Activity 1: Power and privilege

All individuals are products of the system into which they have been socialised; a system that has taught people how to think about themselves and others, how to interact, how to know what is expected and what happens if we deviate from what is expected. Socialisation is ongoing, complex and often invisible. Intentional and continuing critical self-reflection is required to understand and influence the process of socialisation. Power, in this context refers to the capacity that a person has to exercise control over others, deciding what is best for them, deciding who will have access to resources, etc.1


It is important that health professional students understand their place – individually, and as members of the health professional groups they are socialised into – within the institutional or ‘colonised’ health system, and the impact this has on palliative care service provision.

Engaging in regular and ongoing self-reflection regarding health professional knowledge, skills, attitudes, behaviours and power differentials is required to be able to deliver culturally-responsive healthcare.2 This toolkit activity aims to provide students with an overview of these key issues and encourage critical self-reflection.

In the context of the healthcare system, when referring to a person as having privilege, it is about the access they have to resources. Those with more power have unearned access to things that those without power, typically members of marginalised groups, do not have access to. The idea of unearned access is where the inequity lies because access is based on an identity someone holds that has traditionally been associated with power.

For example, in the context of white privilege, people who are white have unearned access to resources that work in their favour as opposed to people of colour who experience a multitude of barriers to gaining access to the same resources. These barriers, which are rooted in historical inequity, include systems, policies, and laws that disenfranchise and impoverish people of colour. White people are not forced to question their behaviours because the system is set up with them at the centre or as ‘normal’ (eg, white children are not usually taught that they might be discriminated against because of the colour of their skin, whereas children of colour often are).1

Understanding bias

Bias refers to prejudice that is in favour of or against one thing, person or group, usually in an unfair way. These learned associations, which develop over time, prompt feelings and attitudes about other people based on characteristics such as racial group, ethnicity, age, gender, sexual orientation, and socioeconomic status.

Biases can be:

  • Implicit – attitudes based on stereotypes people have learned that affect their understanding, actions and decisions in an unconscious manner, or
  • Explicit – attitudes and beliefs that people hold at a conscious level that are formed and acted on with deliberate thought.

Everyone has biases as part of the natural way the brain categorises things. It is important to become aware of our biases to mitigate the impact that these beliefs and attitudes have on our behaviour towards specific groups of people.

A learning experience that can help you understand more about your own implicit biases is the Harvard’s Project Implicit Association Test.3

Activity 2: Racism in healthcare

Racism, or racial discrimination, is the outcome of either implicit or explicit bias. It results in people treating others unfairly because of their skin colour or racial background. Racism can be shown in individuals’ actions and attitudes and it can also be reflected in systems and institutions.1

For Australian Indigenous peoples, racism is a fundamental driver of health and emotional wellbeing. The link between racism and colonisation is important to understand. The behaviour of European colonisers to Australian Indigenous peoples was based on assumptions that the Western worldview was superior, and that there were distinct evolutionary lines of humans. The impact of this ‘ongoing colonisation’ is apparent in the oppression, persecution and marginalisation that Australian Indigenous peoples continue to experience today.2

The healthcare system in Australia is a prime example of how Western or ‘white’ knowledge has been assumed to be superior to traditional healing knowledge (eg, health and wellbeing practices and access to bush medicines) and views of health and wellbeing. This view has contributed to the systemic racism that is evident in Australian healthcare institutions, which prevents Australian Indigenous peoples from receiving quality health and end-of-life care. It has also resulted in the under representation of Aboriginal and/or Torres Strait Islander people working in the healthcare system.

Colonisation continues today both politically and through health service provision, research and scholarship. This is because the context of causal agents … has been maintained through problematic constructions of Aboriginal people that were established when the concept of terra nullius was applied to this continent.

If we all take up an informed and active decolonising gaze, we can shift this colonial context. It is time to make the change; the knowledge is out there, to stop blaming Indigenous Australians for their health circumstances, and to contribute to providing the very best health care, research and scholarship to the first Australians. Juanita Sherwood2

Barriers to quality palliative care

Systemic racism in healthcare, and the place of healthcare institutions in representing Western / white ways of knowing, being and doing, presents a significant barrier for Australian Indigenous peoples to accessing healthcare.

