Aragung buraay: culture, identity and positive futures for Australian children

Ngiare Brown, Peter S Azzopardi and Fiona J Stanley
Med J Aust 2023; 219 (10): S35-S39. || doi: 10.5694/mja2.52139
Published online: 20 November 2023

The Lancet commission on culture in health1 identified positive cultural connections as key to achieving equity in health and wellbeing for all people; however, action towards culture in health has remained largely neglected. The intent of this article is not to debate any singular aspect of culture, identity, Indigeneity, or indeed Indigenous cultural identity, but to promote the application of a human rights and cultural lens across social determinant‐informed policy making, to facilitate positive health impacts and nurture and maintain wellbeing.

“Positive sense of identity and culture” is one of seven domains considered in the MJA supplement on the Future Healthy Countdown 2030. While culture and identity is of importance to all people, it is especially relevant to children and adolescents given it is during early life that culture and identify are formed.2 Childhood and adolescence are also where individuals are exposed to, and where they can shape, the social determinants of health.3 Moreover, in this article, we argue that positive cultural practices and a strong sense of identity are protective factors for child and adolescent wellbeing (Box 1).


In its broadest sense, culture is said to be the whole complex of distinctive spiritual, material, intellectual and emotional features that characterise a society or social group. It includes not only the arts and languages but also modes of life, the fundamental rights of the human being, value systems, traditions, and beliefs. A loss of any cultural foundation is a loss to humankind.5 Importantly, culture is not static, it is fluid and adaptive, changing with time and geography and incorporating new events and exposures.

In Australia, and around the world, various policies have perpetuated the systematic denial of the basic human rights of Indigenous peoples and other marginalised and vulnerable groups. These ongoing experiences of colonisation, exclusion and discrimination are critical to understanding the contemporary determinants of poor health that Aboriginal and Torres Strait Islander people (and other populations) continue to experience.6,7

Conversely, cultural policies and culture in policies aim to protect, stimulate and enrich each people's identity and cultural heritage, and establish absolute respect for and appreciation of cultural minorities and the other cultures of the world.5


The definition of identity is a fluid, complicated and unclear concept that nonetheless plays a central role in ongoing debates.8 In very simple terms, it can be described as a sense of belonging that derives from shared origins or characteristics.9

We identify in many ways — according to gender, religion, geography, culture, hobbies, ethnicities, language groups — and how we identify, or how we attempt to build an identity for ourselves, is complex and multifaceted. For those who identify as Indigenous there are additional layers and complexities, including social and political discourse on identity and cultural belonging — the claims and counter claims, legal criteria imposed by colonisers, community gatekeepers and individuals who do not know the difference between heritage and legitimate Indigenous cultural ancestry and all of the responsibilities that come with such a privilege.10,11

Despite the tension and confusion, there is also growing evidence to confirm that a positive sense of cultural identity is a protective factor and supports the process of resilience.12,13 Further, identity is not only dependent upon individual status, but on community level and collective perspectives and connections. For Aboriginal and Torres Strait Islander peoples, identity is based on a cultural sense of self grounded within a collectivist perspective that views the self as inseparable from, and embedded within, family and community.14


Health and wellbeing are complex concepts and there is no clear consensus across or within cultures as to how these constructs should be defined.15,16 In broad terms, wellbeing is a good or satisfactory condition of existence; a state characterised by health, happiness and prosperity; a positive outcome that is meaningful for people. At a minimum, it includes the presence of positive emotions and moods (eg, contentment, happiness), the absence of negative emotions (eg, depression, anxiety), satisfaction with life, fulfilment, and positive functioning (social, economic). As outlined by national reference and working groups,17,18 there are nine guiding principles that underpin social and emotional wellbeing (Box 2); these include recognition of the centrality of kinship, cultural diversity, and Aboriginal strengths.

