How improving cultural safety can lead to better outcomes

Adjunct Professor Janine Mohamed was only a young girl when she first witnessed systemic racism in the healthcare system.
 
The Narungga Kaurna woman from South Australia was supporting her grandmother while she received care for a chronic mental health condition, and the experience deeply influenced her to make a commitment to dismantling racism and closing the gap through embedding cultural safety.
 
‘I journeyed through the healthcare system with my Nanna who raised me, so I was really lucky to bear witness to her life,’ she told newsGP.
 
‘I saw the good, the amazing healthcare that she was provided, and the non-Indigenous people that opened doors and really took care and valued her.
 
‘But I also saw the devastating effects that poor healthcare had on her, on her self-esteem, which was the intersectionality of back then: mental health, being an Aboriginal person, but being a woman as well. And it broke my heart because she was someone I deeply loved.
 
‘So that sparked the carer in me wanting to understand the system and help my people within that system. I wanted to understand why people did racial profiling, and what I could do to change their thinking.’
 
After studying nursing at the University of South Australia, where she is now an Adjunct Professor, Janine focused on championing culturally safe healthcare, working for more than two decades in nursing, health policy and Aboriginal and Torres Strait Islander health and wellbeing research.
 
Many of these years were spent in the Aboriginal Community Controlled Health Organisation (ACCHO) sector at state, national and international levels: from 2013–18 she served as CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, and in 2019 became CEO of the Lowitja Institute.
 
Adjunct Professor Mohamed’s pioneering efforts most recently resulted in being named 2024 Australian of the Year for Victoria, in recognition for her leadership skills and dedication to Aboriginal and Torres Strait Islander health and wellbeing.
 
‘Winning the award was a green light on having national conversations around racism, and cultural safety as one of the antidotes to that,’ she said.
 
‘I speak on cultural safety and racism, so it’s an acknowledgement of the journey of my work, but [also] the journey of the work that’s come before me as well, because of course, we always build on the legacy that comes before us.’
 
As Lowitja Institute CEO, Adjunct Professor Mohamed plays an important role liaising with government and community stakeholders when advocating for the health and wellbeing of Aboriginal and Torres Strait Islander people.
 
‘I get to work for an ACCHO, and that’s really important to me – actually, I choose to work in these organisations where Indigenous leadership is at the helm,’ she said.
 
‘We’re really guided by the people we have partnership and membership with, so that’s one of the ways I get to ensure that what I’m doing is actually on behalf of community.’
 
It is an important value, according to Adjunct Professor Mohamed, who says a key part of her role is ensuring ACCHOs work with government to fulfill obligations to community.
 
‘It’s so easy for an Indigenous organisation who has contracts with government systems to often be led by the opportunities on the table that government want us to do, as opposed to what community wants us to do,’ she said.
 
The organisation also deeply holds the values of its patron, Dr Lowitja O’Donoghue, whose name was bestowed to ‘live up to what she stood for, and be courageous and have difficult conversations on behalf of Aboriginal Torres Strait Islander people’.
 
‘We’ve really embedded the cultural determinants, the cultural integrity of this organisation: why we exist, who we’re working for, in our everyday [life],’ Adjunct Professor Mohamed said.
 
Alongside the RACGP, which has a dedicated Aboriginal Torres Strait Islander health faculty and is committed to closing the gap in health disparities between non-Indigenous Australians, Adjunct Professor Mohamed said other non-Indigenous organisations can embrace an allyship role by  understanding what cultural safety is, how to share power, and how to create opportunity.
 
‘When I partner with another organisation, I want to make sure that organisation is mature, so I’m not doing the cultural load stuff or having to teach them about what race and racism is, what institutional integrity that values Indigenous people is,’ she said.
 
‘[I want] that work to be already done so we get to do the real work on behalf of community, and when we’re talking about sharing power, and valuing Indigenous people, that’s really easy to do because that organisation knows what it looks like.
 
‘Understanding it, in a nutshell, is being culturally safe, understanding anti-racism and being mature in that space … and a particular point that I always highlight is understanding power and transformation.’
 
Adjunct Professor Mohamed said part of that understanding lies within the healthcare system which, much like her beloved nanna bore witness to, can help to avoid near misses and preventable adverse outcomes.
 
‘I like to talk about non-Indigenous frameworks of risk, and what does that mean when you put that on the lens of Aboriginal people? To say, “You’re not a risk, you’re a priority”, and being heard and valued,’ she said.
 
She believes a growing Aboriginal and Torres Strait Islander workforce is helping to improve outcomes, and is committed to expanding opportunities for Indigenous people.
 
‘We’ve got more doctors and more nurses coming into the system than ever before, and these people are in positions of power within our system and able to make decisions via our voices,’ she said.
 
‘We’ve got to make sure that we retain them, and the only way we’re going to is to ensure our systems value them, and that cultural safety is at the heart of it.’
 
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Aboriginal and Torres Strait Islander health cultural safety racism