Decolonisation: A critical step for improving Aboriginal health
Tania Edwards
Indigenous Research Fellow, Centre for Remote Health, a joint Centre of Flinders University and Charles Darwin University, Alice Springs NT
Juanita Sherwood
Senior Lecturer, Aboriginal Health, Centre for Remote Health, a joint Centre of Flinders University and Charles Darwin University, Alice Springs NT
PP: 178 - 190
Abstract
Aboriginal health continues to be in crisis in Australia although expenditure has increased in service provision, strategic planning, research and policy development over the last thirty years.
This paper recommends that a shift must occur to make Aboriginal health improvement a reality. This shift requires the decolonising of Aboriginal health so that the experts in Aboriginal health, namely Aboriginal people, can voice and action initiatives that address their health issues. This shift is from the current western dominant approach that continues to manage Aboriginal health in its linear spectrum of illness and disease. Aboriginal people view health differently; their contexts for health issues are also diverse requiring a more holistic and informed response.
Keywords
Decolonisation, Aboriginal health, colonisation, Indigenous worldview, western worldview
Article Text
This paper has been written to inform the nursing workforce within urban, rural and remote regions in Australia about the critical importance of de-colonising all aspects of the health service delivery related to Aboriginal health. This deliberation is acknowledged as a challenge to the hegemony of power vested in the bio-medical model of research, policy, planning and praxis. The authors recommend that this challenge is critical for health improvement for Aboriginal peoples.
In writing this paper a post-colonial/anti-colonial approach has been used to explore the health care system, which has traditionally been informed by a dominant western worldview. This worldview is in direct conflict with the Indigenous worldview and the way health and well being are considered by Aboriginal people. This approach progresses a process for de-colonising the ways in which health and illness are perceived and currently acted upon. Additionally, this paper acknowledges the context under which poor Aboriginal health occurs and incorporates the historical circumstances and consequences arising from the colonial experience, the impact of which is often denied or underestimated.
Background: Colonisation is not a Fictional Story
Indigenous peoples worldwide share a commonality of the experience of imperialism and colonisation (Durie 2004; Ermine Sinclair Jeffery 2004; Kunitz 1996; Smith 1999). For Indigenous Australians, and other Indigenous people, this experience has led to the theft of sovereignty, land, health and wellbeing.
Durie (2004: 1139) asserts that:
By implication, concern about the health standards of indigenous peoples needs to take into account the broader perspectives of a world view that has been seriously fractured. Alienation of people from their environment - from the natural world- may be closely linked to the host of health problems that beset indigenous peoples as the more familiar life-style risks of modern living.
In order to undertake a process of decolonisation, it is imperative that all Australian citizens acknowledge and comprehend the impact that invasion, imperialism, colonisation, research and policy have had on the Indigenous people of this country. Smith (1999: 19) advocates:
Imperialism still hurts, still destroys and is reforming itself constantly. Indigenous peoples as an international group have had to challenge, understand and have a shared language for talking about their history, the sociology, psychology and the politics of imperialism and colonialism as an epic story telling of huge devastation, painful struggle and persistent survival.
The year 1788 saw the beginning of a joint occupation of Australia. Aboriginal people, whose connection to their land goes back to time immemorial, were dispossessed of their sovereignty to their respective countries as determined through Aboriginal Law. The colonial project of British imperialism was to confiscate land for the expansion of the British Empire. Indigenous peoples worldwide were dispossessed of their sovereign rights resulting from other European countries imperialist motives. Australia's colonising focused upon usurping Aboriginal people from their land to make way for settler progress. Treaties were not signed with Aboriginal people although the British Government had recommended to both Cook and Philip, that they ensure an agreement with 'the natives' was developed and undersigned (Butler, Cameron & Percival 1995). The first one hundred and fifty years of colonial history in Australia reflects a period of sustained warfare related to Europeans stealing of land, food sources, water, women, economic trade links, and the committing of genocide (Connor 2003; Reynolds 1987a). Conflict over land and responsibility to country were perhaps the most significant issues in relation to worldview clashes. The inability of the western legal system to fully appreciate Aboriginal land ownership led to a continuation of dispossession and lack of governance in our own country (Reynolds 1987b).
