Healthy country, healthy people: the relationship between Indigenous health status and "caring for country"

Objective: To investigate associations between "caring for country" - an activity that Indigenous peoples assert promotes good health - and health outcomes relevant to excess Indigenous morbidity and mortality. Design, setting and participants: Cross-sectional study involving 298 Indigenous adults aged 15-54 years in an Arnhem Land community, recruited from March to September 2005. Main outcome measures: Self-reported involvement in caring for country, health behaviours and clinically measured body mass index (BMI), waist circumference, blood pressure, type 2 diabetes status, albumin to creatinine ratio (ACR), levels of glycated haemoglobin (HbA(1c)) and high-density lipoprotein (HDL) cholesterol, lipid ratio, score on the five-item version of the Kessler Psychological Distress Scale (K5), and 5-year cardiovascular disease (CVD) risk. Results: Controlling for sociodemographic characteristics and health behaviours, multivariate regression revealed significant and substantial associations between caring for country and health outcomes. An interquartile range rise in the weighted composite caring-for-country score was significantly associated with more frequent physical activity, better diet, lower BMI (regression coefficient [beta] = -2.83; 95% CI, -4.56 to -1.10), less abdominal obesity (odds ratio [OR], 0.43; 95% CI, 0.26-0.72), lower systolic blood pressure (beta = -7.59; 95% CI, -12.01 to -3.17), less diabetes (OR, 0.12; 95% CI, 0.03-0.52), lower HbA(1c) level (beta = -0.45; 95% CI, -0.79 to -0.11), non-elevated ACR (OR, 0.28; 95% CI 013-0.60), higher HDL cholesterol level (beta = 0.06; 95% CI, 0.01-0.12), lower K5 score (beta = -0.97; 95% CI, -1.64 to -0.31) and lower CVD risk (beta = -0.77; 95% CI, -1.43 to -0.11). Conclusions: Greater Indigenous participation in caring for country activities is associated with significantly better health. Although the causal direction of these associations requires clarification, our findings suggest that investment in caring for country may be a means to foster sustainable economic development and gains for both ecological and Indigenous peoples' health.