The AHHA chats to Henrietta Marrie about a new framework for abolishing institutional racism and improving the health and wellbeing of Indigenous Australians...

While Henrietta Marrie says it was an “overwhelming honour” to be named in this year’s 100 Women of Influence, the Australian Indigenous rights advocate hopes it can become a platform for improving Indigenous health services and inspiring young Indigenous women.

As an Aboriginal Australian from the Yidinji tribe in Queensland, Henrietta has been advocating for the rights of Indigenous peoples for more than 30 years. With her husband, Adrian, she has recently developed a framework, or “Matrix”, for monitoring institutional racism, an issue that sees Aboriginal and Torres Strait Islander people excluded or alienated at all levels of Australia’s healthcare system.

Henrietta says the Matrix is an integral tool in realising the goal of an Australian health system free of racism and inequality by 2031, as set out in the Australian Government’s National Aboriginal and Torres Strait Islander Health Plan 2013-2023. “The Matrix has been developed to hold public hospitals and health services accountable for First Nations people and the community as a whole,” Henrietta said. “It’s a flexible assessment tool that can monitor an organisation’s progress towards Indigenous equality; you can assess yourself, note the changes that need to be made and then, in a few years’ time, see whether you’ve achieved what you set out to achieve.”

The framework is outlined alongside a case study of the Cairns and Hinterland Hospital and Health Service, but can be adapted to assess any organisation against the set of criteria. Some of these criteria include community engagement, service delivery and cultural competence, as well as Aboriginal and Torres Strait Islander representation in both governance and the workforce. From board composition and organisational structure to newly-reformed policies, employment contracts and public reporting, the Matrix looks at the root of institutional racism. This is in contrast to just examining the end result, which often sees Aboriginal and Torres Strait Islander patients withdrawing from the health system and either self-discharging or simply not seeking help to begin with.

While some organisations may be hesitant about being measured against the framework, Henrietta says it’s important to cast those fears aside and, if issues are identified, to be proactive and work towards correcting them. “Just by looking at the criteria some people will know that their organisation is not inclusive of First Nations people,” she said. “But, if you’re doing it for yourself, no one has to see the results; do it, assess yourself and then simply say ‘right, we’re going to change’.”

Where high levels of institutional racism exist, organisations need to change the institutional culture and become more inclusive of Aboriginal and Torres Strait Islander people. For this to happen, and for healthcare services to become more culturally appropriate, there needs to be communication between the Indigenous populations and those institutions. “While I know that it takes resources, it’s important to talk with individuals in the community, not just the representative bodies,” she said. “The community members have to feel comfortable going in there. If you give them part ownership by asking for their opinions, health services can only improve and become more culturally appropriate.”

After speaking with many Aboriginal and Torres Strait Islander people, both within organisations and those using health services, Henrietta says she was deeply affected by the scope of the inequality and the impact institutional racism was having on their lives. “Since beginning this work, my eyes have really been opened to the extent that racism can exist in a health institution that is supposed to work for the betterment of all people. The people I spoke to about it were very emotional and they had put up with it, not for one or two years, but for 10 years or so,” she said. “In some cases, the employment of First Nations people in these institutions has declined because they were getting put off. In hearing these stories and having members of my family go through similar experiences, I just thought ‘this has to stop, we have to do something about it’.”

When discussing being named in the Australian Financial Review and Westpac’s list of the 100 Women of Influence, Henrietta focussed on what it could mean for future generations of Indigenous women. “I hope it will inspire other First Nations women and girls to get up there, take their dreams and move beyond where they feel comfortable and make a difference; we Indigenous women can actually achieve what we want,” she said. “There are many successful First Nations women in this country and they’ve achieved great things, not just for First Nations people but for the whole community. We need to get these women out there, recognise them and the contribution that they’ve made to the overall social fabric of society.”

She also hopes that the honour will go some way to combating institutional racism and other inequality that exists within Australia’s healthcare system. “Let’s use the award as a way of promoting the change that needs to happen out there,” she said. “If it provides a platform to use, I say ‘let’s use it’. Let’s create that change, let’s create a movement to make people sit up, listen and want to make that change.”

Henrietta Marrie is currently a Senior Fellow at the United Nations University. In June 2014, she and her husband Adrian Marrie published The Cairns & Hinterland Hospital and Health Service (CHHHS): A Case Study in Institutional Racism in support of the Australian Human Rights Commission’s National Anti-Racism Strategy.

To download the December edition of The Health Advocate, click here.