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Research Trainee
Strengthening Indigenous Australian Perspectives in Allied
Health Education: A Critical Reflection
Danielle Manton, Megan Williams
A R T I C L E I N F O
A B S T R A C T
Keywords:
Indigenous Australians
Allied health
Curriculum
Cultural safety
Cultural responsiveness
https://doi.org/10.32799/ijih.v16i1.33218
While professional education in medicine and nursing in Australia has been
implementing strategies to increase accessibility for Indigenous Australians,
allied health professions remain underdeveloped in this area. Failure to improve
the engagement of allied health professions with Indigenous Australians, and
failure to increase the numbers of Indigenous staff and students risks perpetuating
health inequities, intergenerational disadvantage, and threatens the integrity of
professions who have publically committed to achieving cultural safety and
health equity between Indigenous and non-Indigenous people. Knowing this,
leaders in the allied health professions are asking “What needs to change?” This
paper presents a critical reflection on experiences of a university-based
Indigenous Health Unit leading the embedding of Indigenous perspectives in
allied health curriculum, informed by Indigenous community connections,
literature reviews, and research in the context of an emerging community of
practice on Indigenous health education. Key themes from reflections are
presented in this paper, identifying barriers as well as enablers for change, which
include Indigenous community relationship building, education of staff and
students, and collaborative research and teaching on Indigenous Peoples’ allied
health needs and models of care. These enablers are inherently anti-racism
strategies that redress negative stereotypes perpetuated about Indigenous
Australians and encourage the promotion of valuable Indigenous knowledges,
principles, and practices as strategies that may also help meet the health needs of
the general community.
A U T H O R I N F O
Danielle Manton, PhD candidate Indigenous Health Discipline, University of Technology Sydney (UTS), Sydney, New South Wales,
Australia. Danielle is a Barunggam woman and Teaching Fellow currently designing and implementing teaching and learning
opportunities to embed an Indigenous Graduate Attribute across allied health coursework at UTS’s Graduate School of Health.
Affiliations: Baabayn Aboriginal Corporation; Bimbadeen Christian Training College; The Glen rehabilitation centre; Katungul
Aboriginal Corporation Regional Health and Community Services; Gamarada Healing and Life Training; First Peoples Disability
Network Australia. Email: Danielle.Manton@uts.edu.au
Megan Williams, PhD, Research Lead and Assistant Director, National Centre for Cultural Competence, University of Sydney.
Megan is Wiradjuri and has over 20 years’ experience working on programs and research to improve the health of Indigenous people
and their families. Megan has led the embedding of Indigenous knowledges across six health master’s programs, and contributes to
curriculum in social work, journalism, public health, and education. Affiliations: Chair, Human Ethics Review Committee, Justice
Health & Forensic Mental Health Network; Associate Editor, Health Sociology Review; Board Member, Croakey Health Media.
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Glossary
Allied health: Includes health professionals who are not doctors, nurses, or dentists. Allied
health professionals work to prevent, diagnose, treat, and manage illness, disease, and chronic
conditions.
Cultural safety: Development of an environment that is spiritually, socially, emotionally, and
physically supportive and safe for Indigenous people, and that respects their cultures and
identities.
Wholistic health: The social, emotional, psychological, physical, environmental, spiritual, and
cultural wellbeing of the whole community, in which individuals are able to flourish across the
lifespan and generations.
Indigenous Australians: Aboriginal and Torres Strait Islander Peoples, the original inhabitants
and sovereign owners of Australia.
Indigenous Graduate Attribute: University-level requirement for graduates to be responsive to
needs and cultures of Indigenous people, relative to their profession.
Acknowledgements
Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research, and
Enterprise Education Working Party, Liverpool, New South Wales, Australia
Andrew Hayen, Professor of Public Health, Australian Centre for Public and Population
Health, University of Technology Sydney
Mark Ragg, Director, Ragg & Co, Marrickville, New South Wales
Australia Indigenous community partners: Baabayn Aboriginal Corporation; Bimbadeen
Christian Training College; The Glen rehabilitation centre; Katungul Aboriginal Corporation
Regional Health and Community Services; Gamarada Healing and Life Training; First Peoples
Disability Network Australia
Introduction
Because of their diversity and differing expertise, allied health services can offer much to
meet the needs of Indigenous Australians, who currently experience among the worst health
outcomes of any of the population groups across urban, regional, and remote locations in
Australia (Australian Bureau of Statistics [ABS], 2018) and the world (Anderson et al., 2016).
