White Australia: How white healthcare has affected Indigenous Australians

Brittany Suann
Western Australia

 

Littered, dry landscape with broken-down cars next to a single-level house
Rural Australia. Photo by author.

Australian healthcare is among the best, and Australia boasts the eighth lowest mortality rates in the world.1 For Indigenous Australians, however, health outcomes are 2.3 times worse than for non-Indigenous Australians.1 This gap is stark and is evident in mortality rates, the life expectancy at birth being 69.7 years for Indigenous women and 65.6 years for Indigenous men, compared to 85.1 years for non-Indigenous women and 81.0 years for non-Indigenous men.2 Exploring this imbalance requires a reflection on Australia’s history and the lasting impact of colonialism.

After British colonisation in 1788, the Indigenous Australian population dropped dramatically from 750,000 to 93,000 by 1900 due to massacres, the introduction of new diseases, dispossession of land, sterilisation of women, forced child removals (Stolen Generation), and assimilation policies.3 Since colonialism, Indigenous health outcomes have been starkly below national averages, with poor health outcomes, particularly in rural and remote Australia, where 65% of Indigenous Australians live.4

A significant barrier to closing the gap between Indigenous and non-Indigenous health outcomes has been the health authorities’ lack of consultation with Indigenous communities on health matters. Lack of involvement of Indigenous people in Indigenous affairs is historical and permeates through both politics and healthcare. As a stark example, the first Indigenous person elected to the role of Minister for Indigenous Australians was Hon Kenneth Wyatt in 2019, 51 years after the position was created in 1968.

And yet, Indigenous Australians have a beautiful, holistic health philosophy that could greatly benefit all people if listened to. Where most non-Indigenous Australians view their health as a single entity—a state of being well or unwell—Indigenous people view health as a summation of physical, emotional, social, spiritual, cultural, and community wellness. Furthermore, Indigenous uses of bush medicine, healing songs, and traditional healing, which were the primary sources of healthcare prior to colonisation, are often overlooked by white healthcare and are at risk of being lost through loss of storytelling.5

Although vast swathes of money have been spent on Indigenous health initiatives, a 2012 Indigenous Expenditure report by the Australian Productivity Commission detailed $3.1 billion dollar expenditure on Indigenous health during 2010-2011, being spent at a ratio of 4.89:1 ($3152 per Indigenous Australian to $644 per non-Indigenous Australian).6 Despite this, Indigenous health outcomes have only improved by 10% between 2006–2018, which is the same rate as that for non-Indigenous Australians; therefore, no gap has been closed.2 Clearly, money is not the solution to every problem, and beyond the capacity of money lie entrenched social constructs and barriers to improving Indigenous health outcomes.

One must also remember that Indigenous Australians have a deeply personal relationship to country and get strength from being in community. How scary, then, it must be to be transported from remote villages to metropolitan hospitals, being confronted with illness and a world of white walls, white coats, and white people. The lack of social translation we provide in this transition contributes to one of the world’s highest discharges against medical advice (DAMA) rates at 3.9 percent, over five times higher than that of non-Indigenous DAMA rates.7 Staying in hospital may also mean missing a funeral or Men’s business, which has ramifications in Indigenous communities that have been largely under-appreciated. An understanding of culture and culturally safe practices will give rise to improved healthcare systems for Indigenous peoples.7

The best examples of Indigenous health care I have witnessed while studying for my medical degree have been under the guidance of Aboriginal Liaison Officers and Aboriginal Health Workers who work with doctors to provide both social and language translation for Indigenous Australian patients. Their role is to coordinate the emotional, cultural, and community health needs of a patient whilst they receive high quality healthcare, to help improve their long-term health outcomes.8 This style of healthcare has been shown to have significantly improved local health outcomes.9

Another barrier to improving Indigenous health outcomes is the challenge of overcoming years of generational trauma which ravage communities. After years of abhorrible treatment of Indigenous peoples by Australian authorities, there has developed a pervasive generational mistrust of White Australia, with survivors of the Stolen Generation remembering well the impact of being taken away from their communities by the Health Department. Trauma begets abuse, and rates of alcohol and drug use was recorded at 1.4 times higher amongst Indigenous Australians than non-Indigenous Australians.10 These cycles of emotional trauma and addiction patterns work against the important spiritual and cultural healing necessary for improved physical health outcomes.

Improving health outcomes for Indigenous peoples has to include direct consultation with Indigenous community. Asking the white man’s Australia to solve the Indigenous health crisis without consultation with Indigenous peoples does not work. National health strategies have been implemented to improve long-term health outcomes, but evidence continues to suggest those strategies that work best do so by listening to the people who need them the most.

