‘It’s a cultural thing’: excuses used by health professionals on providing inclusive care

Abstract

Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals -as holders of organisational power -and how they construct "truths" or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of "other" cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.

Exploring the relevance of intersectionality in Australian dietetics: Issues of diversity and representation

“…However, Australian dietetics is not immune to the structures and systems of power and oppression (Lassemillante & Delbridge, 2021; Ng & Wai, 2021). Australian dietitians function within the landscape of the Australian health care system and education system, which are recognised to perpetuate significant oppression such as racism for Aboriginal and Torres Strait Islander peoples (Bodkin‐Andrews & Carlson, 2016; Gatwiri et al., 2021; Paradies, 2016), and culturally and linguistically diverse peoples including migrants and refugees (Bastos et al., 2018; Mohamed Shaburdin et al., 2020). Socioeconomic factors are barriers to access to higher education for many people (Rubin et al., 2014), particularly regional students (Edmunds & Harris, 2015), and mature‐age students (Tones et al., 2009).…”

A qualitative evaluation of the implementation of a cultural competence project in rural Victoria

“…8,20 Institutional racism can be expressed in covert 8 ways, embedded within everyday interactions and practices. 21 Griffith et al 22 suggest that institutional racism occurs at three levels: extra-organisational in interactions with the environment; intra-organisational through internal hierarchies, power relationships and systems; and at the individual level of staff interactions. 22 In the present study, comments regarding the size of the local Aboriginal community, the 'relevance' of cultural competence and the suggestion that cultural competence is not a 'priority' all reflect a deep misunderstanding of institutional racism within Victorian health and community service organisations.…”

A realist evaluation of a community of practice for dietitians and nutritionists working in Aboriginal and Torres Strait Islander health

“…All health professions are recognised for their important role in providing culturally responsive and effective health care for Aboriginal and Torres Strait Islander peoples 1 . Simultaneously, health professions are criticised for perpetuating healthcare provision that reinforces racist stereotypes and dismissing the complex interplay between social, political and historical determinants affecting Aboriginal peoples’ experiences of health care 2–4 . Having a suitably qualified and culturally capable health workforce is a priority for governments and health agencies internationally.…”

“…1 Simultaneously, health professions are criticised for perpetuating healthcare provision that reinforces racist stereotypes and dismissing the complex interplay between social, political and historical determinants affecting Aboriginal peoples’ experiences of health care. 2 , 3 , 4 Having a suitably qualified and culturally capable health workforce is a priority for governments and health agencies internationally. The capacity of the existing workforces together with strategies to support the education of workforces in training are essential for ensuring local and global health needs are met and that the perpetuation of biased and exclusionary health provision is minimised.…”

“… 20 , 21 The implication of this is that, for Aboriginal peoples seeking the services of dietitians, their healthcare will be a cross‐cultural experience with non‐Aboriginal dietitians by necessity and not by choice, which in turn results in racism and culturally unsafe practice that may have an impact on their nutrition and health outcomes. 22 , 23 …”