Issue 25 / 2 July 2012

RACISM towards Indigenous Australians has health consequences that should be targeted in medical education, according to a Perspective in the latest MJA. (1)

Professor Dennis McDermott, director of the Poche Centre for Indigenous Health and Well-Being at Flinders University, Adelaide, wrote that doctors needed a grounding in the health consequences of racism and an appreciation of widespread systemic discrimination.

“This includes understanding how the resultant inequitable access to services, patient non-compliance, ‘taking own leave’ from hospital and ineffective health promotion compromise Indigenous health outcomes”, wrote Professor McDermott, a Koori psychologist with more than 30 years experience in community health and Indigenous mental health and wellbeing.

Professor McDermott said the literature provided “solid evidence” that racism was a determinant and driver of health inequalities. “Racism is not only an everyday occurrence for many Indigenous Australians, but also one that gets under the skin, and ‘makes us sick’.”

He said an analysis of the health consequences of racism as part of medical education was made difficult because racist acts and systemic discrimination were not recognised.

“Whether the educational setting is a primary medical degree or further professional development, participants report bringing low levels of understanding of Indigenous issues with them. A new paradigm of learning must emerge”, Professor McDermott said.

He wants new frameworks of thinking to end the current “false dichotomy separating clinical competence from self-reflective practice”.

“Becoming a thinking, culturally safe practitioner is also the prerequisite for emerging as a clinically safe one.

“Developing new frameworks of thinking may require disassembling existing planks of belief: a transformative unlearning. Good cultural-safety education generates disquiet, but makes the uncomfortable comfortable enough, through sensitive classroom facilitation in a mutually respectful environment”, Professor McDermott said.

Most Australians had difficulty recognising the corrosive attitudes many Indigenous Australians reported. This was reflected in the “resurgence of bipartisan paternalism” which resulted in the reimposition of the NT “emergency response” for a further 10 years, Professor McDermott wrote. The Senate approved the 10-year extension of the intervention late last week. (2)

Associate Professor Elizabeth Chalmers, a director of General Practice Education and Training (GPET), said although more could always be done, racism was recognised in educating both GP registrars and in ongoing professional development.

Professor Chalmers, who works in the NT, said since GPET began in 2000, it had an Aboriginal and Torres Strait Islander reference group with a wide membership base, working closely with the National Aboriginal Community Controlled Health Organisation, to help regional training providers develop culturally appropriate programs.

Following an evaluation there is now a GPET board Aboriginal and Torres Strait Islander advisory group, which Professor Chalmers cochairs with Dr Tammy Kimpton from the Australian Indigenous Doctors’ Association, to provide expert and culturally sound advice about activities aimed at increasing the number of GP registrars training in community controlled and other Indigenous health services.

Professor Chalmers said the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine also actively encouraged education and training in Indigenous health. “Currently 98% of AGPT [Australian General Practice Training] registrars undergo a cultural awareness program”, she said.

Cultural training and access to mentors and elders helped to raise awareness of the issues facing Indigenous Australians.

However, Professor Chalmers acknowledged that racism was still sometimes encountered among GP registrars. “We do know of quite a few Aboriginal registrars who have had to deal with racism”, she said.

“We can’t take our eye off the ball”, Professor Chalmers said.

– Kath Ryan

1. MJA 2012; 197: 15
2. The Australian 2012; 29 June

Posted 2 July 2012

11 thoughts on “Call for action on racism consequences

  1. Teng Liaw says:

    It seems to me that the gap and priority in health/medical education and training is to address the “false dichotomy separating clinical competence from self-reflective practice”. The clinically and culturally competent health professional needs a culturally safe and secure health service in which to practice. In general practice, this means a reception, consulting and treatment environment that is safe for the Aboriginal and Torres Straits Islander person as well as for other culturally diverse groups who may have diffciluties with access to safe and effective health care. The comments in this article suggest that GPET and universities are ready participate in the translation of cultural awareness training and self-reflection into practice. Are we?

  2. Dr Horst Herb says:

    The commonly accepted definition of racism appears to be preferential treatment (or the opposite) of one population over another population based on ethnicity as only criteria.

    Singling out ATSI people among Australia’s ethnically diverse population is blatant racism by any generally accepted standard.

    Why can’t the bureaucrats and armchair ethicists not leave us alone and let us do what we do best – namely treating a patient as a patient, solely based on their medical presentation and needs, to the best of our capabilities.

    There are ethnic groups in Australia with much worse risk factors than ATSI people, and there is the one most important thing those armchair experts (who for some reason seem to be incapable of understanding statistics) invariably seem to forget: namely that individual variance exceeds ethnic variance.

    In plain English it means that just because an individual belongs to a certain group, it does not mean that this individual will always share the statistically more likely traits of that group. There will be individuals of non-ATSI background who will have a much higher INDIVIDUAL risk of getting diabetes, infections, alcoholism or whatever the statistical fad of the day is – and viceversa.

    To me as a doctor, a patient is a patient. I will not discriminate against any of my patients in favour or against just because they appear to belong or claim to belong to a certain ethnic background.

    Shame on Australian politicians and bureaucrats to perpetuate and aggravate the damage racism has done to this country by continuing it through their discriminating MBS and PBS subsidies!

  3. Michael Busby says:

    This article contained lots of big words, but not much substance. If you read it slowly and think about each word that has been chosen, it really doesn’t tell you anything. After reading it I am none the wiser. There wasn’t even a single example of racism given, and I have no idea what they are proposing to change.
    That’s not to say that racism doesn’t exist. Sure it does, but I think you’ll find there aren’t too many truly racist people, and few truly racist health care providers. Perhaps an inadequate understanding of different cultural values, sure, but that’s not racism.

