Council of Presidents of Medical Colleges Australian Medical Stakeholders' Forum

I respectfully acknowledge the traditional custodians of the land on which we are gathered today, the Bunurong Boon Wurrung and Wurundjeri Woi Wurrung peoples of the Eastern Kulin Nation, and I pay my respect to their Elders past and present and to their emerging leaders. I acknowledge their connection to land, waters, and community. May I also extend that respect to the Aboriginal and Torres Strait Islander people in attendance at this meeting today. This land always was and always will be Aboriginal Land. I am so grateful to all the Aboriginal and Torres Strait Islander knowledge holders who have generously provided input to the work I have conducted over the years, and I acknowledge the long history and leadership of First Nations Peoples in anti-racism efforts.

I acknowledge Dr Vijay Roach, the Chair of the CPMC, and Mr John Ilott, the CEO, and all the medical leaders with us today. I thank you especially for this invitation to address you.

I would like to express my appreciation to the Council of Presidents of Medical Colleges and to its members for the pivotal work they undertake in providing this nation with the highest quality specialist medical care, through ensuring that individual specialists have a broad base of intercollegiate knowledge. I would also like to acknowledge the influence of the Council in implementing and executing positive policies. I know firsthand how important the work of policy is in creating tangible change within any field of expertise or profession.

The medical profession is one for which I personally hold great respect. I have immediate family members in the field, and I have witnessed the dedication, the struggle, and the fulfilment this profession brings to those individuals and our family and community.

I also say thanks for the impact that the medical profession has on our nation. Thanks for the long hours, thanks for the expertise, and thanks for all the blood, sweat, and tears I’m sure you have all shed along your journeys in the pursuit of health services to our community. This is particularly the case over the last few years as we confronted the spread of the Covid-19 virus.

As the Race Discrimination Commissioner my work has shown me the high levels of intersectionality racism produces through the varying human attributes and characteristics we all hold. I have seen and experienced the harmful and debilitating impact of racism within government establishments, our public institutions, corporations, the school system, our social circles, the workplace and as we know, the healthcare sector.

Work to advance racial justice has made significant strides over the last few decades with collective efforts reminding us of the power we hold as individuals, as organisations, and as global citizens to effect change. However, we cannot ignore the fact that the fight for racial justice and equality is ongoing and is, sadly, no less urgent and pressing than at current times.

I am greatly encouraged and even grateful, when organisations, such as the CPMC, writes to me asking me to address its members because it has, “identified racism as a key issue that needs to be addressed in medical culture in Australia. [CPMC believes] that this issue is inadequately understood and addressed by stakeholders in the Australian medical system. [CPMC seeks] the insights of the Commissioner and his views as to how the medical community can address health inequities in health care.”

This is music to my ears and inspires our communal sense of hope and optimism that organisations on their own volition are becoming aware and able to demonstrate leadership to confront and address an issue that, unfortunately, hasn’t attracted a great deal of priority or actions.

Racism is real and remains a serious problem in Australia. The Scanlon Foundation’s Mapping Social Cohesion reports, Lowy Institute reports, and various other relevant reports have attested to the concerning presence and the increase and rise of racism in recent times. The spread of Covid-19 in Australia has highlighted the existence of xenophobia, racial discrimination, and race hate in Australia, especially targeting Asian Australians.

Racism is as much about impact as it is about intention. We cannot forget those who are on the receiving end of discrimination, whether it is intended or not. Racism not only harms the victims but also our collective wellbeing. It also undermines our values as a free, just, fair, equal, and civilised society.

The pandemic has also shined light on other barriers experienced by communities from culturally diverse backgrounds, such as the lack of culturally appropriate information and services and the inequitable access to and provision of health and other services.  

Within the medical and health profession and field, addressing racism would, in my view, involve two broad streams of priority.

Firstly, the focus is on the culture within the health profession. And this is about how your members from all levels are treated and are able to succeed and flourish as members and as a community irrespective of their diverse backgrounds. The research and data available to us, including the Commission’s 2018 Leading for Change Report, indicate that representation of the Australian population’s cultural and linguistic diversity is missing from many areas of public life, including in employment. The health and medical sector is no exception.

