Social determinants of health are defined as conditions that accompany people’s lives, how they are born, develop, learn, and get older (Cass et al. 2004, p. 145). In the context of the direct and indirect impact of racism as one of the contributors to shaping social determinants of health, it has been identified that health outcomes of Aboriginal Australians were directly influenced by the power imbalance that existed within the healthcare system (Durey, Thompson & Wood 2012, p. 22).
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According to Kelaher, Ferdinand, and Paradies (2014, p. 1), interpersonal racism in health care is likely to be linked to major psychological distress as well as the lack of professionals’ cultural competency. Racism as a social determinant of Aboriginal health has an indirect negative influence not only on the way such populations are perceived but also on the quality of care that they receive, which is a direct impact on the minority (Durey, Thompson & Wood 2012, p. 18). For example, Indigenous Australians were found to be limited in access to such health care services as kidney transplantation (Cass et al. 2004, p. 144).
The problem has gained such a great scale because health professionals have refused to educate themselves on cultural competency and decided to put their prejudices before they care for their patients (Bessarab & Crawford 2013, p. 232).
A brilliant contribution to the research on racism toward Aboriginal populations by Bessarab and Crawford (2013, p. 232) concluded that the stigma or trauma of such groups has been recurring across generations, which means that without an appropriate attitude and awareness from the majority of the Australian population, the minority communities will continue experiencing adverse outcomes of racism not only on their physical but also emotional well-being and development. Such an indirect impact of racism is usually placed on the back burner because the emotional wellness of populations has been considered less important (Bessarab & Crawford 2013, p. 232).
It can be suggested to evaluate the perceptions of the Aboriginal populations within the sphere of healthcare and in society in general; as seen from the reviewed studies, there is a lack of understanding from the majority of the Australian population that negative attitudes supported by racism can directly decrease the quality of care while indirectly fueling the ever-lasting and institutionalized misconceptions that Indigenous people do not deserve the same treatment as the majority (Durey, Thompson & Wood 2012, p. 17).
The Privilege of Whiteness in Relation to Working with Aboriginal People
While most social workers in Australia agree with the fact that Indigenous populations in the country experience the most unfair and challenging disadvantages and acknowledge that they should be at the front line of eliminating the existing barriers, the lack of understanding of one’s whiteness limits the society from developing (Calma & Priday 2011, p. 147). However, with the growing awareness of Australian citizens with regards to their superiority over others because of some social or ethnic characteristics, the topic of privilege has been getting more attention over the years (Calma & Priday 2011, p. 147).
For instance, the study conducted by Zufferey (2012, p. 659) offered a critical look at how the privilege of being white facilitates the increasingly personal and professional power in such spheres as social work. As the author reflected on the colonization of Australia and the way the Indigenous communities suffered from the unequal distribution of power, it was found that the majority of the white population chooses ignorance over knowing how their privilege affects other communities (Zufferey 2012, p. 660).
Moreover, the inability to empathize with the problems of Indigenous people contributed to the growing gap in the distribution of power and resources in the context of social work (Gair 2013, p. 136). Without teaching the Australian population about the need for empathy to facilitate respectful social work interventions conducted by non-Indigenous people, it will be impossible to overcome the privilege of whiteness and its impact on the shaping of the society (Gair 2013, p. 137).
In order to reduce and consequently eliminate the impact of white privilege to help Indigenous Australians improve their social positions, exploring the history and the culture in both individual and collective contexts is paramount (Nelson 2009, p. 97). It is expected that the valuable knowledge and skills that social workers can use in their profession will come from “learning from the past and looking to the future” (Nelson 2009, p. 97).
Reaching the desired educational and health-related outcomes for the Indigenous population of the country falls on the shoulders of social workers who are advised to evaluate the past experiences of the country as a whole and look at the ways that the society can overcome the existing challenges (Nelson 2009, p. 98). It is imperative to take action and engage relevant stakeholders in improving the lives of communities that have been oppressed (Nelson 2009, p. 98).
Reducing the Conflict Between Health Staff and Aboriginal People
The nature of the conflict between Aboriginal people and nurses of other cultural backgrounds lies in the lack of mutual understanding of this large problem (Saethre 2009, p. 773). In order to underline the unfairness that exists in the society, Aboriginal Australians often appeal to health narratives and complain that their care providers do not understand their cultural needs and are insensitive to their racial identity, stating that “foods and medicines from the bush are more efficacious than biomedical treatment” (Saethre 2009, p. 773). On the other end of the spectrum, nurses report that Aboriginal patients refuse to comply with the prescribed medication due to their absence of responsibility (Saethre 2009, p. 773). Thus, there is no mutual consensus when it comes to healthcare delivery.
Saethre’s (2009) research gave a lot of food for thought; some have even proposed that non-Indigenous nurses should not work with Aboriginal Australians, which is a bold statement that perpetuates exclusion (Ranzijn and McConnochie 2013, p. 445). As reported by Ranzijn and McConnochie (2013, p. 445), non-Indigenous professionals felt marginalized when confronted with the idea that they should not work with the representatives of cultural minorities. This means that minimizing the significance of one group for the sake of another is ineffective, and the problem can only be solved when both Aboriginal and non-Aboriginal people meet ‘in the middle’ and listen to what either side of the argument has to say (Ranzijn & McConnochie 2013, p. 446).
Collaboration and mutual support are needed not only for resolving the argument outlined by Saethre (2009, p. 775) but also for shaping a positive environment that will facilitate the successful development of Australian society. It must be mentioned that Aboriginal communities reported an array of issues such as poor communication or disparities in access to services, and without the support from the majority of the population, these problems will remain unresolved (Baldry, Green & Thorpe 2006, p. 367).