Many of the health issues Indigenous Australians experience are those that are likely to greatly
benefit from individual and inter-disciplinary allied health care (Ewen et al., 2019). A person
with Type 2 diabetes mellitus, for example, may benefit from allied health care such as podiatry,
orthoptics, counselling, and psychology, because of frequent co-morbidities of lower-limb
infections and amputation, diabetic retinopathy, and risks of poor mental health and social
isolation (Australian Institute of Health and Welfare [AIHW], 2016; Cunningham, 2010; Deroy
& Schütze, 2019).
However, data suggest Indigenous Australians access allied health services less than
others in Australia. In 2016, claims made for specialist and allied health services to Australia’s
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Medicare Benefits Scheme were 43 percent less for Indigenous Australians compared to others
(AIHW, 2016). This is despite the fact that the allied health workforce in Australia is large,
making up about a quarter of all health professionals (AIHW, 2014). Further, the workforce is
steadily growing and is expected to continue to do so (Department of Health, 2019). However,
the number of Indigenous Australians employed as allied health professionals is small and varies
greatly across the professions (Williams et al., 2020). Government targets for an Indigenous
workforce of 3 percent of the total workforce (NSW Public Service Commission, 2019) have
rarely been met (Williams et al., 2020).
This 3 percent Indigenous workforce target reflects the percentage of Indigenous people
in the general Australian population (ABS, 2017). This workforce target also acknowledges that
allied health professions seek and require growth in the number of Indigenous professionals, and
reinforces the role of allied health professions in treatment of health issues, prevention, early
intervention and follow-up care, inter-disciplinary referrals, and promotion of self-management
(Ah Kit et al., 2003; Bailie et al., 2016; Gibson et al., 2015; Philip, 2015). Allied health
professions are known for being diverse, with 23 recognised by New South Wales (NSW)
Health, the largest government health policy and service delivery organisation in Australia
(Williams et al., 2020). There are many allied health education offerings around Australia, with
coursework training accessible in face-to-face and mixed-mode delivery (Williams et al., 2019).
Yet questions remain about why Indigenous Australians have such low levels of access to
services and such low staff and student numbers.
Methods
This article is a critical reflection on the low numbers of Indigenous Australians working
in, studying, and accessing allied health, informed by the work of two Indigenous Australian
university staff members with teaching and research experience in health. To inform the
establishment of a new Indigenous Health Unit, woven among six allied health units but
autonomous, we conducted a review of international literature pertaining to allied health,
Indigenous Peoples, and workforce development. Community consultations were conducted in
four regions of the Australian jurisdiction of New South Wales (NSW). NSW is home to the
highest number of Indigenous Australians, with 33.3 percent of the Indigenous population of
798,400 people, yet they make up only 3.5 percent of the total NSW population (ABS, 2019).
Meetings were held to ascertain Indigenous organisations’ interest in collaborating to develop
new allied health curriculum. Meetings occurred with Indigenous Elders, service providers, and
community members, and were followed by an Expression of Interest process inviting
Indigenous community organisations to formally collaborate. Six Indigenous organisations self-
nominated to be involved and to form the Indigenous Health Bunya Project (Manton, 2019), a
mixed-methods action research project to develop and evaluate new curriculum from an
Indigenous perspective.
For a separate government-funded research project we were concurrently undertaking to
investigate barriers and enablers for building an Indigenous Australian allied health workforce,
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we conducted three literature reviews. These focused on 1) allied health service delivery related
to Indigenous people; 2) Indigenous employment literature, policies, and workforce data; and 3)
pathways into allied health education for Indigenous people. These three rounds of literature
reviews are synthesised here, along with insights from the Indigenous community consultations.
