This paper combines an art exhibition analysis with a reflective essay to examine the health and wellbeing of Aboriginal and Torres Strait Islander people in Australia. Drawing on Archie Moore's artwork Black Dog from the Defying Empire exhibition, the paper illustrates how racism and discrimination manifest as social determinants of health. The reflective component explores how colonisation, dispossession, and cultural oppression have produced significant mental health burdens and health inequities in indigenous communities. The paper argues that culturally safe, patient-centred care — grounded in an understanding of indigenous cultural identity and history — is essential for healthcare professionals seeking to address these deep-rooted disparities effectively.
The Defying Empire exhibition showcases the works of tens of Aboriginal and Torres Strait Islander artists from all over Australia (National Gallery of Australia [NGA], 2017). Held to commemorate the 1967 referendum that allowed indigenous people to be included in the national census, the exhibition is aimed at celebrating the cultural identity and historical tribulations of the Aboriginal and Torres Strait Islander people. Indigenous communities in Australia have historically been subjected to racism and discrimination, experiences which have negatively affected their health and wellbeing.
Of the several artworks presented during the exhibition, one that stood out is Black Dog, a work produced by Archie Moore. The image embodies the racism faced by Aboriginals and Torres Strait Islanders. As Moore explains, the dog's skin was not dark enough; hence, boot polish was applied to make it blacker. This further enriches the racial connotation intended to be projected by the image. As seen in the image, the dog "sits awkwardly on the floor, staring up at you with accusatory eyes as an indictment of past mistreatment of an individual but also of a marginalised group" (Moore, 2017). The dog also has a name tag on its neck, further depicting the subhuman treatment experienced by indigenous communities. In essence, the dog projects the discomfort, cruelty, and dispossession experienced by the Aboriginal and Torres Strait Islander people. It appears to accuse the majority of the inhuman treatment to which indigenous communities were subjected. These aspects make the image quite distinctive from the rest.
The history exemplified in Black Dog remarkably relates to the health and wellbeing of Aboriginal and Torres Strait Islander people. Indeed, in his artist's statement, Moore acknowledges the link between racism and discrimination and mental illnesses such as depression (Moore, 2017). This amplifies the connection between cultural and racial background and wellbeing. Cultural background is, in fact, one of the social determinants of health (Australian Indigenous HealthInfoNet, 2015).
Mental illness is a common phenomenon among the Aboriginal and Torres Strait Islander people. According to statistics from the Australian Bureau of Statistics (ABS), in 2008, approximately 32% of Aboriginals and Torres Strait Islanders aged 18 years and above were victims of high psychological distress (ABS, 2012). This was more than two times the prevalence for non-indigenous populations. Statistics further indicate that depression and anxiety account for approximately 16% of the overall disease burden among indigenous communities in Australia (Mindframe, 2014). Psychological distress among Aboriginals and Torres Strait Islanders is attributable to, among other factors, discrimination (Balaratnasingam et al., 2015). Indigenous communities continue to experience grief, trauma, and distress owing to colonisation, displacement from their traditional lands, oppression, imprisonment, injustice, exclusion, and racism (Mental Health Coordinating Council [MHCC], 2015). The problem is further compounded by other factors specific to indigenous people, such as poverty, inaccessibility to healthcare, lack of proper housing, high incarceration rates, alcohol and substance abuse, and a disproportionately high morbidity and mortality burden (Mindframe, 2014; Australian Indigenous HealthInfoNet, 2015).
The unique history of the Aboriginal and Torres Strait Islander people requires healthcare professionals to work in a culturally sensitive manner when treating their conditions (MHCC, 2015). To effectively address the health needs of indigenous communities, healthcare professionals must have a comprehensive understanding of their culture and history, which affects their wellbeing in one way or another (Chalmers et al., 2014; Balaratnasingam et al., 2015). With this understanding, healthcare professionals can acknowledge that mental illness among Aboriginals and Torres Strait Islanders is an outcome of racism and cultural oppression. Culturally sensitive care also requires the involvement of indigenous people in the formulation and delivery of services, which is especially crucial in the delivery of mental healthcare (MHCC, 2015).
Understanding the culture of indigenous people enables healthcare professionals not only to make sense of their needs, but also to communicate and interact with them effectively (Mental Health First Aid Australia, 2008). As explained by Parker and Milroy (2013), miscommunication between Aboriginal patients and non-Aboriginal physicians is pervasive, particularly in remote areas where the majority of indigenous communities are concentrated. Without knowledge of Aboriginal culture, healthcare professionals can easily misinterpret behaviours and symptoms when handling Aboriginal patients with mental illness. This can undermine the delivery of services to the disadvantage of the patient, underscoring the need for effective communication strategies when dealing with mental health patients from indigenous backgrounds.
As explored throughout this paper, Aboriginals and Torres Strait Islanders are an especially unique group of people. These communities have a distinctive cultural history that has shaped virtually every aspect of their lives. For many years, indigenous communities in Australia faced displacement, racism, discrimination, and oppression (Taylor & Guerin, 2014). Due to their skin colour, the majority treated them as subhumans. They were driven away from their traditional lands, used as slaves, imprisoned, and excluded from mainstream society. Indeed, until 1967, indigenous communities were not counted in the national census. Whereas they are now recognised as Australians, Aboriginals and Torres Strait Islanders remain disproportionately disadvantaged compared to the majority, with traces of socioeconomic injustice still evident.
The historical experiences of indigenous people in Australia have had significant implications for their social, economic, and physical wellbeing (Balaratnasingam et al., 2015). In comparison to non-indigenous communities, indigenous communities in the country grapple with higher levels of poverty, poorer access to healthcare, more deplorable housing conditions, and a greater prevalence of disease and death (Mindframe, 2014). More importantly, the Aboriginal and Torres Strait Islander people are traumatised by the brutal experiences of colonisation. They encounter grief, psychological distress, and feelings of marginalisation, and feel treated as lesser human beings. These experiences have imposed a great burden of mental health issues on these communities. Anxiety, depression, stress, and psychosis, among other mental health conditions, are common among Aboriginals and Torres Strait Islanders (Taylor & Guerin, 2014).
The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) (2015) recognises the significance of cultural safety when working with cultural communities. The notion of cultural safety denotes a philosophy that influences how healthcare professionals deliver and practise care. This philosophy places emphasis on structural and systemic issues in society and their connection to wellbeing. As per this philosophy, health and wellbeing are significantly influenced by social and cultural factors (Kruske, Kildea & Barclay, 2006). Accordingly, healthcare professionals must recognise these factors in the delivery of care, acknowledge a community's unique needs, and be familiar with their cultural and historical background. This approach to care is imperative for ensuring quality outcomes. For Aboriginals and Torres Strait Islanders, "cultural safety provides a decolonising model of practice based on dialogue, communication, power sharing and negotiation, and the acknowledgement of white privilege" (CATSINaM, 2015).
"How cultural identity shapes health behaviours and outcomes"
"Colonial history creating healthcare access inequities"
"Holistic models and patient-centred care for indigenous people"
Overall, addressing the health needs of Aboriginals and Torres Strait Islanders requires an extensive understanding and acknowledgement of their cultural identity. Healthcare professionals must recognise how the historical experiences of indigenous communities — especially with respect to racism and discrimination — have shaped their health and wellbeing over time. Such an approach is effective because it addresses the underlying determinants of health and wellbeing, rather than treating surface symptoms in isolation.
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