Aboriginal cultural awareness training: policy v. accountability – failure in reality
Barbara Westwood A B C and Geoff Westwood A
+ Author Affiliations
- Author Affiliations
A Echuca Regional Health, 17 Francis Street, Echuca, VIC 3564, Australia.
B Aboriginal Health Unit, South West Sydney Area Health Service (SWSAHS), Locked Bag 7017, Liverpool BC, NSW 1871, Australia.
C Corresponding author. Email: bgwestwood@gmail.com
Australian Health Review 34(4) 423-429 https://doi.org/10.1071/AH09546
Submitted: 15 June 2007 Accepted: 18 February 2010 Published: 25 November 2010
Abstract
Despite 42 years progress since the 1967 referendum enabling laws to be made covering Aboriginal Australians their poor health status remains and is extensively documented. This paper presents results of a study into Cultural Awareness Training (CAT) in New South Wales and specifically South West Sydney Area Health Service (SWSAHS) with the aim of improving long-term health gains. The evidence demonstrates poor definition and coordination of CAT with a lack of clear policy direction and accountability for improving cultural awareness at government level. In SWSAHS staff attendance at training is poor and training is fragmented across the Area. The paper proposes actions to improve Aboriginal cultural awareness for health professionals including incorporating Aboriginal CAT into broader based Cross Cultural Training (CCT).
What is known about the topic? Cross-cultural education programs for both Aboriginal and non-Aboriginal health industry staff are poorly coordinated, delivered and evaluated. There is recognition that improvements in this area could bring real enhancements in service delivery and health outcomes.
What does this paper add? The deficiencies in Aboriginal CAT programs in general are explored and specifically identified in one large NSW health area with a major urban Aboriginal population. This paper reviews CAT themes in the literature and evaluates the effectiveness of known programs.
What are the implications for practitioners? The authors list a series of recommendations that have the potential to improve awareness of Aboriginal cultural issues to provide a basis for development of effective and comprehensive CAT programs to bring real improvements in service delivery.
References
[1] Resources for the 1967 Referendum. Reconciliation Australia. Available at http://www.reconciliation.org.au/home/reconciliation-resources/significant-events---anniversaries/1967-referendum [verified October 2010].[2] The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 1999. Australian Bureau of Statistics and Australian Institute of Health and Welfare; 1999. ABS Cat. No. 4704.0. AIHW Cat. No. IHW3.
[3] The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare; 2001. ABS Cat. No. 4704.0. AIHW Cat. No. IHW6.
[4] Deeble J, Mathers C, Smith L, Webb R, Smith V. Expenditures on health services for Aboriginal and Torres Strait Islander people. AIHW Cat. No. HWE 6. Canberra: AIHW, DHFS and NCEPH; 1998.
[5] Condon JR, Barnes T, Cunningham J, Smith L. Improvements in indigenous mortality in the Northern Territory over four decades. Aust N Z J Public Health 2004; 28 445–51.
| 15707186PubMed |
[6] Wano K. Cross cultural awareness training. In: Best Practice Interventions in Corrections for Indigenous People Conference, 13–15 October 1999; Adelaide; 1999. Available at http://www.aic.gov.au/events/aic%20upcoming%20events/1999/indigenous.aspx [verified October 2010].
[7] Gall D. Aboriginal cultural awareness program. Regina, SK: University of Regina; 2000. Available at http://www.uregina.ca/hr/working-at-the-uofr/representative-workforce-initiatives/aboriginal-awareness-training [verified October 2010].
[8] Annandale M, Instone A. Sei Tapu, O le Ala o le Ola: Draft Evaluation Report of the National Certificate in Mental Health. Prepared for Mental Health Support Workers Advisory Group. Wellington, NZ: Mental Health Commission New Zealand; 2004.
