There is increasing recognition of the impact from structural, cultural, political, and social determinants on the health and wellbeing of communities, particularly those with poorer health profiles. A key principle of these determinants is self-determination. Self-determination by Indigenous Peoples, including First Nations Australians, is a right recognised internationally by the United Nations (1). It does not have a single definition, as it is context specific (2, 3). However, definitions recognise that self-determination is a collective right in which Indigenous Peoples determine their own pathways: socially, politically, economically, and culturally (4).
Why is self-determination important?
Studies have identified both the need to recognise and address historical and ongoing colonisation, dispossession, exclusion, and discrimination to improve the health and wellbeing of First Nations Australians. Critical to addressing this is the promotion and support of First Nations Australian-led decision-making and being able to exercise self-determination in the process (5, 6). It is important to recognise that while including First Nations Australians in policy development is not in and of itself self-determination, First Nations Australians must be included throughout the policy process for self-determination to be possible (7, 8).
First Nations Australian communities have a strong history of leading responses to reduce alcohol, social, and other harms to health (9). For example, supply reduction (e.g. purchasing the hotel/drinking club, and local area controls on availability); harm reduction (e.g. night patrols, sobering up shelters); and, demand reduction (e.g. campaigns to prevent fetal alcohol spectrum disorder; community-controlled residential treatment). Community ownership and leadership have been identified as fundamental to the success of these initiatives (10, 11).
This commentary outlines practical ways policy makers can work with First Nations Australians to facilitate their right to self-determination.
How can First Nations Australians exercise self-determination in policy development processes?
Recently I explored what is needed for First Nations Australians to exercise self-determination in health (and alcohol) policy processes (7, 8). This research found complexities in both the stages of policy development and the nature of First Nations Australian representation in policy processes. Delphi panellists identified five key areas in policy development necessary for First Nations Australians to exercise self-determination in policy. These range from macro-level structural changes, key values, and elements specific to policy development, decision-making, and implementation. Overall, the study found that the way in which alcohol policy is developed is as important as the policy.
The type of representation by First Nations Australians needs to be specific to the stage of policy development being considered (7, 8). That is, who is involved in the priority setting and policy development stages may differ significantly from those in the implementation, monitoring, and evaluation stages. A blanket approach to inclusion is not appropriate.
Eight characteristics of self-determination in developing policy
Eight elements are required for First Nations Australians to exercise self-determination in policy (7, 8).
Be involved. First and foremost, First Nations Australians need to be involved, if not leading, in all stages of policy development, and not just consulted as part of the process.
Resources. First Nations Australian communities are resourced to participate in the process. Often community organisations are asked to bring people together for consultation, which creates a large drain on the resources of these organisations.
Trust building. Trust building through the policy development process is necessary for self-determination as it is recognition that First Nations Australian culture is foremost in the process. First Nations Australian cultures are relational, rather than transactional, and in relationship, there is trust.
Localised. Particularly for alcohol policy, it is important that policies are appropriate and reflect the priorities of the local First Nations Australian communities. There are local factors and values that need to be considered. Blanket and top-down approaches undermine community ownership of issues.
Time. The collective nature of self-determination often requires time for consensus to be reached. If the process is rushed, and not cognisant of cultural obligations and requirements, the policy will be absent of the self-determination required.
Two-way sharing. As part of the consultation and policy development process, First Nations Australian communities need to be informed of the existing evidence-base in their community, as well as how other communities have addressed similar issues.
Feedback. First Nations Australian communities need to have feedback that relates to their priorities, in ways that are appropriate.
Accountable. First Nations Australian leadership in the process is fundamental to exercising self-determination. Such leadership requires that parties are accountable to each other throughout the process.
In summary, self-determination is complex, and has different meaning depending on the context. Despite some evidence of self-determination, systemic change in many areas is needed, including in government. This study identified a starting point, with the identification of elements and structural change needed to facilitate First Nations Australian community-led policy development approaches. Such approaches are vital to ensuring self-determination.
