"Learning about and respecting Aboriginal and Torres Strait Islander peoples culture is a lifelong journey. We are all at different stages of the journey and our paths may vary, but we should all arrive at the same place. A place of self-reflection, reconciliation and appreciation and respect for the worlds oldest living culture. When we arrive at that place we can then be culturally responsive and respectful in all we do. " - Vicki Wade, RHDAustralia Senior Cultural Advisor, 2018.
- Statement on Cultural Competence
Aboriginal and Torres Strait Islander peoples belong to the oldest living culture in the world dating back over 65,000 years. Prior to the arrival of Europeans there were around 600 different clan groups or 'nations' around the continent, each with distinctive cultures and beliefs.
Aboriginal and Torres Strait Islander peoples culture is complex and diverse; the system of kinship puts everybody in a specific relationship to each other, the water and land, based on their clan or kin. Their cultural heritage is kept alive by passing their knowledge, arts, rituals and performances from one generation to another, speaking and teaching languages, protecting cultural materials, sacred and significant sites and objects. Cultural heritage is seen as 'the total ways of living built up by a group of human beings, which is passed from one generation to the next', given to them by reason of their birth (1).
Language is important in understanding Aboriginal and Torres Strait Islander heritage, as much of their history was oral. Hundreds of languages and dialects existed (although many are now extinct), and language meaning, as well as geographic location, is used today to identify different groups. Furthermore, the link between culture and language in improving communication in Aboriginal and Torres Strait Islander health settings is a critical component of delivering cultural safety (2).
It is important that broader Australia acknowledges the unique culture of Aboriginal and Torres Strait Islander peoples. In order to be able to work effectively with Aboriginal and Torres Strait Islander communities, the richness, diversity and complexities of their culture need to be acknowledged and understood in a respectful and competent way. It is also necessary to acknowledge the impacts that colonisation has had, and continues to have on the health and wellbeing of Aboriginal and Torres Strait Islander peoples. Among the impacts are family disruption, cultural displacement and discrimination contributing to poverty, unemployment, homelessness and poor health. Many Aboriginal and Torres Strait Islander people today continue to experience discrimination and social disadvantage (3).
The National Aboriginal and Torres Strait Islander Social Survey (2014-2015) highlighted that one-third (33 per cent) of respondents felt they had been treated unfairly at least once in the previous 12 months because they were of Aboriginal or Torres Strait Islander origin. Although these statistics are not health-specific, these experiences can impact on access to health services with around one in seven (14 per cent) having avoided situations in the last 12 months due to being treated unfairly in the past (4). Unconscious or implicit bias from health workers is particularly detrimental and may perpetuate the inequities and poorer health outcomes experienced by Aboriginal and Torres Strait Islander peoples.
Racism and unconscious bias can be experienced at the individual level, as well as the institutional level through built-in operations and systems. There is opportunity to improve health outcomes for Aboriginal and Torres Strait Islander people by addressing this through education at both the individual and system level (5). Educating health professionals about unconscious bias and how a person’s culture, values and motivations influence their practice is essential for creating a culturally safe health system.
What is Cultural Safety?
There has been a lot of attention in Closing the Gap (CTG) in life expectancy between Aboriginal and Torres Strait Islander peoples and other Australians. However, it is unlikely that we will close the gap unless we look closely at what the major contributors to the gap are, including cultural and social determinants of health. Cultural safety of the health care system and racism are also important contributors that are often put in the ‘too hard basket’. Cultural competence has been broadly described as ‘the ability of systems, organizations, professions and individuals to work effectively in culturally diverse environments and situations’ (6). Cultural competence Is an important building block in clinical care and, while not a panacea to reduce health care disparities, is nonetheless a necessary core competency in delivering high quality patient care. Peak Aboriginal and Torres Strait Islander health bodies argue that boosting the likelihood of culturally safe clinical care may substantially contribute to health improvement (7). Australia cannot effectively close the gap and deliver sustainable and lasting change to improve Aboriginal and Torres Strait Islanders peoples lives until all Australians increase their understanding of Aboriginal and Torres Strait Islander cultures and develop the skills to become culturally competent at both a personal and professional level.
What is RHDA position?
RHDAustralia was established in 2009 under the Australian Department of Health’s Rheumatic Fever Strategy as the National Coordination Unit, with the mandate to reduce death and disability from Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) in Aboriginal and Torres Strait Islander peoples. RHDA is housed in Menzies School of Health Research, which aspires to advance the health and wellbeing of Aboriginal and Torres Strait Islander peoples by working with them, to conduct research that is of the highest quality, meaningful and beneficial and to provide excellent education that is relevant and accessible. In their 2012-2016 RAP, Menzies stated they will continue to develop relationships with Aboriginal and Torres Strait Islander people and their organisations in a manner that is respectful and creates opportunities for Aboriginal and Torres Strait Islander peoples.
