Introduction by Croakey: Meaningful progress in addressing racism within healthcare systems requires fundamental changes to organisational logic and power structures, not merely adjustments to policy and procedures, according to Jayde Fuller, Gamilaroi woman and National Director of the Aboriginal and Torres Strait Islander Health Strategy Unit at the Australian Health Practitioner Regulation Agency (Ahpra).
Reporting below on a recent Ahpra conference, Fuller says it provided both an analytical framework and a practical roadmap for the transformational work needed to address racism within the health sector, and to create genuinely safe and equitable healthcare for all Australians.
“What remains to be seen is whether healthcare leaders have the courage to undertake the difficult work of examining and changing the invisible systems that perpetuate harm while claiming to heal,” she writes.
Jayde Fuller writes:
The Australian Health Practitioner Regulation Agency (Ahpra) held its Combined Meeting in Naarm on 29-30 May 2025, with over 400 people in attendance, including regulators, health program accreditors, and sector leaders.
The conference’s timing reflected Australia’s contradictions around race: held during Reconciliation Week following an election that promised to heal division, yet occurring in the shadow of the 2023 referendum defeat that left many Aboriginal and Torres Strait Islander Peoples questioning whether genuine partnership with settler Australia remains possible.
Against this backdrop of what Indigenous leaders like Professor Marcia Langton have declared the death of reconciliation discourse, the conference challenged fundamental assumptions about how health organisations address racism, revealing why conventional diversity efforts often fail and pointing toward more transformative approaches.
The insights emerging from this gathering suggest that lasting change requires dismantling invisible systems of power rather than simply implementing visible policies.
Operating system beneath the surface
Dr Shereen Daniels, a Black (Jamaican and Guyanese) UK-based anti-racism expert, Managing Director of HR Rewired, and author of ‘The Anti-Racist Organisation: Dismantling Systemic Racism in the Workplace,’ introduced a powerful framework that distinguishes between what happens ‘above the waterline’ versus ‘below the waterline’ in institutional responses to racism.
Above the waterline sit familiar showcase elements: diversity policies, cultural safety training, anti-racism commitments, and inclusion charters. Below operates what Daniels terms “institutional logic” – an invisible operating system that determines who gets protected, what counts as evidence, and how harm is rationalised.
This institutional logic functions like organisational DNA, shaping decisions and behaviours in ways that rarely appear in policy documents but consistently influence outcomes. It explains how organisations can simultaneously espouse a commitment to racial equity while continuing to harm the communities they claim to support.
“The most dangerous institution is the one that believes it is exempt from the logic it enforces,” Daniels warned, directly challenging health regulators to examine their complicity in perpetuating harmful systems while regulating others.
When theory meets reality
The power of Daniels’ framework was dramatically illustrated when her presentation became a real-time demonstration of the dynamics she described.
During the Q&A, the question was asked about “other marginalised racial groups,” exemplifying what Daniels had identified as “what-about-ism” institutional logic deflecting from specific harm by broadening conversations.
When Daniels declined to answer and asked another non-Indigenous person to respond instead, the exchange revealed the protection mechanisms she’d outlined. The subsequent discomfort and repeated justification attempts demonstrated how institutional logic centres the feelings of those least impacted by racism while burdening those most harmed to provide comfort and education.
This moment powerfully illustrated Daniels’ observation: “We have normalised putting Black people under the microscope and dissecting our experiences…we hide behind ignorance, we hide behind discomfort, because we don’t like to put the torch light on whiteness.”
Systemic barriers
The theoretical framework gained concrete illustration through presentations on Aboriginal and Torres Strait Islander Health Practitioners.
Kuku Yalanji man, Karl Briscoe, CEO of the National Association for Aboriginal and Torres Strait Islander Health Workers and Health Practitioners (NAATSIHWP) and co-Chair of the Aboriginal and Torres Strait Islander Health Strategy Group, detailed how systemic racism manifests in workforce development and professional recognition.
“Feedback gathered by our organisation indicates that the issue seems founded on limited understanding of the skills training and roles of Health Workers and Health Practitioners, systemic racism, institutional resistance across the healthcare system,” Briscoe explained, outlining impacts including workforce inability to perform trained clinical skills, professional undervaluing, and poor recruitment and retention.
For Bardi, Jabirr Jabirr woman and Aboriginal and Torres Strait Islander Health Practice Board Chair Iris Raye, this work carries profound personal meaning: “While we say public safety is our priority as Aboriginal and Torres Strait Islander Health Practitioners, it means more to us because this is our family…we’re really personally invested in the Aboriginal and Torres Strait Islander families and communities across Australia.”
This personal investment makes professional devaluation particularly painful.
As Raye pointedly asked: “What’s wrong with being somebody as an Aboriginal Health Worker or an Aboriginal Health Practitioner?”
Redefining accountability and truth-telling
One significant barrier to addressing racism is the weaponisation of racism accusations against those raising concerns.
