To the best of our knowledge, this the first study exploring the perspectives of Aboriginal peoples on the commercial determinants of health. Our interviews with Aboriginal leaders representing diverse sectors and communities across Victoria build on our previous research in this new field exploring how commercial practices influence Indigenous health (30, 31, 33), by shedding light on the contemporary health implications arising from the convergence of colonial legacies and western economic paradigms. Four overarching themes can be drawn from this study. Firstly, this study highlights the breadth of commercial practices adversely affecting Aboriginal communities, such as aggressive marketing of harmful products, particularly gambling, and exploitation of Aboriginal cultural and intellectual property. Secondly, policies and plans aimed at improving commercial engagement with Aboriginal communities, and economic and social wellbeing, including government social procurement policies and private sector corporate social responsibility strategies, such as RAPs, require better oversight, monitoring and evaluation. Thirdly, the privatisation of public services and outsourcing Aboriginal affairs policy work to private consultants was viewed as ineffective and potentially health harming. Lastly the economic and financial freedom that comes from being a business owner can be a strong source of self-determination, empowerment, and sovereignty for Aboriginal peoples.
Within the commercial determinants of health literature, there has been mounting research on the practices of unhealthy commodity industries, particularly the tobacco, alcohol, ultra-processed food, breast milk substitutes and sugar-sweetened beverage industries who use the same ‘playbook’ of practices to promote and sell their products. (20, 23, 47) Gambling marketing was a key concern raised by participants in our study, who suggested that gambling received less attention in Aboriginal health compared to other addiction issues. Australia has the highest per capita gambling losses in the world (48), with the social costs estimated to be $AUD7 billion in Victoria. (49) Aboriginal communities are disproportionately impacted by gambling harms. (50) The limited data available suggests that gambling adversely affects up to 20% of Aboriginal peoples compared to 3.2% of non-Indigenous Australians. (50, 51) With increasing concerns about the normalisation of gambling and the pervasive nature of gambling marketing in Australia, the findings of this study reinforce the need for stronger regulatory controls on the marketing of gambling in Australia and more rigorous monitoring of gambling prevalence and harms, including among Aboriginal peoples. (48, 52)
The exploitation of Indigenous Cultural and Intellectual Property (ICIP) and the associated harms to cultural wellbeing was a unique commercial determinant of health identified by participants in our study. ICIP pertains to the rights of Indigenous peoples to their cultural heritage, including objects, sites, language, Indigenous knowledge and its expression. (53) Indigenous ecological knowledge is a fundamental aspect of ICIP encompassing knowledge of Country as well as native plants and animals. (54) The commercialisation of Aboriginal foods has seen rapid growth in recent years and the Australian “bushfood” industry is estimated to be worth AUD21 million. (55) Nevertheless, the majority of this commercial expansion has been driven by non-Indigenous companies entering the market. The bushfood industry is estimated to be 2 percent Indigenous-owned and operated (56), with only 15 percent of production originating from Aboriginal or Torres Strait Islander communities. (55) The increasing recognition of the nutritional value of Aboriginal foods has led to further exploitation and appropriation, causing harm by disempowering, undermining and suppressing cultural expression, cultural knowledge and connection to Country. ‘Country’ for Aboriginal and Torres Strait Islander peoples brings identity, connection, a sense of belonging and a place to nuture culture. (9, 57)
A 2022 Australian Government Productivity Commission study on inauthentic Aboriginal and Torres Strait Islander art highlighted that inauthentic art is pervasive and causes cultural and economic harm to Aboriginal communities, noting that 75 percent of Aboriginal-style art is produced by non-Indigenous people. (58) The commission outlined a series of recommendations to protect the ICIP of Aboriginal artists. Our findings extend the understanding of commercial practices that exploit Aboriginal cultures including art, Aboriginal foods, and symbols. Previous research on the role of ICIP in Aboriginal health, including a recent case study highlighting the emotional and cultural distress felt by Aboriginal community members prevented them from using the Aboriginal flag due to licencing arrangements with non-Indigenous businesses. (59) These findings algin with international evidence documenting the the tobacco industry’s appropriation of Indigenous imagery, symbols and culture by to market and sell cigarettes and undermine tobacco control policies. (60–62)