In the context of palliative care, a number of common barriers have been identified that impact on the provision of quality care for vulnerable groups, including Australian Indigenous peoples. Barriers have been identified on both the consumer-side and the service-side of healthcare, with some found on both sides:3

Consumer-side Service-side
  • Lack of comfort discussing death and dying
  • Lack of understanding / awareness of palliative care
  • Fear and mistrust (eg, of Western medicine, healthcare services, perceived authority)
  • History of trauma
  • Destruction of social and family connections, resulting in isolation
  • Delayed diagnosis / presentation to healthcare services
  • Fear / perception of stigma / discrimination / racism
  • Financial constraints
  • Lack of relevant cultural self-awareness / competency within available services
  • Lack of health worker skills / experience (in palliative care and/or working with people from underserved population groups)
  • Lack of available services and support to facilitate dying in setting of choice (especially in rural and remote settings
  • Referral issues (lack of / late referral to specialist services)
  • Actual stigma / discrimination / racism
  • Insufficient funding / funding model issues
  • Language and communication barriers
  • Mismatching of cultural understandings and preferences

Barriers are discussed in further detail in Sections 4 and 5.


Key Video Resource – ECU Indigenous Narratives: George’s Story (9:18)

George is a man from the Njaki, Njaki language group of the Noongar peoples in Western Australia. In this video he tells the story of his family’s experience with end-of-life care.4

Check the thinking points below for some questions to consider with regard to this video.

Activity 3: Australian Indigenous peoples

Australian Indigenous peoples are the First Peoples of Australia. There are varying estimates for how long they have lived on this land, however, current research indicates that it is at least 60,000 years, which makes Aboriginal and Torres Strait Islander cultures the oldest continuous cultures on Earth.1

Australia has always been a multicultural continent. There were many different language groups and cultural ways before the arrival of Europeans. Significant diversity of cultures, social structures and ways of life exist among Australian Indigenous peoples. Communities vary according to geographic location, environment and resources, each having their own unique cultural practices and protocols, beliefs, knowledge and material cultures.

The AIATSIS map of Indigenous Australia attempts to represent the language, social or nation groups of Indigenous Australia and serves as a visual reminder of the richness and diversity of Aboriginal and Torres Strait Islander cultures. The map shows the general locations of larger groups of people which may also include smaller groups.2

Although the terms ‘Indigenous’, ‘Aboriginal’ and ‘Torres Strait Islander’ are commonly used now, it is important to remember that these are colonial labels that were imposed on a range of people with diverse cultures and languages. Aboriginal peoples and Torres Strait Islander peoples often prefer to identify themselves by their Country, nation, clan or Island groups (eg, Eora, Maluilgal, Kaiwalagal, Ngunnawal, Larrakia).3

Aboriginal peoples overview

  • Associated with the land, mountains, deserts, rainforests, coastal areas, rivers and waterways
  • Strong spirituality and belief in all living things being connected and carrying energy
  • Refer to maternal or paternal families’ traditional land areas as ‘Country’
  • Self-identify by language group and traditional land area, known as nation or clan
  • Have knowledges tied to Country and environment, constellations, plants and animal life.

The Aboriginal flag, designed in 1971 by artist Harold Thomas, a Luritja man from central Australia. The black represents the Aboriginal people, the red represents the earth and the spiritual relationship to the land, and the yellow represents the sun, the giver of life.

The flag was designed to be an eye-catching rallying symbol for Aboriginal people, a symbol of identity and unity. It was recognised by the Australian Government as an official ‘Flag of Australia’ in 1995.4

Torres Strait Islander peoples overview

  • Have a land and sea culture
  • Have five Island clusters which identify language groups
  • Have 20 communities that make up the Torres Strait region, each with unique history and culture
  • Have beliefs connected to the constellations, seas and sky

The Torres Strait Islander flag was designed by Bernard Namok of Thursday Island.

The colours of the flag represent the Torres Strait Islander people’s connection to the land, sea and sky. The green stripes represent the land – the mainlands of Australia, the black stripes represent the people, the blue represents the sea, the white ‘Dhari’ (headdress) is a symbol of Torres Strait Islanders.

