Using the commons to facilitate health communication

Communication is increasingly gaining attention as an integral component in ensuring evidenced-based public health is practised effectively. A frequent finding is that Aboriginal populations find communication aimed at the broader population lacking in familiar content, which creates communication obstacles. Aboriginal public health research frequently results in deficit health descriptions with little improvement, including communication, in public health evidence. Aboriginal public health evidence exists but does not include strategies as to how best to communicate this evidence. This article discusses the commons as a method to increase Aboriginal accessibility to both the Internet and health messages. The commons is defined as “belonging equally to, or shared alike by, two or more or all in question”. In European history the commons originated in Roman law defining two distinct areas, the public, Res paublica (schools, roads and libraries) managed by councils, and the private, Res privatea (clothing, utensils and equipment) managed by owners. For Aboriginal people the commons has similarity to custodianship. For instance, when describing the effects of mining one Aboriginal man said “when you dig a hole in that country you are killing me”; which can be interpreted that he and the land are a common and not separate Res privatae and Res paublica. In human rights and communication areas, the commons is re-emerging, and putting focus on public need and responsibility that enhance social capital. Modern examples of the commons are free software on the Internet, free access to academic e-journal knowledge, and public paths and bike tracks. In public health communication, the commons translates to spaces where information transfer and activity occur. These spaces are diverse, such as health services, websites, pamphlets, posters, T-shirts, schools, jails, television or sports arenas. That these are equally collaborative spaces is a false notion, with commons often dominated by a particular worldview. This is relevant for Aboriginal health, where commons are often dominated by nonAboriginal people creating unfamiliar spaces and impediment for Aboriginal participation (Figure 1a). For example, health clinics are often developed with minimal or no Aboriginal participation and feature an absence of Aboriginal presence thus creating participation barriers. As a strategy to infiltrate these types of commons Aboriginal peoples have created wedges of familiarity and entry (Figure 1b). For instance, health services may have an Aboriginal clinic or partnership to assist entry into the common. Wedges can be used as levers to change the common, allowing Aboriginal participation with comfort and cultural safety (Figure 1c). The dominant common group can feel ownership and familiarity with the way the common exists. Attempts to improve participation for others involves exposure to different worldviews of how the common could exist and the dominant group may feel threatened by unfamiliarity. When this worldview confusion occurs people make choices. They may decide the other group should adapt to the existing common and disregard or belittle other worldviews or they may make attempts to change and adapt. In 2009 we used the commons lens to design and build a webpage aiming to communicate diabetes management evidence to urban Aboriginal peoples. Undertaking the task were three Indigenous academics, with our combined experience working in Aboriginal health, education and multi-media sectors adding up to some 60 years in total. We also drew on partnerships with a variety of people and organisations to assist with the task. Our first task was to review the common of Internet diabetes information aimed at Indigenous peoples internationally via popular search engines (Google and Yahoo). We located a total of 11 websites. We found these websites mostly featured simply written evidenced-based material. Typically, this was communicated from a clinical voice (occasionally with an image of a clinician) with little or no Indigenous language. It was frequently aimed at individuals, while in contrast, Aboriginal worldviews often see public health as a family and community concern. The messages focused on ideal diabetic management with little information validating experiences of difficulty. Kinaesthetic and aural learning experiences were minimal and most assumed no existing knowledge about diabetes. The full scope of the common was rarely utilised, with an absence of audio, video, flash animation, gaming or circular navigation. Occasionally, websites were adorned with Aboriginal artwork paired with a clinical voice, created a jarring contrast. Aboriginal people have carried health messages for millennia through the familiar practice of oral communication, a complex process of narrative, engagement and deep listening that significantly embeds messages into memory through multiple mechanisms. In our review of the web material available to Aboriginal peoples with diabetes little information was presented in this style. Improving participation in commons can be achieved by reducing unfamiliarity and psychological distance. For Aboriginal people this psychological distance is embedded in history and previous encounters of diminished common access. For example, on arrival colonisers declared Australia Terra Nullis, that is Aboriginal Figure one: Participation in the commons* a) Barrier participation b) Wedge participation c. Free participation