Close the gap

Cultural safety training helps close health gap


Griffith University’s First Peoples Health Unit is leading the charge when it comes to eliminating racism in Australia’s health care system.

Close the gap
Griffith University’s First Peoples Health Unit is working to close the gap and eliminate racism in Australia’s health care system. Photo: Courtesy First Peoples Health Unit


Over the past five years the First Peoples Health Unit has been working to improve the cultural safety of Australian healthcare professionals, starting with staff and healthcare students at the Gold Coast University Hospital.

The First Peoples Health Unit has developed an e-learning training tool called Yuwahn Wupin, comprised of five modules which align with the Australian Government’s Aboriginal and Torres Strait Islander Health Curriculum Framework, which was implemented in 2015.

In the Yugambeh language, Yuwahn Wupin translates to ‘culturally able’ and refers to the e-learning tool’s content, which highlights to healthcare professionals the importance of maintaining a culturally safe healthcare system for First Nations people.

Cultural safety originated as a nursing practice in New Zealand in 1989 after Māori nursing students raised concerns over monocultural education in nursing schools which failed to incorporate the cultural knowledge, history, and identity of the country’s Māori population.

The First Peoples Health Unit’s version of cultural safety incorporates the unique identity of Indigenous Australians in an effort to dispel biased assumptions based on race.

The validated Yuwahn Wupin educational tool incorporates the history, culture, and identity of First Nations people and highlights the role they play in improving health outcomes for Aboriginal and Torres Strait Islander people.

The tool consists of five training modules and quizzes which focus on respecting Indigenous culture, improving communication with Indigenous communities, ensuring quality and safe healthcare, reflecting on how personal culture influences care provided, and being an advocate for change.

The modules inform participants about the pre- and post-colonial experiences of Indigenous Australians and explains how the cultural differences between Indigenous and non-Indigenous people have impacted their quality of life.

Participants in the training include health students and healthcare workers, who also partake in a pre- and post-training survey, which measures how much their beliefs and knowledge base change in response to the training tool.

Professor Roianne West
Professor Roianne West says Indigenous Australians should be the driving force behind improving positive outcomes for all First Nations people. Photo: Courtesy First Peoples Health Unit


Director of the First Peoples Health Unit and Kalkadoon woman, Professor Roianne West, said it was “good policy” to include the voices of Aboriginal and Torres Strait Islander people in providing culturally safe healthcare.

“What’s been done historically has produced a complex situation, but the solution is simple,” Professor West said.

“It’s self-determination and sovereignty for Aboriginal and Torres Strait Islander people,” she said.

Professor West said “critical reflection” was “pivotal” in improving cultural safety.

“Unfortunately, when you’ve got individual and institutionalised racism, even people with the best intentions working in those systems [healthcare and universities], they will inadvertently become part of that system,” she said.

“You… perpetuate the [racist] behaviours which you’ve seen from your peers, educators, colleagues and family.”

Coordinator of Aboriginal and Torres Strait Islander Health Services at Gold Coast University Hospital, Melissa Browning, said a modified version of the Yuwahn Wupin educational tool had been incorporated into Gold Coast Health’s Cultural Practice Program, which was delivered to staff who elected to take part via online and face-to-face training sessions.

“The biggest thing that we [Gold Coast Health] are probably doing [with Griffith University] at the moment is the cultural capability measurement tool… and we’ve adapted it slightly for the Gold Coast,” Ms Browning said.

Ms Browning said pre- and post-training surveys would assess whether or not healthcare staff who undertook the training had their attitudes towards Aboriginal and Torres Strait Islander patients and staff changed.

“We’ve been using it now for a few months and we’re just hopefully towards the end of getting that data,” she said.

“We’ll actually see … whether their [GC Health staff] cultural capability has improved.

“Before they came [to the training sessions] compared to after, [we’ll see] whether they’ve actually learned enough through the training to improve their capability …  and then they go on and have interactions with our patients.”

Gold Coast University Hospital
Gold Coast Health is delivering a modified version of The First Peoples Health Unit’s culturally safe educational training tool to their staff. Photo: Courtney Thomas


Despite positive attitude changes towards Indigenous people and increased efforts to close the gap, the Australian Indigenous Doctors’ Association reported in 2017 that Indigenous doctors experienced racist attitudes (such as slurs, discrimination and disrespect) from fellow staff members at 10 times the rate of non-Indigenous staff.

The association also found that 27 per cent of Indigenous medical students training in hospitals reported poor mental health due to experiencing racism.

Professor of First Peoples Health in the School of Medicine at Griffith University (Adjunct), Professor Gregory Phillips, said it was important to note healthcare professionals didn’t always “intend to be racist” or biased towards Aboriginal and Torres Strait Islander patients and staff, but could be in effect be racist due to a lack of education.

“Most healthcare workers don’t intend it, but if they don’t know what they don’t know… then the effect of it is very real,” Professor Phillips said.

Professor Phillips is also the Chief Executive Officer of ABSTARR, an Aboriginal owned and operated consultancy firm which has delivered leadership training seminars focusing on race and cultural safety to various communities, businesses, and government departments.

He said healthcare workers who failed to consider the cultural differences between Indigenous and non-Indigenous Australians could deter First Nations people from seeking the healthcare services.

“For example, in Victoria… one third of the gap in health outcomes between Aboriginal and non-Aboriginal people is due to racism in the public healthcare system,” Professor Phillips said.

“That racism is coming from other individual healthcare professionals who are exhibiting racist behaviours… and attitudes both on patients and other Aboriginal colleagues,” he said.

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