We all know the failure to reflect and value Australia’s cultural diversity in our workplaces is experienced by employees in many ways. 

For some it means invisibility or leaving parts of themselves ‘at home’, for others the effects can be much more harmful, resulting in discrimination, vilification, or hate at work. 

We all know the stories of fewer opportunities for training and professional development, missed promotions, less interesting or high-stakes work, inappropriate jokes and comments, prejudicial assumptions, and even outright racist interactions at desks, lunch tables and Friday night drinks, with colleagues and stakeholders.  

Frustrations about being unable to access equal opportunities in leadership is also a common theme. This is a particular problem highlighted by Australians of Asian heritage and is sometimes called the ‘bamboo ceiling’.

If organisations are serious about promoting an inclusive culturally diverse workforce, it is critical they examine their leadership, accountability, and workplace culture, to ensure they are functioning in a way that best attracts, promotes, and nurtures a multicultural workforce. 

Addressing unconscious bias and discrimination is necessary. 

Secondly, a lack of diversity in workplace and workplace leadership and the failure to address racism and cultural diversity within the medical and health profession and organisations can impact negatively on the wider community when equality of participation and opportunity is not afforded to everyone.

This can have huge impacts on broader society when we consider some of the decisions made by the sector in the delivery of appropriate and adequate health services to a culturally diverse community. 

For example, we have heard numerous times that racism is a consistent theme for our First Nations People as patients, we know that racism has a direct link to poor health, we also know that there is a lack of service providers in rural areas and that services cannot adequately cater to the intersectional disadvantage patients can experience, nor provide the cultural safety that is needed within our diverse populations. These are just broad themes that are faced from the perspective of the patient and those who receive and need medical and health services.

With that being said, I want to commend the Council of Presidents of Medical Colleges for bringing this issue to light because as I mentioned earlier, racism can enter people’s lives in many forms and in many settings, destroying opportunity and stifling participation within the medical profession or denying adequate and proper health and medical services for those in need in our community.

I believe there are opportunities for you to promote and champion internal equity outcomes and instil best practice anti-racism and inclusion initiatives within your organisations, including through:

• recruitment and promotion processes that demonstrate a stated commitment to diversity,
• establishing principles and policies that will guide the organisation towards its mission and objectives of creating a more equal and diverse workplace,
• creating legal frameworks and practices that set goals, standards, and expectations for the organisation and staff on racial discrimination and racism,
• training for staff to address unconscious bias, prejudice, and discrimination,
• mentoring programs and leadership pathways for diverse staff,
• flexible supports for the wellbeing of diverse staff,
• strong accountability and evaluation for diversity and inclusion and Reconciliation Action Plans,
• creating cultural competence in the workplace,
• taking a stand within the management structure of the organisation, and
• holding your organisation accountable for diversity and equality.

Any mechanisms that your organisation uses to achieve diversity and inclusion must be underpinned by a strong evaluation framework to benchmark and measure successes and identify areas for further improvement, influencing the development of what will follow.

The Commission’s 2016 Leading for Change Report recommended the following actions in improving diversity in leadership in organisations:

Leadership

1. Provide leadership on cultural diversity that is authentic and effective
2. Equip and support leaders from diverse backgrounds to be role models
3. Leaders must be prepared to respond to deflections and backlash

Systems

1. Collect meaningful data on cultural diversity
2. Accompany any data initiative with deeper conversations about cultural differences
3. Where there is data consider targets and accountability for cultural diversity and inclusion across the organisation

Culture

1. Mitigate bias and discrimination by promoting positive contacts between people from different cultural backgrounds
2. Unlock the potential of multicultural talent though targeted professional development
3. Go beyond cultural celebration and cultivate organisational resilience in negotiating cultural differences

In March of 2021 I called for a National Anti-Racism Framework and put forward a Concept Paper outlining key principles, outcomes, and strategies.

In launching the Framework initiative, we are encouraging Australians to share with us their imaginings of what a harmonious and equal society would look like, and what their vision is for a future Australia that is free from racism. The Framework will outline a coordinated and shared ambition, and the proactive and positive measures we can take to ensure this ambition becomes a reality.

