Engaging with holism in Australian Aboriginal health policy--a review.
BACKGROUND
The ideal concept of Aboriginal holistic health is centrally placed in Australian Aboriginal health policies and strategies. Its effective uptake promises, as advocates suggest, reorienting the complex Australian health system to enable health improvements. However, continual reminders assail us that Aboriginal health is shocking, appalling, disastrous, disgraceful and damning. Could incapacity to engage effectively with the concept undermine health system improvements? The aim of this review of Australian literature was to identify the range of meanings attached to Aboriginal holistic health and engage with their implications for the health system.


RESULTS
In terms of literature synthesis I found that policy makers cannot rely on this approach to provide coherent arguments for meaningful engagement with the concept because authors in general: are uncritical and un-reflexive in the use and interpretation of the concept; often provide no reference for their understandings; tend to alter the concept's definition and constituent elements without justification; ignore the wide range of mainstream literature about holism and health; and fail to acknowledge and examine the range of Aboriginal concepts of health. I used the ten themes from this literature to highlight implications for the health system, and found that a most profound contradiction exists in the acceptance of the English language concept 'holistic' as immutably Aboriginal. Additionally, a range of contradictions and mixed messages within the themes challenge the validity of the concept. Significantly, with the boundary of the concept constructed as diffuse and ethereal, the diverse and uncritical literature, and mixed thematic meanings, it is possible to justify any claim about the health system as holistic.


CONCLUSIONS
It seems not so much incapacity to engage, but incapacity to coherently articulate Aboriginal concepts of health, which prevents advisory bodies such as the National Indigenous Council to imbue whole-of-government approaches in accordance with Aboriginal values.
Lutschini
Mark
M
Centre for the Study of Health and Society, Department of Public Health, University of Melbourne, Melbourne, Australia. m.lutschini@pgrad.unimelb.edu.au