Beyond cultural competency: A rights-based pedagogical approach for Indigenous integration in Australian university curricula

Indigenous cross-cultural training has been around since the 1980s. It is often seen as a way to increase the skills and competency of staff engaged in providing service to Indigenous clients and customers, teaching Indigenous students within universities and schools, or working with Indigenous communities (Fredericks and Bargallie, “Indigenous”; “Which Way”). In this article we demonstrate how such training often exposes power, whiteness, and concepts of an Indigenous “other”. We highlight how cross-cultural training programs can potentially provide a setting in which non-Indigenous participants can develop a deeper realisation of how their understandings of the “other” are formed and enacted within a “white” social setting. Revealing whiteness as a racial construct enables people to see race, and “know what racism is, what it is not and what it does” (Bargallie, 262). Training participants can use such revelations to develop their racial literacy and anti-racist praxis (Bargallie), which when implemented have the capacity to transform inequitable power differentials in their work with Indigenous peoples and organisations.

Making a Difference: Fifty Years of Indigenous Programs at Monash University, 1964–2014

Aboriginal peoples and Torres Strait Islander peoples (who comprise the indigenous people or the original inhabitants of Australia before colonization) are more likely to experience cancers with poorer prognoses, are more likely to be diagnosed with cancer at a later stage of disease progression, are less likely to receive adequate cancer treatment and are more likely to pass away due to cancer, compared with other Australians. Cancer and biomedical therapies for cancer often have significant, ongoing effects on patient health-related quality of life (HRQL). Therefore, consideration of HRQL for Aboriginal and Torres Strait Islander peoples with experience of cancer in Australia is imperative. This article examines the literature for HRQL issues self-reported by Aboriginal and/or Torres Strait Islander people with experience of cancer in Australia. A search of peer-reviewed journal articles, government reports, and other literature was undertaken using electronic databases and citation snowballing. Self-reports from Aboriginal and/or Torres Strait Islander people with experience of cancer were examined. HRQL issues were determined utilizing the Australian Psycho-Oncology Co-operative Research Group's definition of HRQL. Fifty-two documents were found with original data from Aboriginal and/or Torres Strait Islander people who self-reported their experiences of cancer. No published reports were found that specifically examined self-reports from Aboriginal and/or Torres Strait Islander people on the impact of cancer and biomedical treatment on their HRQL. Previous literature suggests that there is urgency for improved communication and cultural competency in cancer care for Aboriginal and Torres Strait Islander patients in Australia, with a stronger focus on meeting patient needs and improving HRQL. This review has provided insight into HRQL issues for Aboriginal and Torres Strait Islander patients with cancer in Australia. Further work using patient-reported outcomes measures would provide greater insight into the impact of cancer and biomedical treatments on Aboriginal and Torres Strait Islander patients' HRQL.

To describe rates of hospitalisation and Coaching on Achieving Cardiovascular Health referral, for Queensland's adults with heart and related disease, and comparisons between Aboriginal and Torres Strait Islander and non-Indigenous peoples in northern Queensland. Descriptive retrospective epidemiological study of Queensland Health Patient Admission Data Collection for adults with heart and related disease, and Coaching on Achieving Cardiovascular Health referral data. Relative risk and age standardisation were calculated for Aboriginal and Torres Strait Islander and non-Indigenous peoples. Queensland's adults≥20years, hospitalised with heart and related disease (1 January 2012-31 December 2016). Queensland, Australia. Queensland Health Hospital and Health Services' hospitalisation and Coaching on Achieving Cardiovascular Health referral rates for heart and related disease. Queensland's Aboriginal and Torres Strait Islander peoples have a higher hospitalisation rate for heart and related disease, with higher rates for northern Queensland. Queensland's overall Coaching on Achieving Cardiovascular Health referral rates were low, but higher for Aboriginal and Torres Strait Islander peoples. Deficiencies in documentation of Aboriginal and Torres Strait Islander people's status affected results in some areas. Queensland's Aboriginal and Torres Strait Islander peoples were more likely to be admitted to hospital for heart and related disease and referred to Coaching on Achieving Cardiovascular Health than non-Indigenous peoples. However, hospitalisation and Coaching on Achieving Cardiovascular Health referral rates are unlikely to reflect the needs of Aboriginal and Torres Strait Islander peoples especially in rural and very remote areas given their higher mortality and morbidity rates and fewer services.

