Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia

Document Type : Original Article


1 College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia

2 Torres and Cape Hospital and Health Services (TCHSS), Cairns, QLD, Australia

3 Centre for Primary Health Care & Equity, University of New South Wales, Sydney, NSW, Australia

4 School of Population Health, UNSW, Sydney, NSW, Australia

5 School of Social Sciences, UNSW, Sydney, NSW, Australia

6 School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia

7 NT Health, Darwin, NT, Australia

8 Menzies School of Health Research, Darwin, NT, Australia


In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs, this study aimed to explore whether the governance of the A&TSIHW role supports full and meaningful participation.

The qualitative study was co-designed by a team of Aboriginal, Torres Strait Islander and non-Indigenous collaborators. Data collection comprised document review and interviews with A&TSIHWs (n = 51), clinicians (n = 19) community members (n = 8) and administrators (n = 5) in a north Queensland health district. We analysed governance at multiple levels (regulatory, organisational, and socio-cultural) and used critical race theory to deepen exploration of the role of race and racism in shaping it.

Governance of the A&TSIHW role occurs within a health system where racism is built into, and amplified by, formal and informal rules at all levels. Racially discriminatory structures such as the previous but long-standing relegation of A&TSIHW into the same career stream as cleaners were mirrored in discriminatory rules and managerial practices such as an absence of career-specific corporate support and limited opportunities to participate in, or represent to, key leadership groups. These interacted with and helped perpetuate workplace norms permissive of disrespect and abuse by non-Indigenous professionals. Ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs speaks to the gap between rhetoric and reality of governance for A&TSIHWs.

Strengthening governance to support A&TSIHWs requires critical attention be given to the role of race and racism in regulatory structures, organisational practice, and inter-professional relationships. Addressing all domains will be essential to achieve systemic change that recognises, supports and embeds the unique knowledge, skills and functions of the A&TSIHW role.


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Volume 11, Issue 12
December 2022
Pages 2951-2963
  • Receive Date: 01 September 2021
  • Revise Date: 24 February 2022
  • Accept Date: 22 April 2022
  • First Publish Date: 24 April 2022