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Rural Health System Resources


Deficit Discourse and Strengths-based Approaches - Changing the narrative of Aboriginal and Torres Strait Islander health and wellbeing


William Fogarty, Melissa Lovell, Juleigh Langenberg and Mary-Jane Heron


‘Deficit discourse’ refers to how people talk about other people or groups in terms of a deficiency – absence, lack or failure. It shifts responsibility for problems to the affected individuals or communities, often ignoring how larger socio-economic structures (availability of jobs, housing, education) impacts on the circumstances of different people. This report explores strengths-based approaches to Aboriginal health, and how to shift the deficit narrative in the Australian Aboriginal and Torres Strait Islander health sector. Studies have identified a ‘deficit discourse’ across Aboriginal and Torres Strait Islander health policy and practice. The use of the term 'deficit discourse' is intended to draw attention to the circulation of ideas, the processes by which these ideas shape realities, and the power inequalities that contribute to and result from these processes.

Why is this useful for rural and remote people?

The idea of a 'deficit discourse' or 'deficit narrative' is equally relevant to any discussion of Aboriginal health, as it is in the discussion of rural and remote health. Back in 2015 a former Prime Minister argued about that "we can’t .. endlessly subsidise lifestyle choices [of people who live in remote communities] if those lifestyle choices are not conducive to the kind of full participation in Australian society that everyone should have.” ( The idea that living and working in rural or remote community is nothing more than a 'lifestyle choice' dismisses the reality that rural and remote towns are a living repository of 60,000 years of culture, language and habitation (the oldest living culture on earth). It ignores the fact that commodities today continue to generate more than 65% of Australia's export wealth, and without the toil of people in rural and remote Australia the lifestyles of 'city' Australians would be starkly different. What statements like this, and the policies that reflect it, overlook is that the 'deficit' of jobs, education and health services in rural and remote towns is a very recent phenomenon - not an inherent characteristic of rural and remote life. To the extent that rural and remote towns lack gainful employment, services or amenity, this is partly a reflection of the choices not of rural and remote people, but of governments. One of the 'deficit narratives' in health is that rural people choose to live in unattractive places where doctors do not want work, and if they want better health services they should relocate. But this begs the question: why are these places unattractive and has it always been so? For example in the 1950s and 60s almost every rural town had a thriving local hospital run by the local community that could deliver babies and perform surgeries, and a highly regarded local GP. This fact suggests that rural and remote towns are not innately unattractive places to live and work for doctors. One theory is that government started to centralise services into major cities in the 1980s, at the same time that technology and automation were displacing workers from farms, exacerbating the negative impacts of the economic transition and resulting in fewer jobs in these communities and an increase in poverty. This led to the loss of the local supermarket and services, which contributed to rural and remote towns becoming less attractive. The deficit narrative places responsibility on the shoulders of rural and remote people for actions over which they often have very little control. The idea of a rural deficit has been promoted and reinforced in academic research, media reports and government policies, just as it has been in Aboriginal health. Over time it transforms into an unchallenged assumption that is accepted in policy making circles as an immutable fact. Because rural and remote towns are inherently unattractive, so the argument goes, there is very little point in governments investing in these communities because this characteristic is seen as unchangeable. This deficit discourse pre-emptively defeats any proposals that comes from rural and remote communities for reform and investment because 'everyone knows that it will be a waste of money'. This report prepared for the Lowitja Institute is a highly valuable read for anyone thinking about the solutions to the challenges in rural and remote communities. It builds an understanding about how the 'deficit discourse' seeps into decision making and how rural and remote people are often reactively blamed for the situation in which they live, despite the fact that they often have very little control over the social and economic policies that lead to problems. To fix rural health, we first need to fix the assumptions that disable effective policy action. Rural and remote people need to shift the narrative away from deficits and towards strengths. Rural and remote communities are vibrant places that generate more than 65% of Australia's wealth. They are living museums of Australia's ancient and recent history. They encompass the values of 'community' and 'mateship' that are formative in the Australian idea. They are incubators of innovation and creativity driven by a practical mind-set and the necessity to do things more efficiently to deliver better outcomes for all. The loss of rural and remote Australians would devastate not only the Australian economy, but would rob Australia of the driving ethos of a 'fair go' for all. Investing in rural and remote communities is an investment in a future, and a reflection that Australia continues to be a place where the 'battler' is supported not because of what they lack, but because of what they can contribute.

Suggested Citation

William Fogarty, Melissa Lovell, Juleigh Langenberg and Mary-Jane Heron (2018) Deficit Discourse and Strengths-based Approaches - Changing the narrative of Aboriginal and Torres Strait Islander health and wellbeing


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