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This article was first published on Friday, December 13, 2024
Introduction by Croakey: The power of collective leadership, the need to address racism and other structural drives of inequalities, and the importance of courage and persistence in driving change were among topics covered in an illuminating and wide-ranging discussion on leadership for health equity at a #CroakeyLIVE webinar this week.
Panelists were:
- Hayley Longbottom, a Jerrinja, Cullunghutti, Wandi Wandandian woman and Melanie Briggs, descendant of the Gumbaynggirr and Dharawal peoples, both from Waminda
- Dr Elizabeth Deveny, CEO of the Consumers Health Forum of Australia
- Karl Briscoe, a Kuku Yalanji man who is CEO of the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP) and co-chair of the Close the Gap Campaign
- Adjunct Associate Professor Learne Durrington, CEO of the WA Primary Health Alliance, which sponsored the event.
Marie McInerney writes:
A leading Aboriginal women’s health organisation operating on the New South Wales south coast is not only transforming models of care, including through its landmark Birthing on Country program, but also through its collective models of leadership.
The Waminda South Coast Women’s Health and Welfare Aboriginal Corporation, which recently celebrated its 40th anniversary, has long been a story of strong women, strong community and strong culture, with a determined focus on the social and cultural determinants of health, and a “no wrong door” approach, all led with a decolonising lens.
After years of negotiating funding and regulatory barriers, it recently won funding of $45.5 million for its planned Gudjaga Gunyahlamai Birth Centre and Community Hub in Nowra, which will support culturally safe holistic maternity care for Aboriginal women and their families and become Australia’s first Aboriginal owned and midwifery-led free-standing birth centre.
Earlier this year, after the departure of former CEO Faye Worner, who had presided for more than 17 years in the role, Waminda appointed a Chief Executive Leadership Team, comprising four women — Cleone Wellington, Kristine Falzon, Lisa Wellington and Hayley Longbottom.
While the collective team is a new structure for Waminda, it’s not a new approach, rather it is one that Worner also promoted and that continues to reflect Indigenous ways of knowing, being and doing, Longbottom told this week’s #CroakeyLIVE webinar on #HealthEquityHeroes.
“Collective leadership’s always been the way that we’ve done things here at Waminda,” she said.
It’s also what nourishes Longbottom, a Jerrinja, Cullunghutti, Wandi Wandandian woman, in her work, particularly in managing “the heaviness” that Aboriginal and Torrres Strait Islander communities have to face from the ongoing impacts of colonisation.
The collective leadership “makes it a little bit lighter for us” to carry the work, she said.
Looking at leadership
The #CroakeyLIVE webinar, which you can watch in full here, was hosted by the Western Australia Primary Health Alliance as part of a series of events to mark Medicare’s 40th anniversary.
It heard from Indigenous and non-Indigenous panelists on their leadership perspectives and experiences in addressing health inequities, in a discussion which touched on lived experience, responsibilities and accountability towards generations past and future, disruption, productive conflict and the role for rage and other strong emotions as powerful motivators of change.
Discussions particularly focused on the example that Aboriginal community controlled health organisations (ACCHOs) provide for the broader health sector in holistic action on health.
“If you get it right for Aboriginal and Torres Strait Islander people, you get it right for everyone,” Longbottom said.
Her comment was echoed by Karl Briscoe, CEO of the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP), who said that Aboriginal and Torres Strait Islander-led efforts to eliminate racism from health services will benefit other cultural groups too.
Panel members also reflected on what nourished them in their often demanding roles, with Briscoe saying he took strength from small steps forward in addressing racism.
Leading with purpose
Moderating the discussion, Dr Tim Senior, GP and a contributing editor at Croakey, observed that Waminda’s leadership model stands in contrast to stereotypical individual, hierarchical models of leadership that are espoused not just in the corporate sector but across bureaucracies, tertiary institutions, and health and social sectors.
“I think we listen to the wrong people when we talk about leadership,” Senior said, adding that “the difference between what LinkedIn thinks is leadership and what everyone working in health equity thinks strikes me as quite profound”.
Melanie Briggs, a descendant of the Gumbaynggirr and Dharawal peoples, who is a senior midwife and Birthing on Country project manager at Waminda, said the organisation’s leadership was so special because those who lead do so with purpose and with the backing of community and Elders.
