How can non-Indigenous people working in the health sector be more active and effective in supporting First Nations Peoples’ governance and self-determination, in promoting cultural safety and in stamping out racism in all its forms?
Researchers Dr Elizabeth Rix, Dr Shae L Brown and Dr Darlene Rotumah put forward four practical strategies that are especially timely in the current context of national health reform efforts.
Elixabeth Rix, Shae L Brown and Darlene Rotumah write:
As we witness the rise of populism and increasingly open racism and hate speech towards First Nations Peoples in Australia and Aotearoa/New Zealand, it’s more important than ever to be strategic and determined in building movements of resistance.
We write to encourage everyone working in the health sector – whether as clinicians, policymakers, managers or in other roles – to move beyond being an ally for First Nations Peoples and cultures, toward active accompliceship.
Accompliceship requires promoting cultural safety and practical equity beside First Nations people and culture(s) through partnership, ongoing reflection, learning, advocacy and action.
Readers may have seen articles at Croakey previously by contributing editor Associate Professor Summer May Finlay, (in 2020 and 2024), highlighting distinctions between allies and accomplices, including that the latter get outside their comfort zones and “stand with us at all times”.
We drew on articles by Finlay, Associate Professor Carmen Parter and others in our recent paper urging health professionals to join us on a journey of learning and to shift from being a self-declared ally towards being an active accomplice beside First Nations people.
Accompliceship demands intentional action that supports First Nations Peoples’ self-determination, expertise, sovereignty and respecting Indigenous knowledge and voices, as opposed to allyship that can be claimed without practical action or change occurring.
Timely context
In addition to taking a strong stand against the spread of populism and hate, it is a timely moment for accomplices to step up and engage with health reform efforts.
In particular, Croakey readers could consider the following three opportunities for accomplices to get active in supporting better health and healthcare for First Nations people.
- The third edition of the National Safety and Quality of Health Service Standards is now being developed.
The initial draft document says: “The third edition signals a shift in the structure and emphasis of the NSQHS Standards to support the delivery of high-quality care across Australia, which includes an emphasis on providing culturally safe and equitable healthcare service.” (Read more pp 8-10).
Cultural safety is also mandated in Australian healthcare by the Australian Health Practitioners Regulation Agency. Becoming a culturally safer practitioner demands an understanding of the cultural, historical, the social aspects and systemic racism on First Nations Peoples’ experiences.
- The latest National Health Reform Agreement also includes a section dedicated to improving care for Aboriginal and Torres Strait Islander people, for the first time (Schedule B, pp67-87)):
“In signing the agreement, state, territory and federal jurisdictions have agreed to:
- recognise and actively work to counteract the power imbalances, historical legacies and other challenges that have undermined relationships between governments and Aboriginal and Torres Strait Islander people in the past
- uphold Aboriginal and Torres Strait Islander people’s right to culturally safe, trauma- aware and healing informed and responsive health care, free of racism and inequity
- elevate and formally embed Aboriginal and Torres Strait Islander people and leadership in health governance structures and decision-making arrangements
- embed transparency and accountability to ensure that all Parties acknowledge their shared responsibility to work in partnership with Aboriginal and Torres Strait Islander people to improve the health outcomes of Aboriginal and Torres Strait Islander people
- acknowledge that Aboriginal and Torres Strait Islander people are impacted by all health system policies and practices (not just those programs and policies explicitly aimed at Aboriginal and Torres Strait Islander people), and embed formal mechanisms in processes for program and policy reform and evaluation to consider the impact on Aboriginal and Torres Strait Islander people
- acknowledge the importance of intersectional issues throughout the life course and the interface between health, disability and aged care for Aboriginal and Torres Strait Islander people.”
3. The Joint Standing Committee on Aboriginal and Torres Strait Islander Affairs is inquiring into racism, hate and violence directed at Aboriginal and Torres Strait Islander people. When its report is handed down, accomplices will have an important role in contributing to action, where appropriate.
Action-oriented
Accompliceship, like cultural safety, is grounded in reducing power imbalances and systemic discrimination, and respecting Indigenous knowledge and voices. Cultural safety is only achieved when recipients of healthcare and their families consider treatment to be so.
Accompliceship is an ongoing enacted process. Just as we cannot get fitter and healthier by simply talking about exercise or doing five minutes occasionally, regular practice and being in a relationship with exercise is required. We use this metaphor to think of being an accomplice as equity health and fitness.
The term equity is frequently misused in healthcare to obscure systemic injustices and biases towards First Nations People. Have you ever asked yourself, ‘equity from whose perspective’? Accomplices to First Nations people enact authentic practical equity through everyday actions. Authentic equity includes voice, access, participation, and rights.
The origins of language are important. The term ally is closely related with political positioning in western warfare, whereas accomplices are linked to criminality.
The terms white and whiteness do not refer to skin colour, rather they are fundamentally linked to the dominance of western culture, systemic power and institutional racism. Many Caucasian Australians working in health are resistant (at best) to this understanding and can become fiercely defensive, even outraged at the mention of the term racist or when irrefutable evidence shows the dominance of white culture and the benefits and privileges of whiteness.
Despite cultural safety being mandatory in healthcare, there remains little or no clarity on how to translate this into everyday practice.
