From article by Pamela Wilson

Amid the grim statistics on Indigenous health, residents of the remote community of Utopia have found that retaining a connection to country is their answer to better health.

Utopia is about 250 kilometres north-east of Alice Springs, and its
residents live off the land in a way similar to their ancestors, hunting
bush tucker and retaining cultural traditions.

Research published in the Medical Journal of Australia has found the
mortality rate for Utopia’s residents is 40 to 50 per cent lower than
the Northern Territory average for Aboriginal adults. This is, at least
partly, due to the prevention of diabetes and low rates of obesity,
hypertension and smoking.

The consensus is that Utopia’s Alyawarr and Anmatyerr people are
healthier because of the empowerment that comes from decentralisation and connection to country: Utopia’s 1000 residents don’t live in one main township, but rather are dispersed amongst 20 outstations, spread over almost 10,000 square kilometres.

Community elder Albert Bailey explains, “We are eating kangaroo and
porcupine. We hunt the porcupine at night.”  This is supplemented with bush fruits and vegetables such as tomatoes, potatoes and bananas. Fruit and vegetables are also purchased occasionally from the local store.

The local doctor, Urapuntja Health Service’s GP Dr Karmananda
Saraswati, adds that while their lives are “very organic” and they
adhere to their cultural traditions and look after themselves, they
willingly take the necessary medicines prescribed by the health
service.

“Their traditions are very strong here. That is all hugely empowering
at a community level. (But) sometimes I will get the nankari (witch
doctor(sic) ) instead of the RFDS (Royal Flying Doctor Service) because it’s more appropriate,” says Saraswati.

The health service, which is community-controlled and chaired by Bailey, has prompted residents to take greater responsibility for their health.  The clinic provides an outreach service to outstations, visiting each one at least fortnightly, and employs drivers to ferry patients to the clinic at other times.

The findings of the MJA article concluded: “Contributors to lower than expected morbidity and mortality are likely to include the nature of primary health care services … as well as the decentralised mode of outstation living and social factors, including connectedness to culture, family and land and opportunities for self-determination.”

Common indicators complicated

Paradoxically, a follow-up study to the MJA article on the link between social determinants and heart health for Aboriginal people (yet to published) shows that Utopia has higher unemployment, more overcrowding, lower incomes and lower high school completion rates than the rest of  the NT Aboriginal population.

Primary author of both reports, the University of Melbourne’s Kevin
Rowley, explains that for Aboriginal people some of the common
indicators of health outcomes such as employment and income are
complicated.

“Employment, in itself, is good, but it has to be meaningful. Certainly
in some places, for Aboriginal people, being employed is associated with worse health,” says Rowley, Senior Research Fellow in the School of Population Health.

Dr Paul Burgess, from the Menzies School of Health Research, says while the obvious benefits of decentralisation are better diet, exercise and empowerment, the positive effects for Indigenous communities from living on traditional homelands are more ingrained.

“From an Indigenous perspective, it’s enormously complex. They have a holistic health promotion model, which is built on their attachment to country … built into their identity.”

Whilst Utopia’s model is one that many Indigenous communities aspire to regain, Burgess says that over the past decade the federal and state governments have increasingly diverted funding from outstations to centralised programs. He points out that ongoing research into other remote communities in West Australia, the Northern Territory and Queensland consistently shows that decentralised living leads to better health outcomes.  “The government has moved in the opposite direction to where evidence is pointing to better health outcomes,” he says.

Burgess and many Indigenous health stakeholders, therefore, continue to lobby governments to take note of findings such as those from Utopia, and to reconsider their policies.  Adopting broad-scale management of country programs whereby Indigenous communities are asked to care for the land is just one solution governments could consider to facilitate connection to country amongst Aboriginal people, believes Burgess.

“The landscape is enormous and Indigenous [people]are best placed to manage it and they are motivated to do it,” he said.