Implementation Plan of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 . 25 1.4 Institutional racism: a barrier to health equity Racism can be broadly defined as the behaviours, practices, beliefs and prejudices that underlie avoidable and unfair inequalities across groups in society based on race, ethnicity, culture or religion. 26 Racism can be 19 National Aboriginal Community Controlled Health Organisation – the peak body representing the 150 Aboriginal community controlled health organisations around Australia. 20 Alford (2014, p. 9). 21 Alford (2014, p. 24). Emphases in the original. 22 Alford (2014, p. 26). 23 CGCSC (2016, pp. 22-23). 24 With regard to personal/casual racism against Aboriginal and Torres Strait Islander employees, see for example, Marrie H (2014), Addressing Allegations of Discrimination Against Aboriginal and Torres Strait Islander (ATSI) Employees of the Cairns & Hinterland Hospital and Health Service (CHHHS) and Review of Support Avenues for the ATSI Workforce (Report to the CEO, Cairns & Hinterland Hospital and Health Service), Bukal Consultancy Services P/L, Gordonvale Qld; Moreton-Robinson (2007); and AIDA (2016, p. 2) recognises that “systemic racism as well as racist remarks or behaviour, and inadequate reporting and follow-up mechanisms have a detrimental effect on the growth of the Aboriginal and Torres Strait Islander medical workforce.” 25 CGCSC (2017, p. 4). 26 Kelaher et al (2014, p. 1). Paradies et al (2009, p. 7) also note that systemic discrimination can also refer to institutional, organisational, societal and cultural discrimination.
24 expressed through stereotypes (racist beliefs), prejudice (racist emotions) or discrimination (racist behaviours and practices). 27 Racism can occur at three conceptual levels - internalised, interpersonal and institutional - that are interrelated and frequently overlap in practice. 28 Most importantly, as Dudgeon et al point out: An institution can engage in racist practices without any of its members being individually racist. This is an important point to comprehend if we are to understand the damaging health and educational outcomes affecting Indigenous people. The de jure and de facto rules of an institution, the aggregation of individual behaviours, and institutional culture can all achieve racist outcomes in the absence of a deliberate intention to do so by any individual within the institution. 29 Regarding the reference to institutional racism, in the discussion paper arising from the Racism and Indigenous Health symposium held in November 2007 at Melbourne University (the Melbourne symposium), systemic racism is also referred to as institutional racism. 30 However, a distinction is made here between institutional racism and systemic racism - for the purposes of the Matrix they are not seen as being synonymous.