Non-Indigenous academics teaching cultural safety frequently struggle to understand the concepts unless working alongside First Nations scholars, which is rare given limited funding and lack of prioritisation by universities.
Four strategies
Below are four practical strategies aimed at steering allies towards accompliceship, promoting relationships, respect, responsibility, and reciprocity.
- Reality is complex: Professional practice is shaped and influenced by many complex factors. Recognising that complexity involves understanding diversity, systemic influences, and the personal biases that we all carry from our upbringing and life experiences, is a beginning point.
Our paper unpacks complexity in our ‘own context’, that of ‘people and places’ and the wider context. Accompliceship requires us to understand policies and culturally safe practices while remaining responsive to the needs and preferences of First Nations people.
- Ready to listen and learn: Listening deeply to hear and understand is challenging. Being open-minded and allowing our humanity to show develops our knowledge of discrimination within healthcare policy and practice.
Western science teaches us to view knowledge as fixed and absolute and, that as individuals we can own that knowledge. This devalues and discredits Indigenous ways of knowing, being and doing.
- Taking action: Accomplices can fear making mistakes. We recommend being brave enough to get it wrong; a mistake can lead to relationship building and learning. Taking no action contributes to the complicity of silence.
Actions include standing up against racism, even when you yourself may then become targeted and bullied in your workplace, which is not uncommon for accomplices. Rigid power hierarchies and workplace bullying are real. Taking action includes knowing when to walk alongside First Nations people when facing down racism, but also when to step back and respect Indigenous sovereignty and voices.
- Reflection: Critical reflection is central to being a culturally safe practitioner. Having self-awareness about our own cultural heritage and history supports authentic engagement and unlearning of false colonial narratives or lack of truth-telling about colonisation. Without critically reflecting on our culture and biases, culturally safe practice is impossible.
The phrase “Nothing about us without us” stresses the importance of prioritising First Nations’ voices being front and centre when policies and practice affect lives. To not do so is patronising and insulting. Prioritising First Nations governance and self-determination must underpin all forms of consultation and evaluation, not tokenism. This point is crucial for building trust and positive working relationships.
Accomplices are brave in challenging individual and systemic discrimination and racism even in the face of workplace push-back. By engaging in deep listening, trusting relationships are built. Sharing personal stories when working with First Nations people demonstrates our sincere desire to be an accomplice as opposed to a performative ally.
Becoming an accomplice is a lifelong process that takes humility, persistence and genuine relationship building, towards respect for each other and a stable and healthy future for all. Moving beyond tokenistic inclusion requires authentic relationality and active advocacy.
As the rights and wellbeing of First Nations people come under increasing attack from populists and racist political and public discourse, it is more important than ever that accomplices step up.
We invite all readers to join us in our journey as committed and active accomplices to practical equity and social justice for First Nations Peoples. Doing so is a positive personal and professional stance of commitment to eradicating racism in healthcare for First Nations Peoples and pushing back on the rise of hate speech and the white supremacist style rhetoric of the populists aiming to eradicate decades of progress made in healthcare policy and practice.
Author details
Dr Elizabeth Rix, AKction Project, School of Nursing & Midwifery, College of Health, Adelaide University, is a nurse/researcher living on Bundjalung Country, NSW. Witnessing high levels of racism as a kidney care nurse was the motivation for her doctoral studies, which explored racism and lack of culturally safe treatment and care for First Nations Peoples receiving dialysis in rural/regional NSW. Elizabeth now works with a team of First Nations and white researchers on the AKction (Aboriginal Kidney Care Improving Outcomes Together) at the University of Adelaide, South Australia as a research fellow.
Dr Shae L Brown, Laszlo Institute of New Paradigm Research. Shae L Brown is a non-Indigenous educator and researcher whose work is based in embodied experience of the intelligence in all of nature’s relational dynamics, forms and expressions. Since an invitational community education role with Brewarrina Land Council in 1996, Shae has engaged with Indigenous Knowledge in a range of ways, including through Gnibi College colleagues throughout her doctoral research. Currently Shae is designing patterns-based teaching and learning resources based in deep complexity knowing and competence. This work sits in the relationship of Complexity Science and Indigenous Knowledge.
Dr Darlene Rotumah, Gnibi College of Australian Indigenous Peoples, Southern Cross University, is a Bundjalung woman whose work is grounded in cultural integrity, relational accountability, and the protection of Aboriginal and Torres Strait Islander knowledge systems. She is a Lecturer and Early Career Researcher at Gnibi College of Indigenous Australian Peoples, Southern Cross University, drawing on more than sixteen years of experience in Aboriginal health, where she worked as a health worker, counsellor, and educator supporting social and emotional wellbeing across community. Her research focuses on Indigenous research methodologies, trauma‑informed practice, and the Cultural Domains of Social and Emotional Wellbeing, with particular attention to how Indigenous practitioners navigate mainstream health and education systems. Darlene is recognised for her strengths‑based, culturally grounded approach to teaching and for her leadership in embedding Indigenous ways of knowing, being, and doing across curriculum design. Her work contributes to culturally safe practice and transformative change across health, education, and research sectors.
See Croakey’s archive of articles on cultural safety
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