Wakaya race scholar, from Deakin University, Professor Yin Paradies, who developed Ahpra’s Aboriginal and Torres Strait Islander Anti-Racism Policy, addressed this directly: “It’s almost never racist to suggest that someone may have engaged in racist behaviour. The policy states that weaponisation of this policy against anyone who has used the term racism and racist will not be tolerated.”
This principle fundamentally shifts accountability from those experiencing harm to institutions and individuals causing it. It connects to the critical importance of believing lived experiences.
Gumulgal epidemiologist Professor Lisa Whop from Yardhura Walani at the Australian National University explained in her research on notification experiences: “We talk really seriously about believing the black witness…at the end of the day, it was their experience and it was their story to tell.”
This approach contrasts starkly with traditional institutional responses requiring extensive proof of racist incidents, often re-traumatising those seeking accountability while protecting those causing harm.
Human cost of institutional resistance
Research presented revealed the profound personal and professional toll of systemic racism on Aboriginal and Torres Strait Islander Health Practitioners.
The national consultation findings on the profession’s scope of practice documented “pervasive experiences of racism faced by health workers and practitioners, both interpersonal and structural. These barriers directly undermine workforce retention, professional well-being and the delivery of safe care.”
This stark revelation underscores the urgent need for systemic change.
The consultation process, involving over 285 people across all states and territories, validated that “most of the workforce operates without defined scopes of practice and where they exist, they are often inconsistent, fragmented and restricted.”
This systematic underutilisation occurs despite the workforce’s unique combination of clinical training and cultural knowledge, making them “uniquely positioned to accelerate improved health and wellbeing outcomes” for Aboriginal and Torres Strait Islander communities.
Indigenous models point the way forward
Concrete alternatives emerged through discussions of Aboriginal and Torres Strait Islander anti-racism policies and cultural safety frameworks embodying radically different institutional logics:
Self-determination over institutional control: Cultural safety defined by Indigenous communities rather than institutions, with Indigenous committees leading assessment and response processes.
Impact over intent: Policies focusing on racist impacts rather than perpetrator intentions, accepting racism reports as genuine.
Restorative over punitive approaches: Justice frameworks emphasising healing, relationship repair, and systemic change rather than individual punishment.
Recognition of systemic burden: Policies explicitly addressing unfair loads placed on Indigenous employees to fix problems they didn’t create.
These models demonstrate what moving from power-over to power-with looks like practically, offering concrete examples of restructured institutional logic.
The unlearning imperative
Traditional professional development builds upon existing knowledge, but the conference highlighted how addressing racism requires fundamentally different approaches: unlearning.
This involves critically examining assumed knowledge and biases shaped by colonialism and racism systems, then relearning ways of knowing and being that centre Indigenous epistemology and lived experiences.
For healthcare practitioners, this means developing critical consciousness – the ability to see injustice conditions clearly and engage in collaborative problem-solving that re-humanises relationships.
In a sector where Indigenous Peoples experience racism as patients more than almost anywhere else, this unlearning becomes literally life-and-death.
Regulatory evolution at a crossroads
The conference took place amid significant challenges facing health regulation, including technological disruption, shifting healthcare models, and declining institutional trust.
Ahpra’s new CEO, Justin Untersteiner, outlined ambitious plans shifting from reactive to preventive approaches, building “fences at the top of cliffs rather than bringing ambulances to the bottom”.
However, juxtaposing discussions of racism raised profound questions about whether regulatory reform can succeed without addressing the institutional logic that shapes how regulatory power is exercised.
If regulators seek to prevent harm in the broader health system, it is important that they prevent harm through their institutional practices.
Urgency of now
Perhaps most powerfully, the conference highlighted the human cost of institutional inaction.
Waywurru woman, Sam Paxton, CEO of Weenthunga Health Network, noted: “The cost of slow pace in mandating cultural safety standards and upskilling health practitioners has been paid in Aboriginal and Torres Strait Islander People’s lives and our livelihoods.”
This urgency extends beyond Indigenous communities to all patients and health practitioners experiencing racism in healthcare settings.
Conference data showing healthcare as the second most common place Indigenous Australians experience racism demands immediate, transformative action.
The choice before us
For healthcare leaders, the conference insights suggest critical shifts: from pathologising individuals to analysing systems, from intent to impact, from representation to power redistribution, and from compliance to transformation.
These changes require institutional truth-telling and honest examination of how power operates within healthcare organisations.
The message was unequivocal: meaningful progress requires fundamental changes to organisational logic and power structures, not merely adjustments to policy and procedures.
The health sector now faces a choice between continued surface-level reforms or the deeper transformational work needed to create genuinely safe and equitable healthcare for all Australians.
The conference provided both an analytical framework and a practical roadmap for this transformation.
What remains to be seen is whether healthcare leaders have the courage to undertake the difficult work of examining and changing the invisible systems that perpetuate harm while claiming to heal.
In a post-referendum Australia where reconciliation discourse is dead and buried, the stakes could not be higher.
• Jayde Fuller, Gamilaroi, is National Director, Aboriginal and Torres Strait Islander Health Strategy Unit, Strategy, Policy and Health Workforce, Ahpra.
See Croakey’s archive of articles on racism
