Healthy country, healthy people: the relationship between Indigenous health status and “caring for country”

Christopher P Burgess, Fay H Johnston, Helen L Berry, Joseph McDonnell, Dean Yibarbuk, Charlie Gunabarra, Albert Mileran and Ross S Bailie
Med J Aust 2009; 190 (10): 567-572.


Objective: To investigate associations between “caring for country” — an activity that Indigenous peoples assert promotes good health — and health outcomes relevant to excess Indigenous morbidity and mortality.

Design, setting and participants: Cross-sectional study involving 298 Indigenous adults aged 15–54 years in an Arnhem Land community, recruited from March to September 2005.

Main outcome measures: Self-reported involvement in caring for country, health behaviours and clinically measured body mass index (BMI), waist circumference, blood pressure, type 2 diabetes status, albumin to creatinine ratio (ACR), levels of glycated haemoglobin (HbA1c) and high-density lipoprotein (HDL) cholesterol, lipid ratio, score on the five-item version of the Kessler Psychological Distress Scale (K5), and 5-year cardiovascular disease (CVD) risk.

Results: Controlling for sociodemographic characteristics and health behaviours, multivariate regression revealed significant and substantial associations between caring for country and health outcomes. An interquartile range rise in the weighted composite caring-for-country score was significantly associated with more frequent physical activity, better diet, lower BMI (regression coefficient [b] =  2.83; 95% CI, 4.56 to 1.10), less abdominal obesity (odds ratio [OR], 0.43; 95% CI, 0.26–0.72), lower systolic blood pressure (b =  7.59; 95% CI, 12.01 to 3.17), less diabetes (OR, 0.12; 95% CI, 0.03–0.52), lower HbA1c level (b =  0.45; 95% CI, 0.79 to 0.11), non-elevated ACR (OR, 0.28; 95% CI, 0.13–0.60), higher HDL cholesterol level (b = 0.06; 95% CI, 0.01–0.12), lower K5 score (b =  0.97; 95% CI, 1.64 to 0.31) and lower CVD risk (b =  0.77; 95% CI, 1.43 to 0.11).

Conclusions: Greater Indigenous participation in caring for country activities is associated with significantly better health. Although the causal direction of these associations requires clarification, our findings suggest that investment in caring for country may be a means to foster sustainable economic development and gains for both ecological and Indigenous peoples’ health.

  • Christopher P Burgess1
  • Fay H Johnston2
  • Helen L Berry3
  • Joseph McDonnell1
  • Dean Yibarbuk4
  • Charlie Gunabarra5
  • Albert Mileran6
  • Ross S Bailie1

  • 1 Menzies School of Health Research, Charles Darwin University, Darwin, NT.
  • 2 Menzies Research Institute, Hobart, TAS.
  • 3 National Centre for Epidemiology and Population Health, College of Medicine and Health Sciences, Australian National University, Canberra, ACT.
  • 4 Aboriginal Research Practitioners Network, School for Environmental Research, Charles Darwin University, Darwin, NT.
  • 5 Northern Territory Government Department of Health and Families, Darwin, NT.
  • 6 Arnhem Land, NT.


This study was supported by National Health and Medical Research Council (NHMRC) grants 333421 and 320860, Land & Water Australia, and Pfizer Australia Cardiovascular Lipid (CVL). This study did not involve the use of any Pfizer products, nor did Pfizer receive any commercial benefit from this study. Christopher Burgess was supported by a PhD scholarship, initially from the Centre for Remote Health and subsequently NHMRC public health scholarship 333416. Ross Bailie’s work is supported by NHMRC Senior Research Fellowship 283303. We thank the community health board, Indigenous research assistants and the community outstation resource centre for their support of this work. This project has been endorsed as an in-kind project of the Cooperative Research Centre for Aboriginal Health, a collaborative partnership funded by the Cooperative Research Centres Program of the Australian Government Department of Innovation, Industry, Science and Research.

Competing interests:

None identified.

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