• Racism and discrimination have adverse effects and can contribute to the health burden of medical professionals and their patients.
• The AMA acknowledges that an ongoing and shared commitment across organisations, governments and individuals is required to eliminate racism in healthcare.
• The AMA declares its opposition to racism and practices that involve bullying, bias, discrimination and persecution in both direct and indirect forms.
• The AMA supports the development and implementation of programs and strategies to eliminate racism across the healthcare industry and in Australian society.
• The AMA acknowledges that racism and discrimination in all forms has a negative impact on individual and collective health and is committed to the elimination of racism in the healthcare system across organisations, governments, and individuals we engage with.

Preamble

The Australian Medical Association (AMA) has developed this statement to underpin efforts aimed at overcoming racism in the Australian healthcare sector. As the peak advocacy body for all doctors working in Australia, the AMA represents a diverse range of individuals. The medical workforce is made stronger through the inclusion of people from diverse backgrounds who bring unique skills, perspectives, and networks to the health industry. Working towards ensuring our industry is free from racism and discrimination for professionals and patients contributes to a cohesive healthcare system, one which will be better equipped to deliver optimal health outcomes for the wider Australian community.

Healthcare professionals have a right not to experience racism throughout their careers. This includes during periods of education and training, whether at university or after graduation, extending into continuous professional development, conferences and other professional settings. Relationships in the workplace with superiors, colleagues and patients must be free from bias, discrimination and racism.

Similarly, sensitivity and understanding of diversity of patients must be at the forefront of practitioners’ minds when delivering healthcare. Racism from healthcare providers can result in mistrust and a perception of lower quality of care from all providers, the underutilisation of health services, avoidance of healthcare systems and delays in seeking care, and failure to follow recommendations.^{i ii}

The cultural and linguistic diversity of Australia is of great benefit to our community and the healthcare industry must be responsive to ongoing challenges to harnessing the rewards and recognising the assets that stem from this diversity.

Definitions of Racism

Institutional racism

‘[R]efers to the ways in which racist beliefs or values have been built into the operations of social

institutions in such a way as to discriminate against, control and oppress various minority groups.’ⁱⁱⁱ 

Internalised racism

Is the ‘acceptance of attitudes, beliefs or ideologies about the inferiority of one’s own ethnic/racial group.’^iv

Interpersonal racism

‘Interactions between people that maintain and reproduce avoidable and unfair inequalities across ethnic/racial groups.’^v

Casual/Everyday racism

A form of interpersonal racism which can include speech and behaviours that treat cultural differences
– such as forms of dress, cultural practices, physical features or accents – as problematic, manifesting in disapproving glances, exclusionary body language, and marginalising people’s experiences as invalid.^vi

Indirect racism

‘Indirect discrimination occurs when there is an unreasonable rule or policy that is the same for everyone but has an unfair effect on people who share a particular attribute.’^vii

Implicit/Unintentional racism

'Implicit racism is an automatic negative reaction to someone of a different race or ethnicity than one’s own. Underlying and unconscious racist attitudes are brought forth when a person is faced with race- related triggers, including preconceived phenotypic differences or assumed cultural or environmental associations.'^viii

Racism in the Workforce

The AMA recognises the importance of a culturally and linguistically diverse health workforce. Australia is home to the oldest continuous Indigenous cultures in the world. This rich cultural history is added to by the ongoing immigration of people from culturally and linguistically diverse backgrounds. No doctor or medical student, regardless of ethnicity, should experience racial discrimination, harassment or vilification in their place of work and/or learning environment.

Our workplaces benefit when they harness the skills and perspectives of all peoples that make up Australia. Healthcare delivery is made stronger when it considers and caters for a diverse population. It is vital that doctors and medical students are aware of and sensitive to cultural differences in dealings with colleagues and patients.

Hiring processes

Recruitment, selection and promotion practices should be consistent with equal employment opportunity principles and should not be discriminatory in any way.

