The Gaawaadhi Gadudha logo artwork is by Laurance Magick Dennis. It represents the meeting of fresh (Yuwaalaraay and Gamilaraay) and salt (Yuin-Djirringanj) water. The horseshoe-like shapes are people sitting around a fire. The oval image at the centre is a coolamon (traditional carrying vessel). The dots around the image are ancestors looking on.

While we use the word ‘Aboriginal’ to explain the terminology of ‘the health gap’ in current research and policy, we would like to acknowledge it as a colonised term. We advocate for shifting to the use of cultural group names as identifiers. Where this is not possible, we use ‘Indigenous’.

Research

From a deficit-based approach to cultural connections

Historical injustices affect health today
Indigenous people’s physical, mental and spiritual health and wellbeing has always been shaped by relationships with culture and Country. However, systematic efforts to erase Indigenous peoples and cultures in Australia have deeply disrupted connection to Country. This has hindered the continuity of cultural knowledges and practices. These historical genocides, Stolen Generations and and the enforced adoption of Western ways of life have health impacts today.

Re-centring culture in health
Our research aims to re-frame the dominant and deficit-based approach to Indigenous peoples’ health. We do this by exploring how cultural health, facilitated by Knowledge Holders, is associated with Indigenous peoples’ health and wellbeing. We would ultimately like to see cultural health embedded in Australia’s health and social systems and policies.

Moving beyond the health ‘gap’
Growing evidence shows that culture is positively associated with health and social and emotional wellbeing. Yet, research and policy in Indigenous health tend to focus on deficit-based frameworks which compare disease outcomes between Indigenous and non-Indigenous people.

Co-designing and trialing a cultural health program
2023-2027

The program
Since the study began in 2023, our Cultural Knowledge Holders have led the co-design of a unique and evidence–informed cultural health program.

The program aims to address worsening social and emotional wellbeing among Indigenous adults by improving cultural health. It does so by providing activities that enable people to strengthen their connection to culture and Country in a culturally safe way. These practices are seen as protective factors for social and emotional wellbeing.

120 participants will take part in the program in two NSW communities: Tamworth and Wallaga Lake. Camps will be held in Dharriwaa at Narran Lakes (Yuwaalaraay Country) and Gulaga National Park (Yuin Djirringanj Country) as part of the program.

Measuring wellbeing
We are measuring the impact of the program using a stepped-wedge cluster randomised trial. This means that the program will be introduced gradually across different groups. This approach allows us to assess the effectiveness of the program by comparing outcomes for those who haven’t yet received it with those who have, while ensuring that all study participants receive the program.

Measuring the program using a control trial will produce rigorous evidence about the impact of cultural participation on the social and emotional wellbeing and cultural health of Indigenous people. To understand cultural health, we will use a new psychometric measure. This measure was co-designed with our cultural governance group and validated in a pilot study with Aboriginal adults in NSW. We will measure social and emotional wellbeing using several existing scales that are validated and culturally appropriate.

We will also evaluate the delivery of the program, so these learnings are available for any other groups looking to run a cultural health program.

This study is funded by the Australian Government’s Medical Research Future Fund (MRF2025330).
Ethics approval to conduct this study was obtained from the Aboriginal Health and Medical Research Council (#2257/24).

Image: Dancer on Yuin Country (photo by Anthony Zwi)

Exploring how cultural camps support health and wellbeing 2021-2024

We investigated Indigenous people’s self-reported cultural health and wellbeing after they participated in cultural camps. These camps, facilitated by Knowledge Holders, were held on culturally significant sites Dharriwaa at Narran Lakes (Yuwaalaraay Country), Wallabadah (Gamilaraay Country) and Mystery Bay (Yuin Djirringanj Country).

At the camps, men, women and children from different nations:

visited sacred sites and heard law stories
learned language and cultural landscapes
learned about cultural medicines and food
took part in dancing, weaving and woodwork
joined yarning circles around the fire.

We surveyed people before they attended a camp and immediately after. We found that camps had an overwhelmingly positive impact on peoples' self-rated cultural health, including:

pride in their Indigenous cultural identity
knowledge of cultural stories, foods, medicines and languages
sense of connection to other people
connection to Country and ancestors.

