Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia
Background In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recen...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Kerman University of Medical Sciences
2022-12-01
|
| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | https://www.ijhpm.com/article_4256_626db3378687bbf2293310c771a8724d.pdf |
| _version_ | 1827997402166984704 |
|---|---|
| author | Stephanie Topp Josslyn Tully Rachel Cummins Veronica Graham Aryati Yashadhana Lana Elliott Sean Taylor |
| author_facet | Stephanie Topp Josslyn Tully Rachel Cummins Veronica Graham Aryati Yashadhana Lana Elliott Sean Taylor |
| author_sort | Stephanie Topp |
| collection | DOAJ |
| description | Background In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs, this study aimed to explore whether the governance of the A&TSIHW role supports full and meaningful participation.Methods The qualitative study was co-designed by a team of Aboriginal, Torres Strait Islander and non-Indigenous collaborators. Data collection comprised document review and interviews with A&TSIHWs (n = 51), clinicians (n = 19) community members (n = 8) and administrators (n = 5) in a north Queensland health district. We analysed governance at multiple levels (regulatory, organisational, and socio-cultural) and used critical race theory to deepen exploration of the role of race and racism in shaping it.Results Governance of the A&TSIHW role occurs within a health system where racism is built into, and amplified by, formal and informal rules at all levels. Racially discriminatory structures such as the previous but long-standing relegation of A&TSIHW into the same career stream as cleaners were mirrored in discriminatory rules and managerial practices such as an absence of career-specific corporate support and limited opportunities to participate in, or represent to, key leadership groups. These interacted with and helped perpetuate workplace norms permissive of disrespect and abuse by non-Indigenous professionals. Ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs speaks to the gap between rhetoric and reality of governance for A&TSIHWs.Conclusion Strengthening governance to support A&TSIHWs requires critical attention be given to the role of race and racism in regulatory structures, organisational practice, and inter-professional relationships. Addressing all domains will be essential to achieve systemic change that recognises, supports and embeds the unique knowledge, skills and functions of the A&TSIHW role. |
| first_indexed | 2024-04-10T05:27:44Z |
| format | Article |
| id | doaj.art-38a2f0dea1494b618aca28859dc62eea |
| institution | Directory Open Access Journal |
| issn | 2322-5939 |
| language | English |
| last_indexed | 2024-04-10T05:27:44Z |
| publishDate | 2022-12-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-38a2f0dea1494b618aca28859dc62eea2023-03-07T09:12:01ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392022-12-0111122951296310.34172/ijhpm.2022.67504256Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in AustraliaStephanie Topp0Josslyn Tully1Rachel Cummins2Veronica Graham3Aryati Yashadhana4Lana Elliott5Sean Taylor6College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, AustraliaTorres and Cape Hospital and Health Services (TCHSS), Cairns, QLD, AustraliaCollege of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, AustraliaCollege of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, AustraliaCentre for Primary Health Care & Equity, University of New South Wales, Sydney, NSW, AustraliaSchool of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, AustraliaNT Health, Darwin, NT, AustraliaBackground In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs, this study aimed to explore whether the governance of the A&TSIHW role supports full and meaningful participation.Methods The qualitative study was co-designed by a team of Aboriginal, Torres Strait Islander and non-Indigenous collaborators. Data collection comprised document review and interviews with A&TSIHWs (n = 51), clinicians (n = 19) community members (n = 8) and administrators (n = 5) in a north Queensland health district. We analysed governance at multiple levels (regulatory, organisational, and socio-cultural) and used critical race theory to deepen exploration of the role of race and racism in shaping it.Results Governance of the A&TSIHW role occurs within a health system where racism is built into, and amplified by, formal and informal rules at all levels. Racially discriminatory structures such as the previous but long-standing relegation of A&TSIHW into the same career stream as cleaners were mirrored in discriminatory rules and managerial practices such as an absence of career-specific corporate support and limited opportunities to participate in, or represent to, key leadership groups. These interacted with and helped perpetuate workplace norms permissive of disrespect and abuse by non-Indigenous professionals. Ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs speaks to the gap between rhetoric and reality of governance for A&TSIHWs.Conclusion Strengthening governance to support A&TSIHWs requires critical attention be given to the role of race and racism in regulatory structures, organisational practice, and inter-professional relationships. Addressing all domains will be essential to achieve systemic change that recognises, supports and embeds the unique knowledge, skills and functions of the A&TSIHW role.https://www.ijhpm.com/article_4256_626db3378687bbf2293310c771a8724d.pdfindigenousgovernancecommunity health workersaustraliahealth workforce |
| spellingShingle | Stephanie Topp Josslyn Tully Rachel Cummins Veronica Graham Aryati Yashadhana Lana Elliott Sean Taylor Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia International Journal of Health Policy and Management indigenous governance community health workers australia health workforce |
| title | Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia |
| title_full | Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia |
| title_fullStr | Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia |
| title_full_unstemmed | Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia |
| title_short | Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia |
| title_sort | rhetoric reality and racism the governance of aboriginal and torres strait islander health workers in a state government health service in australia |
| topic | indigenous governance community health workers australia health workforce |
| url | https://www.ijhpm.com/article_4256_626db3378687bbf2293310c771a8724d.pdf |
| work_keys_str_mv | AT stephanietopp rhetoricrealityandracismthegovernanceofaboriginalandtorresstraitislanderhealthworkersinastategovernmenthealthserviceinaustralia AT josslyntully rhetoricrealityandracismthegovernanceofaboriginalandtorresstraitislanderhealthworkersinastategovernmenthealthserviceinaustralia AT rachelcummins rhetoricrealityandracismthegovernanceofaboriginalandtorresstraitislanderhealthworkersinastategovernmenthealthserviceinaustralia AT veronicagraham rhetoricrealityandracismthegovernanceofaboriginalandtorresstraitislanderhealthworkersinastategovernmenthealthserviceinaustralia AT aryatiyashadhana rhetoricrealityandracismthegovernanceofaboriginalandtorresstraitislanderhealthworkersinastategovernmenthealthserviceinaustralia AT lanaelliott rhetoricrealityandracismthegovernanceofaboriginalandtorresstraitislanderhealthworkersinastategovernmenthealthserviceinaustralia AT seantaylor rhetoricrealityandracismthegovernanceofaboriginalandtorresstraitislanderhealthworkersinastategovernmenthealthserviceinaustralia |