Aboriginal people do not conceive land ownership in the same way as defined by the Australian Federal government, being a commodity to be claimed, settled and developed as a way of progressing wealth and society. Rather there is a closely bonded relationship between Aboriginal people and the land (Bird Rose 1996). This relationship is not one which implies freedom to do as one pleases within a given land tenure. Through a system of traditional law, people are connected to country and elements of the landscape, physically and spiritually, and to each other. This law defines inherent roles, responsibilities, and obligations to honour and care for ones country, as failure to do so brings about dire consequence to the individual or their family or communities' health, wellbeing and the future. The land and many aspects within the landscape symbolise the stories of creation from the time before mankind and through traditional law these stories have been passed from generation to generation and have helped to maintain the integrity of this country, the culture, language, ceremonies and the people.
In 1992, the High Court of Australia in Mabo v Queensland [No 2] confirmed the legal fiction of Terra Nullius, by which the British claimed sovereignty over Australia (Brennan 2003). However, the Federal Government in 1997 developed a legal ten-point plan to reduce Aboriginal peoples' opportunities to take back their countries (Behrendt 2003). Aboriginal peoples' well-being is critically connected to country and their responsibilities to country are a key issue that is not recognised in Aboriginal health policy practice and provision.
Reynolds (1992 cited in Habel 1999:47) writes of the complacency and ignorance within the Australian population in regard to the prior occupation of this country by Aboriginal people. Recognition of this history is critical for all health professionals to comprehend. He reports:
Australians are so familiar with the events of January and February 1788 that they have lost sight of the ability to see how extraordinary the claim was...
As many as half a million people, living in several hundred tribal groupings, in occupation of even the most inhospitable corners of the continent, had, in a single instant, been dispossessed. From that apocalyptic moment forward they were technically trespassing on Crown land even though many of them would not see a white man for another thirty, another fifty years... It was a stunning takeover. It would have dazzled even the lions of the modern business world.
This is the context for Aboriginal health status, a context that requires acknowledgement by all peoples working in this health field.
Our Story
The authors of this paper are both Aboriginal Registered Nurses with lengthy experience of working closely with Indigenous people and communities within urban, rural and remote Australian settings. These experiences have shaped and formed our ways of working with our people. We have also had our views, values and beliefs on health shaped by our lived experiences as Aboriginal people growing up and living within Aboriginal society, and as such our worldviews are Indigenous. As Aboriginal people we have been privileged to have our knowledge development nurtured through the sharing of stories from our Elders and other community members. We have participated actively in getting Aboriginal voices heard around their health and social justice needs both in the health field and beyond. This position has been difficult because of the power differentials that continue to exist within the dominant health system. Although our academic standing is equitable with non-Indigenous health professionals our voices, when speaking of our lived experiences, are often contested and dismissed. We believe it is important to acknowledge the isolation and marginalisation we have endured as Aboriginal nurses, academics and researchers within the western academic and health care settings. We have witnessed the continuation of poor policy and service provision in Aboriginal communities. Our stories, perspectives and insights of what will help to improve health outcomes for our communities are regularly silenced. This is a story shared by other Indigenous academics, such as Absolon and Willett (2004:11) who state:
Today we face the fact that Euro-western theories remain safeguarded and upheld as superior sources of knowledge and analysis in text...They feverishly resist any loss of power and authority erecting more barriers and moving the goal posts further along in an effort to exclude and isolate Aboriginal scholars.
The colonial western powers continue to oppress Aboriginal communities and Indigenous academics. Indigenous academics, Kathy Absolon and Cam Willett highlight the importance of locating the Indigenous self within our writings and research (Absolon & Willett 2004). They note that locating our position is vital as we can only write about ourselves; we are speaking and representing ourselves only and our experiences, we are not speaking for all Aboriginal people (Absolon & Willett 2004).
We must also acknowledge that although we have been educated in a western education system throughout our schooling and professional training in nursing, as Aboriginal academics we 'have had to be masters of both our own worldviews and Euro-Western worldviews' (Absolon & Willett 2004 :12). Despite this conditioning, the way we think about health is captured in the following statement:
Indigenous Peoples' concept of health and survival is both the collective and individual inter-generational continuum encompassing a holistic perspective incorporating four distinct shared dimensions of life. These dimensions are the spiritual, intellectual, physical, and emotional. Linking these four fundamental dimensions, health and survival manifests itself on multiple levels where the past, present and future co-exist simultaneously (Durie 2004 :1139).