Position Statement - Equal Opportunity Medical Workforce 2016

Aboriginal and Torres Strait Islander Doctors

Experiences of racism in the health system lead to delays in seeking healthcare, non-adherence to treatment, psychological stress, and are closely linked to poorer mental and physical health outcomes. The AMA also recognises that systemic and interpersonal racism has a detrimental effect on the growth and retention of the Aboriginal and Torres Strait Islander medical workforce. Results from the Australian Indigenous Doctors’ Association (AIDA) 2016 survey of their members revealed that more than 60% of Aboriginal and/or Torres Strait Islander respondents had experienced racism and/or bullying every day, or at least once a week.^ix AIDA’s Policy Statement on Racism in Australia’s health system, indicates that racist behaviour has a detrimental effect on the resolve of Aboriginal and Torres Strait Islander people to join the medical workforce.^x

International Medical Graduates

International Medical Graduates (IMGs) make a vital contribution to the delivery of healthcare in Australia, particularly in rural and regional locations. In 2016 there were 12,495 reported overseas trained doctors in Australia.^xi It is important that all cultural differences are respected and considered.

Position Statement - International Medical Graduates 2015

Patients and the delivery of healthcare

The AMA does not tolerate racism in the delivery of care to patients and in how patients access care. The AMA commits itself to advocating against racism in healthcare, acknowledging that racism can lead to poorer health outcomes. It is important that healthcare delivery is culturally safe and that reasonable efforts are made to ensure communication and access are suitable.

Good medical practice requires genuine efforts to understand the cultural needs and contexts of patients to obtain good health outcomes. Culturally safe and respectful practice includes:

• Understanding that clinicians own cultural beliefs influence interactions with patients and ensuring this does not negatively impact on clinical decision making
• Acknowledgement of social, economic, cultural, historic and behavioural factors influencing health at the individual, community and population levels
• Having knowledge of, respect for and sensitivity towards the cultural needs of the community being served and adapting practice to improve engagement with patients
• Adopting practices that respect diversity, avoid bias, discrimination and racism and challenge beliefs based on assumptions
• Supporting an inclusive environment for the safety and security of individuals and their families
• Creating a positive, culturally safe work environment through role modelling and supporting the rights and dignity of others.

The AMA supports a healthcare system that provides equity of access to quality care for all Australians regardless of their race, sex, age, religion, socioeconomic status or location. To minimise social and cultural barriers to healthcare and reduce inequalities, healthcare providers and organisations should have access to initiatives, training and resources, including interpreter services, which support them to deliver culturally safe healthcare that is responsive to Australia’s culturally and linguistically diverse communities.

Some population groups in Australia experience marked health inequalities compared with the general population. These groups include Aboriginal and Torres Strait Islander Australians, people living in rural and remote areas, people with low socioeconomic status, people in custody, and people with disability.^xii It is essential that evidence-based culturally inclusive policy and adequate Government resources are applied to cater to the unique needs of vulnerable groups to ensure they receive timely, comprehensive, culturally safe, quality healthcare. Evidenced-based policy and sufficient resourcing is also required to address the social determinants of health which play a significant role in disparity and shaping long term health outcomes.

Patient Relationships with Doctors

Racism from patients to doctors and medical students is unacceptable. The approach to patients exhibiting racism towards a doctor should be addressed with consideration for the patient's stability and frame of mind, whether or not the patient has decision-making capacity and the reason for requesting a new doctor, along with the impact on the doctor and alternative arrangements.^xiii

Settings for Healthcare Delivery

The design and functioning of hospitals and other healthcare settings can be inadvertently exclusionary. For example, the segregation in some cultures of men’s and women’s health can make current open plan designs of waiting rooms uncomfortable and may deter some individuals from seeking healthcare.

Providing patient access to open areas, gardens and windows, cultural areas for prayer/ceremonies, culturally sensitive meals, and visual cues including flags, artwork, signage and staff, need to be considered with an inclusionary lens. It is also important that patients are asked if they identify as an Aboriginal or Torres Strait Islander person, however this must be done with reassurance that the answer will not adversely affect the quality of care.