This paper explains how routinely collected data can be used to examine the emergency department attendances of Victorian Aboriginal and Torres Strait Islander people. The data reported in the Victorian Emergency Minimum Dataset (VEMD) for the 2006/2007 financial year were analysed. The presentations of Aboriginal and Torres Strait Islander and non-Aboriginal people were compared in terms of age, gender, hospital location (metropolitan and rural) and presenting condition. Aboriginal and Torres Strait Islander people were found to attend the emergency department 1.8 times more often than non-Aboriginal people. While the emergency department presentation rates of metropolitan Aboriginal and Torres Strait Islander and non-Aboriginal people were similar, rural Aboriginal and Torres Strait Islander people presented to the emergency department 2.3 times more often than non-Aboriginal people. The injuries or poisonings, respiratory conditions and mental disorders presentation rates of the Aboriginal and Torres Strait Islander and non-Aboriginal population were compared. No previous studies have assessed the accuracy of the Indigenous status and diagnosis fields in the VEMD; therefore the quality of this data is unknown.

Aunty Mary Graham, Kombu-merri elder and philosopher, says: "You are not alone in the world." We have a responsibility to each other, as well as to the land; and violence is the refusal of this relationship that binds us (Rose). In this paper, I use Emannuel Levinas’s ethics as first philosophy and epistemological violence to consider how non-Indigenous educators come to know Indigenous people. In his philosophy, Levinas presents a paradox: that to act as if one is a free being, as first philosophy, is to ignore that one is not alone in the world and that the presence of others evokes responsibility. However, to claim to know another is to bring them into one’s totality, one’s knowledge framework; an act of reducing another to who you think they are. We must find a new relationship to knowledge, one that is not based on possession. For non-Indigenous educators learning about teaching Indigenous students and perspectives in schools, much of the curricular material draws on the corpus of knowledge constructed by non-Indigenous researchers, politicians, and professionals about Indigenous people (Nakata, Cultural Interface). This material is already bound by others' interests and motivations. How can non-Indigenous educators engage with Indigenous peoples, histories and knowledges in a way that foregrounds the responsibility that our entanglement prompts? In this paper, I present data from my research into pre-service teachers undertaking a compulsory university subject in Indigenous education, where the pre-service teachers wrote weekly reflective learning journals. This data is drawn primarily from the end of the semester, where students reflected on what their learning would mean as they moved into future practice. I explore the role of responsibility in regards to the ethical violence that Levinas discusses.

Aboriginal and Torres Strait Islander people have a substantially higher prevalence of liver disease than non-Indigenous Australians. Cirrhosis and its complications were the sixth leading cause of mortality for Aboriginal and Torres Strait Islander people in 2020. Liver disease has been estimated to be the third leading cause of the mortality gap between Aboriginal and Torres Strait Islander and non-Indigenous people due to chronic disease, accounting for 11% of this gap. While current trends show reducing mortality rates for Aboriginal and Torres Strait Islander people for conditions including circulatory disease, diabetes and kidney disease, there are no data to suggest a similar decline for liver disease. This review highlights the common causes of liver disease affecting Aboriginal and Torres Strait Islander people, which include hepatitis B, hepatitis C, alcohol related liver disease, metabolic dysfunction-associated fatty liver disease, and cirrhosis and its complications including hepatocellular carcinoma. Current treatments including liver transplantation as well as suggestions for improving detection, treatment and access to liver care will also be discussed. Recent revolutions in the detection and treatment of liver disease make efforts to improve access to treatment and outcomes an urgent priority for Aboriginal and Torres Strait Islander people.

Ngaaminya (find, be able to see): summary of key findings from the Which Way? project

Kidney Outcomes for First Nations Children

Globally, Indigenous people, including Aboriginal and Torres Strait Islander people in Australia, experience significantly poorer health outcomes than their non‐Indigenous counterparts. In part, this can be attributed to the ongoing impacts of colonization, marginalization, and systemic discrimination. In the genomic healthcare era, Indigenous people remain underrepresented in public genetic health services, raising concerns about cultural competency and inclusivity within the genetic counseling profession. Without culturally safe and accessible genetic services, the disparities in Indigenous people's health could widen. This paper explores cultural safety within the context of genetic counseling for Aboriginal and Torres Strait Islander people in Australia. It outlines the historical, social, and cultural factors influencing engagement with healthcare, including the ongoing impacts of colonization, intergenerational trauma, and institutional racism, and discusses how these continue to shape experiences of care today. Drawing on the core competencies defined by the Human Genetics Society of Australasia (HGSA), the paper highlights how relationship building, reflective practice, client‐centered counseling, and advocacy can be applied to foster culturally safe and responsive practice. Ultimately, providing culturally safe genetic counseling requires moving beyond cultural awareness and competency toward practices that empower Aboriginal and Torres Strait Islander clients, families, and communities. This includes recognizing collective decision‐making processes, kinship systems, and the importance of trust and respect in clinical encounters. By embedding cultural safety at both individual and institutional levels, genetic counselors can contribute meaningfully to reducing health inequities and ensuring equitable participation in genomic healthcare for Aboriginal and Torres Strait Islander people.

