Trying to keep a balance: The meaning of health and diabetes in an urban Aboriginal community

Although the predominant paradigm of epidemiological investigation continue s to focus narrowly on the individual and on individual risk factors, there is a growing body of work that calls for a rethinking of the current epide miological models. In this paper we illustrate the need for a more comprehe nsive epidemiological approach towards understanding the risks for diabetes , by exploring the lived experiences of diabetes and lay meanings of risk a mong Aborigines living in Melbourne, Australia. Ethnographic fieldwork was conducted within the Melbourne Aboriginal community in the state of Victori a over a 22-month period (1994-1996). Melbourne Aborigines see non-insulin dependent diabetes mellitus (NIDDM) as the result of living a Life out of b alance, a life of lost or severed connections with land and kin and a life with little control over past, present or future. The lay model regarding d iabetes that is derived from the narratives of Melbourne Aborigines, consis ts of three levels of connectedness important in determining an individual' s susceptibility not only to diabetes but to all disease - (1) family, (2) community and (3) society. This structure of interactive systems at success ive levels from the individual to the population fits within the framework of an ecological paradigm. The strength of ethnography as applied to epidem iology is that it has the capacity to discover previously unknown component s of a system at several different levels, and to build models to explain h ow these components interact. This framework, developed using an ethno-epid emiological approach, has application in other indigenous populations who h ave been dispossessed of their land, their pasts and their future. There is great potential to apply this approach to the major public health challeng es presented by rapid global socio-cultural and environmental change that a re impacting negatively on population health. (C) 2000 Elsevier Science Ltd . All rights reserved.