Strong efforts from both sides are needed to manage the situation. The hostility that prevails the arguments of either side should be treated as the primary barrier to resolving the conflict; representatives from both communities should be encouraged to meet, communicate, express their grievances, and develop an action plan to improve the lives of Australian citizens (Baldry, Green & Thorpe 2006, p. 371). There should be no time wasted on arguments since they limit society from growing and learning.
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Guide to Ethical Research with Aboriginal People
It must be mentioned that the elimination of personal biases toward any group or population is the key to conducting ethical research, especially when it comes to Indigenous Australians who have experienced decades of unfair treatment and oppression (Pyett, Waples-Crowe & van der Sterren 2009, p. 51). Because the participation of Indigenous people in health studies is an irreplaceable element of current research in the Australian context, developing a guide of ethical principles is a step toward achieving success (Kowal, Anderson & Baillie 2005, p. 468). With regard to the studies involving the Aboriginal population of Australia, racism and white privilege are underlying sources of bias that can limit research in the sphere of social exploration (Kowal, Anderson & Baillie 2005, p. 468).
According to Putt (2013, p. 5), there are no specific models recommended for use when involving Indigenous populations into studying controversial topics as well as there is no unified view of the process and outcomes; however, cultural sensitivity and the willingness to a partner can be highly beneficial for enhancing the collaboration between ethnic minorities and majorities. In addition, having an open and transparent partnership is the point of success that many researchers tend to forget (Putt 2013, p. 2).
As mentioned by Jamieson et al. (2012, p. 16), “Indigenous communities are more likely to embrace working with researchers with whom they have an established rapport” than with unfamiliar people regardless of research sophistication. The available studies on the involvement of Aboriginal Australians pointed to the need for establishing trusting relationships with them in order to facilitate the building of knowledge that can help the community overcome the existing gaps in the distribution of power and resources that influence the quality of life (Jamieson et al. 2012, p. 17).
The readings can contribute to the development of a guide to ethical research with Aboriginal people because they have provided valuable examples of how this minority population reacts to different approaches scientists may have when working with Indigenous people (Putt 2013, p. 4). It was found that the engagement of minority populations is impossible without paying attention to the needs of such communities and facilitating partnerships to guide the interactions between researchers and their subjects (Putt 2013, p. 4). A guide to ethical research should include such recommendations as flexibility in the implementation of studies and respect for the history of Indigenous communities (Jamieson et al. 2012, p. 17).
Baldry, E, Green, S & Thorpe, K 2006, ‘Urban Australian Aboriginal peoples’ experiences of human services’, International Social Work, vol. 49, no. 3, pp. 367-375.
Bessarab, D & Crawford, F 2013, ‘Trauma, grief and loss: the vulnerability of Aboriginal families in the child protection system’, In B Bennett, S Green, S Gilbert & D Bessarab (eds), Our voices: Aboriginal and Torres Strait Islander social work. Palgrave Macmillan, South Yarra, Victoria, pp. 230-247.
Calma, T & Priday, E 2011, ‘Putting Indigenous human rights into social work practice’, Australian Social Work, vol. 64, no. 2, pp. 147-155.
Cass, A, Devitt, J, Preece, C, Cunningham, J, Anderson, K, Snelling, P, Eris, J & Ayanian, J 2004, ‘Barriers to Access by Indigenous Australians to kidney transplantation: the IMPAKT study’, Nephrology, vol. 9, no. 4, pp. 144-146.
Durey, A, Thompson, S & Wood, M 2012, ‘Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication’, Internal Medicine Journal, vol. 42, no. 1, pp. 17-22.
Gair, S 2013, ‘Inducing empathy: pondering students’ (in)ability to empathize with an Aboriginal man’s lament and what might be done about it’, Journal of Social Work Education, vol. 49, no. 1, pp. 136-149.
Jamieson, L, Paradoes, Y, Eades, S, Chong, A, Maple-Brown, L, Morris, P, Bailie, R, Cass, A, Roberts-Thomson, K & Brown, A 2012, ‘Ten principles relevant to health research among Indigenous Australian populations’, Medical Journal of Australia, vol. 197, no. 1, pp. 16-18.
Kelaher, M, Ferdinand, A & Paradies, Y 2014, ‘Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities’, Medical Journal of Australia, vol. 200, pp. 1-4.
Kowal, E, Anderson, I & Bailie, R 2005, ‘Moving beyond good intentions: Indigenous participation in Aboriginal and Torres Strait Islander health research’, Australian and New Zealand Journal of Public Health, vol. 29, no. 5, pp. 468-470.
Nelson, A 2009, ‘Learning from the past, looking to the future: exploring our place with Indigenous Australians’, Australian Occupational Therapy, vol. 56, pp. 97-102.
Putt, J 2013, ‘Conducting research with Indigenous people and communities’, Indigenous Justice Clearinghouse, brief 15. Web.
Pyett, P, Waples-Crowe, P & van der Sterren, A 2009, ‘Engaging with Aboriginal communities in an urban context: some practical suggestions for public health researchers’, Australian and New Zealand Journal of Public Health, vol. 33, no. 1, pp. 51-54.
Ranzijn, R & McConnochie, K 2013, ‘No place for whites? Psychology students’ reactions to article on healing members of the stolen generations in Australia’, Australian Psychologist, vol. 48, pp. 445-461.
Saethre, E 2009, ‘Medical interactions, complaints, and the construction of Aboriginality in remote Australia’, Social Identities, vol. 15, no. 6, pp. 773-786.
Zufferey, C 2013, ‘Not knowing that I do not know and not wanting to know: reflections of a white Australian social worker’, International Social Work, vol. 56, no. 5, pp. 659-673.