[9] Wenitong M, Mokak R, Councillor H, Thiele DD, Calma T. Rising to the health challenge for Aboriginal and Torres Strait Islander peoples: what will it take? Med J Aust 2007; 186 491–2.
| 17516892PubMed |
[10] Gracey M, Williams P, Smith P. Aboriginal deaths in Western Australia 1985–89 and 1990–94. Aust N Z J Public Health 2000; 24 145–52.
| Aboriginal deaths in Western Australia 1985–89 and 1990–94.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3ltFGhuw%3D%3D&md5=c77d9250685766fce712d63b3f8a5a58CAS | 10790933PubMed |
[11] McDermott RA, McCulloch BG, Campbell SK, Young DM. Diabetes in the Torres Strait Islands of Australia: better clinical systems but significant increase in weight and other risk conditions among adults 1999–2005. Med J Aust 2007; 186 505–8.
| 17516896PubMed |
[12] Rowley KG, Iser DM, Best JD, O’Dea K, Leonard D, McDermott R. Albuminuria in Australian Aboriginal people; prevalence and associations with components of the metabolic syndrome Diabetologia 2000; 43 1397–403.
| Albuminuria in Australian Aboriginal people; prevalence and associations with components of the metabolic syndromeCrossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3cXnsFWhsrw%3D&md5=673b8ab7526f7be4fb218f02f20a9061CAS | 11126409PubMed |
[13] Couzos S, Thiele DD. The International Covenant on Economic, Social and Cultural Rights and the Right to Health: is Australia meeting its obligations to Aboriginal People? Med J Aust 2007; 186 522–4.
| 17516900PubMed |
[14] Hunter E. Aboriginal Health and History: Power and Prejudice in Remote Australia. Melbourne: Cambridge University Press, 1998.
[15] Australia’s Health 2002. AIHW Cat. No. AUS-25. Canberra: Australian Institute of Health and Welfare; 2002.
[16] The health of the people of New South Wales – Report of the Chief Health Officer. Sydney: NSW Department of Health, Population Health Division; 2006. Available at http://www.health.nsw.gov.au/publichealth/chorep/ [verified October 2010].
[17] Enough to make you sick: how income and environment affect health. Research paper no.1. Canberra: National Health Strategy; 1992.
[18] Gracey M, Gee V. Hospitalization of infants for infections in Western Australia 1980–91. J Paediatr Child Health 1994; 30 502–5.
| Hospitalization of infants for infections in Western Australia 1980–91.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M7mvFCnsw%3D%3D&md5=dd5cf8424efd985a8b01410594a3e0e8CAS | 7865262PubMed |
[19] Read AW, Gibbins J, Stanley FJ, Morich P. Hospital admissions before the age of 2 years in Western Australia. Arch Dis Child 1994; 70 205–10.
| Hospital admissions before the age of 2 years in Western Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c7ot12lug%3D%3D&md5=19097e445fbc0e83f01bbc6b80ac5c6eCAS | 8135564PubMed |
[20] Rousham EK, Gracey M. Persistent growth faltering among Aboriginal infants and young children in north-west Australia: a retrospective study from 1969 to 1993. Acta Paediatr 1997; 86 46–50.
| Persistent growth faltering among Aboriginal infants and young children in north-west Australia: a retrospective study from 1969 to 1993.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s7ns12qug%3D%3D&md5=c6fa791c1939ff4a9d222bf4271fbf8dCAS | 9116425PubMed |
[21] Alessandri LM, Chambers HM, Garfield C, Vukovich S, Read AW. Cumulative mortality in children aged 1 to 6 years born in Western Australia from 1980–89. Arch Dis Child 1999; 80 15–20.
| Cumulative mortality in children aged 1 to 6 years born in Western Australia from 1980–89.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3lslKjsQ%3D%3D&md5=463e7f3bddff1291509f6e8e2e822902CAS | 10325753PubMed |
[22] Healthy people 2005 – new directions for Public Health in NSW. State Health Publication No: (HP) 000099. NSW Health Department, Public Health Division; 2003. Available at http://www.health.gov.au [verified April 2007].
[23] The World Health Report 2000: Health Systems Improving Performance. Geneva: World Health Organisation; 2000.
[24] Eckermann AK, Dowd T. Strengthening the role of primary health care in health promotion by bridging cultures in Aboriginal health. Aust J Adv Nurs 1991; 9 16–20.
| 1:STN:280:DyaK3s%2FgtVOgtg%3D%3D&md5=e980444987aff75956e259075fe35aeeCAS | 1840735PubMed |
[25] Adams K. Cultural awareness and cultural vision: the First National Forum of Aboriginal and Torres Strait Islander nurses. Lamp 1997; 54 29–30.
| 1:STN:280:DyaK1c%2Fjs1CjtQ%3D%3D&md5=67ea7e51009fc6aafcf6a3607999926fCAS | 9369671PubMed |
[26] National Aboriginal Health Strategy Working Party. A National Aboriginal Health Strategy. Canberra: Commonwealth Department Aboriginal Affairs; 1989.