Benefits of a Diverse Workforce

Australia is one of the most culturally and linguistically diverse societies in the world.^xiv A culturally and linguistically diverse workforce that reflects the diversity of the community is better able to serve patients. A workforce composed of doctors from diverse backgrounds enables more flexibility, responsiveness and empathy in the delivery of healthcare in Australia. The AMA believes that broad collaborative efforts within the healthcare sector can better utilise the benefits of the diverse cultures and languages within Australia, collectively working together towards the eradication of racism. 

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Endnotes 

ⁱ Paradies, Yin, ‘Racism as a determinant of indigenous health and wellbeing’, Deakin University, http://www.sanyas.ca/downloads/racism-as-a-determinant-of-indigenous-health-and-wellbeing.pdf accessed 30 November 2017.

ⁱⁱ Ferdinand, Angeline S., Paradies, Yin, and Kelaher, Margaret, ‘Mental health impacts of racial discrimination in Australian culturally and linguistically diverse communities: a cross-sectional survey’, BMC Public Health, 2015; 15: 401.

ⁱⁱⁱ McConnachie K, Hollingsworth D, Pettman J. Race and racism in Australia. Sydney: Social Science Press, 1988.

^iv   Dr Yin Paradies, ‘Measuring interpersonal racism: An Indigenous Australian case study’, Senior Research Fellow McCaughey Centre, University of Melbourne, http://caepr.anu.edu.au/sites/default/files/Seminars/presentations/Yin%2010%20August%20CAEPR%20lecture%20-%20slides.pdf.

^v Ibid.

^vi Nelson, Jacqueline Nelson, and Walton, Jessica, ‘Explainer: what is casual racism?”, The Conversation, September 2 2014, http://theconversation.com/explainer-what-is-casual-racism-30464, accessed 3 April 2018.

^vii Australian Human Rights Commission, ‘Indirect Discrimination’, Australian Human Rights Commission website, https://www.humanrights.gov.au/quick-guide/12049, accessed 1 February 2018.

^viii Implicit Racism, Encyclopedia.com,  https://www.encyclopedia.com/social-sciences/encyclopedias-almanacs-transcripts- and-maps/implicit-racism, accessed 6 April 2018.

^ix AIDA 2017 Report, ‘Report on the findings of the 2016 AIDA member survey on bullying, racism and lateral violence in the workplace’, https://www.aida.org.au/wp-content/uploads/2017/07/Report-on-AIDA-Member-Survey_Final.pdf , accessed 13 July 2017.

^x Racism in Australia’s health system, AIDA Policy Statement,  https://www.aida.org.au/wp-content/uploads/2015/03/Racism- in-Australias-health-system-AIDA-policy-statement_v1.pdf, accessed 30 November 2017.

^xi Medical Training Review Panel 19th Report, 2016, Commonwealth of Australia as represented by the Department of Health, http://www.health.gov.au/internet/main/publishing.nsf/content/8795A75044FBB48CCA257F630070C2EE/$File/Medical%20Training%20Review%20Panel%20nineteenth%20report.pdf accessed 21 November 2017

^xii Australian Institute of Health and Welfare, ‘Australia’s Health 2014’, https://www.aihw.gov.au/getmedia/d2946c3e-9b94-413c-898c-aa5219903b8c/16507.pdf.aspx?inline=true, accessed 24 January 2018.

^xiii Kimani Paul-Emile, Alexander K. Smith, Bernard Lo, and Fernández, Alicia, ‘Dealing with Racist Patients’, The New England Journal of Medicine, March 2 2016,  http://www.nejm.org/doi/full/10.1056/NEJMp1514939, accessed 21 November 2017.

^xiv Ozdowski, Sev, ‘Australian Multiculturalism: the roots of its success’, University of Western Sydney, https://www.westernsydney.edu.au/equity_diversity/equity_and_diversity/tools_and_resources/reportsandpubs/australian_multiculturalism_the_roots_of_its_success, accessed 21 November 2017.