Focus Topics

topic 2 | 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.

  1. Watch the video of George’s story and consider the following questions:
    • What is important to him and his family at this time?
    • How is this similar to, or different from, what would be important to you if you had a loved one at the end of life?
    • What barriers can you identify (with reference to the content in this section) that influenced the end-of-life care experience for him and his family?
    • In an ideal situation, how should the healthcare team have dealt with the situation described in this narrative?
    • What changes could be made to this health service to ensure that they better accommodate families like George’s in the future? For further information regarding this, refer to Activity 6.
  1. Human Rights Comission. What is racism? 2021; Available from: https://humanrights.gov.au/our-work/race-discrimination/what-racism.
  2. Sherwood, J., Colonisation – It’s bad for your health: The context of Aboriginal health. Contemporary Nurse, 2013. 46(1): p. 28-40.
  3. Australian Government Department of Health. Exploratory Analysis of Barriers to Palliative Care – Summary Policy Paper. 2020; Available from: https://www.health.gov.au/resources/collections/exploratory-analysis-of-barriers-to-palliative-care.
  4. Australian Learning and Teaching Council. Creating cultural empathy and challenging attitudes through Indigenous narratives. 2012; Available from: https://altc-betterhealth.ecu.edu.au/index.php.