Indigenous Allied Health Australia (IAHA) Submission to Consultation on A National Code of Conduct for health care workers. Thank you for the opportunity to contribute to the Consultation on A National Code of Conduct for health care workers (The National Code). There are many organisations and individuals who will make submissions that address the breadth of issues within the Discussion Paper for this consultation. Indigenous Allied Health Australia (IAHA), the national Aboriginal and Torres Strait Islander allied health peak body, aims to highlight the importance of cultural responsiveness to Aboriginal and Torres Strait Islander peoples, and to also highlight the unique considerations for the delivery of health services to this group. It will articulate why IAHA believes this should be mandated within the National Code. The recommendations within this submission aim to ensure that health care workers are responsive to the cultural needs of Aboriginal and Torres Strait Islander individuals, families and communities within the context of a holistic view of health and wellbeing. IAHA full members are Aboriginal and Torres Strait Islander allied health professionals who have graduated from a tertiary allied health course with a recognised qualification and Aboriginal and Torres Strait Islander students who are enrolled in an allied health course. IAHA associate members are individuals and organisations who are committed to allied health as a mechanism to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples as associate members. This may include, but is not limited to non- Indigenous allied health professionals, allied health assistants, Aboriginal and Torres Strait Islander people studying or working in other health related fields. Therefore, a large number of IAHA members will be subject to the minimum standards of professional conduct set out within the National Code. IAHA understands that the National Code, once implemented in each state and territory, is expected to prescribe minimum standards of professional conduct for any person who provides a health service which is not subject to regulation under the National Law. In some circumstances this will include health practitioners registered under the National Law, to the extent that they provide services that are unrelated to or outside the typical scope of practice of their registration as a health practitioner. IAHA asserts that being culturally responsive is a minimal standard for professional conduct for all health care workers and should be included in the first standard Health care workers to provide services in a safe and ethical manner. The draft National Code within the discussion paper is based on those Codes of Conduct that apply under statute in New South Wales and South Australia. This draft includes the following standard:
1. Health care workers to provide services in a safe and ethical manner 1. A health care worker must provide health services in a safe and ethical manner. 2. Without limiting subclause 1, health care workers must comply with the following: a) A health care worker must maintain the necessary competence in his or her field of practice b) A health care worker must not provide health care of a type that is outside his or her experience or training, or provide services that he or she is not qualified to provide c) A health care worker must only prescribe treatments or appliances that serve the needs of clients d) A health care worker must recognise the limitations of the treatment he or she can provide and refer clients to other competent health care workers in appropriate circumstances e) A health care worker must recommend to clients that additional opinions and services be sought, where appropriate f) A health care worker must assist a client to find other appropriate health care services, if required and practicable g) A health care worker must encourage clients to inform their treating medical practitioner (if any) of the treatments or care being provided h) A health care worker must have a sound understanding of any possible adverse interactions between the therapies and treatments being provided or prescribed and any other medications or treatments, whether prescribed or not, that he or she is, or should be, aware that a client is taking or receiving, and advise the client of these interactions. IAHA proposes that an additional point be added to sub-clause 2 of this standard as follows: A health care worker must provide care that is culturally responsive to the needs of clients, particularly Aboriginal and Torres Strait Islander peoples. The inclusion of this sub-point in the National Code would benefit all Australians, including Aboriginal and Torres Strait Islander peoples, by celebrating and acknowledging the diversity within our multicultural society. Rationale IAHA acknowledges Article 24(2) of the United Nations Declaration on the Rights of Indigenous Peoples (the Declaration) which recognises the right of Aboriginal and Torres Strait Islander peoples to the highest attainable standard of physical and mental health 1. This right is in addition to the basic right to health for all described within the Universal Declaration of Human Rights (1948). IAHA endorses the definition that Aboriginal and Torres Strait Islander health means not just the physical well-being of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total well-being of their Community. It is a whole-of-life view and includes the cyclical concept of life-death-life. Health care services should strive to achieve the state where every individual is able to achieve their full potential as a human being and thus bring about the total well-being of their community. 2 1 http://www.un.org/esa/socdev/unpfii/documents/drips_en.pdf accessed 11 September 2013 2 National Aboriginal Health Strategy, 1989
Taking into consideration this widely accepted Aboriginal definition of health it is clear that good health is not just the absence of disease. If Aboriginal and Torres Strait Islander people are to achieve the highest attainable standard of physical and mental health as stated in United Nations Declaration on the Rights of Indigenous Peoples, then they must have the right to equitably access culturally responsive health care. Optimal health is a basic human right 3 and also a right for Aboriginal and Torres Strait Islander peoples as the recognised first peoples of Australia. Equitable access to culturally responsive health care can help achieve this. Wide disparities in the mortality and morbidity rates between Aboriginal and Torres Strait Islander and non-indigenous Australians persist in spite of successive government policies aimed at reducing such inequities. In large part, these inequities are the result of overt and covert discriminatory structures, words and/or actions that may be unrecognised by the agent or agency using them. These structures, words and actions are also a predictable consequence of institutional cultures that reflect the social and political values of the privileged groups that often dominate health service delivery and design 4. Racism is linked to or associated with poor self-assessed health status, anxiety, depression, poor mental health, psychological distress, suicide risk, diabetes, smoking, alcohol and substance misuse and emotional and behavioural difficulties. 