A national inquiry into racism, hate and violence and hate directed at First Nations people is hearing clear recommendations for action by governments and institutions, including health services, reports Jason Staines.
Jason Staines writes:
Australia is not lacking in evidence about the prevalence and harmful impacts of racism towards Aboriginal and Torres Strait Islander people. What it does lack, according to submissions to an ongoing parliamentary inquiry, is concrete action.
The Joint Standing Committee on Aboriginal and Torres Strait Islander Affairs has received more than 600 submissions from individuals and organisations across the country as it looks into racism, hate and violence directed at First Nations people.
The inquiry has now moved into a series of public hearings around the country, with evidence already heard in Canberra, Perth, Darwin and Alice Springs, and further hearings scheduled for Brisbane, Cairns and Thursday Island.
Witnesses include the Australian Human Rights Commission, Meta, the National Aboriginal Community Controlled Health Organisation (NACCHO), the Torres Strait Regional Authority, health organisations, legal groups, Aboriginal and Torres Strait Islander community organisations, and young people and LGBTQIA+ advocates.
The hearings have already echoed many of the themes emerging from the written submissions, including growing concern about online racism, institutional accountability and the need to move beyond documenting racism towards implementing practical reforms.
The inquiry has also attracted controversy after Northern Territory Government agencies declined invitations to make submissions or appear at the Darwin hearings.
Committee Chair Senator Jana Stewart said the Territory’s participation was particularly important given almost 30 percent of its population is Aboriginal, while a committee member, Independent MP Andrew Gee, said the decision showed contempt for parliamentary scrutiny.
Witnesses were also critical, with Northern Land Council chair Matthew Ryan describing the no-show as “ignorant and racist”. Several Queensland Government agencies have also declined invitations to appear at upcoming hearings.
The inquiry was launched amid disappointment that the Albanese Government refused to widen the terms of reference for the Royal Commission into Antisemitism and Social Cohesion to include the experiences of First Nations people following an alleged terror attack during an Invasion Day rally in Boorloo Perth.
In reviewing more than 30 submissions, Croakey found they describe racism across almost every sphere of life: hospitals, schools, workplaces, housing, the justice system, social media, policies across diverse spheres, and political debate.
The wide-ranging health impacts include that racism within the health system undermines access to care and the safety and quality of care.
While submissions to the inquiry differed in their emphasis, there was a large degree of agreement about what should happen next. Rather than proposing dozens of competing solutions, many converge around a relatively small number of themes centred on reforming institutions rather than focusing on individual behaviour change.
Focus on implementation
Perhaps the strongest theme is that governments already know what needs to be done.
The Law Council of Australia argued there is no shortage of inquiries, reports or recommendations documenting racism and its impacts.
It called for implementation of existing commitments, including those arising from previous inquiries and Australia’s obligations under international human rights instruments.
That sentiment was echoed across submissions from Aboriginal community-controlled health organisations and peak medical bodies, including NACCHO, the Aboriginal Medical Services Alliance Northern Territory (AMSANT), the Australian Indigenous Doctors’ Association (AIDA), the Australian Medical Association (AMA) and the Royal Australian College of General Practitioners (RACGP).
Rather than another cycle of reviews, many argued the priority should be acting on reforms that have already been identified.
Roadmap
NACCHO noted that successive inquiries had reached similar conclusions but governments had been slow to respond. It recommended that governments implement previous inquiry recommendations and formally endorse, fund and implement the National Anti-Racism Framework.
This recommendation appeared repeatedly across submissions: implement the Australian Human Rights Commission’s National Anti-Racism Framework.
The Australian Council of Social Service (ACOSS) described the framework as an opportunity for a coordinated, whole-of-government response to racism. Rather than isolated initiatives, it envisages national leadership, measurable goals and accountability.
“We urge the Federal Government to implement the 63 recommendations of the Australian Human Rights Commission’s Anti-Racism Framework,” said the ACOSS submission.
“The Framework calls for an implementation plan specific to First Nations people in recognition of their unique experiences of racism. We urge the Federal Government to implement this and the broader anti-racism framework without delay.”
Support for implementing the framework also came from the Law Council, the Aboriginal Health and Medical Research Council (AH&MRC), NACCHO, AMSANT, AIDA, Indigenous Allied Health Australia (IAHA) and the RACGP.
Few recommendations attracted such broad endorsement across organisations with otherwise differing priorities.
Self-determination
Many First Nations organisations submitted that Aboriginal and Torres Strait Islander people should play a much greater role in designing, delivering and evaluating policies affecting their communities.
NACCHO argued that Aboriginal community-controlled organisations are not simply preferred service providers but are themselves an anti-racism strategy. It linked community control to improved health outcomes, greater trust and more culturally appropriate care.
One example it cited was the surge in racist abuse experienced by Aboriginal organisations during and after the Voice referendum. NACCHO described the practical burden placed on staff who found themselves spending significant time responding to racist abuse on social media.
AMSANT, AH&MRC, IAHA, the Close the Gap Campaign and several other organisations similarly argued that consultation alone is insufficient.
Instead, they advocated genuine partnership, shared decision-making and, in some cases, transferring decision-making authority to Aboriginal organisations themselves. The emphasis was not simply on listening to Aboriginal voices, but on sharing power.
Make cultural safety measurable
Many submissions also argued that cultural safety needs to move beyond aspiration.