To Aboriginal people, health is broader than merely the absence of disease ( House of Representatives Standing Committee on Family and Community Affairs 2000). This holistic view of health encompasses social, emotional, physical, and spiritual wellbeing. Dispossession, poverty, injustice, racism, and social exclusion fragment and injure Aboriginal people, their families, communities, and their sovereign rights. When compared to other Indigenous populations who share a history of colonisation, Australia's Indigenous peoples fair worse than those of New Zealand, Canada and America (Kunitz 1996; Ring & Brown 2003; Ring & Firman 1998). These countries are undergoing a process of decolonisation and their Indigenous peoples would appear to have achieved more freedom to determine their own health through their negotiated treaties.
We believe it is critical that Indigenous knowledge be incorporated into the macro and micro Aboriginal health agenda to achieve health improvement. In saying this, the criticism we consider to be important is that current health policy and praxis approaches in Indigenous health remain linear (Absolon & Willett 2004). This linear activity relates to western knowledge systems, which dissect knowledge and health into compartments and categories or boxes. This is in conflict with Indigenous knowledge systems that produce and transfer knowledge within a holistic model. As such health is not separated from any aspect of a person's life (National Aboriginal Health Strategy Working Party [NAHSWP] 1989). This is in contrast with the approaches used by Western health systems that fund Aboriginal health projects according to body parts and diseases (NAHSWP 1989). The rhetoric of Indigenous health policy, funding, and praxis, is that policies acknowledge the Indigenous ways of defining health, but the reality is that policy and strategies target Aboriginal people using Western models of health.
There are presently a number of Indigenous health professional associations and bodies representing Aboriginal health such as the National Aboriginal Community Controlled Health Organisation (NACCHO), the Australian Indigenous Doctors Association (AIDA) and the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN), who recommend that it is essential that Indigenous people be allowed to equitably participate in the Aboriginal health agenda. This requires that health departments, services, and, employees consider, comprehend and act upon the determinations of Aboriginal people. Indigenous health bodies have defined frameworks for this to occur and Preamble from CATSIN (CATSIN 1999-2005: 2-3) as follows is one example:
We are Aboriginal and Torres Strait Islander Peoples before we are nurses.
We are First Nations people and intend to maintain our cultural heritage.
We recognise that we are on a lifelong journey with cultural obligations and commitment to our communities.
We challenge the western health model in which nurses live and work, as this model promotes separation, hierarchy and power struggles; it denies the emotional, social, spiritual and political aspects of health in a holistic way.
The philosophy that promotes all peoples as equal, or to be treated the same, denies difference and cultural identity. Justice and recognition of Aboriginal and Torres Strait Islander history is a requirement of reconciliation.
All faculties (sic) of nursing need to re-examine their models, of (sic) nursing philosophy and nursing practice. We are the experts in our health and believe our experience and world view challenges these models. Non-indigenous nurses can learn and benefit from our experience.
Many Aboriginal and Torres Strait Islander nurses are forced to live a 'double life'. This living in two worlds and two cultures causes internal conflict. We see this as a continuation of the assimilation process and support all measures to reverse or challenge this process.
Our position is to stay firm in recognising these challenges and be prepared to meet them as best we can.
Current Situation
There is significant evidence confirming that Aboriginal health continues to be a major challenge to governments, its agencies, health professionals and Aboriginal communities (Couzos & Murray 2005; House of Representatives Standing Committee on Family and Community Affairs 2000; Smith 2004). Despite the high level of expenditure and commitment to improving Aboriginal health outcomes through health policy, work force strategies that are inclusive of Aboriginal Cultural Awareness Programs (ACAP), research, and health infrastructure there has been only slight improvements (Ring & Brown 2003).