The National Anti-Racism Framework will be a long-term, central reference point to guide actions on anti-racism and equality by all levels of government, peak bodies, civil society, communities, educators, business, and other sectors.

There has been limited discussion about race and race issues among our national leaders and little in the form of national initiatives and activities focussed on protecting and promoting the rights of all Australians to be free from discrimination based on race, ethnicity, cultural identity, or nationality.

We have since undertaken in-depth public consultations and engagement to develop the Framework and this has included consultations with government, peak bodies, and communities at large.

The call for a Framework is timely and is a response to rising community, business, and corporate sector awareness of racism and the building momentum for individual, organisational, and national action on racism.

I am committed, and the Commission is committed, to create an environment and culture in Australia that value and harness the full contributions, potential and attributes of people from across our culturally diverse society.

But even as we strive to foster workplaces and businesses’ acknowledgement, recognition, and appreciation of cultural diversity and inclusion as important benefits and assets to an organisation’s bottom line and productivity, we must never forget that social justice and human rights imperatives of promoting and protecting racial justice and equality must remain the key focus of our work in relation to cultural diversity and inclusion. It is not just about organisational efficiency, profits, and productivity, but it is about the inherent rights of people to be able to live and be treated fairly and equally irrespective of their racial or cultural background.

The fight against racism is not only against the individual, but it is also against systems and institutions that practise, perpetuate, and reinforce racism in any form. J. Kēhaulani Kauanui, Professor of American Studies and Anthropology at Wesleyan University, explains, “racism is a structure, not an event.” And you, the leaders in the medical profession, understand more than anyone else about systems and institutions within our society and how they function and how they can be changed.

It is essential that we approach racism in a proactive rather than reactive way. There is a critical need to ensure that organisations provide access to anti-racism programs, tools, knowledge, and support systems that exist as part of their organisational structure, rather than something that is added as an after-thought or as an attempt to deal with a racial incident or issue that has occurred.

A point of guidance on where you can start or continue to build on the work that you are already doing is by focussing on four areas of possible attention. They are what I have referred to as the 4 Ps: principles, policies, programs, and practices within your organisation. By principles I mean the organisation’s mission statement, as well as its commitment and charter on values and culture on diversity, inclusion, and equality, which are underpinned by policies that breathe and give life to those values and commitments. This is then supported by practical and effective programs that support practices within the organisation that are real, meaningful, and responsive to the needs and requirements of its staff.

As a society, we must recognise and call out interpersonal racism and the structural inequality that exists in many of our institutions and organisations, and then take active steps to eradicate it. Our shared task and responsibility are to unite our community as a society that is culturally diverse, open, accepting, socially cohesive, and inclusive and one that values equity, equality, fairness, and equal justice and opportunities for all Australians. You serve as a powerful catalyst and example of accountability, inclusion, and equality.

The call is for leaders in the medical and health fields to exercise the leadership which they possess to work towards creating better and more just and equal organisations and places for everyone, irrespective of their race. It is not easy and requires commitment and courage. As Dr. Martin Luther King Jr. taught us, “human progress is neither automatic nor inevitable. Every step toward the goal of justice requires […] the tireless exertions […] of dedicated individuals.”

The power of advocacy, campaigning, and policy implementation are core responses to addressing any form of discrimination. Each of you, as medical and health leaders, are a leader and a trusted advisor in a privileged position to have a positive influence. So, I implore you to please use it and rethink your possibilities, rethink your limitations, and rethink your role and responsibility in addressing racism in medical culture.

Thank you again for inviting me to speak to you today. I hope you will follow the development of the Framework with interest and seize any opportunities you have to be a part of this important journey. And I share in the hope and expectation that you, as leaders in critical and important roles, will work with us in not only addressing workplace inequalities and discrimination, but also engaging and committing in defining and framing the architecture and reference points in the medical and health profession for an organisational structure and culture that foster and nurture equality, inclusion, and diversity and where racism is properly and effectively countered.  

I look forward to sharing more with you in the Q & A session as we continue the dialogue.