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Workforce matters, for health and safety for Aboriginal and Torres Strait Islander people

Three recent reports and a new book share some critical messages for addressing systemic failures that are harming Aboriginal and Torres Strait Islander people, reports Associate Professor Megan Williams, a Wiradjuri scholar from the University of Sydney.

Her article is published on what would have been the 58th birthday of Tanya Day, whose death in custody in December 2017 is the subject of one of these reports. Across social media today, supporters shared photographs of themselves wearing pink to pay their respects, using the hashtag #PinkforTanya, in response to a request by her family.

Readers are advised this article contains names and sensitive information about deaths of Aboriginal and Torres Strait Islander people in Australian government services.


Megan Williams writes:

Commission recommendations, Inquest findings and Ombudsman reports about Aboriginal and Torres Strait Islander people’s health and wellbeing are frequently quoted in attempts to improve systems and prevent further harms and deaths occurring. Their pages often include recommendations for mainstream, non-Indigenous workforce development, ranging from disciplinary actions to supervision and training.

Two recent reports reiterate this – the Victorian Director of Public Prosecution’s (DPP) decision to not prosecute two police officers involved in the death in custody of 55-year-old mother and grandmother, Aboriginal woman Tanya Day, and the Queensland Office of the Health Ombudsman’s investigation into the death of six-year-old Torres Strait Islander boy Charlie Gowa. He was turned away from Bamaga Hospital multiple times after being inadequately assessed or treated.

It was a landmark decision of the Victorian Coroner’s Court to refer Victorian police officers for investigation by the DPP. Coroner Caitlin English’s findings were clear about the need to investigate “whether any type of racism, systemic or otherwise, was a factor in the cause or circumstances of Ms Day’s death” (page 18). Coroner English recommended investigation of not only the medical management and whether the death was preventable but also the context and circumstances.

The OHO’s investigation into Bamaga Hospital revealed the context and circumstances of Charlie’s death; it occurred from an extensive list of systemic issues, which meant he was turned away daily for six days without adequate assessment or treatment of meliodosis, a bacterial infection.

No charges have been laid against staff responsible regarding either the death of Tanya Day or Charlie Gowa. The Human Rights Law Centre, which represented the Day family in the coronial inquest into Tanya’s death, indicated that the DPP had to consider likelihood of a conviction and if prosecution was in the public interest.

Both these reports, however, outline a number of issues of public interest, particularly staff incompetence, unconscious bias, poor professional networks to provide alternative supports in decision making and care-giving, and as Coroner English put it: the culture of complacency in relation to assisting Aboriginal and Torres Strait Islander people.

Workforce focus

A third report, We Are Working for Our People, has a much more proactive lens.

It outlines the benefits of Aboriginal and Torres Strait Islander workforces, particularly for ensuring health services are culturally safe.

The Career Pathways Project surveyed almost 400 Aboriginal and Torres Strait Islander health professionals, interviewed almost 250 people in groups and undertook 70 career trajectory interviews. It was funded by the Lowitja Institute and undertaken collaboratively by the Aboriginal Medical Services Alliance Northern Territory (AMSANT), Bila Muuji Aboriginal Health Services from central NSW, consultants Human Capital Alliance, UNSW and Western Sydney University. I participated in research design and the Aboriginal Reference Group and contributed to some of the NSW data analysis and reporting.

AMSANT CEO John Paterson said the research indicates:

It is evident that a strong Aboriginal and Torres Strait Islander health workforce makes a big difference in ensuring the delivery of a culturally safe and effective health service that must be fully recognised by the broader health sector.”

The Career Pathways Project’s suite of reports highlights how Aboriginal and Torres Strait Islander staff strengths are cultural knowledges and values, culturally-safe clinical practices, respectful communication, trustworthiness, ability to address individual and community needs, and leading and advocating for system change.

These important elements of service delivery were missing from the care of Tanya and Charlie, and Coroner English’s report and the OHO’s report recommended improvements to ensure culturally-safe care. While both these reports mentioned Aboriginal and Torres Strait Islander workforces, they did not elaborate on their strengths, nor on their role in righting systemic bias and racism.

This can be a function of systemic bias in itself, with inquiries into deaths of Aboriginal and Torres Strait Islander people led by non-Indigenous people also being limited in their views of what is possible – of what Aboriginal and Torres Strait Islander workforces can achieve, and how, and even of what questions to ask in inquiries to bring Aboriginal and Torres Strait Islander knowledges into the public domain.