Statistical data from the last fifteen years demonstrates that progress in improving Aboriginal health outcomes has not been forthcoming (ATSISJC 2004; ABS 2003; Paul & Atkinson 1999; Ring & Brown 2002; Smith 2004). Although health service support and provision in the 1970s impacted significantly upon childhood mortality, there has been minimal improvement in the health disparities of Aboriginal people in recent times. For example, Aboriginal people are dying 20 years before their non-Indigenous peers (Ring & Brown 2002). However, non-Indigenous peoples have seen improved health gains through research, policy, and praxis. This may be as a result of how the general Australian population view Aboriginal people as these researchers concluded from the following excerpt:
It is a statistical fact that Aboriginal and Torres Strait Islander People are the poorest, unhealthiest, less employed, worse housed and most imprisoned Australians, but only half the community believes Aboriginal people are worse off than other Australians (only around 30 per cent believe they are 'a lot' worse off), then there is a significant gap between the facts and what many believe about the position of Aboriginal people. (Newspoll survey 2000 cited in Behrendt 2003: 65)
We believe the critical issues that underlie the lack of improvement in Aboriginal health are the continuation of colonisation, through the dominance of western worldviews in research, policy, planning, and praxis; the lack of Indigenous health models and the dominance of the bio-medical model; and everyday personal and institutional racism.
Post-colonialism
Post-colonialism and anticolonial critiques are not simply discursive methods, they are also a framework of and for remembering. This approach is therapeutic, allowing the fragments or silent voices of the past to remember their history and the colonial experience (Absolon & Willett 2004). William Cooper, Aboriginal activist and co-founder of the Australian Aborigines' League, is quoted in Attwood (2003: 69) as having defined Aboriginality as a form of remembering:
Cooper defined Aboriginality instead in terms of historical experience or rather historical consciousness. At the heart of this was the remembrance of a 'horror and fear of extermination'. This was, he said, 'in the blood', a 'racial memory, which recalls the terrible things done to [us] in years gone by'. Among Aborigines, he confided on another occasion, this was a collective memory; rooted in their experience of colonialism...
Homi Bhabha recognised that memory is an important yet difficult path to take when exploring colonialism. On the notion of remembering, Bhabha (1994: 63 cited in Ghandi 1998: 9) wrote:
[it] Is never a quiet act of introspection or retrospection. It is a painful remembering putting together of the dismembered past to make sense of the trauma of the present.
Colonisation has been a tradition and action, which enabled the British people to claim their superiority over Indigenous people worldwide. This process ensured colonising nations usurped, dislocated, dismantled and demeaned the First Nation peoples in order to occupy and promote their own authority over their new subjects and country (Said 1994). Colonial strategies such as research and writing through academia informed and influenced non-Indigenous populations of the supposed primitive, exotic and barbaric nature of Indigenous peoples (Said 1995). This strategy de-humanised Indigenous people and helped to further escalate the antagonism and violence towards them (Memmi 1965). Warfare in Australia although not recognised in most historical texts was ongoing and sustained by government forces against the Indigenous people to enable further undisturbed settlement throughout the country (Reynolds 1982). The impact of this warfare, which was fundamentally a battle for land ownership, caused unnecessary grief and death for both sides. As Lake explains:
colonialism was a two-way encounter in which the British transformed the lives of indigenous peoples, but the colonial experience also re-defined British identities. The fact that Aboriginal retaliation and revenge were 'indiscriminate' is explained by the Aboriginal perception that a group of people defined by their 'whiteness' had taken their country. The racialised identity of the colonists was itself one of the main outcomes of the colonial encounter. Aboriginal perception and response thus played a key role in producing the settlers' racial identity as 'white men' and by extension the racial identity of the emergent nation, in whose name the federal fathers would formulate the project of White Australia (Lake 1992: 171).
It is possible to reflect upon the racialised theme that became a strong definer of Australian identity. Other colours and cultures, which do not fit with this definition, were discussed and observed as different and inferior. Differential treatment or racism has resulted from the experience of Britain's re-defining the self (Baum 1998). In this sense, whiteness has become a position of privilege within the Australian framework, one that is informed through a western worldview and the associated concepts of superiority (Moreton-Robinson 2000). There have been minimal shifts in this definition and Australian policy and praxis remain enshrined within a framework working for white Australians while marginalising the Indigenous population. These perspectives have been informed by and through research.
