Lay societal perspectives on health lie at the intersection of discourse, the socio-cultural context and the subjective experience. Thus, an analysis of lay knowledge is vital for understanding societal perspectives on the role of social determinants on health outcomes. Such an analysis also provides insight into societal understandings and experiences of the manner in which power, macro and micro-level politics, and governance intersect to provide different causal pathways for resource access to prevent illnesses, or if an illness is present, to determine what resources are available to people to respond to the illness. Awareness and accessibility to resources can, therefore, result in different health outcomes for different groups of people.
Dementia is often portrayed in public discourse as a global tsunami, giving the impression that dementia is an unstoppable and unpreventable illness engulfing society. Correlated with the above portrayal is societal attitudes towards dementia. A widely publicized poll suggests that people are more fearful of developing dementia than cancer. Recent studies however indicate that while certain risk factors are inherent, a large proportion (35%) of dementia risk factors are modifiable across the life course and which if addressed, could reduce the risk of dementia.
While dementia is often thought of as an individual’s disease, dementia has to also be considered in relation to the wellbeing of family carers, who provide the backbone of support to people living with dementia. At the national level, formulation of policies for good dementia care needs to be tailored to the needs of both the individual with dementia and their families within their cultural contexts. Some current work in this area include appropriately designed living facilities for people with dementia and incorporating cultural knowledge around elder care.
The HIV status of the South Pacific region is generally discussed within the context of the wider Asia Pacific region. Given the larger population size in Asia and the larger number of HIV cases, the South Pacific region is often overshadowed, with less attention paid to the specific needs of the people of the region. This is a significant concern as findings indicate that in the South Pacific region HIV is increasing.
The South Pacific region is categorized into three tiers by HIV prevalence: The first tier comprises of Papua New Guinea (PNG), which has the most number of cases in the region. This is followed by Fiji, French Polynesia, New Caledonia and Guam, which collectively form the second tier. Other small island countries form the third and last tier, with few known cases of HIV.
Poor health infrastructure, and particularly in the case of Fiji and PNG political instability and low national budgets means that the islands will be unable to cope with a rapid increase in the need for HIV treatment. Hence, a major area of concern is raising health literacy around HIV and at the same time, improving societal empathy and compassion towards those living with HIV.
UNAIDs Commission has recognized the importance of whole community involvement in HIV/AIDs prevention, as articulated in the Multisectorial Combination Prevention (CP) Framework. The CP framework recognizes the need to involve communities in HIV prevention. In other words, health literacy needs to be community tailored. Within the South Pacific region, UNAIDS cites national media as a key player in facilitating this multisectorial approach: The South Pacific media have “the potential to play a more effective role in covering human rights issues and promoting HIV prevention
and awareness, and in bringing about attitude change in the region” (UNAIDS, 2009: 74).
The South Pacific media have responded to the challenge. Some of the key areas of heightened media action in HIV awareness are:
Within the Pacific context, qualitative methods of data collection such as individual interviews, focus group interviews and talanoa are well utilized. Another increasingly popular method of data collection is the analysis of media discourse.
Local news media play an essential role in the dissemination of health-related information. Women, indigenous and rural communities rate media as their main source of information on Non-communicable diseases (NCDs), above that of information received from medical practitioners.
A framework for media discourse analysis is framing: Media framing is a selection process, whereby an event is problematized and related to other events in the world, made into an issue from a particular viewpoint, with a cause, effect, possible solutions and quite often has moral judgments implicitly or explicitly associated with it. Framing is therefore an important tool for taking complex issues and anchoring these issues within the audience’s underlying schemas.
How an event is presented in media influences the manner in which the audience perceives and behaves towards the event. Extant literature demonstrates the impact news frames have on audience’ interpretations, recollections, attitudes, evaluations and decision making on national issues and policies. Hence, close examination of media’s health framing provides an important means of engaging with societal knowledge, attitudes and behaviors around health and such studies have implications for health education, policy developments and health governance laws.
Research of the people, by the people, for the people of the Pacific
The Pacific region has a rich oral heritage, that can be seen in Pasifika narratives, songs and dances. A specific form of interview, Talanoa Methods has been specifically developed for research in the Pacific region. Talanoa is a culturally relevant and respectful methodological approach, based at the intersection of Critical Theory, Kaupapa Mäori Theorising and Tongan Kakala framing. Some of the key proponents of the Talanoa method are Nabobo-Baba and Timoti Vaioleti
The methodology is situated within cultural worldviews, knowledge systems, lived experiences, and values of the people being represented and re-presented through research.
Talanoa is at times equated with face-to-face interaction methodology. However, Talanoa is more than that. Talanoa respects cultural conceptualizations of how things ‘should be’. It is about being respectfully aware of cultural protocols and practices, values, ethics, philosophies, and principles around knowledge sharing. It is also about having the cultural understanding of what/when/where/how/why certain knowledge can and can’t be made available to different interlocutors.
Talanoa is a collaborative storytelling practice, which ranks from informal<——->formal and can occur at all levels of society. Talanoa is about knowledge sharing and power sharing between researcher and participant(s). Importantly, Talanoa is about reciprocity and continuity of relationship: end of research does not mark the end but the beginning of a relationship between the researcher and participant(s).
Summary of Talanoa epistemology
Research into Pacific people’s health conceptualizations is of benefit to both the local populations as well as contributing to the global efforts to address societal health outcomes. Within the immediate context, research into Pacific perceptions of health and wellbeing provides a valuable avenue for acknowledging the wealth of knowledge Pasifika people have. Such research also provides a culturally respectful and relevant foundation from which to address population health within Pacific islands and their diasporic communities.
Growing evidence also points to the importance of social ties for better health and increased life span. The essence of a Pacific community rests on collective identities and communal practices. As such, Pasifika worldviews of social ties and collective efficacy can play an integral role in improving population health outcomes globally.