Indigenous wellbeing is an inclusive concept that encompasses physical, psychological, social and cultural aspects, both individual and collective. Issues core to Indigenous wellbeing also include connection to one another and to the environment and natural world. For children and adolescents — as for all people — wellbeing is deeply impacted by the intergenerational impacts of discriminatory policies and practices, and the resultant trauma, grief, violence, diminished family and community cohesion, cultural dislocation, and socio‐economic disadvantage.19

Indigenous resilience

Resilience may be defined as the capacity to cope with, and bounce back after, the ongoing demands and challenges of life, and to learn from them in a positive way.20 This includes positive adaptation despite adversity, or a class of phenomena characterised by good outcomes despite serious threats to adaptation or development.21

Resilience may also be considered as adaptation over time, “a dynamic process involving an interaction between both risk and protective processes, internal and external to the individual … of varying degrees of impact, and … at varying points in development”.22

The exploration of resilience is a powerful and culturally relevant construct. Cultural resilience is the capacity of a community or cultural system to absorb disturbance and reorganise while undergoing change, in order to retain key elements of structure and identity that preserve its distinctness.8,22,23 Iris Heavyrunner and other educators proposed additional cultural protective factors, cultural resources for resilience — symbols and proverbs from common language and culture, traditional child rearing philosophies, religious leadership, counsellors and elders.24

Social determinants of health

We understand the social determinants of health to mean the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.25 It is widely accepted that health inequities arise from these social, material and political circumstances in which people live, and the systems put in place to deal with ill health.26 Marmot has also observed that the health gap between Indigenous and non‐Indigenous Australians “bespeaks large social inequalities”.27

However, addressing only social determinants will continue to fail Indigenous Australians. The social determinants of health are deeply situated within a deficit context. Although important in the pathway between cultural discrimination, marginalisation and poor health, a social determinants approach in isolation risks reinforcing this deficit perspective, emphasising poorer health outcomes for those from lower socio‐economic populations, with lower educational attainment, long term unemployment and welfare dependency, and intergenerational disadvantage.28

Cultural determinants of health and wellbeing

Indigenous peoples the world over have long understood that positive cultural practices are protective, and can build resilience, particularly in children and young people. The United Nations and its affiliated agencies have considered culture in the context of community development, creating toolkits and indicators to measure impacts of culture on development and social outcomes,29,30 but have not connected culture to health outcomes.

The lead author of this article (NB) has been working for many years to articulate and develop a framework for the cultural determinants of health using a strengths‐based approach that acknowledges that stronger connections to culture and country build stronger individual and collective identities, a greater sense of self‐esteem, resilience, and improved outcomes across the social determinants of health, including education, economic stability and community cohesion. A positive sense of self, inclusive of domains across culture, spirituality, politics and social engagement, is a key factor in strengths‐based approaches and positive trajectories across the life course.

A growing body of evidence demonstrates that the protection and promotion of traditional knowledge, family, culture and kinship contribute to community cohesion and personal resilience.4,11,17 Further, cultural links and practices — for example, extended family, access to traditional land, revitalisation of traditional languages, learning dance and story, and understanding traditional roles and responsibilities — are protective factors that improve resilience against emotional and behavioural problems.31

To illustrate this approach, NB developed a conceptual framework (Box 3) reflective of the Articles of the United Nations Declaration on the Rights of Indigenous Peoples, proposing that these cultural determinants underpin social determinants.32

The original framework has been expanded to consider examples of implementation and measurement of these cultural determinants and is presented in Box 4.33 Both frameworks were presented at the United Nations Permanent Forum on Indigenous Issues.

Relevance and utility

A combined social and cultural determinants approach recognises that there are multiple, complex drivers of wellbeing and ill health, many of which lie outside of the health sector, and which therefore require a collaborative, inter‐sectoral approach.

Indigenous perspectives and practices also hold the promise of benefiting mainstream systems and enabling positive social determinant impacts for all. Lessons learned through experience in Indigenous health and politics (nationally, regionally, globally) reinforce that Indigenous perspectives, values and practices can enrich our professions, communities and policy environments far beyond the limits of Indigenous services. What we do as Indigenous communities, parents, clinicians, educators and knowledge holders may be freely gifted if the systems and services are ready to embrace truth telling, understand the context, and honour the gift.

To reinforce the message — Indigenous rights are human rights. The cultural determinants are just as relevant to culturally and linguistically diverse groups, LGBTQIA+ people, refugees and non‐Indigenous communities as they are to Indigenous peoples. The guiding principles are self‐determination, freedom from discrimination, freedom from assimilation, and collective rights.

If we, as a nation, want our children to be physically, emotionally and psychologically healthy, to be generous, kind and resilient, to be active social and economic participants, and if we hope to mitigate their risk of vulnerability to antisocial influences or radicalisation, then we need to work harder to ensure they know that they are loved, supported, heard. Positive cultural practices are protective factors against toxic stress, health risk, mental health, and behavioural issues.