Research
Research has a bad name as lived from an Indigenous experience (Smith 1999). It has been used as a tool to inform the government of ways to 'manage the problem' through the strategies it helps to develop and ratify. An attitude of superiority by researchers and the majority of non-Indigenous Australians has prevailed in respect to their status and the right to progress development and populate Australia. As Ermine, Sinclair and Jeffrey (2004: 16) argue:
Challenging research hegemony involves understanding colonial history, and ensuring that research has practical applications that empower and liberate the people through practical and ameliorative results; which, in contemporary Indigenous contexts, means engaging in a de-colonisation agenda. The important point to be made is that, given the context of colonization and colonialism, the research agenda for Aboriginal people is very specifically directed towards the amelioration of the impact of those dynamics.
Research has in essence become a critical tool for informing government agencies about their Aboriginal subjects that they have had to manage (Ermine et al 2004) By and large, the interpretations of the results of this research have not always bid well for Indigenous Australians. As Smith (1999:39) explains:
Research has not been neutral in its objectification of the other. Objectification is a process of de-humanisation. In its clear links to Western knowledge research has generated a particular relationship to indigenous peoples which continues to be problematic.
We argue that the current western epistemology related to research and specifically health is generally accepted as a positivist model that has not involved Aboriginal people in research about themselves (Absolon & Willett 2004; Ermine et al 2004). We believe Aboriginal peoples' knowledge and experience is important in informing change around the Aboriginal health agenda, which remains in the domain of western knowledge power-brokers and bio-medical health regimes. It is not difficult to appreciate that 'Rarely, the topic of Indigenous knowledge is discussed in relation to Aboriginal health' (Smylie 2003:141) .
Research is an important agent for change and can make a significant difference to Aboriginal health outcomes if and when Aboriginal peoples' voices, opinions and knowledge inform the process. As such, researchers need to expose societal structures that are responsible for disadvantaging Aboriginal Australians in respect to their culture and status of health, instead of focusing on disease causation and remedial measures. Underlying structural inequalities have a major impact on health and wellbeing, and influence how health policy and services are determined. Health and culture need to be viewed and evaluated from the context of the historical and political consequences of this praxis (Smye & Browne 2002).
Health Policy, Planning, Praxis and the Right to Self-determination
Policy and praxis informed through research targeting Indigenous Australians has been from an Indigenous perspective, oppressive, injurious and in breach of human rights (Behrendt 2003). The era of Protection, Assimilation and what is now Practical Reconciliation have all further disadvantaged, dispossessed, and disconnected Indigenous Australians from their land, health and well-being, family, culture, language, dignity, and governance (Dodson 1997a). The United Nations Human Rights Commission (1994: Part 1, Article 3) stated that:
Indigenous peoples have the right for self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development.
However, Australia is the only first nation country where Aboriginal peoples have no policy for self-determination particularly since the recent abolishment of Aboriginal and Torres Strait Islander Commission (ATSIC) in 2005. The Human Rights and Equal Opportunity Commission (HREOC), is now one of the few national bodies and mechanisms through which government activity can be monitored. A core function of HREOC is to advocate for social justice, which implies that people can make choices about how they live and have the means to make these choices. Social justice recognises:
- The right to a distinct status and culture
- The right to self-determination
- The right to land (Calma 2005)
Federal government actions have been informed by a western worldview and will ultimately impact further upon Aboriginal health. Aboriginal health, of course is another area that this worldview has dominance over and as such, Smye and Browne (2002: 50) note that:
Western society does not fully reflect the holistic approaches of Aboriginal traditions (O'Neil & Post 1994), nor does it acknowledge the social political and historical context of Aboriginal health.
Pathologising Aboriginal Peoples with disease-based ideologies, which relate to their lack of coping with modern society, have not worked. These health stories have only reinforced the Social Darwin theorising of health education and other professional philosophies. Models of health systems developed to fix the Aboriginal problem have only caused further problems for Aboriginal Peoples and perpetuate the ignorance of Indigenous knowledge.
Indigenous health workers, nurses, doctors, allied health professionals, academics and researchers are concerned with the unrelenting approaches to health, which fail to hear Aboriginal voices. Smylie (2003: 139-140) rightly states:
Contests between indigenous peoples and states have been fought in a variety of sites, most obviously around territorial lands, waterways, and oceans. But increasingly the contests are shifting to intellectual and cultural sites and are about the terms under which there are effective interventions for many of the health conditions that impact on Aboriginal communities. However, there remains a paucity of health programming that enables widespread implementation of manoeuvres that could improve Aboriginal health outcomes. With few exceptions, knowledge translation activities that link health research to practice in Aboriginal communities have been overlooked. When knowledge translation does occur, there appears to be little adaptation of mainstream approaches to the Aboriginal community context.
