud of your work achievements? Your culture? Your family? Your community? The sport you play? Your hobbies? Your education? Have you done something courageous, admired, respected? This question empowers people, rather than focusing on their disadvantage (or perceived disadvantage). It sets a positive tone for discussion and action.

Question 2 gives immediate, deep insight. By asking someone what they are afraid of, you get to the problem behind the problem and find out what they value most.

At the World Indigenous Network Conference we asked this question of over 300 Indigenous leaders from around the world. They were most afraid of being the last ones – the final custodians of culture and story.

The problem behind this problem is the loss of generations of important knowledge and lessons for living at a time when humanity needs it more than ever. In the digital age, there is no need for stories to be lost. With these insights, we have spent the last year framing digital solutions to connect elders and young people in communities. We hope this contributes to improved health outcomes. It’s part of our personal commitment to closing the gap.

Question 3 cuts to the chase, getting straight to the practical. As Maslow so famously taught us, we cannot look at higher order needs if more desperate needs are not met. If I have unmet physiological needs (I am hungry, and so are my kids), then I cannot fill my esteem needs (feeling self-confident and respected by others). By getting straight to the most pressing need (often in communities where there may be many urgent needs), we have a chance to use limited resources to help in the most effective way.

Question 4 shows capacity, in the person and the community. It empowers you to feel like the problem can be tackled, and that you are part of the solution. None of the problems facing our community can be solved unless we all do what we can. It also embeds self-determination.

In our experience, people can sometimes assume Indigenous people are disadvantaged because they have a narrative that we can’t or won’t help themselves. But this not the case! We are some of the most resourceful, strategic, intelligent people on the planet – if we weren’t we wouldn’t be where we are today!

If you are a government organisation or an NGO, then looking at capability ensures that you are not using your resources to do something for the community that we can do for ourselves – or that we can do collaboratively with you.

To conclude, let us share a little secret with you. The key to unlocking the power of these questions is not interrogate or approach them as research or a survey.

Weave them into conversation. Know your own answers, and be prepared to share them. These questions are tried, true and come with generations of wisdom.

We hope you take this gift, and value it as we do. Thank you so much Christine, good health to you and your family, and to everyone reading this.

On Twitter:
@jade_mikaela


@ruthmirams

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2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2019 Conferences
#ACEM19
#CPHCE19