Introduction by Croakey: A new report highlights the importance of funding and policy support for decolonising practice by Aboriginal and Torres Strait Islander primary healthcare services.
Its recommendations include that policies and funding models need to respect and support Aboriginal and Torres Strait Islander ways of knowing, being, and doing and facilitate strengths-based approaches.
It also highlights the need for policy to support the recruitment, retention, and professional development of Aboriginal and Torres Strait Islander primary healthcare practitioners and managers, as “decolonising practice can only be founded on a strong Aboriginal and Torres Strait Islander workforce”.
The article below is by Associate Professor Tamara Mackean and Associate Professor Toby Freeman, on behalf of the Decolonising Practice research team. Please note the declaration of Croakey Professional Services involvement.
Tamara Mackean and Toby Freeman write:
The ‘no’ result of the referendum on an Aboriginal Voice to Parliament in 2023 showed how far Australia is from coming to terms with its colonial legacy, and understanding the need for self-determination for Aboriginal and Torres Strait Islander peoples.
Across Australia, governments are faltering in their steps towards truth telling, healing, and recognition of Aboriginal and Torres Strait Islander sovereignty.
In Queensland, the newly elected government has repealed the Path to Treaty Act and cancelled the Truth Telling and Healing Inquiry. In the Northern Territory, the treaty process has been recently dismantled.
Voices and action for Aboriginal and Torres Strait Islander sovereign resistance are crucial now more than ever.
A new report from a team of researchers led by Stretton Health Equity, The University of Adelaide, and The Aboriginal and Torres Strait Islander Public Health Research Team, Flinders University, indicates how the Aboriginal and Torres Strait Islander primary healthcare sector contributes to this sovereign resistance, through decolonising practices that support the voice, agency, and health of their communities.
Colonisation in Australia is built as a structure of systemic racism and contributes to major effects on the health and wellbeing of Aboriginal and Torres Strait Islander peoples.
The mainstream healthcare system has consistently failed to meet the needs of Aboriginal and Torres Strait Islander peoples or treat them with dignity and respect.
Instead, it has perpetuated the harms of ongoing colonisation through racism, poor access and quality of care for Aboriginal and Torres Strait islander peoples, and undermining Aboriginal and Torres Strait Islander knowledges and conceptions of health.
Decolonising healthcare practices are the ways of working that unpack colonial approaches to health, so Aboriginal and Torres Strait Islander peoples can not only survive but thrive.
This means transforming the policies, processes and practices that influenced health in the past, and which are still present today.
Decolonising practice:
- is led by Aboriginal and Torres Strait Islander ways of knowing, being and doing
- breaks down systemic racism
- challenges the power imbalances in all structures formed by society
- acknowledges and addresses white privilege
- is strengths-based.
The Decolonising Practice in Aboriginal and Torres Strait Islander Primary Health Care Project report summarises the key findings from the seven-year research project funded by the National Health and Medical Research Council.
It provides detailed evidence for the importance of decolonising practice and how primary healthcare services, particularly Aboriginal Community Controlled Health Organisations, take these principles – such as pushback against harmful government practices, provision of culturally safe care, Aboriginal and Torres Strait Islander leadership, and centring culture, community, Country, and Aboriginal and Torres Strait Islander ways of knowing, being, and doing – and put them into practice on the ground.
In this way, properly resourced and preferably community controlled Aboriginal and Torres Strait Islander primary healthcare services offer real transformation of power relationships and social and cultural determinants of Aboriginal and Torres Strait Islander health, rather than only treating the Aboriginal and Torres Strait Islander burden of ill health that has resulted from colonisation.
Policy recommendations we have identified based on our findings include:
- Ensure Aboriginal and Torres Strait Islander primary healthcare decolonising ways of working are protected and sustained by the policy environment
- Continue to grow and resource the Aboriginal community controlled sector
- Funding models for Aboriginal and Torres Strait Islander primary healthcare should be flexible enough to respond to local community needs, allow community participation in decision making, and enable resources to be spent on healing strategies outside of individual health care.
- Policies and funding models need to respect and support Aboriginal and Torres Strait Islander ways of knowing, being, and doing and facilitate strengths-based approaches
- Decolonising practice can only be founded on a strong Aboriginal and Torres Strait Islander workforce, and policy needs to support the recruitment, retention, and professional development of Aboriginal and Torres Strait Islander primary healthcare practitioners and managers. This includes support for skill development around advocacy, interagency working, and community engagement skills.
The research was conducted through partnership with Aboriginal and non-Indigenous researchers, and five Aboriginal primary healthcare services across Australia, both community controlled and state managed services.
We interviewed and ran workshops with service staff, board members, community members, peak bodies, and policy actors to understand in depth the context of each service partner and the broader policy environment. Analysis, interpretation, and write up was led by the Aboriginal research team.
The team worked with Croakey Health Media, who contracted journalist Jade Bradford (Ballardong Noongar) and artist Jarnda Bina Councillor-Barns (Karrajarri, Nuggaja, Noongar, Maori) to develop the report.
Providing a free, accessible report of the research findings was seen as crucial for reciprocity for the Aboriginal and Torres Strait Islander primary healthcare sector, and to support dissemination of the findings and celebrate the strengths of the ways of working of these services. The research team would like to express their gratitude to Croakey Health Media, Jade Bradford, and Jarnda Bina Councillor-Barns for this collaboration.
Declaration from Croakey Health Media: Our non-editorial arm, Croakey Professional Services, contributed to this report. We are grateful for the opportunity, and also acknowledge that this work helps to support the sustainability of our wider public interest journalism activities.
