Dancing with power: Aboriginal health, cultural safety and medical education

This thesis is a study of the relationships between Aboriginal and Torres Strait Islander health scholars and the medical schools within which they work. It is an empirical study, and a story, not only of the inclusion of Indigenous health into medical curricula in Australia, but an analysis of the relationships that underpin the way Aboriginal health in Australia is conceptualised, defined and translated into policy and practice. Theory, literature, field notes, case studies and Indigenous autoethnography are synthesised into a rich analysis of the pedagogy of place, power and power relations, structural violence and whiteness. The notion of ‘inclusion’ is revealed as problematic in Australian health, higher education, state and social institutions, in that these institutions tend to include Aboriginal peoples on terms which appear altruistic, but which actually reify white power and racism. In this way, medicine and medical education is practiced upon and for Aboriginal peoples, rather than with, using paradigms that render Aboriginal individuals as the problem. Medical schools and state institutions have difficulty in understanding Aboriginal paradigms of health care, and in particular, difficulty in implementing and applying these paradigms in action. Medical schools, while sustaining Indigenous health programs, can exhibit differing and covert values and motivations, a reticence to share economic control and governance, and poor adherence to, or understanding of, accountability and quality as it relates to Aboriginal health. The thesis proposes clearer definitions of what constitutes ‘Aboriginal health’ and ‘cultural safety’, a clearer model of applied cultural safety, and an implementation framework for making institutions culturally safe as a pretext for the practice of Aboriginal health using Aboriginal health paradigms.