Our Indigenous Health Unit’s andragogy and the framework for adult learning, which
was conceptualised to guide curriculum development, is also described. This framework
incorporates the Cultural Responsiveness Framework of the national organisation Indigenous
Allied Health Australia (IAHA, 2019a), the 8-Ways Aboriginal Pedagogical Framework
(Yunkaporta, 2009), and the National Health and Medical Research Council’s (NHMRC) ethics
guidelines for Aboriginal and Torres Strait Islander health research (NHMRC, 2018) to provide
an informed foundation for the Indigenous Health Unit’s teaching and research. Our critical
reflection on literature, consultations, frameworks, and experiences has followed Kolb’s learning
cycle (Lisko & O’dell, 2010), occurring in the context of an emerging community of practice, the
Aboriginal Health and Wellbeing Education Working Party of Maridulu Budyari Gumal, a multi-
institutional research translation collaboration (2020). Themes arising from our reflections are
presented here to guide future allied health curriculum and workforce development strategies for
Indigenous Peoples and allied health professionals more broadly.
Results
Invisibility of Indigenous Australians in Allied Health
Literature reviews and community consultations confirmed that Indigenous Australians
are relatively invisible in the allied health professions in Australia. Aboriginal Community
Controlled Health Organisations (ACCHOs) are the largest providers of health care to
Indigenous Peoples in Australia (Australian Institute of Health, 2016); however, allied health
care in ACCHOs is minimal, with long waiting lists and limited availability due to funding
restrictions, remoteness of service locations, and low number of staff willing to work remotely.
Allied health staff in these services are rarely Indigenous people, and Indigenous Australians are
seldom reflected in recruitment, advertising, or mentoring programs to grow the allied health
workforce (Williams et al., 2019). The evidence base about Indigenous Australians and allied
health is small, and that which exists positions Indigenous people as service users, with
publications written “about” rather than “by” Indigenous people.
In research reviewing Australian allied health professions’ commitments to Indigenous
health, only minimal evidence of advocacy, partnerships, and professional development activities
was found (Williams et al., 2020). This inactivity generally persists, even though the poor health
of Indigenous Australians has been well-reported and responded to by other health disciplines,
such as medicine and nursing, as well as by ACCHOs for at least three decades. Allied health
professions have only minimal engagement in collective national-level advocacy to improve
health equity between Indigenous Peoples and other Australians, such as through the Close the
Gap campaign. This campaign stimulated, and also annually independently reviews, the
Australian government’s Closing the Gap framework, which has seven national targets for
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improvements in Indigenous health (Council of Australian Governments, 2008; Prime Minister
and Cabinet, 2019). Few allied health professions have been involved in these national target
developments. Further, few allied health professionals include information regarding Indigenous
Australians on their websites, and few include Indigenous Australians in their leadership teams
or on written communications available to members (Williams et al., 2019). Very little growth in
numbers of Indigenous allied health professionals has occurred in the last decade for which NSW
data are available. Only four out of 23 allied health professions counted met the 3 percent target,
with seven having no Aboriginal and Torres Strait Islander staff (Williams et al., 2020). Overall,
in Australia the Indigenous allied health workforce represents less than 0.5% of the Australian
allied health workforce (IAHA, 2018).
Leadership of Allied Health Professionals: Accreditation and Indigenous Graduate
Attributes
Indigenous Australians are also relatively invisible in the accreditation processes of allied
health professions. Some professions have developed accreditation standards that incorporate
Indigenous Peoples’ perspectives into tertiary curriculum and/or professional development
(Australian Health Practitioner Regulation Agency, 2019; Australian Pharmacy Council, 2014;
Australian Physiotherapy Council, 2017; Australian Psychology Accreditation Council, 2019;
Human Genetics Society of Australasia, 2016; Speech Pathology Australia, 2018a, 2018b).
These accreditation requirements go some way to recognising Indigenous people as non-Western
cultures different from the mainstream Australian population, requiring culturally and socially
relevant models of care based on Indigenous leaders’ expertise and community need. However,
some allied health professions do not require Indigenous perspectives for accreditation, nor do
they provide a rationale for this or any other explicit sector, staff, or student development options
(Williams et al., 2019).