The RACGP’s submission outlined ways cultural safety could be embedded through professional education, professional standards, workforce development and quality improvement.
Rather than simply encouraging doctors to undertake training, it proposed embedding anti-racism throughout healthcare training, professional standards, continuing professional development and quality assurance – treating it as an ongoing component of good clinical practice rather than an optional extra.
AMSANT proposed national standards, measurable indicators and public reporting. The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), AIDA, IAHA, the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP) and the Rural Doctors Association of Australia all supported stronger cultural safety across the health workforce.
As the CATSINaM submission noted: “Embedding cultural safety as a core governance and quality requirement, rather than treating it as an optional or solely educational initiative.”
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Public health framing
Health organisations consistently framed racism as a public health concern.
AIDA argued racism contributes directly to poorer health outcomes and undermines access to healthcare. “Racism in Australia’s health system has a real and damaging impact on the health outcomes of Aboriginal and Torres Strait Islander people and dismantling racism requires system-level change,” said the AIDA submission.
The RACGP called for systemic responses rather than isolated initiatives.
“Racism is a public health emergency and a most significant contributor to health inequities experienced by Aboriginal and Torres Strait Islander peoples,” the College said.
“Eliminating racism requires coordinated, sustained action across healthcare systems, policy settings and professional practice.”
AH&MRC illustrated what that can mean in practice. Its submission argued that Aboriginal patients are often labelled “non-compliant” when treatment breaks down, particularly in areas such as kidney disease. Rather than seeing this as a failure by patients, it argued such situations often reflect culturally unsafe health systems, limited transport, historical disadvantage and clinician assumptions that influence treatment decisions.
Submissions discussed how racism affected physical health, mental health, trust in healthcare, workforce participation and the ability of health systems to provide equitable care.
AMA President Dr Danielle McMullen said in a statement to Croakey: “Racism has no place in healthcare. Every patient deserves culturally safe, respectful care, and every healthcare organisation has a responsibility to make that a reality.”
McMullen also said the burden of tackling racism “cannot fall on Aboriginal and Torres Strait Islander doctors and health workers alone”.
“Creating a fairer health system is a responsibility shared by all of us.”
Accountability matters
Another recurring theme was accountability. Rather than relying on awareness campaigns alone, several organisations called for mechanisms to measure institutional performance.
AMSANT argued that measuring cultural safety and racism was only meaningful if institutions were held accountable for the results, calling for national performance indicators, public reporting and funding incentives tied to improvement.
It called for: “A national set of KPIs to measure cultural appropriateness and quality of care for Aboriginal people across all layers of the Australian healthcare system … Regular, mandatory and publicly accessible reporting on these KPIs … [and] a national accreditation system that tracks and supports healthcare services to improve on and maintain benchmark levels of cultural safety.”
The RACGP proposed embedding anti-racism into quality improvement processes, while IAHA, Close the Gap and other organisations argued for stronger oversight and clearer accountability for outcomes.
The underlying principle was that racism should be monitored much like any other issue affecting quality, safety or equity.
Tackle online and environmental racism
Several submissions highlighted the growing role of digital platforms in spreading racism.
NACCHO described the direct impact on Aboriginal organisations and staff: “We have found that as the comments on paid advertisements cannot be disabled, the racist abuse is unavoidable and effectively built into the system itself.”
The organisation went on to describe the “constant psychological and cultural load” of responding to online abuse and called for stronger regulation of social media platforms.
AH&MRC highlighted the long-running problem of lead exposure among Aboriginal children in Broken Hill, arguing it should be understood not simply as an environmental issue but as environmental racism.
It pointed to the disproportionate burden borne by Aboriginal children and backed calls from Maari Ma Health Aboriginal Corporation for an Aboriginal-specific lead strategy, investment in housing and a major overhaul of remediation efforts.
Common thread
The submissions Croakey reviewed came from organisations with very different roles – from Aboriginal community-controlled health services and specialist medical colleges to legal bodies and advocacy organisations.
Health organisations understandably focused on hospitals, workforce reform and cultural safety. Legal organisations emphasised rights, accountability and legislative reform. Aboriginal organisations consistently highlighted self-determination and community control.
A common thread ran across these perspectives.
Much public discussion about racism focuses on changing individual attitudes or confronting overt prejudice. The submissions to this inquiry largely start from a different premise. They argue that while individual behaviour matters, lasting change depends on changing the institutions, policies, funding arrangements and governance structures that shape people’s everyday experiences.
Whether that happens will depend less on what the committee ultimately recommends than on whether governments are prepared to act.
Many submissions pointed to a history of inquiries whose recommendations have been only partially implemented, while the widespread support across sectors for the National Anti-Racism Framework remains to be matched by government funding and action.
The refusal of Northern Territory Government agencies to appear before the inquiry has only reinforced concerns among some witnesses about political commitment to addressing systemic racism.
For the health sector, that suggests the task does not end with making a submission – or even when the committee hands down its report.
If the broad consensus reflected in the submissions is to translate into lasting change, health organisations, professional bodies and Aboriginal community-controlled organisations are likely to face the longer challenge of keeping pressure on governments to implement the reforms they have so consistently called for.
• Declaration: Croakey Health Media made a submission to the inquiry based upon our extensive archives on racism and health, and will report more on this in coming weeks
See Croakey’s archives on cultural safety
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