Transforming institutional racism at an Australian hospital

Bourke, Christopher; Marrie, Henrietta; Marrie, Adrian

doi:10.1071/ah18062

Cited by 60 publications

(59 citation statements)

References 48 publications

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“…The complete absence of Aboriginal people from population-wide national food and nutrition committees over a 10 year policy trajectory affirms the Australian norm of 'legal invisibility' of Aboriginal people in Australian policy-making, and recreates institutional inequity in policy responses. 54 We found that the vast majority of submissions in population-wide food and nutrition policy processes were from non-Aboriginal organisations. Along with the membership of oversight committees consisting of non-Aboriginal experts, civil servants and politicians, and the control of the policy process by governments, politicians and government statutory organisations, this indicates the dominance of non-Aboriginal voices in the legitimation of knowledge, decisions about who makes the rules and where resources are allocated.…”

Section: Cultural Safetymentioning

confidence: 84%

First Nations Peoples’ Participation in the Development of Population-Wide Food and Nutrition Policy in Australia: A Political Economy and Cultural Safety Analysis

Browne

Gilmore

Lock

et al. 2020

Int J Health Policy Manag

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Background: Healthy and sustainable food systems underpin the well-being of Indigenous peoples. Increasingly governments are taking action to improve diets via population-wide policies. The United Nations Declaration on the Rights of Indigenous People states that Indigenous peoples have the right to participate in all decisions that affect them. We analysed Australian national food and nutrition policy processes to determine: (i) the participation of Aboriginal organisations, (ii) the issues raised in Aboriginal organisations’ policy submissions, and (iii) the extent to which Aboriginal organisations’ recommendations were addressed in final policy documents. Methods: Political economy and cultural safety lenses informed the study design. We analysed publicly-available documents for Australian population-wide food and nutrition policy consultations occurring 2008-2018. Data sources were policy documents, committee reports, terms of reference and consultation submissions. The submissions made by Aboriginal organisations were thematically analysed and key policy recommendations extracted. We examined the extent to which key recommendations made by Aboriginal organisations were included in the subsequent policy documents. Results: Five food and nutrition policy processes received submissions from Aboriginal organisations. Key themes centred on self-determination, culturally-appropriate approaches to health, and the need to address food insecurity and social determinants of health. These messages were underrepresented in final policy documents, and Aboriginal people were not included in any committees overseeing policy development processes. Conclusion: This analysis suggests that very few Aboriginal organisations have participated in Australian population-wide food and nutrition policy processes and that these policy development processes are culturally unsafe. In order to operationalise First Nations peoples’ right to self-determination, alternative mechanisms are required to redress the power imbalances preventing the full participation of Aboriginal and Torres Strait Islander peoples in population-wide food and nutrition policy decisions. This means reflecting on deeply embedded institutional structures and the normative assumptions upon which they rest.

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Section: Cultural Safetymentioning

confidence: 84%

First Nations Peoples’ Participation in the Development of Population-Wide Food and Nutrition Policy in Australia: A Political Economy and Cultural Safety Analysis

Browne

Gilmore

Lock

et al. 2020

Int J Health Policy Manag

View full text Add to dashboard Cite

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“…DAMA is considered an indirect measure of the cultural competency of health care services and, in the case of Aboriginal Australians, may reflect suboptimal responsiveness of hospitals to Aboriginal needs and poorer quality of care [13]. This has been well-documented in Australian hospitals and has been termed “institutional racism”, [26]. The provision of culturally appropriate care for Aboriginal patients is directly linked to health outcomes [27].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital

Sealy

Zwi

McDonald

et al. 2019

IJERPH

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Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.

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“…There is a widely held argument among researchers and practitioners that the socio-economic circumstances and political underrepresentation of minority groups point to ongoing systematic and structural racial inequality and injustice (Larkin 2013 ). Whether these are indicative of an underlying institutional racism, with race/ethnicity still determining one’s place in Australian society, is a heavily debated issue across public policy and academic discourse (Bourke, Marrie, and Marrie 2018 ; Fuller, Howard, and Cummings 2004 ; Mellor 2003 ).…”

Section: Institutional Racism In the Australian Contextmentioning

confidence: 99%

“…This is clearly seen in Australia, in the poor health outcomes of Aboriginal and Torres Strait Islanders, as consistently reported in the Closing the Gap report. According to this report, social determinants of health and risk factors accounted for 53 per cent of the health disparity between Indigenous and non-Indigenous Australians while interpersonal and institutional racism and related factors accounted for the remaining 47 per cent (Bourke, Marrie, and Marrie 2018 ). Institutional racism places a heavy burden on the Indigenous people and is perpetuated by their systematic exclusion from the healthcare system.…”

Section: The Cost Of Institutional Racismmentioning

confidence: 99%