Cultural factors critical to the health and wellbeing of Aboriginal and Torres Strait Islander adults have been assessed in the largest cohort study ever, conducted by Professor Raymond Lovett, yielding a new resource for health practitioners, policymakers and Indigenous communities.
The Mayi Kuwayu study, supported by an NHMRC Project Grant, drew 13,000 participants from across Australia. It explored the relationship between cultural engagement, identity formation, and health and wellbeing outcomes. The project enabled Professor Lovett and his team, from the Australian National University, to develop a suite of culturally relevant measures—a combination of existing, adapted and novel measures.
“Social determinants of health sit within a cultural context. We essentially asked Aboriginal and Torres Strait Islander people: ‘What is important to your wellbeing?’” said Professor Lovett.
“Prior to this work, there were no measures for kinship systems, language and connection to country and cultural engagement. Using a salutogenic or strengths-based approach, we identified cultural and other assets that promote wellbeing. We also developed measures linked to health, like exposure to racism,” said Professor Lovett.
The team analysed psychological distress levels (using the Kessler scale) of Indigenous people compared to the general Australian population. They found that rates of very high psychological distress are double for people that are exposed to any form of racism or discrimination and that racism exposure contributed to 50% of the gap in high psychological distress.
“We now know from this research that if we remove racism from the health inequity equation, half of that gap or disparity in high to very high distress will disappear. Aboriginal and Torres Strait Islander people know it's crucial to health and wellbeing. This large cohort study shines a light on the value of addressing discrimination and racism, in all its forms, to create equitable health,” said Professor Lovett.
While the public health landscape is very focused on health behaviours, such as tobacco and alcohol use, according to Professor Lovett, not recognising and addressing the root causes of stress response activation (such as discrimination and racism) is unhelpful and in itself, discriminatory.
“Smoking and alcohol, for example, are major contributors to cardiovascular disease and cancer, the 2 biggest contributors to Aboriginal and Torres Strait Islander mortality[1]. If we work on things that reduce or eliminate stress response and activation, or support those salutogenic health promoting behaviours, then long term, there will be life improvements,” said Professor Lovett.
Professor Lovett is a sought-after expert internationally, having worked with researchers from New Zealand, USA, Canada and Mexico in recent years. He is grateful for the enthusiasm and support from others and is committed to supporting the next generations.
“I’ve been so lucky to be mentored by very senior Indigenous researchers from other institutions and countries. And it’s been a privilege to be able to ‘pay it forward’ by bringing on additional students, thanks to this project and the funding from NHMRC,” he said.
Next steps
Results from the Mayi Kuwayu study are being used to train local Indigenous communities to collect and process their own data. This grassroots approach fosters ownership and relevance in health research. Professor Lovett plans to turn this project into a sustainable cohort study that spans 50 years or longer, allowing for comprehensive tracking of health outcomes and the impact of interventions over time.
Professor Lovett’s team will soon be recruiting for new participants and following up past participants who have been involved since 2018. He will also be exploring digital infrastructure options to better support data collection and participant engagement.
“Having an ethical, community-focused and Indigenous-controlled resource that will contribute to a holistic and robust understanding of Aboriginal and Torres Strait Islander culture, health and wellbeing is critical. A long-term commitment is needed to drive meaningful change in life expectancy and overall health,” said Professor Lovett.
Chief investigator: Professor Raymond Lovett
Administering institution: The Australian National University
Grant information: Project Grant (2017–2021), $2,004,365.82.
[1]Australian Government Institute of Health and Welfare National Indigenous Australians Agency, 1.23 Leading causes of mortality [website], https://www.indigenoushpf.gov.au/measures/1-23-leading-causes-of-mortality