DR Summer May Finlay didn’t know the realities of the health inequities between Indigenous and non-Indigenous Australians until she began working in the public health sector.
“[The gap in life expectancy] manifested in my family,” Dr Finlay tells the MJA.
“It was my reality, my normality, so I didn’t understand there was a gap. Death and dying was a very common conversation in our family.
“My mother experienced a large amount of death in her immediate family and extended family – my aunty, my uncle, cousins – they’ve all died really young.
“I didn’t realise it wasn’t normal.”
Dr Finlay is a proud Yorta Yorta woman. Yorta Yorta country stretches across the Murray River from Cohuna to the west, Albury in the east, and includes Echuca, Shepparton, Benalla, Corowa and Wangaratta and extend northwards to just south of Deniliquin.
Dr Finlay’s grandmother, Edna, was part of the Cummeragunja Walk Off in 1939 as a young child. About 200 Yorta Yorta people walked off the Cummeragunja Mission Station as a protest against poor living conditions and bad management. The strike, the first ever mass strike of First Nations people in Australia, lasted 9 months.
Given that family history – her grandmother died at the age of 49 – it’s perhaps not surprising that Dr Finlay gravitated to working in the First Nations health space, even though she says she “fell into it”.
“I started out doing a degree in arts and business subjects, but I hated it, so I dropped out,” she says. “I worked in retail until I was 23, until I decided I wanted to do speech pathology.”
She returned to university studying linguistics as a major, but “the university I was at didn’t offer speech pathology – because I wasn’t very planned”. She then spent 12 months overseas.
“When I came back it was 2009 – post GFC. I wanted to do Aboriginal language research, but I couldn’t find a job,” Dr Finlay says. “There was a job going at the Victorian Aboriginal Community Controlled Health Organisation, in Aboriginal public health research.
“I thought, well, two out of three isn’t bad, right? That was literally my thought pattern. There was a nice fit between public health and social science.”
These days Dr Finlay is a Lecturer in the Faculty of the Arts, Social Sciences and Humanities at the University of Wollongong – teaching Indigenous Social Determinants of Health, and Collaborative Research Methodology – and also a Postdoctoral Fellow at the University of Canberra on a National Health and Medical Research Council-funded project.
She and her colleagues wrote a chapter in the recent MJA Supplement Australia in 2030: what is our path to health for all?. The chapter -- Aboriginal and Torres Strait Islander connection to culture: building stronger individual and collective wellbeing – illustrates the deep need to address cultural determinants of health for First Nations peoples, as well as the social determinants.
“The fact that I was able to write this with my colleagues and publish it in the MJA – a mainstream setting – this wouldn’t have happened 10 years ago,” Dr Finlay says.
“It might have been in the Aboriginal and Islander Health Worker Journal, for example, which clearly was designed to promote Indigenous voices. But in terms of this actually hitting the mainstream – that’s the difference now.”
Nevertheless, there are challenges ahead in implementing the practical measures Dr Finlay and her colleagues advocate for in the Supplement.
“If I'm honest, the research had me thinking that this is a generational change, so a year is like a drop in the bucket,” she says.
“The theoretical concepts are still evolving, but they're evolved enough to a point where we can concretely talk about the benefits of them, and it will be an ever-emerging space, I suspect.
“There still is a significant gap in expectations around having Aboriginal and Torres Strait Islander people leading [these initiatives].
“So often research projects or programs are being funded where they say they're embedding the cultural determinants or looking at cultural competency – and it's led by non indigenous people.
“At best there are Aboriginal people involved but they are often not in senior leadership positions. And at worst, Aboriginal people are tokenistic. Cultural competency guidelines being developed by non-Aboriginal people with Aboriginal people consulting – allowing non-Aboriginal people to tick the box to say whether or not they were culturally competent.
“Well, no, sorry.”
Is it fair to say that in past year or two, there have been some shifts in policy mission statements, but not a lot of actual cultural change within the sector?
“That's probably a good summary,” Dr Finlay says.
“We do see people talking about it, because they know they should be doing it. But often, what I find is people don't really understand what [cultural competence] means in practice, or the importance of it.
“Or they think they're doing it, and they're being told they're doing it well by non-Indigenous people, but they actually don't ask Aboriginal and Torres Strait Islander people, whether they're actually doing it well.
“And, ultimately, when it comes to the cultural determinants, it's Aboriginal and Torres Islander people that need to be determining whether it's been done in the right way or being done well.”
Do people in the health sector understand “institutional racism”?
“The challenge with institutional racism is that people hear the word racism, and they go, but that's not me. They're thinking about interpersonal racism,” says Dr Finlay.
“Very often I find the naysayers genuinely don't understand what institutional racism is. Others have a better understanding of it but often they say, but I'm just one person.
“If all of the ‘just one person’ actually got together and looked at how they put it as an individual, and then as a collective, look to unpick the institutional racism and replace it with better systems and structures, then we would actually be a damn sight better off.”
And still there is optimism, she says.
“My generation is doing better than my Mum’s generation, and her generation is doing better than my grandmother's generation in a lot of ways. So, I'm always optimistic,” she says.
“There's a lot of work that needs to be done. Obviously, closing the gap in mortality by 2031 is not likely to be achieved unless there is a seismic shift in the way we do everything.
“I want to make sure that my children's generation is better off, but will they have parity? And what does parity look like?
“When we talk about parity, we don't want to be Aboriginal but in a white way. What we want is to be Aboriginal and have the opportunities that our peoples want to have, and to be able to do that in a way that is determined by our cultural needs.
“I am optimistic, but I'm still realistic enough to recognise that it's going to be a hard slog. My advocacy days are not over. There's no way.”
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.