  4. Max King says:

    I agree with Michael Busby – froth and bubble. Racism is a very important concept that has been progressively diluted e.g. AFL policy about childish insulting behaviour as racism.

    The frequent use of the term “racism” in the article was silly – similar to a child saying “f..k” to its mother – similar to calling someone a Hitler.

    If discrimination, ignorance, neglect are the problems then describe them so, but please don’t further abuse and devalue the concept of racism by using it for emotional blackmail.

  5. Sim says:

    Let us all face facts, that racism is alive and kicking in Australian way of life. Racism can be seen everywhere in shopping centres, schools, hospitals, restaurants and public places. Dr Horst and Michael Busby are trying to downplay the ugly presence of racism. It can only be seen by victims and not victors of racism. Racism is not only directed to ATSI people but anybody including professionals who look different from the mainstream.

    Evidence is there to tell the results of centuries of this discrimination both politically, economically, health and socially. Those who cannot see the tragedy must paint themselves with a brown or black colour and go shopping or to a public gathering to be aware of what a victim of racism faces everyday.

  6. Rose says:

    Racism is shown in public hospitals where “taking own leave “from hospital is encouraged by staff who make it so unpleasant for patients that they leave the day after their baby is born, with no Medicare enrolment for the baby, no birth certificate – check the statistics for your own area health service – no breastfeeding established, no Boostrix for the mother nor advice for the extended family. Surely a starting point in Aboriginal health would be with maternity services, to fund iron and folic acid supplements in antenatal patients, instead of midwives telling patients to buy them from the pharmacy, and to fund maternity units based on outcomes including having breastfeeding established prior to discharge.

  7. Anonymous says:

    At medical school, we are taught to interact differently with Indigenous Australians (by Indigenous health workers), presumably as some form of reverse discrimination. But the “racism” goes both ways, where we are referred to as “white” (despite half of the students being Asian) and held responsible for the NT intervention without knowledge of our political beliefs. What would be helpful is some constructive dialogue where practical tips for dealing with culturally sensitive issues is put forward. I am yet to see a compelling reason for stepping away from the egalitarian notion of treating all patients alike.

  8. Sue Ieraci says:

    I don’t think the authors are accusing each individual health practitioner of racism, but rather describing the entrenched societal racism that has led to poor health outcomes for indigenous people. Sim is right – many of us don’t perceive the racism experienced by others if it is not directed at us. I still cringe at the subtle put-downs I received as a child for looking non-Anglo – how much more powerful the generations-long severe negative influences on our indigenous people.

  9. another GP says:

    In not disciminating to those with more need, higher morbidity and mortality, from a specific popluation, you may be doing a clinical dis service and discriminating.

    The medical ethics we signed up for includes the prinicpal of Justice.

    Counter-intuitively some mention population groups which you say have worse stats that the atsi pop, but that we shouldn’t be looking at population groups anyway??

    The article is simply stating the well known facts about the physical manifestations of being subject to racism (not that the health professions are racist – but they need to understand and treat the consequences in patients who experience racism, such as measurable increases in BP, anxiety, anger, etc) just google social determinants and racism and you find find many clinical scientific publications that show the link including refs from johns hopkins. the natsis survey clearly shows the level of racism experienced by atsi people. have a good look at the phsyiology and pathology via the allostatic load (mcewen) and let’s think about the patients we care for more and our ideology less

  10. Aka says:

    Ignorance or skepticism of the effects of racism in the colour-blind approach such as Horst Herb and Michael Busby use does not absolve racism. By asserting that they treat all people the same, I can only assume that they take their own culture as the norm, for they fail to see that any other peoples may have different culture, knowledge, or life experiences/opportunities than they have. This notion that they can treat everyone the same is a one-size-fits-all, and as silly as insisting that all their patients must have a regular prostate exam – male and female.
    The colour-blind approach can incubate racism as its followers use their own culture and life experiences/opportunities as they make everyday decisions on their patients.
    Perhaps the answer to Teng Liaw is that combating racism is a work in progress – with a hell of a long way to go.

  11. Dr Horst Herb says:

    To Aka: colour blind approach??? Where did I say that I treat all patients “same”? I said I do treat patients on the base of their individual needs, regardless of their race, colour, religion, political affiliation or whatever.
    I worked in many cultures, from the tropics to the arctic, on 4 continents. I am fluent in 5 languages, and even speak two indigenous languages at basic conversational level, so I guess that prevents me to some degree of being “culturally unaware”. Perhaps my degree in anthropology an human genetics (done prior to medicine, LMU university of Munich 1985) helps a bit too in ethnic understanding.

    The (usually missed) point is that we are ALL individuals, with different needs and expectations. Just because you formally belong to one or another cultural or racial group does in no way infer that you share their common traits, even if those traits would be more prevalent in that group *on average*. Hence, as doctors who see *individual* patients, we must take into consideration those *individual* traits. In the community where I live, the few aboriginal people I see are middle class, well educated, and often professional. Some are not. Same as people of South American / Northern European / Mediterranean / Oriantal or Asian orgin – they all have their individual needs, and they all get looked after accordingly. There are some moslem women who don’t mind if I do their pap smear as a male doctor, and there are some agnostic “western” ones who do.

    Forget about stereotypes, ask people what they want and expect – and make a difference.

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