This point is particularly relevant to nursing practice and training related to Aboriginal Peoples and communities. Indigenous health is observed as a critical health focus, but it is difficult to make an impact if health services and professions are to continue doing health the same old way.
This praxis, research and writings remain critically ill-informed in relation to Indigenous peoples' concerns, expectations, and experience. Indigenous peoples are the experts in relation to their own health and health needs. Indigenous knowledge, local, traditional and ecological, provides essential ways of knowing related to Indigenous worldviews that are important for formulating health policy and praxis. According to Durie (2004: 1139):
Indigenous knowledge can prevail in modern times for the benefit of Indigenous peoples, if not all peoples. Much of the debate is between science and indigenous knowledge and takes three distinct forms; opposition to the promotion of science as the only valid body of knowledge; the rejection of science in favour of indigenous knowledge; and the misinterpretation of knowledge by the use of system-bound criteria.
The silencing of Aboriginal voices and knowledge in relation to health research, policy, planning and praxis has been detrimental to Aboriginal people as the poor health outcomes demonstrate. Aboriginal voices have not just been silenced by researchers, they have also been silenced by the institution the researchers serve.
Institutional Racism
Institutional racism failed to target research relating to Indigenous health although there is a groundswell of non-Indigenous people who have recognised that this is perhaps one of the major problems that continues to marginalise Aboriginal and Torres Strait Islander people on every level of their being. Smye and Browne (2002: 42) note that:
Social disadvantages stemming from high poverty rates, unemployment, dependence on social assistance and structural barriers to life opportunities created by a long history of individual and institutional discrimination have taken their toll...
Institutions and their respective policies have historically and today continue to create the marginalisation, poverty and unemployment rates that Aboriginal people experience. The denial of this historical causality has been at the heart of conflict between Aboriginal and Western worldviews. Aboriginal people have experienced discrimination through a history of social service policy and provision. Much of the social policy in Indigenous affairs has been founded upon misrepresentations from previous research, education and negative media images concerning Aboriginal peoples, which have been fundamentally racist. This racism both at individual and institutional levels has injured Aboriginal people individually and collectively. These circumstances have been recognised in New Zealand where 'cultural safety', a concept being used to call attention to the processes and practices that re-create trauma for Indigenous peoples, and consequently create barriers to health, is being recommended as part of the solution to institutional and individual racism in health care. Researchers, health advisors, nurses, doctors, and health professionals need to become aware of their own worldview in order to stop injuring Aboriginal people. This is a process that has been developed by an Indigenous Maori nurse leader; Irihapeti Ramsden (Smye & Browne 2002). It is an essential strategy that requires development in Australia, as Henry, Houston and Mooney (2004: 517) argue that:
Our health services are 'institutionally racist' and; that such racism stems from Australia being, or at least having become an uncaring society.
Their examples relate to the following; funding not proportionate to essential need; culturally unsafety; inequitable funding to provide comprehensive primary health care; different modes of treatment reliant on identification of Indigenous versus non-Indigenous status where non-Indigenous people receive more comprehensive care; funding bodies failing to acknowledge Aboriginal people's holistic concepts of health, and, funding programs related to diseases rather than people. Essential services in Aboriginal Community Controlled Health Services must be authenticated and proposals written one to every three years to continue services where non-Indigenous mainstream services do not have to undertake this paperwork exercise (Henry 2004: 517). These issues all impact on and further marginalise Aboriginal people.
Evidence for the Need to Change Approaches
The following data related to Aboriginal health status provides conclusive evidence that despite what is being done, it is not working and hence health improvement outcomes have not been realised:
Life expectancy is twenty years less than for non-Aboriginal people.
Life expectancy of Aboriginal people is considerably worse than for other comparable Indigenous populations, such as the Indigenous peoples of United States and Canada, and Maori of Aotearoa New Zealand.
Aboriginal boys born today have only a 45 per cent chance of living to age 65 (81 per cent for non-Aboriginal boys); Aboriginal girls have a 54 per cent chance of living to age 65 (89 per cent for non-Aboriginal girls).
