Rhetoric, reality and racism: the governance of Aboriginal and Torres Strait Islander Health Workers in a state government health service in Australia

Topp, Steph, Tully, Josslyn, Cummins, Rachel, Graham, Veronica, Yashadhana, Aryati, Elliott, Lana, and Taylor, Sean (2022) 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, 11 (12). pp. 2951-2963.

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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.

Item ID: 73681
Item Type: Article (Research - C1)
ISSN: 2322-5939
Keywords: Indigenous; Community Health Workers; Health Workforce; Human Resources for Health; Queensland
Copyright Information: © 2022 The Author(s); Published by Kerman University of Medical Sciences. This access article distributed under the terms of the Creative Commons Attrib ution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Date Deposited: 26 May 2022 23:42
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 40%
44 HUMAN SOCIETY > 4407 Policy and administration > 440708 Public administration @ 20%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450409 Aboriginal and Torres Strait Islander health services @ 40%
SEO Codes: 20 HEALTH > 2002 Evaluation of health and support services > 200206 Health system performance (incl. effectiveness of programs) @ 30%
21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210303 Aboriginal and Torres Strait Islander health system performance @ 40%
23 LAW, POLITICS AND COMMUNITY SERVICES > 2302 Government and politics > 230204 Public services policy advice and analysis @ 30%
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