AUSTRALIA’S health systems and routine practices are Eurocentric and can be discriminatory for Indigenous Australians.
Many might protest about this statement and argue that much reform has occurred in recent years, but statistics paint a different picture of the health and wellbeing status of Indigenous Australians.
These ethnocentric health service delivery models mean compromised care and poor health outcomes for Indigenous people, often linked to reduced access to services, less compliance with treatment and poorer treatment options.
Aboriginal community controlled health services were set up to counter the financial, cultural and social barriers to health care access and reduce experiences of racism in Australia’s health systems.
With only 140 services Australia-wide, their reach and capacity in meeting the needs of all Indigenous Australians is limited. Service balance is provided by mainstream health systems that generally do not account for Indigenous cultures or holistic notions of health.
Logic tells us that in service delivery to Indigenous Australians, what we are doing is not working well and that continuing with more of the same is futile. But how far are those involved in health systems prepared to move out of their comfort zones to ensure the right to equality in health care for Indigenous people in ways that meet their needs?
We must change the way we do business if we want to change health outcomes for Indigenous populations — this needs fundamental shifts that place their cultures and world views at the core of health systems.
Cultural competency — behaviours, attitudes and policies that come together to enable a system, agency or professional to work effectively in cross-cultural situations — is flagged as a key strategy for reducing inequalities in health care access and improving the quality and effectiveness of care for culturally and linguistically diverse groups.
However, in Australia there is an absence of cultural competency standards within legislation or policy, of a coherent approach for articulating the language around cultural competency, of inclusion and teaching of cultural competence, and a lack of national standards for the provision of culturally competent health services.
The Australian Institute of Health and Welfare issues paper on cultural competency, that we coauthored with Dr Anton Clifford and Professor Komla Tsey, found that that developing and embedding cultural competence in health services requires a sustained focus on knowledge, awareness, behaviour, skills and attitudes at all levels of service — at the operational or administrative service level, health practitioner level, practitioner–patient level and student-training level.
Cultural awareness alone is not enough. Our paper identified the five main approaches and strategies aimed at improving culturally competent health care delivery to Indigenous populations and making systems more responsive:
1) Reforming health service and systems to facilitate culturally competent health care delivery
2) Improving access to health care for Indigenous populations
3) Improving the cultural competence of the health workforce
4) Training and educating health care and medical students to be culturally competent practitioners
5) Developing culturally tailored health interventions to improve Indigenous groups’ access to health care interventions.
This highlights the need for multilevel strategies. Research on cultural competence is overwhelmingly descriptive, with few methodologically strong evaluation studies.
As well, from the initial level of influence, many higher education institutions that are responsible for educating future health professionals are neglecting their obligations to Indigenous Australians. Indigenous educators at Australian universities resent the institutional constraints placed on their endeavours to impart cultural competencies in their teaching — in the misguided belief that they make non-Indigenous Australians feel uncomfortable.
Australian efforts to increase levels of cultural competence have not kept pace with other colonised countries such as New Zealand and the US where such standards are enshrined in legislation.
Again, we must ask: how far are we willing to go?
Culturally competent service delivery models are not a cure-all for Indigenous health, but they do go some way to making important inroads towards responsive care.
Dr Roxanne Bainbridge is a Gungarri Aboriginal woman from South Western Queensland and a senior research fellow in The Cairns Institute at James Cook University. Dr Janya McCalman is also a senior research fellow in The Cairns Institute at James Cook University where they co-lead the Empowerment Research Program under the mentorship of Professor Komla Tsey.
Acknowledgments: We thank Dr Anton Clifford, School of Public Health at the University of Queensland, and Professor Komla Tsey, education for social sustainability, The Cairns Institute, James Cook University, for their contributions to this article.