Moving Beyond the Frontline: The power and promise of an Indigenous Health Workforce

If you have worked in Indigenous health you would be all too familiar with the discourses of ‘Closing the Gap’ and ‘compliance’ which remind us that the Black body is to be regulated and remedied by the health system. In more recent decades, these Black bodies have been co-opted into the same system and in fact the same agenda, not as clients but as clinicians; as members of the health workforce who will supposedly remedy the ills created by a system that wilfully refused to provide care to our people for generations.

Within the agenda of growing an Indigenous health workforce, we hear talk of ‘building capacities and aspirations’ of Blackfullas via ‘pathways’ and ‘pipelines’, as if our under-representation in the health workforce is not a product of racism, but a product of us just not knowing or wanting any better. Here, we are framed as empty vessels whose ‘aspirations’ and ‘capacities’ need building to gain entry into the health system. We are to be captured and channelled through ‘pathways’ and ‘pipelines’.

But to where exactly? We do not know.

And maybe we are not meant to know. Maybe it does not matter. After all, control over the lives of Blackfullas has been the primary occupation of the settlers in enabling their ongoing occupation of our lands. If we should reach that destination, on the mountain top of which they sit – when our ‘capacities’ and ‘aspirations’ have been suitably built, what happens to them? Worried that there won’t be enough room for them, they instead keep us swirling in the muddied waters of those damn pipes.

While building an Indigenous health workforce is vital to improving health outcomes for our mob, we cannot talk about the health workforce without talking about power and how it operates in the colony.

I was just 17, in my first year of a health science degree when I first encountered the words of the late John Newfong, a Ngugi man and journalist who several years earlier had provided the forward to the nation’s first National Aboriginal Health Strategy. He asserted: “In the planning of any National Aboriginal Health Strategy, the reality of Aboriginal Australia must first be addressed”. Those 8 pages were foundational to me as a Blackfulla studying and working in the health system. He spoke not of gaps or incapacity. In fact, his forward proclaimed to deal with “reality and not the myth”. He spoke of slavery and sovereignty and of land and labour as central to our understanding of health inequality and health advancement.

While building an Indigenous health workforce is vital to improving health outcomes for our mob, we cannot talk about the health workforce without talking about power and how it operates in the colony. Newfong observed that unlike other parts of the British empire, Aboriginal Australians were “not even kept alive for their labour”. It was not until World War I broke out that Aboriginal people were recognised as a viable workforce, albeit underpaid and still described as ‘unreliable’. Today, ‘capacity’ and ‘aspiration’ operate not to build an Indigenous health workforce, but to maintain power over Indigenous peoples within the health system. In his forward Newfong highlighted the need to contest those mythologies and misconceptions that were constructed to “deny, diminish, and to deprecate the dispossessed”. He spoke of how “Aborigines are yearly subject to fashions in the white man’s thinking” which has enabled the ongoing expansion of the white frontier of which we were forced to accommodate.

How might we subvert the everyday mythologising of our presence as a cheap and substandard labour force that requires propping up by white overseers?

In the current fashion of ‘Closing the Gap’ Newfong’s words ring true, yet ironically, I could not imagine talk of this nature featuring in contemporary Indigenous health policy agendas. And we must ask ourselves, how is it that with greater numbers of Blackfullas than ever before within the health workforce, that our voice might be weakened politically and ideologically? In the broader context of Indigenous affairs, black arm-bands and white blindfolds, pendulum swinging and practical reconciliation, free speech and interventions, the answer is perhaps clearer. Though one would think that such oppressive conditions would inspire greater resistance.

I wonder how, in the advances we have made, we might reflect upon and return to a more radical reframing of the capabilities of an Indigenous health workforce; one which talks of collective resistance and struggle rather than individual aspirations and incapacities? How might we subvert the everyday mythologising of our presence as a cheap and substandard labour force that requires propping up by white overseers? How might we use the positions we hold, whether we are located in clinical, administrative, research, or policy contexts, to reconfigure power relationships rather than reproduce them? Perhaps we could return to the call of Newfong and speak of sovereignty rather than capacity more explicitly within the discourses of Indigenous health advancement. Perhaps we could think of resistance as an everyday workplace practice. But most importantly, perhaps we could see Black excellence and leadership as a destination that we are already at, rather than an aspiration to be built.

“This struggle may be a moral one, or it may be a physical one, and it may be both moral and physical, but it must be a struggle. Power concedes nothing without a demand. It never did and it never will”

Frederick Douglas, 1857

This article is in Partnership with the University of Queensland’s – Poche Centre for Indigenous Health. The National Conference on Indigenous Health Workforce Leadership will examine critical success factors for enabling Indigenous leadership across the health system. Friday 2nd Nov, follow the event on twitter #MovingBeyondTheFrontline