For almost a century political and public health commentators, have been linking the poor health of Australian Aboriginal people to their living environment. (1,2,3) However, during this time there have been no substantive attempts to detail the elements of the living environment that are likely to contribute to poor health, what health problems they are likely to cause, and how they might be corrected.
In 1985 on the Anangu Pitjantjatjara Lands, in the north-west corner of South Australia, we began a process of addressing these questions. In 1986 we undertook a detailed study of the living environment of Aboriginal people (Anangu) in this region. In this project we assessed the safety of the houses and determined a range of Healthy Living Practices (HLPs) that would be necessary for anyone living in this environment, regardless of background, if they were to keep themselves and their family healthy (4). In addition to urgent safety issues these were:
- Washing people, especially children
- Washing clothes and bedding
- Removing wastewater safely
- Improving nutrition
- Reducing the impact of crowding
- Reducing the impact of animals, insects and vermin
- Reducing the impact of dust
- Improved temperature control
- Reducing minor trauma
These Healthy Living Practices were prioritised on the basis of existing public health knowledge and their likely impact on health status. We placed life threatening safety issues highest and then washing and waste disposal, then storing, preparing and cooking food to improve nutrition.
VIDEO: Brian Doolan, Fred Hollows Foundation CEO, speaks about the history and importance of “health hardware”
Housing and immediate surrounding living environment was tested to determine if there was functioning “health hardware” (a term borrowed from the late Professor Fred Hollows) necessary to carry out these healthy living practices. During this work we defined reasonable targets for each of the HLPs. For example, we developed an objective that mothers should be able to wash their children once a day and wash hands and face frequently all year round. Our assessment focused on testing the functional capacity of households to conduct these HLPs. The report prescribed a range of design and implementation recommendations for the provision of health hardware. A major finding of this work was that maintenance programs were crucial to sustaining any health supporting function of housing. When maintenance programs were absent or failed, housing infrastructure often became a health hazard.
These decisions about priorities and health hardware were made given our knowledge of Aboriginal health problems at the time and also of the existing public health literature. It is important to review the relevance of our approach 25 years later.