Yarning about vaccinations: Empowering individuals to have supportive conversations with Aboriginal peoples about vaccinations, using a community-engaged approach.

Cultural competence in health care is designed to ensure that health professionals are able to provide quality health care to culturally and ethnically diverse populations. Cultural competence can be effective for improving health professionals' knowledge, attitudes and skills and patient satisfaction. The impact of cultural competence education and training included in university-based professional training of health professionals is relatively unclear. This study aims to describe the characteristics and assess the methodological quality of published evaluations of cultural competence education and training interventions targeting university based health professionals in training. A systematic search of the cultural competence literature identified 16 published evaluations of cultural competence education and training interventions included in university based professional training of health professionals. Information on the characteristics and methodological quality of included studies was extracted using standardized assessment tools. Nine studies evaluated the integration of cultural competence into health or medical curriculum, four evaluated a cultural immersion experience, and three evaluated cultural awareness education and training. Positive outcomes commonly reported were improvements in students' knowledge of cultural competence and attitudes towards Indigenous and culturally diverse peoples. The methodological quality of evaluations and the reporting of key methodological criteria were variable. Eleven studies conducted a quantitative and five studies a qualitative evaluation. Strengths of quantitative evaluations included adequate study designs and valid and reliable measurement instruments. Selection bias and poor attrition were the main limitations of quantitative evaluations. Qualitative evaluations were adequate on most methodological criteria but the reporting of ethical and some methodological issues was less than adequate. There is insufficient evidence to provide a strong basis for recommending the inclusion of specific cultural competence education and training strategies in the professional training of university based health professionals. Future evaluations should compare similar types of strategies, and extend their measurement of outcomes beyond those relating to the knowledge, attitudes and skills of health professionals, to those relating to health care outcomes of ethnically diverse peoples.

Collaborative Creative Processes That Challenge Us as "Anomaly", and Affirm Our Indigeneity and Enact Our Sovereignty

Background and context: Cancer survival rates in Australia are among the best in the world, yet Aboriginal and Torres Strait Islander (indigenous) people continue to experience disparities in the distribution and burden of cancer, and unwarranted variations in outcomes. Indigenous Australians are 40% more likely to die of cancer than non-Indigenous Australians. Cancer Australia developed the National Aboriginal and Torres Strait Islander Cancer Framework (the framework), which identified 7 national priorities to address disparities in cancer outcomes experienced by indigenous Australians. An ongoing collaboration with indigenous Australians was integral to developing this shared agenda. Priority 5 in the framework highlights the need to ensure indigenous Australians affected by cancer receive optimal and culturally appropriate treatment, services, and supportive and palliative care. Aim: To improve cancer outcomes for indigenous Australians through the development and national endorsement of a population-specific Optimal Care Pathway (OCP) to guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. Strategy/Tactics: Cancer Australia formed a partnership with the Victorian Department of Health and Human Services (DHHS) to address Priority 5 and develop the OCP. The approach to development was underpinned by Cancer Australia's Model of Engagement for Aboriginal and Torres Strait Islander People and guided by the national Leadership Group on Aboriginal and Torres Strait Islander Cancer Control (Leadership Group). Program/Policy process: Cancer Australia, in collaboration with DHHS: • reviewed experiences of care and the framework's comprehensive evidence base • developed a draft OCP to complement tumor-specific pathways • facilitated an Expert Working Group, comprising indigenous health sector leaders and consumers to refine and validate the draft OCP • undertook national public consultation, including with the indigenous health sector and community, health professionals and professional colleges • received an indication of support to proceed to endorsement from the Leadership Group. Outcomes: The first population-specific OCP for Aboriginal and Torres Strait Islander people with cancer received national endorsement. It will guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. What was learned: Key elements of optimal care include: addressing the cultural appropriateness of the healthcare environment; improving cross-cultural communication; relationship building with local community; optimizing health literacy; recognition of men's and women's business; and the need to use culturally appropriate resources. The national priority in the framework informed and unified high-level direction, which was integral to effective OCP development and endorsement. The evidence-based, step-wise development approach contributed to its relevance, utility and quality.

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