“Because there’s no one way to deal with things, especially in community, and we’ll all share our experiences and our knowledges and work together collectively to make decisions,” she said.
The whole organisation “is such a great leadership model”, she added.
Briggs talked about the power of “a group of women standing side by side with one another every day” and the importance of Aboriginal led and designed programs “that keep us safe”, standing up against institutions and racism that seek to impose control on communities and their ways.
Those programs include the Nabu family preservation and restoration program, which, through wrap-around care, “stops our babies from being removed, stops families being torn about”, she said.
Waminda also worked with the New South Wales Ministry of Health to change legislation requiring birth centres to have a medical officer onsite 24/7 and negotiated with its local health district to become the first ACCHO in Australia to employ midwives who are credentialed at a public hospital.
Those shifts took many years, many business cases, many different risk assessments, and many reports, she said.
“But we stuck at it and we’ve done it and it’s a prime example of where this whole country is going to benefit from that. Absolutely there’s ways of changing things and if we do it collectively, then we will.”
As well as listening to and taking direction from Elders and a Board, Waminda is also setting up a new Youth Governance Committee, to hear from those who are “going to be our next generation”, Longbottom said.
“We believe that everybody is a leader in their own right and that, with the supports and the opportunities, then they’ll thrive,” she said.
Asked if that understanding was crucial for health equity, she said: “100 percent”, explaining that Wamina’s social impact for people, families and communities is “next level”.
As well as growing its workforce and including more Aboriginal midwives and health practitioners, Waminda has launched initiatives like Black Cede, a social and cultural enterprise led by Aboriginal women, which cultivates traditional bush foods from a community garden for a café and online store.
Its wider purpose is to provide “scaffolding” that spans health, wellbeing, and employment and housing.
Crossing the boxes
Longbottom’s belief that everyone is or can be a leader resonated with fellow panelist Dr Elizabeth Deveny, CEO of the Consumers Forum of Australia.
“I was taught the opposite of that,” she told the webinar, sharing raw insights about her own life and journey to leadership, having grown up with a father who was “not what you call a loving father” and who made it “very clear early in my life that women had no role in leadership”.
“Very strongly I was led to believe that women were bad, couldn’t do anything well, and certainly should keep their heads down,” she said.
Up until the last decade or so, Deveny would have avoided any claim to leadership at all, “because I would have thought I was too big for my boots [to be] saying anything like that, and that it could actually be dangerous as a woman to declare that you have power or wanted to lead.”
Her journey of change came through the values and culture espoused in particular organisations, being frustrated by poor management practices or unfair treatment of employees but thinking there wasn’t much she could do about it.
That was until she took on a leadership role and realised there was an upside to the extra responsibility and work. That was to be able to say ‘no we don’t do this here’, ‘let’s behave like this here’, ‘if you want to work here, we’re not going to do that’.
“I thought, wow, that actually I could make this a place I wanted to work,” she said, describing her sense of leadership as being “vocational”, wanting to be a good boss and to provide a safe and supportive environment.
Deveny has now come full circle, she said, “from a place where no one would have said that to me ‘everyone is a leader in their own right’. I do think it’s absolutely right everyone can do that, and that’s what I would say now in my organisation: everyone can lead, and everyone should lead.”
Deveny said she didn’t believe in imposter syndrome, which she regards as a social construct – rather she wants it to be okay to “not be the usual person” for the role. She acknowledged that she brings some privilege to her position, but “there are a lot of things about my story …[that are] not about privilege”.
She never felt she had the background for leadership roles that others assumed – “they always struck me that they tick boxes that I have crosses in”, but agrees with the adage that ‘you can’t be what you can’t see’.
Courage and daring
Deveny also talked about the role of rage, how it had powered the establishment of CHF in the 1980s, in the wake of the AIDS crisis.
“People were very angry because people were dying everywhere and governments weren’t taking it seriously enough,” she said. “That community managed to use that rage in a way that led to real change,” she said, referring to the emerging role of consumers in health and research.
As long as rage is justified, and is not violent, it can be an “important tool if you want to shift things,” she said.
Noting that one of CHF’s organisational values is ‘daring’, she said the organisation wants “to be courageous, and that sometimes will mean that we’ll also be angry about things”.