On the other hand, most Australian tertiary education institutions have committed to
including Indigenous Peoples’ perspectives or other diverse cultural perspectives in their
curriculum (Universities Australia [UA], 2020). University of Technology Sydney, the tertiary
institution that is home to this Indigenous allied health project, requires that all graduating
students meet an Indigenous Graduate Attribute (IGA). An IGA in this Australian tertiary
education context is a short, aspirational statement added to all coursework descriptors and
course outlines which indicates that as a result of completing the course, all students will have an
improved awareness of Australia’s Indigenous cultures (Behrendt et al., 2012; Bodkin-Andrews
et al., 2018; Bosanquet et al., 2012; Bullen & Roberts, 2018; UA, 2011). IGAs are not
compulsory for Australian universities to implement (NHMRC, 2018), but of Australia’s 40
tertiary institutions, 31 have committed to developing cultural capability among students
generally, and 14 routinely report on progress toward meeting an IGA (UA, 2020). Universities
with an IGA require coursework-teaching staff to audit their curriculum and identify content and
assessment items that could be added to meet the IGA. Usually an IGA requires that all students
become culturally aware of and responsive to the needs of communities with whom they may be
in contact as professionals (Bath et al., 2004; Bovill, 2017; Durey et al., 2017; Graduate School
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of Health, 2018). IGAs may enable students to develop cross-cultural skills relevant to
succeeding in future careers and complementary to knowledge gained throughout their education
(Hunt et al., 2015; Page, 2014). Embedding an IGA may facilitate students and staff transferring,
adapting, and developing knowledge and skills to engage with diverse Indigenous communities
across Australia (Goerke & Kickett, 2014), using higher education to stimulate positive change
in Australian culture and workplaces (Behrendt et al., 2012; Krakouer, 2015; Page et al., 2018;
Power et al., 2016; Ryan & Ryan, 2013).
However, inclusion of Indigenous content in the curriculum is not enough (Fredericks,
2008). The extant literature on transformational learning theory and practice asserts that critical
self-reflection, immersion in settings to apply knowledge and practice skills, and feedback from
mentors are essential (Huria et al., 2017). In the Australian Indigenous health education context,
these types of opportunities for students have rarely been achieved, particularly not in such a way
as to support students becoming culturally safe health service providers, nor to improve
accessibility of health services (Fitzpatrick et al., 2019). Such immersion opportunities are
urgently required, with a concerted and coordinated effort to ensure staff and students are
supported in real-world contexts to develop knowledge and skills, and, most importantly, to be
supporting and serving community needs and priorities.
Tertiary Aboriginal and Torres Strait Islander Teaching Staff
In allied health, Indigenous staff are vital to gather, critique, and convey evidence and
practice wisdom from culturally relevant perspectives, as well as to make connections to
ACCHOs for student placements and provide support for staff and students throughout studies
and placement (Lucas et al., 2018; Thackrah et al., 2017). Indigenous Peoples’ experiences in
Australia, including segregation, assimilation, ongoing social exclusion, and frequent
experiences of racism, are sensitive and nuanced issues, and it takes expertise and resources to
teach students and health professionals about them. Further, health policy and models of health
are complex and require teaching expertise. Models of health require Indigenous Australian
perspectives, given that concepts of health are culturally determined and are wholistic (Prime
Minister and Cabinet, 2019).
At the same time that students are grappling with new information such as this wholistic
health definition, they are often also dealing with concerns about how much they have not known
about the poor treatment of Indigenous Australians (Gerrett-Magee, 2006; O’Dowd, 2012;
Reynolds, 2000), and questions about their place in perpetuating inequality (Fitzpatrick et al.,
2019). These can be considerable blocks to learning that must also be sensitively addressed
(Fitzpatrick et al., 2019). However, one shortfall in achieving such sensitive education and in
meeting embeddedness of an IGA is that tertiary institutions generally do not meet their targets
for Indigenous Australian staff numbers, who are best placed to deliver culturally informed
course content and guide curriculum (UA, 2011, 2017).
This is despite Australian government funding for tertiary instructions that requiresthem
to have Indigenous employment strategies, appoint senior Indigenous leaders, and implement
annual reporting mechanisms to stimulate necessary changes. These requirements have been
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devised to both increase staff numbers and ensure accountability and sustainability of
improvements over time (UA, 2017). Other supports for Indigenous staff include mentoring;
academic development programs; flexible arrangements such as supporting staff to work from
the traditional Country and/or community to which they and their ancestors belong; paid leave to
honor culturally significant events such as funerals, ceremonies, and days of observance; and
network meetings (Behrendt et al., 2012; Onnis, 2019; Roche et al., 2013).