Underneath the Dhari is a white five-pointed star. The star is an important symbol for navigating the sea. The points of the start represent the five Island groups in the Torres Strait and the white symbolises peace.

Each part of the flag gives meaning to Torres Strait Islander culture and holds special legal and political status worldwide.4

About Australian Indigenous peoples

Click on the tabs below to learn more about the languages, kinship systems and Lores of Australian Indigenous peoples:

It is estimated that prior to colonisation, there were 600 different Aboriginal groups across the country. Language is a key part of understanding Aboriginal and Torres Strait Islander culture and heritage as history and knowledges are primarily passed on orally, through stories, songs and dances. Past policies of assimilation prevented people from using their own language which has contributed to the breakdown of traditional languages and the passing on of cultural knowledge between generations. In some communities, traditional languages were never lost. In others they are being revived, and used and taught in schools.5
Kinship systems
While the diversity of the many different cultures, languages and customs is broad, the value of connection to family and community, and Country and Sea, and respect for Elders, are common.

Australian Indigenous peoples have kinship systems and understandings of ‘family’ that go beyond the European idea of family, extending to much wider groups. These systems are based on beliefs about everyone, and everything being interrelated and interconnected – not just people, but plants, animals, and rocks – on the land and in the sea. Kinship forms a framework for each person’s identity, defining connectedness, roles, reciprocal responsibilities, obligations and interactions.

The classificatory kinship system has many different types of relationships under one term. For example, ‘Mother’ refers to maternal mother and her sisters, ‘Brothers’ and ‘Sisters’ refer to all the children of mothers, fathers, aunts and uncles in a large family group. The extension of kinship relationships to the community is complex and alters in different areas. Kinship connections are deeply rooted and multi-layered – all relationships have roles and reciprocal responsibilities. Everyone has a role within the family and maybe the community. It includes the responsibility to care for all living things, for Country and a responsibility for someone else in the family. IPEPA Cultural Considerations 3

The benefits of kinship systems in supporting people affected by life-limiting illness include:

  • Shared decision-making across families / community so that difficult decisions are not the responsibility of one person
  • Strong support for the sick person and their family during the end-of-life and bereavement journeys
  • Shared and collective resources, including finances, time and help with care and transport.6

Many people have retained kinship connections, while those in areas that were colonised earlier and most intensively, or who are survivors of the Stolen Generations, may no longer have large family or community groups. Many people living in urban settings still have large family and community groups and have strong kinship ties with family regardless of where the extended family are living.

The establishment of Link-Up organisations in each state / territory provide assistance to Aboriginal and/or Torres Strait Islander people who are trying to locate family.4

Learn more about various aspects of kinship by accessing the video resources provided by the National Centre for Cultural Competence7 in the Related Links section on this page.

Lores / Traditional laws
The many different Aboriginal and/or Torres Strait Islander communities have sophisticated codes of conduct to guide behaviour. These can be called traditional or customary laws, also known as lore and are unique to each cultural group. Lores help guide their own communities in how to behave according to traditional beliefs and practices, such as leadership and etiquette, property, special events like marriage, coming of age and death, and sacred knowledge. Lore is passed on down the generations through songs, stories, art and dance, and governs all aspects of traditional life, for those who are connected to culture in this way. An example of this is the responsibility for decision-making at end of life. An Elder or other family member may be obligated under Lore to make decisions on behalf of the sick person.5

For many Aboriginal and/or Torres Strait Islander people, it is important to pass on cultural knowledge and family history at the end of life. This is often a key focus during the last days. This topic is explored further in Section 6.

Activity 4: Connection to Country and Spirituality


Australian Indigenous peoples are strongly connected to particular lands and waters, or Country, through lines of descent, as well as clan and language groups. With colonisation, many groups were forcibly removed from their lands so that Europeans could exploit the lands’ wealth and resources.

