Health system access, cultural safety and health workforce

Health inequities are also related to interactions with and access to the health system (AIHW 2020). According to the Aboriginal and Torres Strait Islander Health Performance Framework, Aboriginal and Torres Strait Islander Australians experience multiple barriers in relation to health system access including cost, lack of culturally safe services (see Box 3), lack of appropriate services, racism and discrimination and government policies which have contributed to family disruption (AIHW 2020; DoHAC 2020).

According to the Aboriginal and Torres Strait Islander Health Performance Framework, in 2018-19 30% of Aboriginal and Torres Strait Islander peoples reported that they needed to, but did not see, a health care provider on at least one occasion in the past 12 months (AIHW 2020). Cost, long waiting time, lack of transport and services being far from where people live were among the top reasons for lack of access to services.

Box 1: Cultural safety in health care for Aboriginal and Torres Strait Islander health care users

Cultural safety focuses on the right to autonomy, dignity, empowerment, and respect, and acknowledges societal position, culture, and diversity within a broader structural framework when addressing the care needs of an individual (DoHAC 2020). 

Cultural safety is defined with reference to the experiences of Aboriginal and Torres Strait Islander health care users, of the care they are given and their ability to access services and to raise concerns (AIHW 2022). Cultural safety in health care has the following elements:

  • Culturally respectful health care services: Cultural respect is achieved when the health system is a safe environment for Aboriginal and Torres Strait Islander health care users, and where cultural differences are respected. Cultural respect is reflected in health care provision, structures, policies and programs.
  • Patient experience of health care: The experiences of Aboriginal and Torres Strait Islander health care users, including having their cultural identity respected, is critical for assessing cultural safety. Aspects of cultural safety include good communication, respectful treatment, empowerment in decision making and the inclusion of family members.
  • Access to health care services: Aboriginal and Torres Strait Islander people do not always have the same level of access to health services as non-Indigenous Australians (AIHW 2022).

Culturally appropriate and relevant care is the responsibility of the entire health system (AIHW 2020). The National Agreement on Closing the Gap priority reform 3 ‘Transforming Government Organisations’ states that mainstream government organisations must improve accountability and respond to the needs of Aboriginal and Torres Strait Islander people by committing to systemic and structural transformation (Productivity Commission 2020).

The National Aboriginal and Torres Strait Islander Health Plan 2021­-2031 is another key policy which aims to improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people (DoHAC 2021). The Health Plan acknowledges the importance of both the cultural and social determinants of health and aims to ensure Aboriginal and Torres Strait Islander people have a healthy life through access to culturally safe and equitable health care (DoHAC 2021).

Transformation elements outlined in the agreement to achieve this reform include:

  • identify and eliminate racism
  • embed and practice meaningful cultural safety
  • deliver services in partnership with Aboriginal and Torres Strait Islander organisations communities and people,
  • increase accountability through transparent funding allocations
  • support Aboriginal and Torres Strait Islander cultures
  • improve engagement with Aboriginal and Torres Strait Islander people (Productivity Commission 2020).

Aboriginal Community Controlled Health Services are crucial in providing care, and an increase in the number of Aboriginal and Torres Strait Islander peoples in the health workforce will improve access to culturally appropriate health care for Aboriginal and Torres Strait Islander peoples (AIHW 2020). 

In 2020, according to the Department of Health and Aged Care National Health Workforce Dataset, there were 762,794 registered health professionals in Australia. Of relevance to Aboriginal and Torres Strait Islander mothers and babies, 55% (418,349) were Nurses and Midwives, 16% (121,187) were Medical Practitioners and 0.1% (760) were Aboriginal and Torres Strait Islander Health Practitioners (AIHW analysis of DoHAC 2022).

Overall, 1.2% (9,346) of registered health professionals identified as Aboriginal or Torres Strait Islander, 1.5% (6,214) of Nurses and Midwives, 0.6% (694) of Medical Practitioners and 100% (760) of Aboriginal and Torres Strait Islander Health Practitioners (AIHW analysis of DoHAC 2022).

Improvements in the way the health system serves Aboriginal and Torres Strait Islander peoples is also fundamental for addressing the health gap (AIHW 2020). Particularly in relation to the priority reforms of the National Agreement on Closing the Gap including, working in partnership and sharing decision making with Aboriginal and Torres Strait Islander peoples, building the community-controlled sector, transforming government organisations to deliver culturally safe services and sharing data and information to meet the needs of communities (Productivity Commission 2020).

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