Upskilling Mainstream Allied Health Professionals
The low number of Indigenous tertiary education staff puts the onus on the general body
of allied health professions’ teaching staff to upskill themselves, become confident in conveying
quality information about Indigenous Australians’ health needs and issues, and adequately
address student learning needs. Knowledgeable allied health practitioners are vital—for
promoting health, preventing disease, and providing diagnosis, treatment, and management
(Gibson et al., 2015). Further, as IAHA (2015) advocates, “It is the responsibility of health
service providers to demonstrate culturally responsive leadership, and build governance
structures and environments that ensure health professionals are encouraged, expected and able
to respond” respectfully to the needs of Indigenous people (p. 8) and the needs of people from a
range of cultures (Hawala-Druy & Hill, 2012).
However, histories of massacres and poisonings of Indigenous Australians, and of land
theft by colonisers, can render academic staff and students uncomfortable, as can Indigenous
Peoples’ cultural practices and assertions for land and human rights. For these reasons, education
about the history and culture of Indigenous Australians is often avoided (Yunkaporta &
McGinty, 2009). This risks perpetuating stereotypes and misinformation, and limits progress for
Indigenous Peoples (Nakata, 2007). Further, without professional development and training,
academics are likely to fear incorporating Indigenous perspectives in their curriculum. Although
most academics are experts in their field and may teach with excellence, this expertise does not
inherently transfer to the teaching of Indigenous perspectives and knowledge (Nakata, 2007).
Learning critical self-reflection is therefore essential, as are developing and adapting critical
reflection tools (Jackson Pulver et al., 2019; Lucas et al., 2018), and evaluating teaching and
learning strategies to develop the cultural responsiveness of the health workforce (Fitzpatrick et
al., 2019).
Terminology Troubles: Is it Cultural Awareness, Competence, Safety, or Other?
Education about Indigenous Australian cultures suffers from confusion about
terminology, and competition between education providers erodes the trust and motivation that
organisations might have for accessing training (SPHERE Network, 2019). Some start with
“cultural awareness”—basic information-giving that is foundational to further steps (Power et
al., 2016; Russell-Mundine, 2017; West et al., 2017). However, this is heavily critiqued as not
being robust enough, particularly because it does not require improvements in how people
behave or relate (Fredericks & Thompson, 2010).
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Frequently the term “cultural safety” is named as the ideal (Bin-Sallik, 2003; IAHA,
2019a; Williams, 1999), partly because “safety” is decided by service users (Papps & Ramsden,
1996) and because it reflects a wholistic definition of health. Cultural safety aims to provide:
An environment that is spiritually, socially and emotionally safe, as well as
physically safe for people; where there is no assault, challenge, or denial of their
identity, of who they are and what they need. It is about shared respect, shared
meaning, shared knowledge, and experience of learning together. (Williams, 1999, p.
213)
Further, cultural safety training has been described as being about empathy, ensuring
service providers reflect on their own attitudes and practices to balance power in client–
service provider relationships (Hughes, 2018).
These elements of cultural safety are difficult to make a reality. Cultural safety
training has also been criticised for focusing on service delivery, rather than on systemic
change required to bring about health equity (IAHA, 2019a).
Others instead assert that cultural responsiveness should be the goal because it
includes cultural safety but also addresses broader socio-cultural needs of populations
(Carteret, 2010; IAHA, 2019a). Working in a culturally responsive way includes strengths-
based and action-oriented approaches for achieving cultural safety, and also action to
increase accessibility of health care, through leadership and good governance. As IAHA
(2015) asserts, with cultural responsiveness, “the processes and supportive structures
around health service delivery are equally as important as actual health outcome measures
when determining the overall effectiveness of health service delivery” (p. 8).
This positions cultural responsiveness as requiring that the social determinants of
health be addressed—an action some health service providers argue is not their role,
however, given their focus on individual-level clinical care (Jackson Pulver et al., 2019).
Knowledge Hierarchies and Their Limits
As a result of perceived complexities in developing cultural responsiveness, tertiary
teaching staff may choose to meet minimum requirements of university and accreditation
mandates (Hennig & Paetkau, 2018), despite these seldom being developed by Indigenous
peoples nor with cultural responsiveness in mind. Indigenous Australians are relatively
powerless; it is tertiary institutions that have the history and power to define adequate learning
and knowledge (Pease, 2013), asserting a generalised set of facts, which overwhelmingly reflects
and reinforces Western science (Pease, 2013), as if it were applicable to all (Greenhalgh et al.,
2016). Universities in Australia have existed for no longer than 160 years (UA, 2017), a fraction
of the 60,000 years of Indigenous Australian cultural continuity, which is too often overlooked
(Dudgeon & Bray, 2018; Sherwood, 2013).