Employment is a key social determinant of health associated with numerous positive health outcomes (63), and Australian governments have committed to increasing Aboriginal and Torres Strait Islander employment through the Closing the Gap initiative. (64) Our findings support the literature that empowering Aboriginal communities through employment and business ownership promotes transformative change to financial wellbeing for communities who have faced generations of economic exclusion. (65) Our findings additionally offer valuable insights into the contribution of Aboriginal-owned businesses and procurement policies in bolstering the Aboriginal workforce presence in specific industries. The Victorian and Federal governments have procurement policies that outline specific targets for awarding contracts to Aboriginal-owned businesses. (66, 67) Such policies have led to modest progress in Aboriginal employment within the construction sector, with 10% of Aboriginal people working in the sector 2021 compared to 8.9% following the introduction of the procurement policy in 2015. (68) However, participants in our study suggested “Black-cladding”, where non-Indigenous businesses seek to exploit Aboriginal identity to win government contracts, may be undermining the authenticity and effectiveness of Aboriginal procurement policies. The Victorian government defines an Aboriginal business as being at least 50% Aboriginal and/or Torres Strait Islander owned, while Supply Nation, the national Indigenous business certifying body requires businesses to be at least 51% owned, managed and controlled by Aboriginal and/or Torres Strait Islander peoples. (69) The emphasis on majority Indigenous management and control, rather than just 50% ownership, has been suggested as a strategy to reduce the incidence of black cladding. (70)
A unique finding of our study was the numerous social, cultural, and economic benefits associated with Aboriginal-owned businesses, both for employees and business owners. Many of these insights align with prior research, which has consistently highlighted the higher levels of Aboriginal and Torres Strait Islander employment within Indigenous businesses compared to non-Indigenous businesses, the embedded cultural practices, and stronger connections with community networks. (71–73) Our findings also underscore the ongoing challenges for Aboriginal employees within the mainstream private sector, including lack of cultural safety and workplace racism. Previous research has echoed these concerns, emphasizing the inadequacy of cultural competency training, often viewed as mere “tick-the-box exercises”. (p.13, 71) Despite the growth in Aboriginal employment and income in recent years (74), workplaces remain one of the most common settings to experience racial discrimination which contributes to Aboriginal peoples being locked out of the economy. (75)
Corporate social responsibility (CSR) involves the voluntary commitments of commercial entities to enhance ethical standards and promote societal wellbeing. (76) While this approach can have positive impacts, it is often perceived as a strategy to bolster a company’s reputation. (20, 77) The predominant example of CSR raised in this study was Reconciliation Action Plans (RAPs), which were viewed with mixed enthusiasm. Concerns were raised about corporate accountability and the burden placed on Aboriginal staff to educate non-Indigneous colleagues about the issues impacting Aboriginal and Torres Strait Islander communities. (78) Weenthunga Health Network, a Victorian Aboriginal health workforce organisation coined the term ‘colonial load’, (79) emphasising the cognitive load imposed by colonial instutions, racist and unsafe workplaces on Aboriginal staff. (79) Previous research has highlighted that CSR practices, including RAPs, and cultural awareness training are insufficient to mitigate the harms caused to Aboriginal communities by some commercial entities. (80) Although third-party CSR auditing organisations may enhance CSR effectiveness (81), RAP evaluations currently rely on limited surveys and infrequent self-reporting. (82)
The rapid increase in privatisation and outsourcing of public services in Australia and its potential impact on health and social inequities has received limited attention in the CDoH literature. (83, 84) Privatisation is part of the political and economic system that enables commercial entities to cause harm. (20) Notably, Australia has the highest rate of private incarceration in the world and Aboriginal peoples are both overrepresented in the criminal justice system and significantly more likely to die while in prison. (85–87) Participants in our study highlighted the risks posed by privatisation of healthcare services in Victorian prisons, potentially contributing to Aboriginal deaths in custody and culturally unsafe practices while private operators profit from the incarceration of Aboriginal peoples. (85)
Participants also raised concerns about the extensive use of consultancy firms to advise governments on health and Aboriginal affairs policy. Recurring government contracts enable consultants to wield considerable influence over health policy, giving rise to potential conflicts of interest when these firms maintain both government and commercial clients. (84, 88) According the Australian government’s procurement website, there are, as of October 2023, 1,578 active contracts between private consultancy firms and Federal government agencies responsible for Indigenous affairs (89), underscoring the extent to which the consultancy industry has embedded itself in the public sector. Over the past decade the ‘Big Four’ consultancy firms have donated AUD4.2 million to the major Australian political parties, while their government contracts increased from AUD282 million to AUD1.4 billion from 2012 to 2022. (90)
Strengths and limitations
This study is strengthened by the participation of Aboriginal peoples across various sectors and First Nations, including Aboriginal leaders in both metropolitan and rural/regional areas. Additionally, our methods and findings were enriched by the guidance of an Aboriginal advisory committee and involvement of experienced Aboriginal researchers throughout the study. However, it is important to acknowledge the study’s limitations, particularly in terms of its geographic scope which is limited to Victoria. Although participants from a variety of sectors were interviewed, it was difficult to recruit politicians, senior public servants and Aboriginal people working in the corporate sector. Our findings are based on the perspectives of 23 participants who may not represent the diversity of Aboriginal communities, cultures and experiences across Victoria or Australia. To address this gap, future CDoH research should include the voices Aboriginal and Torres Strait Islander peoples across the country, particularly in remote areas of Australia.