Country is defined by spiritual as well as physical links. Landforms may have deep meaning, recorded in art, stories, songs and dance.  The connection to Country is one of belonging, and indicates a responsibility to care for the land, rather than ownership or possession.1

When we talk about traditional ‘country’… we mean something beyond the dictionary definition of the word…we might mean homeland, or tribal or clan area and we might mean more than just a place on the map. For us, country is a word for all the values, places, resources, stories and cultural obligations associated with that area and its features. It describes the entirety of our ancestral domains. Mick Dodson 1

All areas of Australia have traditional owners, even places where there are now large cities. Even though people may not live in a traditional way on the land, they are still bound to it. The importance of being connected to Country can be particularly strong for Aboriginal and/or Torres Strait Islander people who are approaching the end of life. This is explored in further detail in Section 6.


Dreaming is an English word that attempts to describe a deep, timeless concept in Aboriginal cultures and Torres Strait Islander cultures.

Dreaming is more than a mythical past; it prescribes our connection as people with the spiritual essence of everything around us and beyond us. Dreaming stories are not in the past, they are outside of time – always present and giving meaning to all aspects of life. The Dreaming is passed from generation to generation through stories, song, dance and art. This knowledge gives us special responsibility and is seen as a great honour. Mick Dodson 1

The cultural belief that life is a continuum – Life-Death-Life – is common among Australian Indigenous peoples. The underlying belief that all living things – people, animals, plants – have a spirit and those spirits are the continuum that connects the living to the past, present and future. At the time of death, the spirit leaves the body and returns to the Ancestors’ Country. Family responsibilities continue after death to ensure a safe passage of the spirit into the Dreaming and returning the body to Country.2


Many Australian Indigenous peoples hold strong spiritual and cultural beliefs about the cause of serious illness, which may conflict with the medical explanation. By demonstrating respect for diversity (through listening without judgement) to the person and family’s cultural and spiritual beliefs, a relationship of trust and rapport can be built.2

Australian Indigenous peoples’ spirituality has adapted over time due to the influence of other religions and changes in lifestyle. Christianity was first introduced to Australian Indigenous peoples by missionaries who often forced Biblical teachings on people. Many people continue to embrace Christian spirituality today, with over half reporting a Christian affiliation.3

In some communities, spiritual beliefs can be fused with traditional beliefs and values. Every year, Torres Strait Islanders celebrate ‘The Coming of the Light’ on 1 July, recognising the adoption of Christianity throughout Island communities during the late nineteenth century. Christian principles were seen to be somewhat compatible with the traditional Islander religion and the Christian missionaries were able to provide practical support to the Islanders in negotiating with outsiders regarding the maritime industry.4

Key Video Resource – PCC4U/IPEPA Yarn: Cultures, beliefs and the end-of-life journey (5:34)

This video excerpt provides a perspective on the diversity of cultures and beliefs around the end-of-life journey for Australian Indigenous peoples.5

Check the thinking points below for some questions to consider with regard to this video.

Activity 5: Health and wellbeing

Before colonisation, Aboriginal and Torres Strait Islander people lived in family and community groups and moved across the land following seasonal changes. The Aboriginal and Torres Strait Islander concept of health is not just about the individual person, but a whole-of-life view that includes the social, emotional and cultural wellbeing of the community. Swann et al 1

Prior to European settlement, it is estimated that there were between 315,000 and 750,000 people living in Australia, with upper estimates being over a million.

British settlers brought with them a range of diseases such as measles, smallpox and tuberculosis. These diseases, in combination with the direct violence and many massacres that were perpetrated, throughout the whole of Australia, by European soldiers and settlers, resulted in countless deaths. In addition to this, the mass appropriation of land and water by the British Crown denied people access to the resources that were essential to sustaining health, social and emotional wellbeing.

The limited information that is available suggests that the Aboriginal and/or Torres Strait Islander population had declined to around 60,000 by the 1920s.2

Today the burden of disease, poor socioeconomic status and severe disadvantage of the Indigenous Australians is a testament to a history of colonisation and its continuation. The practice of colonisation targeted Aboriginal people in a ‘deliberate and calculated’ manner which aimed to ‘displace and distance people from their land and resources’. Sherwood3

Discrimination and the destruction of identity, language, culture and land, that resulted from colonisation, profoundly impacted the health and wellbeing of Australian Indigenous peoples and continues to do so today. This is covered in greater detail in Section 4.

