This weeks BIRM blog is about the definition of institutional racism used in the Bukal Institutional Racism Matrix.
Systemic – the components of a system
In the quote below, Pat Anderson talks about ‘systemic racism’:
‘there is a growing body of evidence that the health system itself does not provide the same level of care to indigenous people as to other Australians. This systemic racism is not necessarily the result of individual ill-will by health practitioners, but a reflection of inappropriate assumptions made about the health behaviour of people belonging to a particular group.’ Pat Anderson, Chair of the Lowitja Institute
Structural – the design of a system
Stakeholders refer to the healthcare ‘system’ which means the organisations, mechanisms, processes, funding, and governance of the institution of health. In the next quote, the Australian Human Rights Commission states ‘systemic or institutional‘.
‘[racism] can also occur at a systemic or institutional level through policies, conditions or practices that disadvantage certain groups… On a structural level, racism serves to perpetuate inequalities in access to power, resources and opportunities across racial and ethnic groups.’ AHRC – National Anti-Racism Strategy.
Adding further to the definitional issues, the AHRC used the phrase ‘on a structural level’. Now there is “systemic”, “institutional”, and “structural” racism. The word “structural” conjures images of the hidden framework of buildings, the unseen iceberg below the waterline, or the soil underneath a garden bed. But for the health system, structural refers less to physical and more to ethereal forces.
For example, in my analysis of healthcare governance documents – that is, searching the textual structure – I found that Australia’s First Peoples were excluded from their intellectual development. It is as though Australia’s First Peoples didn’t exist in the intellectual development of healthcare governance – we are ‘structured-out’. That’s how I think of ‘structure’ in the health system. Here’s what Adrian Marrie wrote:
‘In the context of the Matrix, structural racism is located at the legislative level as hospital and health service (HHS) laws effectively provide the legislative architecture or infrastructure which structures governance, management, performance, employment, reporting and accountability arrangements.’ Adrian Marrie (2017)
Marrie is writing about health laws as enabled through Acts of parliament whereas I think about guidelines for governance in documents. Both Acts and guidelines are written expressions of social values and norms to which a system enables through its design. Confusing the situation, Marrie and many others in Australia join the terms institution/organisation (italics added):
‘In identifying institutional racism, this is seen as a phenomenon that has many manifestations that can occur across all facets of an organisation’s activities and as reflected in the culture of an organisation as a whole – therefore, from a point of view of analysis and measurement institutions/organisations are treated holistically as discrete entities.’ Adrian Marrie (2017)
Institution – chronically reproduced rules and resources
I disagree that an organisation is an institution because of my reading of Anthony Giddens’s Structuration Theory (AGST). Giddens (1984) is clear that an organisation is a discrete unit of ‘power relations’, that ‘structure’ is ‘rules and resources’, and:
‘Institutions refers to the more enduring features of social life – as reproduced practices across space and time, as chronically reproduced rules and resources’ (p. 375)
That is, an institution is, for example “religion”, “democracy”, “sport”, “marriage”, “welfare”, “racism”, and “health”. Therefore, the thousands of healthcare organisations are physical manifestations of a system that is structured in accord with rules and resources that reflect the social values and norms of society.
I argue that the BIRM uncovers ‘chronically reproduced’ practices – institutionalised practices, that have been recurring over a long span of time without being realised or detected. Much like how difficult it can be to think about social values and norms and give practical examples, so to it can be difficult to pin-down the practical differences between confusing concepts.
Therefore, I propose the schema of Institution : System : Organisation : Committee : Voice. The way I see it, BIRM shows how the lack of engagement with the Voices of Australia’s First Peoples, such as through governing Boards (Committees), is a phenomenon throughout the health System (where multiple Boards do not have Indigenous members). Boards are designed as stipulated in the laws of the Queensland Health System which reflect broader social values and norms – Institutionalised as they are in the social ideal of ‘health’. I wrote here about the relationship between health and racism in Queensland to demonstrate the institutional nature of racism.
“#CallOutIRAustralia is about unpacking the institutionalised social values and norms circulating within the structural design of the health system and infecting organisational governance.” Mark Lock (25 January 2019)
- Anderson, P. (2013) ‘Racism a driver of Aboriginal ill-health‘ (accessed 25 January 2019)
- Australian Human Rights Commission (2012) ‘National Anti-Racism Strategy‘ (accessed 25 January 2019).
- Marrie A., (2017) ‘Addressing Institutional Barriers to Health Equity for Aboriginal and Torres Strait Islander People in Queensland’s Public Hospital and Health Services‘ (accessed: 2 January 2019).
- Giddens A. (1984) ‘The Constitution of Society: Outline of the Theory of Structuration‘ Berkeley: University of California Press.