Moving towards a more sensitive measure of wellbeing

The Human Development Index is a tool developed by the United Nations to measure and rank countries’ levels of social and economic development based on four criteria: life expectancy at birth; mean years of schooling; expected years of schooling; and gross national income per capita.34 A key question is whether these truly reflect and measure what is most relevant to people, including Indigenous peoples. Using economic parameters does not capture how people feel about their lives; for example, the quality of their relationships, their positive emotions and resilience, the realisation of their potential, or their overall satisfaction with life.

Further, wellbeing approaches acknowledge that money is not the answer, and that macro‐economic measures such as gross domestic product do not comprehensively capture or reflect what ordinary people perceive about the state of their own lives. Hence the need to develop less traditionally mainstream measures and indicators to reflect progress toward improved social and cultural determinants of health — metrics that better capture how people feel about cultural identity, cultural connections, language reclamation, and Indigenous content in mainstream curricula.

Box 1 – Aragung buraay: culture, identity and positive futures for Australian children

What are the most pressing issues where change could make a real difference by 2030 and why?
  • Policies have perpetuated the systematic denial of the basic rights of Indigenous peoples and other marginalised groups, including cultural practice and identity. Positive cultural practices and a strong sense of identity are protective factors for child and adolescent wellbeing that we urgently need to foster through intentional policies. Indigenous perspectives and practices also hold the promise of benefiting mainstream systems and enabling positive social determinant impacts for all.
What are some of the key indicator measures available?
  • Currently available national indicators of cultural wellbeing are limited. Those that are available are:
    1. ‣ Cultural pride: Proportion of children and adolescents who are proud of their culture (measured in the National Aboriginal and Torres Strait Islander Social Survey [NATSISS] for Indigenous youths aged 18–24 years). This measure should be included in regular national surveys such as the National Health Survey to be inclusive of all children.
    2. ‣ Language: Proportion of Indigenous 10–24‐year‐olds who speak a few words or more of Indigenous language, included in the NATSISS.
    3. ‣ Racism: Proportion of Indigenous 10–14‐year‐olds attending school who are bullied or treated unfairly because they are Indigenous, and the proportion of Indigenous people 15–24 years of age who felt discriminated against in previous 12 months. These are included in the NATSISS and are therefore currently specific to Indigenous people. These are measures that should be included in regular national surveys such as the National Health Survey to be inclusive of all children.
    4. ‣ Impact: The impacts of cultural wellbeing and toxic exposures such as racism on health and wellbeing are many. One indicator is suicide mortality for children and adolescents (aged 10–24 years) reported in 5‐year age bands.4
A measure that is needed is:
  • Aboriginal and Torres Strait Islander education content for all children — this can be measured by the number of states/territories that have Aboriginal and Torres Strait Islander education content for all children as part of the core education curriculum.

Box 2 – Nine guiding principles that underpin social and emotional wellbeing

  • Health as holistic
  • The right to self‐determination
  • The need for cultural understanding
  • The impact of history in trauma and loss
  • Recognition of human rights
  • The impact of racism and stigma
  • Recognition of the centrality of kinship
  • Recognition of cultural diversity
  • Recognition of Aboriginal strengths
Created by Social Health Reference Group;17 adapted from Swan and Raphael.18

Box 3 – The cultural determinants of health and wellbeing32

Referencing the United Nations Declaration on the Rights of Indigenous Peoples and other human rights instruments, the cultural determinants of health and wellbeing include, but are not limited to:
  • Self‐determination
  • Freedom from discrimination
  • Individual and collective rights
  • Freedom from assimilation and destruction of culture
  • Protection from removal/relocation
  • Connection to, custodianship and utilisation of country and traditional lands
  • Reclamation, revitalisation, preservation and promotion of language and cultural practices
  • Protection and promotion of traditional knowledge and Indigenous intellectual property
  • Understanding of lore, law and traditional roles and responsibilities

Box 4 – Implementation and measurement examples of the cultural determinants of health and wellbeing33

Cultural determinants

Human rights instrument/s


Sector/service examples

Indicator/measure examples



Human rights, law and justice, social inclusion

  • Aboriginal Community Controlled Health sector
  • The number of new and established Aboriginal Community Controlled Health Services

