Cultural Safety And Institutional Racism In Australia: A Focus On Aboriginal And Torres Strait Islanders

Personal and Institutional Racism in Australia

According to Australian Government Report (2017), Australia has indigenous people practicing unique traditions, retaining cultural, social, political, and economic characteristics that distinguish them from the rest of the dominant societies they live in. Quite often, because of these characteristics, these groups are discriminated against. The first way is personal discrimination/ racism. Personal racism occurs an individual holds a discriminatory attitude/ belief or engages in discriminatory behavior towards a certain group of individuals. These actions are usually based on biases or stereotypes. For instance, a white man in an office demeaning people of color would be exercising personal racism.

Institutional racism, on the other hand, is a mode of racism that is usually expressed in the practices of social and political institutions (Marrie, 2017). It can be seen when there are disparities in factors such as wealth, employment, political power, and education affecting certain groups in a population. Of the two, personal racism is quite obvious and easily perceived compared to institutional racism. Foley (2013) denotes that when an institution fails or neglects to provide service to certain groups based on color, ethnic origin or other forms of stereotypes, it will have exercised institutional racism.

Whiteness has a hinge on the distribution of power according to race (Cunneen, Allison, and Schwartz, 2016). The concept of whiteness outlines that white people have been given many privileges by society because their race is considered superior. It is a system that privileges whites and disadvantages the ‘non-whites’. Whiteness establishes the belief that what is good for whites must be good for the rest of the people. That is, western culture is better and the other cultures are secondary to it; perhaps of little significance. The nursing practice in Australia is not without the fingerprints of whiteness in it. It is conspicuously highlighted by the fact that the majority of the registered nurses are white/ Caucasian. The non whites figure mostly as low paid aides, janitors and house keepers. The white privilege is also depicted by its ability to stipulate and validate rules and regulations of daily concourse and discourse. It generally has the power to dictate membership, knowledge and language of the whole nursing practice. Consequently, different standards of patient care are applied depending on race. 

Cultural Safety and Cultural Competency

Cultural safety and cultural competency are based on essential practices in ensuring cultural respect and effectiveness while working with Aboriginal and Torres Strait communities (Artuso, Cargo, Brown, & Daniel, 2013). These demand that practitioners possess cultural awareness, which is the knowledge and understanding of the existence of different cultural groups, including identification of own cultural values, practices and identity. Cultural safety, therefore, involves creation of an environment where a person from the Aboriginal and Torres Strait Island is treated well and in a respectful manner and are enabled to participate in changes made to services they experience as negative.

Whiteness in the Nursing Practice

Cultural competency on the other hand is the enactment of culturally respectful practices (Weiss & Wilkinson, 2018). It creates effective cross cultural relationships by employing proper behavior, attitude and policies. For the application of these two, practitioners are required to notice own cultural practices and individual behaviors and how they affect the Aboriginal and Torres Strait Island people. They are also required to act differently to their usual culturally preferred ways and continuously review and be open to feedback. To practice cultural competence, practitioners are required to actively pursue cultural encounters so as to sharpen their cultural skills knowledge and understanding. With continued practice of such, a culturally safe environment can be created and maintained.   

While analyzing information provided by Marrie (2017), I found out many issues that need to be considered on policy making and governance to cover the Aboriginal population. For instance, such a rich state as Australia with all its policies is up to now unable to handle sufficiently this issue of prejudice against the Aboriginal and Torres Strait Islander people. The question comes, is it a policy issue, lack of goodwill or an impossible matter to effectively handle? It’s shocking and quite unfortunate that such a rich heritage and culture of indigenous people would be undervalued and its people continuously looked down upon. After learning this, I have become a staunch supporter of a culturally safe environment. I intend to work to influence my surroundings and perhaps few others to set the ball rolling towards finding a workable solution to this crisis.

Australia’s Indigenous people suffered from the onset of British settlement. With the arrival of the British in the 1700’s, so came disease epidemics such as smallpox and measles that caused a significant population decline among the indigenous people of Australia Nelson, Hynes, Sharpe, Paradies, and Dunn (2018). Secondly, they were violently driven out of their land and water sources which brought about displacement and disorientation of communities. Some vanished without a trace. Whereas 2016 statistics indicated some slight improvements and growth in income, housing, education and population; the indigenous people remain to be significantly behind the rest of the population. The indigenous population is composed of Aboriginal people and Torres Strait Islanders who are situated in northern Queensland on the islands between Australia and Papua New Guinea. They are about 3% of Australia’s population. 

According to Kowal (2015), there exists an alarming inequality between the indigenous people and the general public. For instance, statistics for 2016 indicate that the average infant mortality rate for the general population was at 3.3% whereas that for indigenous population was at 6.1%! Unemployment rate for the general public was at 5.8% whereas for the indigenous population was at 20.8%. Also, the rate at which students are attending high school for the general public was at 79.3% and that of the indigenous people was at 49%.

Cultural Safety and Cultural Competency

From these statistics it can be clearly seen that a disparity exists. The prejudice against this indigenous population was present even in times past. Until the 1960’s, full blood aboriginals were excluded from the Australian population statistics in accordance to the Australian constitution (Tseen, 2018).  Prior to 1962, indigenous Australians were not allowed to vote also. This right was only extended to indigenous Australians who had served in armed forces in 1949. In terms of health, the indigenous people are also the most vulnerable compared to the general population. They are significantly affected by infectious diseases such as scabies. They have a higher suicide rate. In 2015, they had a double suicide rate compared to the general public! They also suffer high rates of hart disease. In the rural Aboriginal areas, due to the high food costs, Aboriginal people tend to go for nutritionally poor diets that are cheaper. Poor health then becomes the norm for the majority. Not only that, but also, the general standard of health and infrastructure in indigenous communities is lower compared to other Australians.

