In the Australian state of Queensland, institutional racism can have fatal consequences.
Data from the state health service shows that the rates of discharge against medical advice – where a patient leaves a healthcare facility without the blessing of doctors – are 3.4% among Indigenous people compared to 1% among non-Indigenous people.
“When patients leave against medical advice, that means they got home still very ill and often death happens very quickly,” says Henrietta Marrie, an Elder of the Gimuy Walubara Yidinji people of Far North Queensland and Director of the soon-to-be-established First Peoples Think Tank at Central Queensland University.
The higher rate of discharge against medical advice is just one data point among many that lay bare the stark disparity and health inequity between Indigenous and non-Indigenous Australians. And doctors, researchers and Indigenous organisations are increasingly pointing to institutional racism as a major cause of this inequality.
But if the phrase “institutional racism” risks sounding like a problem that is too overwhelming and complex for policymakers to take on, Marrie and her academic collaborator and husband, Adrian, have come up with a way to quantify it.
A Matrix for Measuring Racism
The tool, which the Marries dubbed “the matrix,” gives health facilities a score based on five measures: inclusion of Indigenous people in governance; implementation of relevant policies; rates of Indigenous employment; service delivery and financial accountability for Indigenous funding.
“The main thing we were concerned about was to try and create an objective, evidence-based measuring system,” Adrian Marrie says.
In 2017, when the Marries applied their matrix to the hospitals and health centres in Queensland, the results were striking.
The maximum possible score a health service can get across all the measures is 140 – which indicates that there is no institutional racism there at all. Of the 16 facilities in Queensland, ten scored less than 20 out of 140, placing them in the “extreme range of institutional racism,” according to the scale. The other six were found to be in the “very high range.” No institution scored higher than 37.
The results may sound dispiriting, but the matrix gives hospitals concrete steps they can take to work towards to reduce institutional racism within their walls by, for example, increasing the numbers of Indigenous employees and making financial data available to the public. And Henrietta Marrie says the hospitals were willing to make changes.
“Nobody was waving a big stick over them,” she says. “It was up to them to fix the problem they had.”
She cites the example of one hospital which used insights from Indigenous doctors to find new ways of explaining heart function to patients. “They talked about how river systems operate, and all the tributaries that come into it. If they’re blocked, you’re not going to get clear water running through.”
“It was so important to see some of the changes with which hospitals were trying to deal with working with patients who are Aboriginal or Torres Strait Islander,” she said.
From Measurement to Improvement
Henrietta Marrie said it was vital that the tool they created could be used without the participation of the hospital in question — they use publicly available data including annual reports, agreements with the government, operational plans and board minutes.
She pointed out that this both protects anyone using the matrix from the threat of legal action — because all the information is already in the public domain — and keeps costs low. Anyone, anywhere, can collect the relevant data and give an institution a score.
The couple say the matrix can be tweaked to capture many forms of institutional discrimination, be it against women, LGTBIQ people, people with disabilities or other marginalised groups, by using similar public data sources against different individual measures.
They also hope to apply it in the many other sectors where Indigenous Australians face institutional racism, such as the justice system. In the meantime, the South Australian government has recently invited them to apply the matrix to its 10 health districts.
Back in Queensland, Adrian Marrie is optimistic that things are changing within the health system. He says the health department responded to the initial findings by implementing an action plan to address each of the measures on which institutions were failing. Now he says he’s “confidently expecting” that most hospitals and health centers will improve by 40-50 points during the next audit, at the end of 2020.
That will mean those institutions have “moderate” levels of institutional racism, something Adrian Marrie describes as “quite the achievement!”
It’s clear that a moderate level of institutional racism is still far too high, and that as long as this type of discrimination exists in Australia, the gap between Indigenous and non-Indigenous people will persist.
But recognising the problem is a hugely important first step, Adrian Marrie says, invoking “the basic public service mantra: ‘what can be measured, can be managed’.” –Megan Clement
(Picture Credit: Pixabay)