Power, politics and the street-level bureaucrat in Indigenous Australian health

Abstract

Street-level professional workers' influence over Indigenous health policy implementation is an important variable in a contested policy environment distinguished by an Indigenous median age of death approximately 20 years less than for non-Indigenous citizens. Street-level workers are guided by personal political values in the ways that they prioritise their work and make decisions about the care that will be available to particular patients. The possibility that street-level workers may make decisions with reference to stereotypical or prejudiced judgements about Indigenous peoples makes their bureaucratic discretion a point of particular significance. Alternatively, their capacity to work on the assumption that they have the professional agency and a moral duty to make a substantive contribution to improving Indigenous health outcomes positions their work in the context of social justice. The street-level worker is, then, drawn into the politics of public policy and policy activism, where ideology sits alongside professional knowledge and skills as determinants of Indigenous health outcomes, and where public policy's intellectual and practical inconsistencies simultaneously constrain opportunities for bureaucratic discretion in some respects and provide new opportunities in others, such that the street-level worker is a central participant in the politics of Indigenous health.

The uses of knowledge in global health

“…Even plumbers will sometimes have to be emancipators. [53][54][55][56] Professors will often need to be just as political. Uses and users of knowledge can also be fluid.…”