This relative socioeconomic disadvantage experienced by the indigenous people places them at a higher risk of exposure to behavioral and health risks. For instance, they have a higher rate of cigarette and alcohol consumption compared to the rest of Australians. Hence, higher rates of cancer and drug related illnesses (Suberta, 2013). At the 2001 census, the indigenous people had an employment rate of 20%. This – at that time – was three times higher than that of the non-indigenous group. Further more 97% of Aboriginal and Torres Strait Islander people have experienced racism, whereby two out of three individuals have had eight or more experiences of racism annually. Kowal (2015) denotes that with such statistics, it is certain that there is white privilege being exercised – perhaps in a subtle manner. It is hard to see why there is such a skewed distribution of disadvantages towards one group of people while the rest of the nation is okay – unless white privilege is at play.

Culturally safe practices act as a tool that affects both the patients from the Aboriginal and the institutions providing health care. This is because cultural safety is achieved through respect, recognition and nurture of the unique cultural identity of a patient (Harris and Jackson Pulver (2017). Culturally unsafe practice would diminish or demean the cultural identity and ultimately the well being of a person. Consequently, when a person from these cultures is demeaned by a care giver; they suffer, and so does the image of the care giver and the institution at large.

Disparities in Health, Education, and Employment

With a culturally safe environment, there shall be an improved health status of the Aboriginal and Torres Strait Island people. To the native Australians, access to decent health care will increase because of the continued trust, respect and inclusion. 

A culturally safe environment will also enhance the delivery of health services to the people (Davidson & Abbott (2017). A culturally safe workforce that is in good relationship with the people receiving the service will have easier flow of services. This can be seen in such a way that if a person feels unsafe about a service, they may not take full advantage of it and perhaps even influence a community at large.

The broadness of cultural safety as a concept makes it applicable in all areas such as employment, education and health (Buultjens, 2014). As a result, the practicing of such safety will create a general growth and quality of life of the indigenous population. This will become a move from having health care as a privilege to it being an equal right to all people. Such that there will be standardized health care infrastructure and practitioners where indigenous populations are located.

It’s a reported fact that cultural competence is key to ensuring that nurses create a culturally safe environment while providing health care to Aboriginals and Torres Strait Islander people (Dunn, 2018). In response, for there to be compassion and respect, it requires that the nurses consistently work to gain trust, confidence and mutual understanding. This is based on three key factors. One is Knowledge – nurses have to be informed, I included.

I have come to notice that nurses should endeavor to; firstly, understand the culture base of the Aboriginal and Torres Strait Islander people in their areas. For certain the cultures may vary with the different locations, and it would take determined interest to acquire knowledge on these groups. Having an awareness of cultures around a service area enables a nurse to quickly assess a patient’s medical needs. This can be related to the aboriginal populations of the world such as those in Canada. So, there should be some urgency by governments to implement related policies such as the UN Declaration on the Rights of Indigenous People. There are some cultures, for example, that bears on whether people seek medical attention in the first place, what type of help they seek and how much stigma is associated with certain sicknesses. So a nurse must be in a position to listen to the patient’s perception of the problem, explain, acknowledge the differences in perception and be able to recommend and negotiate a treatment plan. 

Importance of Cultural Competence

I have also observed that for nurses to serve as competent care givers, they need to understand the massive role that attitude plays. An understanding of basic features of a culture such as family hierarchy, spirituality, attitudes of patients and families will help the care giver identify and debunk stereotypes from other cultures. Encouraging diversity and cultural inclusion among co-workers, peers and patients will ensure that a care giver remains aware of the existing similarities and differences in cultures. Attitude attracts or repels; so it is important for care givers to use it wisely.

For further effectiveness, I see that it is necessary for nurses to develop a skill set that includes communication and conflict resolution. My understanding is now shaped in a way that key responses have to be informed with the right knowledge. Right knowledge will result into rightful course of action. With these, understanding and easy management of patients can be achieved. I am part of this course.

The struggle is still ongoing by the Aboriginal Australians to retain their ancient culture, to fight for recognition and restitution from the Australian government (Fitts & Soldatic, (2018). It is therefore important that I chip in any way that is possible to allow for a culturally safe environment. It is not acceptable that over half of Aboriginal and Torres Strait Islander people are experience psychological distress after being subjected to discrimination. It is not acceptable that just over half of indigenous people aged 15 – 64 were not employed in 2012-2013 (Weiss & Wilkinson, 2013). It requires that I actively participate in raising awareness of the disparity and obvious discrimination against the indigenous people. After acquiring this information, I am fully informed and no longer blind to this plight. This is the first step in the journey of a thousand miles. 

References

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Buultjens, J. (2014). Indigenous Entrepreneurship in Northern Nsw, Australia. Journal of Developmental Entrepreneurship, 17(3), 23-46.

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Kowal, E. (2015). Time, indigeneity and white anti-racism in Australia. Australian Journal of Anthropology, 26(1), 94–111. https://doi.org/10.1111/taja.12122

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