In the past, perspectives of Indigenous Australians across most levels of education have
focused on deficits (Bodkin-Andrews et al., 2018; Hogarth, 2018), with reliance on statistics to
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convey health inequity, mortality rates, and comparisons to other Australians (Brough, 2001).
While a realistic picture is required, biomedical and epidemiological data gathered by non-
Indigenous people overlook contextual information that would provide a wholistic understanding
(Tsey et al., 2019).
Through a deficit lens, negative statistics and problems perpetuate stereotypes and
oppressive actions, without commitment to Indigenous Australians’ community-driven change
(Page et al., 2018). This reinforces the notion that Indigenous Australians as a population all
have the same problems and are in need of help from outsiders (Fredericks, 2008). Tertiary
students have most often been learning “about” Indigenous communities and culture from an
outsider position (Norman, 2014)—which is also likely to reinforce deficit discourse (Nakata,
2007; Norman, 2014)—rather than through authentic voices and connections. The result is a
discriminatory system that silences Indigenous Australians’ ways of knowing, being, and doing
(Hogarth, 2018), minimises opportunities for self-determination to be progressed, and risks
assimilation of Indigenous Australian students into the dominant mainstream culture rather than
strengthening Indigenous solutions. Invisibility of Indigenous perspectives in allied health
curriculum specifically, and in the allied health professions generally, is likely to persist because
of the minuscule number of Indigenous allied health professionals. There are still too few
Indigenous allied health professionals, or other Indigenous health professionals, with experience,
time, or support of supervisors to influence curriculum, development of models of care, and the
non-Indigenous staff training required to bring about change (Bailey et al., 2020; Williams et al.,
2020).
Community Connections to Bring About Change
Some tertiary institutions do, however, state that they aim to reflect the communities they
are located in (University of Technology Sydney, 2019), and occasionally tertiary staff
embedding an IGA have developed local community relationships to enrich student learning and
professional practice (Bodkin-Andrews et al., 2018). This is beneficial to Indigenous Australians,
who are diverse and have more than 250 nations across Australia (Guilfoyle et al., 2010).
Consequently, it is inappropriate for one person or group to represent all communities (Carroll et
al., 2015). Through strategic local community connections, relationships can develop, with the
value of personal connections role-modelled to staff and students (Gibson et al., 2015).
Research and reflections from medicine and from nursing education highlight that
developing cultural responsiveness best occurs as a shared process with Indigenous communities,
and that it draws on diverse inputs and voices of community members (Carroll et al., 2015). This
shared process is asserted in the United Nations Declaration on the Rights of Indigenous Peoples,
which states that communities have the expertise and right to meet their social, cultural, and
economic needs (Bretag, 2013; United Nations, 2012; Wiessner, 2009). Self-determination is
reinforced by Australian national and state government frameworks that recognise the inherent
right of Indigenous Peoples to self-determine health care (Ah Kit et al., 2003; Hunt, 2017).
Community engagement is also an ethical principle that shapes decision-making among
Indigenous Australians (West et al., 2017) and promotes self-determination (Carroll et al., 2015;
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Hunt, 2017). In self-determining strategies for future health education and care, Indigenous
voices carry within them the experience of families and communities over generations, pre- and
post-colonisation (Geia et al., 2013). They provide students and staff with an authenticity that is
difficult to dismiss (Mills et al., 2018; Norman, 2014). When they are included in teaching and
learning, Indigenous voices are to be privileged and central (Fredericks, 2008), not an add-on to
dominant Western paradigms (Durey et al., 2017; Fredericks, 2008; Hogarth, 2018; West et al.,
2017). This in turn requires Indigenous teaching staff, working in partnership with local
communities to promote their realities, needs, and aspirations.
Limitations
This article is a critical reflection of two Indigenous Australian academics. While
reflection followed a process and incorporated three rounds of literature reviews and community
consultations, there was a dearth of research-based literature on Indigenous Peoples and allied
health to draw on. This article, however, offers an informed perspective, well positioned from
within allied health tertiary education and constantly engaging with allied health professionals
about overcoming barriers to engaging with Indigenous peoples.
