Uncovering the determinants of cardiovascular disease among indigenous people

Objective. This paper attempts to delineate an appropriate methodology for research into cardiovascular diseases (CVD) in the context of the Australian Indigenous population. Design. Our argument proceeds in three main stages of critical analysis of the appropriate literature. First we demonstrate the extremely complex aetiology of CVD and also argue that, in any population, exposure to many of the more important risk factors at an individual or group level is generated through social and behavioural factors whose causation, persistence and reproduction are both complex and multilayered. Secondly, and having established that the aetiology and morbidity of CVD in various populations is a product of a complex and interactive hierarchy of biomedical, social and political processes, we argue that only research methodologies capable of encompassing the complete span of this hierarchy can be expected to generate results which are efficacious as a basis for intervention. Thirdly, and most importantly, we argue that in the Indigenous context a central and essential feature in the development of an appropriate methodology must be to centre Indigenous people themselves as the dominant partner in setting the research agenda and the conduct of research. Results/conclusions. We conclude that an appropriate methodology for the elucidation of the aetiology, and sequelae of CVD in Indigenous people, would go far beyond 'black box' epidemiology, would recognise the essentially social nature of chronic disease by deploying appropriate social theory within a transdisciplinary framework and would centre Indigenous people as the dominant partner in the research process.