Factors known as the ‘social and cultural determinants of health’ impact the health and wellness of individuals. They are the conditions that people are born into, grow and live in and include early child development, employment, education, access to healthcare, and social exclusion. These determinants play a large part in the health inequities between population groups, particularly the differences between Australian Indigenous peoples and non-Indigenous Australians.1

There are a number of factors that have been found to support the health of Australian Indigenous peoples, including cultural continuity, self-determination, supporting Indigenous knowledge systems, maintaining family networks, and strong community governance.1

Currently, research is being undertaken in the Mayi Kuwayu National Study of Aboriginal and Torres Strait Islander Wellbeing, to demonstrate the link that culture has to health and wellbeing:4

Our people and communities have been saying for a long time that strong culture is vital to our health and wellbeing. However, there is a lack of evidence that shows how and why this may be so. The Mayi Kuwayu Study aims to provide this evidence. Aboriginal people across this land have held the world’s oldest continuing cultures for a long time. The strength of our varied cultures is different across the country and is a result of Australia’s history. There is a desire among many people and communities to strengthen, maintain and revive culture. These strengths may be used to overcome the impacts of colonisation, and help to ensure ongoing resilience and connection to country, people and culture. Mayi Kuwayu Website

This content continues on the next page.

Activity 5: Health and wellbeing (contd)

Social and emotional wellbeing

The term social and emotional wellbeing has been used to reflect holistic Aboriginal and Torres Strait Islander concepts of health:

Aboriginal health does not mean the physical wellbeing of an individual, but refers to the social, emotional and cultural wellbeing of the whole community. For Aboriginal people this is seen in terms of the whole-life-view. Health care services should strive to achieve the state where every individual is able to achieve their full potential as human beings, and must bring about the total wellbeing of their communities. Gee et al 5

The diagram below provides a conceptualisation of social and emotional wellbeing from Australian Indigenous peoples’ perspective:5

Conceptualisation of social and emotional wellbeing

Men’s and Women’s Business

It is important for healthcare workers to be aware that practices for traditional Australian Indigenous peoples have strong gender roles expressed through ‘Men’s Business’ and ‘Women’s Business. Men address men’s matters and women address women’s matters. However, some people may be comfortable with Western ways of relating to men and women, so it is important to ask for the person’s preference rather than make assumptions.6

Key Video Resource – Spirituality (Dadirri) (3:42)

The strengths of Indigenous spiritual practices are being acknowledged in many parts of the world. In Australia, people from both Aboriginal and Torres Strait Islander and non-Indigenous backgrounds have embraced the Aboriginal spiritual practice of Dadirri, described by Elder, Dr Miriam-Rose Ungunmerr as ‘deep listening and silent awareness’ to support healing and wellbeing.7

Dadirri is from the Ngan’gikurunggurr and Ngen’giwumirri languages of the Aboriginal peoples of the Daly River region (Northern Territory, Australia).

Check the thinking points below for some questions to consider with regard to this video.

Activity 6: United Nations Declaration on the Rights of Indigenous Peoples

The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) was adopted by the United Nations (UN) General Assembly in 2007. It establishes a universal framework of minimum standards for the survival, dignity and wellbeing of the Indigenous peoples of the world. It is particularly significant because Indigenous peoples, including Australian Indigenous peoples, were involved in its drafting.1

UNDRIP sets out general principles and recognises rights to:

  • Nationality, self-determination, equality and freedom from adverse discrimination
  • Culture, spirituality, education and language
  • Land and resources
  • Participatory rights in development and other economic and social rights.

Note: A focus on key frameworks such as UNDRIP and its connection to palliative care, is an important part of a rights-based approach to learning. These links will become clearer as you progress through this section.

Key Video Resource – UN Declaration of the Rights of Indigenous Peoples (10:27)

This video provides an overview of the importance and impact of UNDRIP for Australian Indigenous peoples.1

Check the thinking points below for some questions to consider with regard to this video.


