Indigenous people (Aboriginal and Torres Strait Islanders) comprise 2.4% of the Australian population (AIHW 2006), and their appalling health and severe socio-economic disadvantage (low incomes and educational levels, high unemployment, poor housing etc) continue to be a national disgrace. Life expectancy for Indigenous males is 59 years and for Indigenous females is 65 years. This is approximately 20 years less than for other Australians, with about 70% dying before the age of 65 years. This is in stark contrast to the non-Indigenous population, where the corresponding proportion is 21%. Indigenous death rates for circulatory diseases are three times higher than other Australians, diseases of the digestive system five times, and endocrine, nutritional and metabolic diseases are eight times higher. Indigenous infants and children have death rates three times higher than non-Indigenous Australians (AIHW 2006). This situation is not new. The very poor state of Aboriginal health was widely known by the early 1970s (Saggers & Gray 1991) and little has changed in the intervening years.
The health problems and severe disadvantage suffered by Indigenous Australians is similar to that of other Indigenous peoples worldwide and, according to the International Council of Nurses (1999), a matter of concern for nursing (see Willis, Smye & Rameka 2006). Also of concern is the way health care services are delivered, including the behaviour of health care providers with respect to Indigenous peoples (ICN 1999). Australian nurses share these concerns (Armstrong 2004; van Holst Pellekaan & Clague 2005), but few point to the link between past government policies and current nursing practice. One who does is Sally Goold, Executive Director of the Congress of Aboriginal and Torres Strait Islander Nurses. She believes that racism, prejudice and discriminatory practices are alive and well in nursing and in the Australian health care system today precisely because of 200 years of colonization and the implementation of paternalistic and racist policies. Such policies denied Aboriginal people control over their own affairs, restricted their movement, and forbade them to speak their language and perform their ceremonies (Goold 2001). Goold provides compelling evidence of contemporary nurses ignoring Indigenous patients, treating them as 'nonpersons, invisible, unseen and unheard' (Goold 2001: 96). As the former Governor General of Australia, Sir William Deane, quite rightly explains:
the past is never fully gone. It is absorbed into the present and the future. It stays to shape what we are and what we do.
(Cited in Stephens 1999)
Goold is not alone in believing that racism has become 'institutionalised' into contemporary health care services in Australia. Institutional racism can be defined as the ways in which 'racist beliefs and values have been built into the operations of social institutions in such a way as to discriminate against, control and oppress various minority groups' (Henry, Houston & Mooney 2004: 517). Henry et al. (2004) consider institutional racism has been an almost constant feature of Australia's history, and that health care services are no exception. But they caution this has not always been deliberate. Very often institutional racism is covert and relatively subtle, unintentional and unrecognized even by those involved in it. Unquestioned adherence (by nurses) to dominant group norms, for instance, is one way of institutionalising racism.
The purpose of this paper is to explore the link between past government policies concerned with Aboriginal people and nursing practice as a way of understanding how racism became institutionalised into nursing and health care in Australia today. Such an examination is, I believe, crucial for contemporary nurses. Historical knowledge is a powerful tool for alerting nurses to the insidious and often covert nature of racism, for understanding how the past influences the present, and it underpins the abolition of racist practices, attitudes and behaviours in nursing and health care. …