Discussion
The longstanding rhetoric that Indigenous Australians’ poor health is an intractable
problem (Hogarth, 2018; Jackson Pulver et al., 2019) is slowly changing. One challenge for the
future, however, is ensuring Indigenous voices are embedded in health curriculum, including
allied health, which is profoundly underdeveloped compared to other health disciplines. This is
arguably more possible now than ever before in Australia, enabled by tertiary institutions’
commitments to students achieving IGAs. Speaking with authority to allied health students and
helping them achieve IGAs requires knowledge, experience, and authenticity (Bodkin-Andrews
et al., 2018). Promoting Indigenous ways of knowing, being, and doing by including Indigenous
voices in curriculum provides this authenticity with a relevance that is hard to dismiss (Mills et
al., 2018; Norman, 2014).
There are, however, many challenges when working at the “cultural interface”—the
space between Indigenous and Western knowledge systems (Nakata, 2007). Navigating these
knowledges and worldviews requires advanced skills of Indigenous teaching staff to not only
interpret the wide range of information and convey it sensitively to a novice audience of
students, but also cope with deficit discourse about Indigenous Peoples.
Unfortunately, there are few Indigenous allied health professionals in Australia, and
tertiary institutions rarely meet their Indigenous staff target numbers. However, there are a
number of important developments, including an Australian tertiary sector–wide strategy for
increasing Indigenous staff and student numbers (UA, 2020), and IAHA’s Indigenous allied
health workforce development strategy (IAHA, 2018). IAHA’s workforce surveys and
reflections show improvements among its Indigenous allied health student and professional
membership in access to supportive networks and mentoring, development of cultural
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responsiveness of their contexts more generally, and some influence as leaders (IAHA, 2019b,
2019c). Until such time as Indigenous allied health student, professional and academic staff
numbers grow, the onus must be on the general body of allied health and teaching staff to be
critically reflective and contribute to conveying good information about culturally responsive
models of allied health care for Indigenous Australians. However, while tertiary educators may
have extensive experience with clinical care, this has generally not rendered them confident with
Indigenous Australians. The issue is circular: tertiary education institutions suffer from not being
able to employ more Indigenous Australian staff to develop and deliver allied health curriculum
given there is a shortage of Indigenous allied health staff, and it is difficult to recruit and retain
Indigenous Australians in allied health coursework if the curriculum or institution does not
represent their needs, cultures, and aspirations.
One potential circuit breaker is genuine partnerships with Indigenous organisations. This
could be achieved through partnerships between Indigenous organisations, Elders, experts, and
tertiary institutions, which tertiary institutions are supporting now more than ever through their
strategic plans. There is a growing conviction, too, that conveying Indigenous knowledges in
allied health curriculum, workforce development, and service delivery has much to offer all
communities (IAHA, 2015), because Indigenous health is wholistic and draws on fundamental
interpersonal skills such as respect, engagement, and shared responsibility for making progress
(Berglund & McNeill, 1989; NHMRC, 2018)—all of which align with the aspirations of the
allied health professions.
Conclusion
It is perhaps only when Indigenous Australians’ ways of knowing, being, and doing are
recognised for their intrinsic value that they may inform and influence mainstream teaching and
service delivery, thereby contributing to achieving health equity. Until then, concerted effort is
required to bring the current and next generations of allied health professionals to a standard at
which they are confident engaging with Indigenous Australians. One strategy for this is
developing partnerships between tertiary institutions and Indigenous organisations that are
mutually beneficial: identifying needs of local Indigenous communities and designing
curriculum that develops service providers of the future who are able to assist in meeting these
needs. An extension of that is advocating for Indigenous Peoples’ health rights within
curriculum, and providing evidence about Indigenous people’s self-determined models of health
care. These are inherently anti-racism strategies that redress negative stereotypes perpetuated
about Indigenous Australians and enable the promotion of valuable Indigenous knowledges,
principles, and practices as strategies to meet community care priorities and standards. These
connected health service provider actions will contribute to transformational change required to
improve health equity, because it is intergenerational change—tertiary-level training strategies
will result in the next generations of health service providers being arguably more prepared than
current and previous generations.
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