The right to self-determination

UNDRIP outlines the right of Indigenous peoples to self-determination. By virtue of that right they freely determine political status and can freely pursue their own social, cultural and economic development. Self-determination is a right of peoples rather than individuals, and instead of being about creating a separate Indigenous ‘state’, it is an ongoing process to ensure that Indigenous communities are able to meet their own needs.1

The right to self-determination is based on the acknowledgement that Indigenous peoples are Australia’s first people, as was recognised by law in the historic Mabo judgement. The loss of this right to live according to a common set of values and beliefs, and to have that right respected by others, is at the heart of the current disadvantage experienced by Indigenous Australians. Australian Human Rights Commission2

Colonisation, which eroded and eventually removed self-determination for the ‘colonised’, is a fundamental determinant of Indigenous peoples’ health across the world. Indigenous people make up an estimated 6% of the world’s population and across the globe have disproportionately high rates of poverty, noncommunicable diseases, infant and maternal mortality, mental illness, and infectious diseases. There is also a life-expectancy gap of up to 20 years.3

Activity 7: UNDRIP and health

UNDRIP is a key part of this toolkit as it forms the foundation for the ‘rights-based’ approach that is essential in supporting culturally-responsive palliative care. It is important for health professionals to understand the rights that Australian Indigenous peoples have with respect to health and end-of-life care, and how colonisation has undermined these rights.

With regard to health and healthcare, UNDRIP includes the following rights for Indigenous peoples:

  • An equal right to the enjoyment of the highest attainable standard of physical and mental health
  • The right to promote, develop and maintain their institutional structures and their distinctive customs, spirituality, traditions, procedures, practices and, in the cases where they exist, judicial systems or customs, in accordance with international human rights standards
  • The right to traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals
  • The right to access, without any discrimination, all social and health services.1

UNDRIP establishes a framework for addressing the health and wellbeing of Indigenous peoples that includes the obligation of UN member states both to provide accessible, quality healthcare to Indigenous peoples, and to respect and promote Indigenous health systems, each of which must be fulfilled in order to ensure the health of Indigenous peoples.1

The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 outlines the commitment of all Australian health practitioners regulated under the National Scheme to provide culturally-safe care for Aboriginal and/or Torres Strait Islander individuals, families and communities. Statements within this document underscore the commitment of the regulating bodies to ensure delivery of safe, accessible and responsive healthcare for Aboriginal and/or Torres Strait Islander people that is free of racism.2

Indigenous Allied Health Australia (IAHA) is the peak national body representing Aboriginal and/or Torres Strait Islander allied health workforce. IAHA has published a policy position statement outlining their commitment to the rights of Australian Indigenous peoples to access allied health services that are available, affordable, acceptable and appropriate. This strengths-based approach focuses on working with Australian Indigenous peoples and communities to determine and act on their allied health service needs.3

IAHA work with communities in a way that recognises their Culture, strength, resilience, knowledges and leadership to drive culturally safe and responsive solutions and strategies to improve health and wellbeing. In doing so, we support the right to self-determination. Indigenous Allied Health Australia3

Activity 8: Human rights and palliative care

The World Health Organization (WHO) describes palliative care as a human right and states that it should be provided through person-centred and integrated health services. When it comes to provision of palliative care, UNDRIP provides a framework and a responsibility to ensure that Aboriginal and/or Torres Strait Islander people who are affected by life-limiting illness are able to access quality, culturally-responsive palliative care.1

The ‘right to health’ stated in UNDRIP includes a range of socioeconomic factors that influence the conditions in which people can have a healthy life and extends to the various underlying determinants of health such as food and nutrition, clean water, housing, adequate sanitation, safe working conditions and a healthy environment.2

For Australian Indigenous peoples, the determinants of health also include factors such as cultural practice and expression – connection to Country, being on Country, self-determination and leadership, language, family, kinship and community, and identity (as described in Section 2).3

The National Palliative Care Strategy acknowledges the issues that Australian Indigenous peoples experience in accessing palliative care:

…palliative care is not equally available to all people across Australia, for reasons of geography, awareness, economics, workforce and accessibility. Aboriginal and Torres Strait Islander people, in particular, are impacted by unique factors such as intergenerational trauma, cultural dislocation, oppression, and systemic racism that influence their decision making around end-of-life considerations. National Palliative Care Strategy 2018 4

Key Video Resource – ECU Indigenous Narratives: Des’s Story (3:16)

Des is a man from the Badimaya language group in the mid-west of Western Australia. He is an Aboriginal health worker. In this video, he tells the story of an Elder and his end-of-life journey.5

Check the thinking points below for some questions to consider with regard to this video.