Age standardised death rates for Aboriginal males are 2.8 times those for non-Aboriginal males; age standardised death rates for Aboriginal females are 3.3 times those for non-Aboriginal females.
Over the last forty years, the Aboriginal infant mortality rate has declined (though it is still three time the national average); over the same period, adult mortality in the Aboriginal population has increased (Aboriginal Medical Services Alliance Northern Territory 2005).
The data provides a clear picture of the lack of effective governance, health workforce, policy, research and infrastructure in addressing the health of Aboriginal health and Aboriginal peoples. Despite further research, Aboriginal health has remained unacceptably poor as many researchers have chosen to ignore the root causes of health problems, such as poor housing and lack of education, marginalisation, social exclusion, and racism. These cannot be considered in isolation to the disease or a specific health issue being researched. Aboriginal people are often considered formally and informally to be the source of their own problems. There has been a legacy of denial and white-washing of history that has failed to recognise the origins of the real problems. Smith (1999: 176) suggests:
Researchers are in receipt of privileged information. They may interpret it within a overt theoretical framework, but also in terms of a covert ideological framework. They have the power to distort, to make invisible, to overlook, to exaggerate and draw conclusions, based not on factual data, but on assumptions, hidden value judgements, and other often down right misunderstandings. They have the potential to extend knowledge or perpetuate ignorance.
The dominance of western worldviews in Australia relates to the tradition of knowledge constructs and intellectual paradigms considered to be Eurocentric that have colonised not just the landscape but also peoples. A worldview is best described as 'First of all, an explanation and interpretation of the world and second, an application of this view to life' (Solomon 1994:1). These worldviews are a cultural and value-based construct as are Aboriginal worldviews which differ because of the significant divergent cultural, historical experiences and learning frameworks. Incorporating knowledge of the past as experienced by Indigenous Australians will broaden their worldview.
De-colonisation
De-colonising processes require all individuals to explore their own assumptions and beliefs so that they can be open to other ways of knowing, being, and doing. For the health departments and their employees it requires evaluating what is not working and being big enough to accept that change needs to happen. This change needs to be informed by Aboriginal people, the experts of their own health. Aboriginal health bodies and health professional associations have experience in effective ways of knowing about Aboriginal health and need to be heard, as do the communities they serve. Health agencies need to provide sustainable and adequate funding for comprehensive primary health care to be provided by culturally safe health professionals. This again requires the equitable guidance by and through the community.
The health research, policy and praxis focus requires a shift towards health and wellness, effectively accepting and acting upon the way Aboriginal people view health, rather then the mechanistic bio-medical approach currently in vogue. As such the health agenda needs to be deconstructed so that the focus is not just on disease and illness. It needs to acknowledge the inequities in society and how they really impact on peoples' health and wellbeing, and other determinants of health as prescribed by Aboriginal voices.
Specifically for nursing, CATSIN (1999-2005: 1) has recommended as part of the de-colonisation process that:
Education for all nurses include mandatory subjects in Indigenous history, culture, health and principles of self-determination and management;
Indigenous studies are not to be included in multi-cultural studies. We are the First Nations people who have and are still being colonised;
Non-indigenous university staff must have colonisation and anti-racist workshops;
Aboriginal and Torres Strait Islander RNs need to be engaged as consultants to faculties of nursing, to act as educators and mentors; and
The implementation of a process whereby Aboriginal and Torres Strait Islander nurses are able to learn about their own history for personal growth and development.
Conclusion
We believe that Australian nurses must undergo a process of decolonisation in order that Aboriginal Peoples' pain, worry, anguish and torments are heard, recognised, accepted, so that there may be an improvement in the health and wellbeing of Aboriginal people. To do this, non-Indigenous Australian nurses need to be receptive to and respectful of the voices of Aboriginal society, without expecting that as a people we must constantly justify and argue for our basic rights. It is only when this process is undertaken that we can all come together as a healthy nation free of guilt, blame, and separation. This is what decolonisation is all about. It allows us to work together for the good of all. As Fine (cited in Hollingsworth 1998: 72) notes:
For if we do not dare to analyse the very institutions in which we work and the ways in which we and our colleagues are implicated in the reproduction of racism and the propping up of whiteness, then how can we move beyond theory at its most hollow? How can we move towards transformation?
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