Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia

• DOI: 10.34172/ijhpm.2022.6750
• Publication Date: 2022-04-28T09:28:35Z
• Authors: Stephanie M. Topp; Josslyn Tully; Rachel Cummins; Veronica Graham; Aryati Yashadhana; Lana Elliott; Sean Taylor
• Keywords: Institutional racism

Background: In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams primary care professionals. Spurred by research documenting ongoing structural violence experienced Indigenous health providers more recent challenges to recruitment retention A&TSIHWs, this study aimed explore whether the governance A&TSIHW role supports full meaningful participation. Methods: The qualitative was co-designed a team Aboriginal, non-Indigenous collaborators. Data collection comprised document review interviews with A&TSIHWs (n=51), clinicians (n=19) community (n=8) administrators (n=5) in north Queensland district. We analysed at multiple levels (regulatory, organisational, socio-cultural) used critical race theory deepen exploration racism shaping it. Results: Governance occurs within system where is built into, amplified by, formal informal rules all levels. Racially discriminatory structures such as previous but long-standing relegation into same career stream cleaners were mirrored managerial practices an absence career-specific corporate support limited opportunities participate in, or represent to, key leadership groups. These interacted helped perpetuate workplace norms permissive disrespect abuse Ongoing resistance required of, demonstrated speaks gap between rhetoric reality for A&TSIHWs. Conclusion: Strengthening requires attention be given regulatory structures, organisational practice, inter-professional relationships. Addressing domains will essential achieve systemic change that recognises, embeds knowledge, skills functions role.