“We talk about being unapologetic. I think that those are spaces we all should be okay to claim, not just the polite and ‘thanks so much’ spaces and yes, the collaborative leadership. There’s a million ways to do it right, but I think that rage is okay to be one of our tools.”
Agreeing with Longbottom and Briggs that “you can’t have health equity while you’ve got rampant racism”, Deveny highlighted the importance of structural change and courageous action.
“We’re not going to do things to improve the health and wellbeing of Australians who get most disadvantaged by just offering them a free GP appointment,” she said.
Health leaders therefore need to be willing to speak out more broadly – “not just stick to their knitting area” – to tackle bigger structural equity issues. “I think we have an obligation to do that,” she said. (Also see her recent Croakey article on this).
Making progress
Speaking about progress, Karl Briscoe highlighted the work of the Australian Health Practitioner Regulation Agency (Ahpra), in partnership with the then National Health Leadership Forum (now known as the National Indigenous Health Leadership Alliance or NIHLA), to embed cultural safety in the Health Practitioner Regulation National Law in 2017.
While there was much work yet to be done, this reform had achieved much within a short space of time, he said, including resulting last year in a doctor being suspended for 12 months for “discriminatory and offensive behaviour” towards an Indigenous ophthalmologist.
“Those small steps do have major impacts in the health and wellbeing of Aboriginal and Torres Strait Islander people,” he said.
Briscoe also highlighted the work of Ngiyampaa/Wongaibon epidemiologist Professor Ray Lovett on culture as a protective factor in Aboriginal and Torres Strait Islander health, as well as the strengths-based work of the Close the Gap Campaign, which Briscoe co-chairs.
The campaign uses its annual reports to highlight programs and initiatives that are working in communities. This has led, for example, to increased funding for Indigenous rangers, he said.
Speaking also about being a grandfather, Brisco said that “at the end of the day, we’re all here to make a change to make it better for the next generation”.
Aboriginal and Torres Strait Islander people “don’t want the next generation to go through what we’ve been through”, he said.
That commitment to future generations was what struck Adjunct Associate Professor Learne Durrington, CEO of the WA Primary Health Alliance, in reflecting on the webinar themes, which she described as highlighting the importance of “passion, persistence and purpose” in leadership.
Durrington, who reflected on her own leadership in this previous Croakey article, welcomed the discussion about collective leadership – “because none of us can do it all” – and the importance of having strong values as a touchpoint in the “complex and tricky environments that we work in”.
She expressed personal frustration at the failure to address family violence in Australia, despite decades of work and her own hopes, working in the field in the 1980s, that change was coming, echoing Deveny in saying “we’ve got to be courageous” about speaking out.
“I really get it can be unrelenting, but if we don’t do it, nothing will happen,” Durrington said.
Systems and subversion
Senior also raised the role of subversion, talking about his recent Churchill Fellowship investigating GPs and primary care teams working in marginalised communities in the United Kingdom and Ireland. See the #ChurchillDeepEnd series.
It became apparent, he said, that GPs knew the health system didn’t work for them and their patients, but found ways of “subverting the systems they were working in, deliberately finding the holes in the system [and the ways] that will get around systems”.
Longbottom also acknowledged that systems are complex and change difficult, saying organisations like Waminda have to “fight and push back on that every single day”.
However, she said people talk too often about not being able to change “the system”, when in fact the system is made up of people.
She and Briggs urged allies to step up particularly to eliminate racism from health services, warning that the battle needs to start at the top, “calling out racism in Canberra”, so it can trickle down to legislation, policies and practices that look at Aboriginal and Torres Strait Islander people as a risk.
“How about we look at the system as a risk?” Briggs said.
Longbottom said it was not up to Aboriginal and Torres Strait Islander people to stop racism in this country, but up to the 97 percent who are “the occupants of this country”.
She urged allies who voted Yes in the Voice referendum to step up in addressing racism, to take their allyship not just to workplaces but in their homes and among family and to reflect on “how we got to a space where the oldest living culture in the world is the most disrespected culture in the world”.
“What is the history of where you come from? Because every single person in this country needs to know about this stuff,” she said. “That’s the truth telling that needs to happen in this country.”
• Read this live thread from the webinar via X/Twitter.
Watch on replay
See Croakey’s archive of articles from the #Medicare40Years series
