Applying the health ecosystem approach in the analysis of health care and support for first nations in the pacific
Challenges related to the complexity of health service systems are particularly relevant in the analysis of healthcare delivery for First Nations people in Australia and other nations in the Western Pacific region. Gathering knowledge about what services are available - and how, to what extent, or even if, core precepts of Indigenous models of health and wellbeing are embedded in service systems - is extremely challenging. In Australia, for example, the Social and Emotional Wellbeing (SEWB) model is much broader in scope than that of the prevailing western healthcare system of delivery: focussed on domains of country, culture, spirituality, community, family and kinship, mind and emotions, and body, and not just physical or mental health. Despite decades of policy acknowledging the need for culturally valid understandings of service provision, and the unsuitability of existing systems to the needs of Indigenous people, data is lacking, though urgently needed, on the effects of these policies on actual service provision. Additionally, the extent to which community-based services can deliver SEWB care is partly determined by complex funding and delivery structures, leaving them to balance care congruent with community wellbeing need and also with the requirements of funding bodies based on an entirely different model of healthcare.