Melbourne School of Population and Global Health - Theses
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ItemConnections, constraints and continuities: wellbeing, relationality and young Pasifika women in Melbourne Australia( 2019)Among many theoretical and methodological approaches to studying wellbeing the relational approach I adopt in this thesis has the potential to enrich understanding of the concept. The assumption of this thesis is that observing the flow of relationships and practices in lived spaces foregrounds the forces that enable and disrupt wellbeing. The thesis captures these flows through an ethnographic exploration of the experiences of young Pasifika women in Melbourne’s west. Through my roles as a volunteer, a participant and a researcher with a Pasifika youth group, I attend to their unique transnational context which shapes the young women’s relationships and practices and is essential to their wellbeing experiences. The meaning the young women make of wellbeing is interpreted through their family and community relational processes, through their participatory activities in cultural projects and through their perception and reporting of the impact of broader structures of power such as educational and regulatory regimes. I argue that the agency of the state specifically through restrictions imposed on migrants from Aotearoa/New Zealand after February 2001 - including eligibility for education and welfare services - is a constituent factor in diminishing young Pasifika’s wellbeing potential. In researching relational wellbeing I draw on scholarship informed by Pasifika, medical anthropological and critical theoretical frameworks. These frameworks provide a valuable basis for the analysis of processual and political dimensions of wellbeing. In studying the spaces the young women inhabit the thesis engages with conceptual issues central to this literature. I have identified and separately examined wellbeing practices in three spaces which I call restorative (Chapter Four), participatory (Chapter Five) and structural (Chapter Six). My argument is counterposed to a common notion of wellbeing as an abstract, measurable and ahistorical entity. For these young women, wellbeing experiences are grounded in, and shaped by ongoing historical, socio-economic and political processes. In Chapters Two and Three I provide an account of these processes in the historical/ethnographic context. This is essential to developing my concept of wellbeing as social and historical experiences embedded in the relational spaces. There is both potential and constraint in these spaces; and the young women’s wellbeing experiences emerge from complex processes of negotiation and balancing of these. My thesis argues that wellbeing is essentially an unfinished project as the young women weave stories of possibilities into their imaginings. In using multidisciplinary perspectives on wellbeing, this thesis makes an original contribution to health literature on Pasifika youth in Australia. The thesis presents an alternative epistemological foundation to health and wellbeing approaches that do not adequately address the relational dynamics of wellbeing in minority populations. It focuses on strengths and capabilities of the young women; it also argues that a study of wellbeing is incomplete unless it foregrounds the impact of structural forces on wellbeing pathways. This thesis will be of interest to Pasifika and minority youth who contest deficit-based portrayals of their communities. It will also be of interest to scholars and policy makers working at the intersections of immigration, justice and settlement agencies and health delivery.
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ItemMarkers of midlife: interrogating health, illness and ageing in rural Australia( 2007-06)The aim of this thesis is to explore rural women’s midlife experiences and interrogate the roles of health, social and community factors in these. In the cultural imagination, midlife signifies the onset of ageing and is thus framed in a discourse of decline. For women, it is often considered in terms of menopause and the end of fecundity and fertility. I propose that women’s experience of midlife is much broader than this; instead, it is characterised by transformation in multiple domains and health status is important. I suggest that the continuity theory of ageing is useful when conceptualising the life course. The concept of habitus enables exploration of how identity is re/constructed during the ageing process in response to changing bodily circumstances, such as health problems. (For complete abstract open document)
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ItemThe usage of psychotropic medications by family caregivers( 1996-07)This is a randomly selected, cross-sectional, population based study of women caring for family or friends who are elderly or have a long-term illness or disability. The purpose of the study was to investigate the usage of psychotropic medications by carers in order to identify predictors of usage of these medications relating to the caring situation. Data collected in 1993 by the Carers’ Program in the state of Victoria, Australia was used for statistical and qualitative analysis. The data base consisted of 157 carers and 219 non-carers. Women who had the main caring role for a relative or friend with a disability for at least 4 hours per week were selected for the study. Women who were living with a partner or children or both and had the main responsibility for household tasks but were not caring for someone with special needs were selected as the comparison group. Using this group of non-carers allowed direct comparison of carers and non-carers to be made and to identify the difference that the role of caregiving to someone with special needs makes when compared with usual family care responsibilities.