5 Consequently research indicates that experiences of racism are associated with both poor health outcomes and health risk behaviours. It is essential that the harmful effects of racism on Aboriginal and Torres Strait Islander people are recognised and acknowledged by all Australians. Allied health professionals are well-placed, due to the large number of professions represented and the wide range of settings in which they interact with Aboriginal and Torres Strait Islander people 6, to play a role in the elimination of racism in healthcare settings. IAHA asserts that a culturally responsive health workforce is imperative in order to ensure Aboriginal and Torres Strait Islander people receive the health care required to significantly improve health and wellbeing outcomes. Culture can be defined as complex beliefs and behaviours acquired as part of relationships within particular families and other social groups 7 and can predispose people to view and experience health and illness in ways that can influence decisions, attitudes and beliefs around access and engagement in healthcare. This may include acceptance or rejection of treatment options, commitment to treatment and follow up, success of prevention and health 3 NHLF Position Paper The right to health http://www.iaha.com.au/iaha%20documents/000176_nationalhealthleadership.pdf 4 Larson, A., Coffin, J., Gilles, M., Howard, P. 2007. It s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Australian and New Zealand Journal of Public Health. Vol 34 S1 322-328 5 Y Paradies, R Harris & I Anderson Exploring the Health Effects of Racism for Indigenous people The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a Research Agenda, Cooperative Research Centre for Aboriginal Health Discussion Paper Series: No. 4 (2008); Y Paradies, Y. (2006a). Race, Racism, Stress and Indigenous Health. PhD thesis, Department of Public Health, The University of Melbourne (2006); Y Paradies & J Cunningham The DRUID study: Exploring mediating pathways between racism and depressive symptoms among Indigenous Australians (2012) 47 Social Psychiatry and Psychiatric Epidemiology 165; S Zubrick, S Silburn, D Lawrence, F Mitrou, R Dalby, E Blair, J Griffin, H Milroy, J De Maio, A Cox & J Li Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People, Curtin University of Technology and Telethon Institute for Child Health Research (2005); L Jamieson,Y Paradies, W Gunthorpe, S Cairney & S Sayers, Oral health and social and emotional well-being in a birth cohort of Aboriginal Australian young adults (2011) 11 BMC Public Health 656. At http://www.biomedcentral.com/1471-2458/11/656 (viewed 4 April 2014); N Priest et al, above note 35. 6 Armstrong, K and Kendall, E. 2010. Translating knowledge into practice and policy: the role of knowledge networks in primary health care. Health Information Management Journal, Vol 39 2: 9-17. 7 Saggers, S., Walter, M. & Gray, D. 'Cultre, History and Health' in (eds) Thackrah, R. Scott, K., & Winch, J. 2011. Indigenous Australian Health and Cultures: An Introduction for health professionals.
promotion strategies, perceptions of the quality of care and views about the facility and its staff 8. The key concern for the person, family or community at the centre of care is how the health care worker responds to any particular encounter. Health care workers must demonstrate their ability to respond appropriately and walk the talk. IAHA has determined that in the context of holistic and person centred therapeutic relationships with Aboriginal and Torres Strait Islander people, health care workers must be culturally responsive, a construct that entails life-long self-reflection and new learning as opposed to the notion of finality that other terms such as cultural competency may imply. Culturally responsive care can be defined as an extension of patient centered-care that includes paying particular attention to social and cultural factors in managing therapeutic encounters with patients from different cultural and social backgrounds 9. IAHA views it as a cyclical and ongoing process, requiring health care workers to continuously self-reflect and proactively respond to the person, family or community with whom they interact. It is the responsibility of the individual health care worker to deliver culturally responsive healthcare. Being culturally responsive places the onus back onto the health care worker to appropriately respond to the unique cultural attributes of the person, family or community they are working with. Self-reflection and reducing power differences are central to being culturally responsive; therefore making assumptions based on generalisations about a person s ethnic, cultural or social group is unacceptable. Part of the challenge of becoming culturally responsive health care workers is learning to reach beyond personal comfort zones and being able to comfortably interact and work with people, families and communities who are both similar and markedly different 10. IAHA asserts that all health care workers need to be culturally responsive to positively affect the health and wellbeing of all Australians, including Aboriginal and Torres Strait Islander people. Background About IAHA Indigenous Allied Health Australia Ltd. (IAHA) is the national Aboriginal and Torres Strait Islander allied health peak body. IAHA was established in 2009, from a network of committed allied health professionals and transitioned into a Company Limited by Guarantee in 2013. IAHA currently has 462 members, including full and associate members across a number of allied health professions. All Aboriginal and Torres Strait Islander allied health professionals who have graduated from an allied health course with a recognised qualification and Aboriginal and Torres Strait Islander students who are enrolled in an allied health course are eligible for Full Membership of IAHA. IAHA welcomes non-indigenous allied health professionals, all allied health assistants and Aboriginal and Torres Strait Islander people studying or working in other health related fields as Associate Members. 8 Aboriginal Cultural Security - An outline of the Policy and its Implementation, NT Government. http://www.health.nt.gov.au/library/scripts/objectifymedia.aspx?file=pdf/9/26.pdf&siteid=1&str_title=an outline of the Policy and its Implementation.pdf Accessed March 2013 9 Marcia Carteret, M. Ed. Key Concepts in Cross-Cultural Communications http://www.dimensionsofculture.com/2010/10/576/ Accessed March 2013 10 Ring J. M., Nyquist J. G., Mitchell S. (2008). Curriculum for culturally responsive health care: The step-by-step guide for cultural competence training. Oxford, UK: Radcliffe Publishing.
IAHA Vision IAHA appreciates all people working in Indigenous health and values the holistic approach to health care and education, in respect of Aboriginal and Torres Strait Islander people, their culture, spirituality, traditional healing, inspiring us to work collegiately in following our vision: For Indigenous Australians to have access to professionally and culturally competent allied health services delivered by Indigenous allied health professionals who are recognised and acknowledged as an essential part of a holistic approach to Indigenous Health. IAHA Purpose To advance the health status of Indigenous Australians through IAHA s contribution to the national health agenda, facilitation of improved education opportunities for and representation of Indigenous allied health professionals.