 

End notes

  1. “Aboriginal and Torres Strait Islander Health Performance Framework – Summary report 2020,” Indigenous Health Performance Framework, Australian Institute of Health and Welfare, December 8, 2020, https://indigenoushpf.gov.au/publications/hpf-summary-2020.
  2. “Closing The Gap Report,” Life Expectancy | Closing the Gap, Australian Government, 2020, https://ctgreport.niaa.gov.au/life-expectancy.
  3. “Eight Facts about Indigenous People in Australia,” Amnesty International, Amnesty International Australia, January 16, 2019, https://amnesty.org.au/eight-facts-about-indigenous-people-in-australia/?cn=trd&mc=click&pli=23501504&PluID=0&ord=.
  4. Yuejen. Zhao et al. “Improved Life Expectancy for Indigenous and Non‐Indigenous People in the Northern Territory, 1999–2018: Overall and by Underlying Cause of Death,” Medical Journal of Australia 217, no. 1 (2022): 30-35, doi: 10.5694/mja2.51553.
  5. Oliver, Stefanie J. “The Role of Traditional Medicine Practice in Primary Health Care Within Aboriginal Australia: A Review of the Literature,” Journal of Ethnobiology and Ethnomedicine 9, no. 1 (2013): 46, doi:10.1186/1746-4269-9-46.
  6. “2012 Indigenous Expenditure Report: Overview,” Productivity Commission. September 2012. https://pc.gov.au/ongoing/indigenous-expenditure-report/2012/ier-2012-overview.pdf.
  7. “Cultural Safety in Health Care for Indigenous Australians: Monitoring Framework,” Australian Institute of Health and Welfare, Australian Government, June 29, 2022, https://aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/summary.
  8. “Patient Perspectives – Hospital Care for Aboriginal People,” Bureau of Health Information, August 2016, https://bhi.nsw.gov.au/__data/assets/pdf_file/0010/323929/patient-perspectives-hospital-care-for-aboriginal-people-report-2016.pdf.
  9. Yvonne Dimitropoulos et al. “Outcomes of a co-designed, community-led oral health promotion program for Aboriginal children in rural and remote communities in New South Wales, Australia,” Community Dental Health 37, no. 2 (2020): 132-137, doi: 10.1922/CDH_00005Dimitropoulos06.
  10. “Alcohol, Tobacco & Other Drugs in Australia,” Australian Institute of Health and Welfare, July 25, 2019, https://aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/aboriginal-and-torres-strait-islander-people.

 

Bibliography

  • “2012 Indigenous Expenditure Report: Overview.” Productivity Commission. September 2012. https://www.pc.gov.au/ongoing/indigenous-expenditure-report/2012/ier-2012-overview.pdf.
  • “Aboriginal and Torres Strait Islander Health Performance Framework – Summary report 2020.” Indigenous Health Performance Framework. Australian Institute of Health and Welfare, December 8, 2020, https://www.indigenoushpf.gov.au/publications/hpf-summary-2020.
  • “Alcohol, Tobacco & Other Drugs in Australia.” Australian Institute of Health and Welfare, July 25, 2019. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/aboriginal-and-torres-strait-islander-people.
  • “Closing The Gap Report.” Life Expectancy | Closing the Gap. Australian Government, 2020. https://ctgreport.niaa.gov.au/life-expectancy.
  • “Cultural Safety in Health Care for Indigenous Australians: Monitoring Framework.” Australian Institute of Health and Welfare. Australian Government, June 29, 2022. https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/summary.
  • Dimitropoulos, Yvonne, Alexander Holden, Kylie Gwynne, Loc Do, Roy Byun and Woosung Sohn. “Outcomes of a co-designed, community-led oral health promotion program for Aboriginal children in rural and remote communities in New South Wales, Australia.” Community Dental Health 37, no. 2 (2020): 132-137. doi: 10.1922/CDH_00005Dimitropoulos06.
  • “Eight Facts about Indigenous People in Australia.” Amnesty International. Amnesty International Australia, January 16, 2019. https://www.amnesty.org.au/eight-facts-about-indigenous-people-in-australia/?cn=trd&mc=click&pli=23501504&PluID=0&ord=.
  • Oliver, Stefanie J. “The Role of Traditional Medicine Practice in Primary Health Care Within Aboriginal Australia: A Review of the Literature.” Journal of Ethnobiology and Ethnomedicine 9, no. 1 (2013): 46–46. doi: 10.1186/1746-4269-9-46.
  • “Patient Perspectives – Hospital Care for Aboriginal People.” Bureau of Health Information, August 2016. https://www.bhi.nsw.gov.au/__data/assets/pdf_file/0010/323929/patient-perspectives-hospital-care-for-aboriginal-people-report-2016.pdf.
  • Zhao, Yuejen, Shu Qin Li, Tom Wilson, and C. Paul Burgess. “Improved Life Expectancy for Indigenous and Non‐Indigenous People in the Northern Territory, 1999–2018: Overall and by Underlying Cause of Death.” Medical Journal of Australia 217, no. 1 (2022): 30-35, doi: 10.5694/mja2.51553.

 


 

BRITT SUANN is a final year medical student from the University of Western Australia. She is passionate about health equity issues and the importance of providing culturally safe healthcare and enjoys writing in her spare time.

 

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