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New cultural safety strategy seeks to eliminate racism in health sector

Croakey is closed for summer holidays and will resume publishing in the week of 18 January 2021. In the meantime, we are re-publishing some of our top articles from 2020.

This article was first published on March 04, 2020


Introduction by Croakey: The staff and management committee of the Australian Health Practitioner Regulation Agency (Ahpra), and members of the national, state and territory boards involved in regulating and accrediting health professions will undergo cultural safety training.

The move is among commitments in a five-year Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy launched last week at a 10-year anniversary meeting of the National Registration and Accreditation Scheme. It can be downloaded here.

The strategy also calls for two Aboriginal and Torres Strait Islander representatives to be appointed to the Ahpra management committee, as well as two Aboriginal and Torres Strait Islander representatives to be appointed to each national board and accreditation authority by the end of 2025.

The strategy includes a commitment to develop and implement a monitoring and reporting framework for patient safety and notifications for Aboriginal and Torres Strait Islander people, and to convene this year a national summit on Aboriginal and Torres Strait Islander health workforce.

Ahpra has committed to ensure monitoring and reporting against the Strategy’s objectives and key performance indicators.

Below, Dr Tess Ryan, a Biripi woman and Melbourne-based writer who was recently elected president of the Australian Critical Race and Whiteness Studies Association, says that implementation of the strategy is “badly needed”.


Tess Ryan writes:

The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 gives expert and clear guidelines in matters of culturally safe and effective health care. This also acts as a call to action for many health providers to adopt this strategy as a ‘how to guide’ for best practice in working with Aboriginal and Torres Strait Islander people.

The strategy has set an overarching goal of eliminating racism in health and establishing health equity by 2031.

Aiming to make “cultural safety the norm for Aboriginal and Torres Strait Islander patients”, the strategy delivers a “clear direction and course of action for Ahpra, National Boards and Accreditation Authorities, who together regulate Australia’s 740,000 registered health practitioners” (Ahpra, 2020).

A clear definition of cultural safety is required as a baseline for implementation of this strategy, and includes “ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of  racism” (Ahpra, 2020).

Without consistency in this definition across health platforms, confusion over what is deemed culturally appropriate and safe creates a grey area within which problematic systemic issues can flourish.  This consistency must be threaded throughout training and education, organisational codes of conduct and ongoing professional development of staff to manage a change in systemic environments.

P 9 of the strategy

A recent edition of the British medical journal, The BMJ, discussing racism and health demonstrated issues ranging from patient care to research, policy and education where racism and ethnicity become barriers. This is a global issue.

Patient safety must be for all, and we must ensure equity in health delivery regardless of race, ethnicity, class or gender.

The long history of equity disparity for Aboriginal and Torres Strait Islander people in Australia is littered with such phrases as ‘eugenics’, ‘lock hospitals’ and government attempts to purify whiteness through the generations of stolen children.

A strategy such as this is badly needed to begin to address this history.

Three key areas

The strategy sets out objectives in three areas – increased participation, greater access, and influence. Increased participation of Aboriginal and Torres Strait Islander expertise is essential.

As a part of self-determination, Aboriginal and Torres Strait Islander people need to have prominence in the decision-making process including representative roles and continued governance. Seats at the table, beyond tokenism, are imperative in changing the system.

Greater access to patient experiences in health care, including knowledge of patients’ reluctance to present due to lack of cultural safety in services, is important.

If an individual does not feel listened to and respected, why would they choose to be placed in that environment?

A monitoring and reporting framework regarding patient safety enables a ‘checks and balances’ function of the health system. One of the issues relating to cultural safety is that, for each individual case we may hear of, many more go unreported. For example, an individual may drop off a service for chronic disease management, and the care provider may assume there was a lack of self-care involved in this process, rather than a genuine fear of a health care system that does not understand cultural nuances in behaviour.

The strategy also discusses influence, and this is where I feel a strong commitment has been shown from Ahpra as they positioned this document at the forefront of their recent meeting.

This enables those 740,000 health practitioners a moment to reflect on their practice and use this strategy as a guide for future directions in the health field.

An invitation to readers

As the incoming President of the Australian Critical Race and Whiteness Studies Association (ACRAWSA), I believe this strategy should be implemented across as many health organisations as possible to assist in shifting paradigms within not only the Aboriginal and Torres Strait Islander Health space, but in many areas where race, culture and health intersect.

Our Association was first established in 2003 as a way for scholars interested in Critical Race Studies to share their knowledge and build a strong understanding of what is regularly seen, but not named or discussed in Australia.

As an Association, we see racism in both theory and practice. It is in the lack of historical knowledge within educational curriculum, a criminal justice system that arrests a Black woman for public drunkenness who dies in custody, and a health system that can overlook cultural difference at the expense of the patient’s needs.

There are ways we can begin to address these issues, such as educating the professions in theoretical knowledge and calling these instances by their name as they happen.

However, we also need self-determined approaches, frameworks and collaborative practicable process for systemic change to occur.

This strategy holds a strong alignment with the Australian Critical Race and Whiteness Studies Association as we aim to highlight critical race impacts, race literacies and whiteness as a normative practice or default in Australian society overall.

The challenge for the association is encouraging people to build their education in race theory and be able to identify in practice what is happening when an individual is receiving different treatment according to their race. Within a health environment, this can range from an Aboriginal or Torres Strait Islander person being assumed as a non-compliant patient, or result in the death of a patient due to a fear of a health system which denies them care based on a racial or cultural bias and stereotype.

I cannot over-emphasise how strongly this strategy needs to be implemented across the health sector Australia wide, for various reasons.

A five-year plan (and beyond) to establish health equity is evidence that the issue requires commitment and energy to implement, and with an uptake in participation from healthcare providers, we may begin to see a shift in the disparities we see in Aboriginal and Torres Strait Islander health.

I invite health professionals wishing to upskill in this area and develop a better understanding of the theory and practice of cultural safety to consider joining the Australian Critical Race and Whiteness Studies Association.

Declarations from Croakey: Melissa Sweet was MC at the two-day combined meeting of the National Registration and Accreditation Scheme on behalf of Croakey Professional Services. Dr Tess Ryan is a member of the Reconciliation Action Plan Committee for the Australian Physiotherapy Council.


Tweets from the launch

Karl Briscoe, Professor Roianne West and Professor Gregory Phillips addressed the launch.