[27] Ngalawa Bunga Mana (Life Information) Aboriginal Health and Demography in South Western Sydney. Sydney: South Western Sydney Area Health Services; 2003.
[28] Swan P, Raphael B. Ways Forward: National Aboriginal and Torres Strait Islander Mental Health Policy. Canberra: Australian Government Publishing Service, 1995.
[29] The Last Report: Report of the NSW Task Force on Aboriginal Health. Sydney: NSW Department of Health, Aboriginal Health Branch; 1990.
[30] Ring IT, Firman D. Reducing indigenous mortality in Australia: lessons from other countries. Med J Aust 1998; 169 528–9–532–3.
[31] McClean R, Forwood A. NSW Health review of cultural awareness training [electronic resource]: report to NSW Health regarding the effectiveness of cultural awareness training. Melbourne: Dench McClean; 1999. Available at http://trove.nla.gov.au/work/15952993?selectedversion=NBD28441129 [verified October 2010].
[32] Palmer GR, Short SD. Health Care and Public Policy: An Australian Analysis. Melbourne: Macmillan Education Australia Pty Ltd; 1994.
[33] Legge D, Butler P, Scott J. Policies for a healthy Australia. Canberra: Department of Human Services and Health; 1995.
[34] Westwood B. Cross-cultural Training for Aboriginal Health Issues – South Western Sydney Area Health Service. Aborig Isl Health Work J 2005; 29 22–5.
[35] Westwood B. Cross-cultural training for Aboriginal Health issues across South Western Sydney Area Health Service report. SWSAHS; 2004.
[36] The report of the NSW task force on Aboriginal Health. Cited in: The Southern Area Health Improvement Plan. Southern Area Health Service Public Health Unit; 1990. Available at www.snswphu.webcentral.com.au/absect2.htm [verified April 2007].
[37] Bowen S. Cultural Competency in Paediatric Health Care: Issues and Best Practices. 2002. Available at www.caphc.org/pdfs/cultural/background_summarypdf [verified April 2007].
[38] Cultural Competency in Health: a guide for policy, partnerships and participation. Canberra: National Health and Medical Research Council; 2005.
[39] Purden M. Cultural considerations in interprofessional education and practice. J Interprof Care 2005; 19 224–34.
| Cultural considerations in interprofessional education and practice.Crossref | GoogleScholarGoogle Scholar | 16096157PubMed |
[40] Betancourt JR. Cultural competence – marginal or mainstream movement? N Engl J Med 2004; 351 953–5.
| Cultural competence – marginal or mainstream movement?Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXnt12nur0%3D&md5=897300489d1b6e5c01fbd1bbda9675b9CAS | 15342800PubMed |
[41] Johnston M, Kanitsaki O. Cultural safety and cultural competence in health care and nursing: an Australian study. Melbourne: RMIT University; 2005.
[42] Fitzgerald MH. Establishing cultural competency for mental health professionals. In: Skultans V, Cox J, editors. Anthropological approaches to psychological medicine. London: Jessica Kingsley; 2000. pp. 184–200.
[43] Sinnott MJ, Wittman B. An introduction to Indigenous health and culture: the first tier of the Three Tiered plan. Aust J Rural Health 2001; 9 116–20.
| An introduction to Indigenous health and culture: the first tier of the Three Tiered plan.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2Fhs1Ggsw%3D%3D&md5=cfabaaf5e5f8e52bf71488e53ce1b6e4CAS | 11421962PubMed |
[44] Cope B, Kalantzis M. Productive Diversity: A New Australian Model for Work and Management. Annandale, NSW: Pluto Press; 1997.
[45] Gardenswartz L, Rowe A. Diverse Teams at Work: Capitalising on the power of diversity. Alexandria, VA: Society for Human Resource Management; 2002.
[46] Dowd S. Improving cultural competence: a systems perspective. Best practices for culturally and linguistically appropriate services in managed care. Harvard Pilgrim Health Care, Boston, 2002. Available at http://www.cms.gov/healthplans/quality/project03.asp [verified May 2007].
[47] Diversity Champions. Diversity at the Wales Co-operative Centre. Available at http://www.walescoop.com/c/102/i/648/ [verified October 2010].
[48] Stewart S. Cultural Competence in Health Care. Sydney: Diversity Health Institute; 2006.