As one Career Pathways Project interviewee commented:

I don’t hear the conversation too often around how important having Aboriginal people at the forefront is key to closing the gap… And in fact what I’ve experienced is actually winding back of stuff that places Aboriginal people there.” (Manager, ACCHO) (page 39).

In discussing the Career Pathways Project findings, Lowitja Institute CEO Dr Janine Mohamed reflected, for example, that Aboriginal and Torres Strait Islander people are more likely to use services where Aboriginal and Torres Strait Islander health staff and professionals work.

She said:

Growing and supporting the Aboriginal and Torres Strait Islander health workforce is therefore critical to achieving health justice for our people.”

Queensland Health’s Aboriginal and Torres Strait Islander staff numbers are lower than other public sectors, at 1.67%, and considerably lower than the Queensland public sector target of three percent.

Accountability

The Career Pathways Project report highlights key obstacles to career progression and job satisfaction of Aboriginal and Torres Strait Islander health staff. Twenty percent of Career Pathways Project survey respondents said racism and opposition from colleagues for career development was a barrier, and 20 percent believed lack of cultural awareness among colleagues held them back.

The issues are circular – until mainstream health, police and corrections services enact policies already in place for cultural safety and adhere to quality standards, they will fail in their attempts to increase their Aboriginal and Torres Strait Islander workforces.

These messages are also clearly articulated in Dr Debbie Bargallie’s new book, Unmasking the racial contract: Indigenous voices on racism in the Australian Public Service, which highlights the importance of addressing racism across entire systems.

The Career Pathways Project report calls for greater workforce accountability through accreditation, and outlines the effort Aboriginal and Torres Strait Islander professionals have made to see this is achieved:

You know, we’ve worked with the Australia Safety and Quality Commission. So, they set the standards for hospitals.

We’ve worked with them on ensuring that they now have a standard that names cultural safety…hospitals need to respond to that accreditation standard.

We’ve worked, certainly across the Australian universities…talking to them about having [something] built into the…accreditation standards for courses and educational institutions.” (Stakeholder) (p. 32)

The public discourse that underscores cultures of complacency must change too. Media and public discourse continue to overwhelmingly portray Aboriginal and Torres Strait Islander people as disadvantaged, poorly educated and unwell, and untrustworthy.

Responsibility

Responsibility is thus on managers of services to develop competencies of staff, as the Career Pathways Project reports:

Managers in all health services need to be competent at managing a culturally diverse workforce, with this considered as a mandatory skill, supported by access to specific evidence-based professional development strategies.”

Coroner English recommends Aboriginal and Torres Strait Islander community be involved in providing training, including around unconscious bias and how to reduce its impact.

However, the issue of ‘cultural load’ on Aboriginal and Torres Strait Islander people to provide cultural leadership or mentoring, as well as carry out their core clinical or operational duties has been raised in other studies and Croakey reportage. The over-burden on Aboriginal and Torres Strait Islander staff leads to burn-out and shows discrepancies in remuneration and career progression

Therefore, as the Career Pathways Project says, “Appropriate cultural mentoring for non-Indigenous managers and leaders” is required for improvements in their skills.

The system also fails at recruitment, team meetings, supervisory meetings, annual appraisals, contract renewal time, strategic planning for units and departments and annual reviews of government agencies.

At each of these moments, there should be criteria for cultural competence of the staff, cultural safety and safety generally of the process and setting, and cultural responsivity of the organisation to meet the needs of Aboriginal people.

But how will they get this training? There are limited professional and higher education opportunities for staff development.

HRLC Senior Lawyer Monique Hurley argues, “It should not be left to Aboriginal families, like the Day family, to continue fighting for justice and accountability.”

Author note: I express deep sadness at the loss experienced by the families referred to in this article, which triggers memories of my own family experiences. I am contactable for further information about the Career Pathways Project research, and a similar suite of workforce research reports in NSW that have been declined for release by government.

Associate Professor Megan Williams is the Research Lead and Assistant Director of the National Centre for Cultural Competence at The University of Sydney. Pictured below with Professor Simon Bronitt, Dean of Sydney School of Law, who is cited in Coroner English’s report.

Further reading

The Career Pathways Project report, via The Lowitja Institute

Human Rights Law Centre

Systemic racism in the health system blamed for the death of six-year-old Torres Strait Islander, by Amy McQuire

Anna Talbot – National Justice Project reported by the ABC

Office of the Health Ombudsman report.

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quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
Coronavirus outbreak 2019-2020
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
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plain packaging
prevention
public health
public interest journalism
road safety
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Web 2.0
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Royal Commission
Social determinants of health
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education
justice
Justice Reinvestment
NBN
Newstart
poverty
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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2018 conferences