RHDAustralia believes that cultural sensitivity is needed in order to provide culturally safe care to over 6000 Aboriginal and Torres Strait Islander peoples on the RHD registers (managed by each of the Jurisdictional Control Programs (JCPs) in Western Australia, South Australia, Northern Territory, New South Wales and Queensland). There is no other disease that more deeply reflects the underlying social and cultural factors than ARF and RHD. If we are to reduce the burden of ARF and RHD within Aboriginal and Torres Strait Islander communities, we need to ‘fix’ the deeper causative social determinants.
RHDAustralia recognises that many of the peak Aboriginal health organisations such as Australian Indigenous Doctors Association (AIDA), Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), Indigenous Allied Health Australia (IAHA), and National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA) have developed their own frameworks on either cultural safety, cultural competence or cultural responsiveness. RHDAustralia acknowledges and adopts the six new Australian Commission on Safety and Quality in Health Care targets that are specific to Aboriginal and Torres Strait islander peoples. These targets include one specific to improving cultural competency of hospitals (8). Within these frameworks and standards there are many common threads that RHDAustralia adopts. These include:
- Culture being at the center of care
- All forms of racism are harmful and are not to be tolerated
- Cultural awareness alone is not enough to produce change, the journey to cultural safe care includes cultural sensitivity and self reflection as an integral part on the continuum.
- The need to decolonise the health system and address the social and cultural determinants of health.
What are RHDA recommendations ?
- Health care providers who care for Aboriginal and Torres Strait Islander peoples with ARF/RHD respect their traditions and culture.
- A greater understanding of the effects of colonisation is required and how this has impacted negatively on health outcomes.
- Working actively to eliminate all forms of racism in the health care system.
- Education and training of the ARF/RHD health workforce includes cultural awareness as an introduction aiming towards culturally safe care.
- That Aboriginal and Torres Strait Islander values and principles are respected and embedded in all work undertaken.
- Research that benefits Aboriginal and Torres Strait Islander peoples is priority.
- That all RHDAustralia staff engage in self–reflection and assess where they are on their cultural safety journey.
- That RHDAustralia staff will promote and participate in cultural significant days .
2. Amery R. Recognising the communication gap in Indigenous health care. Med J Aust 2017; 207: 13-15.
3. The National Aboriginal and Torres Strait Islander Social Survey (2014-2015) Australian Bureau of Statistics 2016b).
4. Bean R. The Effectiveness of Cross-Cultural training in the Australian Context. Canberra: DIMIA, Commonwealth of Australia; 2006.
5. Durey A. Reducing racism in Aboriginal health care in Australia: where does cultural education fit? Aust NZ Public Health 2010; 34: 587-592.
6. J, McCalman, C, Jorgan & R, Bainbridge. Organisational systems' approaches to improving cultural competence in healthcare: a systematic scoping review of the literature, International Journal for Equity in Health (2017) 16:78
7. Congress of Aboriginal and Torres Strait Islander Nurses and Midwives. Cultural safety in policy and practice seminar report: summary and implications. Canberra: CATSINaM; 2016.
8. The Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute. National Safety and Quality Health Service Standards user guide for Aboriginal and Torres Strait Islander health. Sydney: Australian Commission on Safety and Quality in Health Care; 2017.
- RHDA Reconciliation Statement 2018
The reconciliation tree stands strong and tall as a reminder that we at Rheumatic Heart Disease Australia (RHDA) will endeavor to grow stronger with Aboriginal and Torres Strait Islander communities across Australia. We are committed to working side by side with Aboriginal and Torres Strait Communities in all that we do.
As the tree needs water and nourishment so does our relationship with the Aboriginal and Torres Strait Islander peoples. We will do this by our 10 steps towards reconciliation.
Each finger print depicting the leaves represents each person’s commitment to the 10 RHDA reconciliation steps. This is a very personal commitment as a piece of who you are; your fingerprint is symbolised in time and place.
10 Reconciliation Steps
- We will strive to lessen the burden of ARF and RHD on Aboriginal and Torres Strait Islander peoples.
- We will empower Aboriginal and Torres Strait Islander communities by providing education and resources that are culturally appropriate, and made in consultation and partnership with communities and people living with ARF/RHD.
- We believe that all human beings are precious and deserve respect.
- We care about those who are marginalised, less fortunate and disadvantaged - we will strive to close these disparity gaps.
- We stand in solidarity and will act as RHD health advocates for Aboriginal and Torres Strait Islander peoples.
- We will seek to gain a better understanding of the plight of Aboriginal and Torres Strait Islander communities.
- We will do things with the Aboriginal and Torres Strait Islander peoples and not to them.
- We will celebrate the diversity of Aboriginal and Torres Strait Islander peoples.
- We will be sincere in our communications and be respectful of culture and maintain dignity at all times.
- We will ask everyday what can we do better for Aboriginal and Torres Strait Islander peoples.
- NAIDOC 2018