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ItemRace, racism, stress and Indigenous health( 2006)This thesis is a transdisciplinary study aimed at exploring the role of race, racism and stress as determinants of health for indigenous populations and other oppressed ethnoracial groups. Commencing with an analysis of continuing racialisation in health research, it is shown that there is no consistent evidence that oppressed ethnoracial groups, who suffer disproportionately from type 2 diabetes, are especially genetically susceptible to this disease. Continued attribution of ethnoracial differences in health to genetics highlights the need to be attentive to both environmental and genetic risk factors operating within and between ethnoracial groups. This exploration of racialisation is followed by a theoretical examination of racism as a health risk factor. This includes a comprehensive definition of racism, a diagrammatic representation of the aetiological relationship between racism and health and an examination of the dimensions across which perceived racism can be operationalised. An empirical review of 138 quantitative population-based studies of self-reported racism as a determinant of health reveals that self-reported racism is related to ill-health (particularly mental health) for oppressed ethnoracial groups after adjustment for a range of confounders. This review also highlights a number of limitations in this nascent field of research. This thesis then attempts to clarify the plethora of conceptual approaches used in the study of stress and health as a first step towards comprehending how stress interacts with both racism and health. A review of the empirical association between stress and chronic disease for fourth world indigenous populations and African Americans was also conducted. This review, which located 65 studies, found that a range of chronic diseases (especially chronic mental conditions) were associated with psychosocial stress. Utilising the conceptual work on operationalising racism discussed above, an instrument was developed to measure racism and its correlates as experienced by Indigenous Australians. This instrument demonstrated good face, content, psychometric and convergent validity in a pilot study involving 312 Indigenous Australians. The majority of participants in this study (70%) reported some experience of inter-personal racism, with this exposure most commonly reported in employment and public settings, from service providers and from other Indigenous people. Strong and consistent associations were found between racism and chronic stress as well as between racism and depression (CES-D), poor/fair self-assessed health status/poor general mental health (SF-12) and a marker of CVD risk (homocysteine), respectively. There was also evidence that the association between inter-personal racism and poor mental health outcomes was mediated by somatic and inner-directed disempowered reactions to racism as well as by chronic stress and a range of psychosocial characteristics. To conclude this thesis, an examination of approaches to addressing racism for Indigenous Australians is undertaken. The theoretical issues pertinent to the study of anti-racism are discussed along with empirical findings from social psychology on effective approaches to anti-racism. Recommendations for implementing these approaches through institutional and legal policies are also presented. Strategies for engendering political will to combat racism in the current neo-liberal capitalist climate are also briefly considered.
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ItemThe participation of Indigenous people in national Indigenous health policy processes( 2008)It is acknowledged that part of the failure to improve Indigenous health is due to the lack of participation of Indigenous people in national policy and decision making processes. In this three part study I investigated the nature of Indigenous people’s participation in national Indigenous health policy processes. I combined quantitative and qualitative methods through the perspective of policy networks. The first part of the study was directed at the prominence of informal networks in the evolution of Indigenous affairs policy. I aimed to determine and describe the structural location of Indigenous people in an informal network of influential people. I administered a network survey questionnaire during the period 2003/04. In a snowball nomination process influential people nominated a total of 227 influential people. Of these, 173 people received surveys of which 44 people returned surveys, a return rate of 25 per cent. I analysed the data to detect the existence of network groups; measure the degree of group interconnectivity; measure the characteristics of bonds between influential people; and I used demographic information to characterise the network and its groups. I found a stable pattern of relationships in the three features of the informal network: the whole network was diverse, and the Indigenous people were integrated and embedded in the network. It would not have existed without Indigenous people due to a combination of their greater number, their distribution throughout the network groups, and the interconnections between the groups. I argued that the findings showed that Indigenous people were fundamental in this informal network of influential people. The second part of the study was directed at the role of national health committees in engaging with advice about Indigenous health. I aimed to describe the structural location of Indigenous people in national health committees. Using internet sites I identified 121 national health committees at the end of 2003, and obtained information from 77 committees or 64 per cent of all committees. I calculated the proportion of members who were Indigenous within each committee; the proportion of committees which were Indigenous health committees; and constructed a visual representation of the formal reporting relationship between all the committees and Cabinet. I then determined the importance of each committee in terms of a committee network using eigenvector centrality scores. Finally, I identified the linking people between the informal network and the national health committees. I found that in a traditional hierarchical view that Indigenous people and Indigenous health committees were small in number and distant from Cabinet. In contrast a network view assumes that the importance of a committee depends on the combination of the number of interlocks, comembership, and betweenness with other committees. In this network view, Indigenous health committees were similarly located to other committees. A small number of elite knowledge brokers linked the informal networks and the national health committees. I argued that the findings showed a formal systemic deficiency in the strategic location of Indigenous people. The third part of the study was directed at the significance of inter-personal bonds between influential people in influencing policy processes. I aimed to describe the interpersonal relationships between influential people through a semi-structured interview. The interview questions were designed to elicit responses in the broad context of knowledge and influence in national Indigenous health policy processes. From a list of 47 potential interviewees I obtained 34 interviews (a response rate of 72 per cent), transcribed 32 interviews and coded them thematically. I found that underlying the episodic meetings of national health committees was the constant activities of informal networking. The influential non-Indigenous people had to pass some rules of entry in order to engage in and utilise informal processes. The interviewees demonstrated a value of connectedness in interpersonal relationships through agreement with principles such as social models of health. However, advice about Indigenous health issues may need to be continually rediscovered as it remains anchored to local contexts in a macro context where advice faces pathways that are confusing and convoluted. I argued that the findings indicated a meta-level vacuum in conceptualising the relationship between the concepts of participation and advice in national Indigenous health policy processes. The findings from the three parts indicated three characteristics of an ongoing meta-process (informal network), absence of a meta-perspective (national health committees), and a meta-concept of participation (interviews). I suggest that they form a meta-frame of participation. In this frame the energy dispersed in the many efforts at improving Indigenous peoples‟ participation are unfocussed because of multiple and uncoordinated policy origins. Therefore I concluded that the nature of participation of Indigenous people in national Indigenous health policy processes is one of unfocussed energy.