Activity 9: Historical trauma

For Australian Indigenous peoples, the historical legacy of dislocation and displacement resulting from colonisation, has many significant impacts on their experience of living in Australian society today.


It is important to have an awareness of both the historical trauma and its ongoing effects (particularly the impact of intergenerational trauma), as well as the impacts of living with significant inequalities in education, employment and health, and institutional racism in mainstream services.

Healthcare professionals, especially those involved in palliative care, need to be aware of the impact that this experience has on Australian Indigenous peoples’ trust in mainstream or non-Indigenous health services. The need for provision of trauma-aware, healing-informed care and a focus on healing programs is of key importance. It is also important to understand the protective factors and healing properties associated with cultural connection and expression.


Many non-Indigenous Australians have not learned the truth about the history of Australian Indigenous peoples since colonisation.

A brief overview of historical events and their impact is provided here:

Timeline of Australian History and the impacts on Aboriginal peoples

Timeline of Australian History and the impacts on Torres Strait Islander peoples

Students are encouraged to engage in more in-depth exploration of this content through accessing the further resources provided throughout the toolkit.

Impacts of historical trauma

Traditional cultures throughout Australia were significantly impacted by colonisation. Traditional peoples and cultures were systematically supressed as European lifestyles and religions (Christianity) were imposed. Almost all aspects of Aboriginal and Torres Strait Islander cultures were forbidden or discouraged, including practices associated with dying and death and the passing on of such sacred ceremonial knowledge.

Government policies of dispossession, dislocation, segregation, assimilation, removal and integration greatly impacted traditional Aboriginal and Torres Strait Islander cultures and customs.6 The lack of acknowledgement of the historical trauma invalidates the experiences and suffering of many Australian Indigenous peoples and is a source of ongoing pain and suffering.1

All over the world, when communities have traumatic experiences, there are long term consequences. Their children and grandchildren are affected and, depending on whether and how wrongdoings are acknowledged, and continuing problems are addressed, the trauma tracks down the generations.

Australians of today are not directly responsible for what happened in the past. But it is part of our shared history as Indigenous and non-Indigenous Australians and, together, we are responsible for what happens in the future.

Royal Commission Indigenous Deaths in Custody 1989-1996.4

The impacts of historical trauma can be seen in a number of areas:1

Social exclusion:
Since colonisation, Australian Indigenous peoples have been marginalised in all aspects of life. Being denied participation in the mainstream social system meant being denied the rights and privileges of that system. The current impact of this can be seen in the high rates of poverty, incarceration, unemployment, homelessness, poor health, suicide and lack of educational outcomes.
Institutionalised racism and discrimination:
Institutional discrimination occurs when a society’s institutions discriminate against a group of people. This occurred at the beginning of colonisation when both Australian Indigenous peoples were ‘legally’ dispossessed and exploited. However, this also set up a legacy of discrimination against Australian Indigenous peoples. For example, our health, education, legal and political systems are based on non-Indigenous ways of knowing, being and doing, which fail to acknowledge traditional cultural value systems. This helps to explain the lack of trust many Aboriginal and/or Torres Strait Islander people have in Western medicine and the health system, especially around end-of-life care, when spiritual and cultural aspects of care are often especially significant.
Undermining law, society, culture and belief systems:
Colonisation undermined both Aboriginal and Torres Strait Islander laws, society, culture and belief systems with the view that European culture was superior to all others. This has impacted Aboriginal and Torres Strait Islander cultures, societies and languages, which has had a strong impact on people’s sense of identity and belonging. Cultural disconnection and the weakening of identity are the underlying causes of many of the struggles faced by Australian Indigenous peoples today.
Intergenerational trauma:
The social and economic impact of invasion and control of Australian Indigenous peoples has accumulated across generations and has been amplified by policies and practices that have systematically disadvantaged them. For many, this has resulted in the transmission of trauma, poverty and other forms of disadvantage from generation to generation. It is important to view the challenges faced by many families and communities today in the context of this history.