Abstract
Australia’s mainstream health services located in rural contexts are mandated to provide health care to the entire local population. However, complex power relations embedded and reflected within the cultures of mainstream generalist health services are excluding the most marginalised residents from health care. This paper argues that unless inclusion in rural, generalist mainstream health services is improved, the health experiences of these residents will not substantially change and Australia will continue to report significant health differentials within its population. The concept of culturally inclusive health care is difficult for Australian mainstream generalist health practitioners to engage with because there is limited understanding of what culture is and how it operates within diverse communities. This makes it challenging for many in mainstream health institutions to begin deconstructing how it is that exclusion occurs. Frequently, ‘culture’ is assigned to ‘Others’, and there is little recognition that all people, including White, mainstream Australians, are cultural beings, and that health disciplines, services and systems have particular cultures that make assumptions about how to be in the world. Consequently, current approaches to the provision of culturally inclusive health care are not shifting the power relations that (re)produce exclusion. In this paper, we outline a new interdisciplinary methodology that operationalises Foucault’s concepts of power, resistance and discourse within a Participatory Action Research (PAR) design and utilises Continuous Quality Improvement (CQI) processes to respond to these power relations and provide health institutions with a process to improve their inclusivity, specifically for Australia’s most marginalised residents. It is suggested that employing this new methodology will promote a different way of thinking and acting in health institutions, producing a deconstructed process for health services to adapt to improve their inclusivity.
Highlights
A new interdisciplinary methodology for improving the cultural inclusivity of mainstream rural health services is outlined. This methodology operationalises a Foucauldian lens to move beyond dominant cultural discourses, and a Foucauldian-inspired framework to disrupt, in a practical way, the power relationsproducing exclusion in mainstream health institutions. We suggest that this methodology will affect a shift in power, and a shift in the practices of mainstream health institutions to improve their inclusivity, for Australia’s most marginalised residents
Current approaches to improving inclusion in mainstream Australian health services Exclusion represents a major obstacle to national health equity goals (Downing & Kowal 2011)
Operationalising Foucault’s toolkit in the analysis and response to exclusion in Australian mainstream health services In Australia, exclusion from the institutions that provide health care is, we argue, an effect of the power relations operating within a diverse, multicultural society
Summary
Current approaches to improving inclusion in mainstream Australian health services Exclusion (for example, the well-documented way in which First Nation Australians have less access to mainstream health services, resulting in significant ‘gaps’ between First Nation and non-First Nation Australians’ health indicators, including life expectancy) represents a major obstacle to national health equity goals (Downing & Kowal 2011). A genuine shift within mainstream generalist health services requires the deconstruction, critique, and modification of institutional cultures, organisational policies, procedures, education, awareness, practice, how clients are engaged (Downing & Kowal, 2011), and fundamentally, the dominant discourses directing these features. It requires the disruption of current power relations (re)producing exclusion in health institutions
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