Key findings:

Camps had a positive effect on participants’ social, emotional, and spiritual health and wellbeing. This was often described as healing or stress relief. Participants linked this to connection with Country and each other, and engagement in in cultural practices.

“To heal trauma in Indigenous populations we need to strengthen cultural identity…culture strengthens identity, and identity strengthens who we are as people. So, culture is everything, and it should be everything.” (Yuin Women’s Circle)

“We need this, this is what it's all about. This is how we used to heal. Healing happens in circles in our culture. Everything happened around fires, around gatherings and this is bringing it back to where they used to send the message sticks out and everyone would come.” (Gomeroi Women’s Circle)

“Improving our young people, with connecting with the environment and their senses, using the eyesight there, smell, touch.” (Dharriwaa Men’s Circle)

This study was funded by the Australian Government’s Medical Research Future Fund (MRF2009522).
Ethics approval to conduct this study was obtained from the Aboriginal Health and Medical Research Council (#1851/21).

Find out more

Image: Dharriwaa on Yuwaalaraay Country (photo by Brooke Brady)

Publications

Yashadhana, A, Zwi, AB, Brady, B, De Leeuw, E, Kingsley, J, O'leary, M, Raven, M, Serova N, Topp, SM, Fields, T, Foster, W, Jopson, W, Biles, B 2023, 'Gaawaadhi Gadudha: understanding how cultural camps impact health, well-being and resilience among Aboriginal adults in New South Wales, Australia – a collaborative study protocol’, BMJ Open, 13, pp. e073551, http://dx.doi.org/10.1136/bmjopen-2023-073551

Yashadhana, A, Fields, T, Liu, E, Serova, N, O’Leary, M, Kenning, G, Kuchelmeister, V, Lockhart, J, de Leeuw, E 2023, ‘Therapeutic aspects of Connection to Country and cultural landscapes among Aboriginal peoples from the Stolen Generations living in urban NSW, Australia’, Public Health Research & Practice, vol. 33, 4, e3342332, https://doi.org/10.17061/phrp3342332

Thorpe, A, Yashadhana, A, Biles, BJ, Munro-Harrison, E & Kingsley, J 2023, ‘Indigenous health and connection to Country’, Global Public Health, Oxford Research Encyclopedia of Global Public Health, 31 January, https://oxfordre.com/publichealth/view/10.1093/acrefore/9780190632366.001.0001/acrefore-9780190632366-e-436

Fields, T, Foster, W, Biles, BJ & Yashadhana, Y 2024, ‘Redefining the gap in Aboriginal health: from deficit to cultural connection’, The Lancet Regional Health – Western Pacific, vol. 52, 101176, https://doi.org/10.1016/j.lanwpc.2024.101176

Biles, BJ, Serova, N, Stanbrook, G, Brady, B, Kingsley, J, Topp, SM & Yashadhana, A 2024, ‘What is Indigenous cultural health and wellbeing? A narrative review’, The Lancet Regional Health – Western Pacific, vol. 52, 101220, 10.1016/j.lanwpc.2024.101220

Brady, B, Zwi, AB, Kingsley, J, O’Leary, M, Serova, N, Topp, SM, Biles, BJ, Fields, T, Foster, W & Yashadhana, Y 2024, ‘Measuring the health and wellbeing impacts of cultural camps among Aboriginal adults: preliminary evidence from the Gaawaadhi Gadudha Research Collaborative’, The Lancet Regional Health – Western Pacific, vol. 52, 101200, https://doi.org/10.1016/j.lanwpc.2024.101200

Yashadhana, A, Biles, BJ, Serova, N, Topp, SM, Kingsley, J, Zwi, AZ, Fields, T, Foster, W, O’Leary, M, Brady, B, De Leeuw, E & Raven, M 2024, ‘Gaawaadhi Gadudha: exploring how cultural camps support health and wellbeing among Aboriginal adults in New South Wales Australia, a qualitative study’, The Lancet Regional Health – Western Pacific, vol. 52, 101208, 10.1016/j.lanwpc.2024.101208

Image: Dharriwaa on Yuwaalaraay Country (photo by Brooke Brady)