Decolonising Practice in Aboriginal and Torres Strait Islander Primary Health Care

The Decolonising practice in Aboriginal and Torres Strait Islander primary health care project (2018-2024) partnered with five Aboriginal and Torres Strait Islander primary health care services around Australia to understand and establish an evidence base for decolonising practice in primary health care to address the negative health effects of ongoing colonisation for Aboriginal and Torres Strait Islander peoples.

Artwork by Elizabeth Close

Commissioned artwork by Elizabeth Close

The project was led by Aboriginal and non-Indigenous researchers, with service partners, and used cooperative inquiry to establish a theoretical framework for decolonising practice in Aboriginal and Torres Strait Islander primary health care, and build an evidence base for this way of working.

By decolonising practice, we mean taking action to address the negative health effects of ongoing colonisation. This may include strategies such as:

  • Aboriginal and Torres Strait Islander leadership and governance
  • Employment of Aboriginal and Torres Strait Islander staff
  • Working in ways consistent with sovereignty and self-determination
  • Anti-racism strategies
  • Action and advocacy on social determinants of Indigenous health in the community
  • Ways of working that strengthen cultural identity and integrity
  • Culturally respectful service provision within a welcoming and safe space
  • Integrating Indigenous knowledges

Outputs

This project concluded at the end of 2024. We produced a knowledge sharing report Decolonise Now: Community-led Pathways to Decolonising Practice in Health to summarise our findings, with the help of Croakey Health Media, with journalist Jade Bradford, a proud descendent of the Ballardong Noongar people, and artist Jarnda Bina Councillor-Barns, a Karrajarri, Nuggaja, Noongar, Maori woman from Boorloo (Perth).

We also produced a short film in collaboration with The Story Catchers to share the key ideas and importance of decolonising practice in Aboriginal and Torres Strait Islander primary health care.

In 2020, community workshops were held at four of our partner Aboriginal and Torres Strait Islander primary health care sites and provided a summary of feedback from community members at these forums.

Resources

Editable Framework

One of the outputs of the project was to produce an editable Decolonising Practice Framework to use as an adaptable resource for other health services. This takes the graphical depiction of the framework developed in the research, and allows organisations and services to tailor it to their local context and ways of working.

Spread the Word 

Decolonising practice is as much about lobbying and advocacy as it is about changing the processes and practices within our organisations. The following resources are freely available to help raise awareness and promote broader change:

#DecoloniseNow posters  (printable as A4 | A3)

#DecoloniseNow social media tiles

Journal Articles

The following journal articles have been published from the research to date:

Freeman, T., Mackean, T., Sherwood, J., Ziersch, A., O’Donnell, K., Dwyer, J., Askew, D., Shakespeare, M., D’Angelo, S., Fisher, M., Browne, A., Egert, S., Baghbanian, V., & Baum, F. (2024). The benefits of cooperative inquiry in health services research: Lessons from an Australian Aboriginal and Torres Strait Islander health study. International Journal of Social Determinants of Health and Health Services, 54(2), 171-182.

Freely available at: https://journals.sagepub.com/doi/full/10.1177/27551938231221757

Freeman, T., Baum, F., Mackean, T., Ziersch, A., Sherwood, J., Edwards, T., & Boffa, J. (2019). Case study of a Decolonising Aboriginal Community Controlled Comprehensive Primary Health Care Response to Alcohol-Related Harm. Australian and New Zealand Journal of Public Health, 43, 532-7.

Freely available at: https://www.sciencedirect.com/science/article/pii/S1326020023007446

D’Angelo, S., Fisher, M., Mackean, T., O’Donnell, K., Dwyer, J., Sherwood, J., Ziersch, A., Freeman, T., Shakespeare, M., Askew, D., Browne, A., & Baum, F. Next steps in decolonising Aboriginal and Torres Strait Islander primary health care policy in Australia: An analysis of key stakeholder views. International Indigenous Policy Journal, 15(3)

Freely available at: https://ojs.lib.uwo.ca/index.php/iipj/article/view/18660

Need for the research

Aboriginal and Torres Strait Islander health services, state government managed or community controlled, are tasked with promoting the health and wellbeing of Aboriginal and Torres Strait Islander peoples. At the same time, there is a wider social, policy, and political environment that is continuing to contribute to ongoing colonisation of Aboriginal and Torres Strait Islander peoples through maintaining unequal power relationships, and inequities in the social determinants of health such as employment, education, housing, incarceration, and racism and discrimination. This ongoing colonisation and inequity negatively affect the health and wellbeing of Aboriginal and Torres Strait Islander peoples, but government policies and strategies addressing Aboriginal and Torres Strait Islander health are often silent on issues of colonisation and power.

Aboriginal and Torres Strait Islander health services to different extents may be able to act on the effects of ongoing colonisation – to contribute to “decolonisation” - to reduce the impact on Aboriginal and Torres Strait Islander peoples’ health and wellbeing. Examples may include collaborating with other sectors to improve social determinants of Aboriginal and Torres Strait Islander health in their local communities, advocating to governments, empowering local communities as a health promotion strategy, and employing Aboriginal and Torres Strait Islander staff.

Chief investigators

Prof Fran Baum, Stretton Health Equity, University of Adelaide
Dr Toby Freeman, Stretton Health Equity, University of Adelaide
A/Prof Tamara Mackean, College of Medicine and Public Health, Flinders University
Prof Juanita Sherwood
Prof Anna Ziersch, College of Medicine and Public Health, Flinders University
Prof Annette Browne, University of British Columbia
A/Prof Deb Askew, University of Queensland
Prof Michael Kidd
Dr Kim O’Donnell, Adelaide Nursing School, University of Adelaide, and College of Medicine and Public Health, Flinders University.

More information about the project

Contact: Sharna Pearce
Email: sharna.pearce@adelaide.edu.au

Artwork

Elizabeth Yanyi Close is an Anangu woman from the Pitjantjatjara and Yankunytjatjara language groups. Elizabeth started painting professionally in 2007, and has been creating large scale street works and has over 20 large scale murals across the Adelaide CBD, interstate and overseas.

Above is the image she created for the project. Elizabeth says the artwork “represents the collaborative responsibility that the health sector has to contribute to decolonising health, it is about bringing our stories together, acknowledging our shared histories in order to move forward with a decolonised and growth mindset.”