Freedom from discrimination


Politics, service delivery, social policy, law and justice

  • 3AQ (availability, accessibility, acceptability and quality framework) culturally safe services
  • Zero tolerance policies and legal protections (Commonwealth, states and territories)
  • Decreased number of complaints to Australian Human Rights Commission

Individual and collective rights


Law and justice, employment, economics, social policy

  • Citizenship, cultural rights, human rights
  • Some knowledge cannot be individually owned (eg, genetic/biological information)
  • Australia incorporates Articles of international human rights instruments into domestic legislation
  • Constitutional reform — does not allow Commonwealth to enact racist legislation
  • Compulsory research agreements that ensure legal and ethical protections, addressing self‐determination, priority setting, benefit sharing

Freedom from assimilation and destruction of culture

ILO Convention (No. 169) on Indigenous and Tribal Peoples; ICCPR

Law and justice, service delivery, social policy, politics, education

  • Inclusive policies and resourcing
  • Education reform
  • National curriculum in primary and secondary schools addressing history, Indigenous culture, local language, local teachers
  • Policy impact assessments
  • Political representation
  • Repatriation of historically held collections

Protection from removal/relocation


Law and justice, service delivery

  • Birthing
  • Dialysis
  • Education
  • Ongoing removal of children
  • Develop a model of service delivery, funded to provide co‐located primary, secondary and tertiary services
  • The number of Aboriginal Community Controlled Health Services supported to provide comprehensive co‐located care (eg, midwife‐led antenatal and birthing clinics in regional/remote areas)
  • Aboriginal Community Controlled Health Services as child protection hubs/champions

Connection to, custodianship and utilisation of country and traditional lands

ILO Convention; ICESCR; Convention on Biological Diversity

Native title and land rights, environment

  • Formal acknowledgement and validation of cultural knowledge and practices
  • Upscaling Indigenous enterprises
  • Increased number of rangers and trainees
  • Micro‐financing initiatives/opportunities
  • Expedited native title determinations
  • Heritage and National Park orders

Reclamation, revitalisation, preservation and promotion of language and cultural practices


Education, employment

  • Australian Institute of Aboriginal and Torres Strait Islander Studies
  • Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council
  • Language education courses
  • Employment of cultural educators
  • Funded local cultural education initiatives
  • Network of cultural immersion schools

Protection and promotion of traditional knowledge and Indigenous intellectual property

ILO Convention; Universal Declaration on Bioethics and Human Rights

Law and justice, ethics

  • International human rights instruments and agencies
  • Domestic legislation (Commonwealth)
  • Ethical guidelines and legal protections — custodianship of traditional/cultural language, songs, stories, images, designs, biological material
  • Authority to negotiate benefit

Understanding of lore, law, traditional roles and responsibilities



  • Strong, resilient
  • Surviving in difficult environments
  • Strict social structures, clear social roles
  • Need platforms for protection, promotion, revitalisation of traditional knowledge and practices
  • Engaging and remunerating traditional healers
  • Cultural education networks

CRC = Convention on the Rights of the Child; ECOSOC = Economic and Social Council; ICCPR = International Covenant on Civil and Political Rights; ICERD = International Convention on the Elimination of All Forms of Racial Discrimination; ICESCR = International Covenant on Economic, Social and Cultural Rights; ILO = International Labour Organization; UDHR = Universal Declaration of Human Rights; UNDRIP = United Nations Declaration on the Rights of Indigenous Peoples; UNESCO = United Nations Educational, Scientific and Cultural Organization; UNPFII = United Nations Permanent Forum on Indigenous Issues.

Provenance: Commissioned; externally peer reviewed.

  • Ngiare Brown1
  • Peter S Azzopardi2
  • Fiona J Stanley3,4

  • 1 South Australian Health and Medical Research Institute, Adelaide, SA
  • 2 Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC
  • 3 Telethon Kids Institute, Perth, WA
  • 4 School of Paediatrics and Child Health, University of Western Australia, Perth, WA



This article is part of the MJA supplement on the Future Healthy Countdown 2030, which was funded by the Victorian Health Promotion Foundation (VicHealth) — a pioneer in health promotion that was established by the Parliament of Victoria as part of the Tobacco Act 1987, and an organisation that is primarily focused on promoting good health and preventing chronic disease for all. VicHealth has played a convening role in scoping and commissioning the articles contained in the supplement.

Competing interests:

No relevant disclosures.


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