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Abstract
Indigenous people in Australia suffer from significant disparities in health compared to their non-Indigenous peers. Policies to address it have had little success. Using Michel Foucault’s concept of ‘enunciative modalities’ and Wiradjuri historian Lawrence Bamblett’s theory of deficit discourses and ‘straightline stories,’ which builds on Foucauldian theory, this essay explores the reasons for the failures, the complicity of architecture, and responses by the discipline. This article (coauthored with an Aboriginal doctor and academic, and an Elder in the community) argues hospitals, in particular, are alienating environments. It proposes a new Indigenous-led typology to mediate hospital care that is spatio-temporally and materially different.
Correction Statement
This article was originally published with errors, which have now been corrected in the online version. Please see Correction (http://dx.doi.org/10.1080/10464883.2022.2072151)
Notes
1 The terms Indigenous, Aboriginal, and Aboriginal and Torres Strait Islander, First Nations are used interchangeably. While Indigenous is the inclusive term adopted by governments, there are many people and organizations in the community in Victoria who prefer to self-describe as Aboriginal while others are now using the term First Nations. In describing affiliations for individuals, tribal or clan names are used instead.
2 Council of Australian Governments, National Indigenous Reform Agreement (Closing the Gap) (Canberra: Council of Australian Governments, 2009).
3 Vicki Smye and Annette Browne, “’Cultural Safety’ and the Analysis of Health Policy Affecting Aboriginal People,” Nurse Researcher (through 2013) 9:3 (2002): 42; Elana Curtis, Rhys Jones, David Tipene-Leach, Curtis Walker, Belinda Loring, Sarah-Jane Paine, and Papaarangi Reid, “Why Cultural Safety Rather than Cultural Competency Is Required to Achieve Health Equity: A Literature Review and Recommended Definition,” International Journal for Equity in Health 18:1 (2019): 1–17;
4 Alison Markwick, Zahid Ansari, Darren Clinch, and John McNeil, “Perceived Racism May Partially Explain the Gap in Health between Aboriginal and Non-Aboriginal Victorians: A Cross-sectional Population Based Study,” SSM—Population Health 7 (2019): 100310.
5 Michel Foucault, Archaeology of Knowledge (London & New York: Routledge, 1972).
6 Paul Hirst, “Foucault and Architecture” AA Files 26 (Autumn 1993): 52–60.
7 The research project Exploring the Contribution of Indigenous Cultural Practices for Health and Wellbeing in Indigenous Young People is funded through the NHMRC Million Minds Round Program Grant led by Sandra Eades: “Bringing Family, Community, Culture and Country to the Centre of Healthcare: Culturally Appropriate Models for Improving Mental Health and Wellbeing in Aboriginal and Torres Strait Islander Young People,” ID 1179461.
8 Australian Institute of Health and Welfare, Australia’s Health 2018, Australia’s Health Series 6, AUS 221 (Canberra: AIHW, 2018), https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf.aspx?inline=true
9 Peter S Azzopardi, Susan M. Sawyer, John B. Carlin, Louisa Degenhardt, Ngiare Brown, Alex D. Brown, and George C. Patton, “Health and Wellbeing of Indigenous Adolescents in Australia: A Systematic Synthesis of Population Data,” The Lancet 391:10122 (2018): 766–82.
10 S. Kennedy, M.P. Kidd, J.T. McDonald, and N. Biddle, “The Healthy Immigrant Effect: Patterns and Evidence from Four Countries,” Journal of International Migration and Integration 16:2 (2014): 317–32; S. Jatrana, K. Richardson and S.R.A. Samba, “Investigating the Dynamics of Migration and Health in Australia: A Longitudinal Study,” European Journal of Population (2017) https://doi.org/10.1007/s10680-017-9439-z.
11 See discussions of ‘deficit discourse’ in Cressida Fforde, Lawrence Bamblett, Ray Lovett, Scott Gorringe, and Bill Fogarty, “Discourse, Deficit and Identity: Aboriginality, the Race Paradigm and the Language of Representation in Contemporary Australia,” Media International Australia 149:1 (2013): 162–73; and for a critical discussion of the biases within statistics around Indigenous peoples see Maggie Walter and Chris Andersen, Indigenous Statistics: A Quantitative Research Methodology (London: Routledge, 2013), https://doi.org/10.4324/9781315426570.
12 Paul Keating “Redfern Speech (Year for the World’s Indigenous People)—Delivered in Redfern Park by Prime Minister Paul Keating, 10 December 1992, https://antar.org.au/sites/default/files/paul_keating_speech_transcript.pdf.
13 Tom Calma, Social Justice Report 2005, Canberra: Human Rights and Equal Opportunity Commission, 2005, https://humanrights.gov.au/sites/default/files/content/social_justice/sj_report/sjreport05/pdf/SocialJustice2005.pdf.
14 Close the Gap Statement of Intent: Indigenous Health Equality Summit, 12 February, 2008, https://antar.org.au/sites/default/files/statement_intent_2008.pdf.
15 Council of Australian Governments. National Indigenous Reform Agreement (Closing the Gap). Canberra: Council of Australian Governments, 2009.
16 Council of Australian Governments, National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, 2008, https://www.coag.gov.au/sites/default/files/agreements/partnership-agreement-on-closing-the-gap_0.pdf.
17 Chris Holland, Close the Gap—Progress and Priorities Report 2014 (Canberra: Close the Gap Campaign Steering Committee for Indigenous Health Equality, 2014) https://humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice/publications/close-gap-progress-and.
18 Australian Government, Closing the Gap Report 2020 (Canberra: Commonwealth of Australia, 2020), https://ctgreport.niaa.gov.au/sites/default/files/pdf/closing-the-gap-report-2020.pdf.
19 Chris Holland, Close the Gap.
20 Lawrence Bamblett, Our Stories Are Our Survival (Canberra, ACT: Aboriginal Studies Press, 2013), 34.
21 Bamblett, 34.
22 Foucault, Archaeology, 55–56.
23 Foucault, 60.
24 Foucault, 56–57.
25 Carroll Go-Sam, “Fabricating Blackness: Aboriginal Identity Constructs in the Production and Authorisation of Architecture,” in Audience: Proceedings of the 28th International Conference of the Society of Architectural Historians, Australia and New Zealand, eds. A. Moulis and D. van der Plaat, Brisbane, Qld, Australia, July 7–10, 2011, 1–27.
26 Australian Government, Closing the Gap in Partnership, “Priority Reforms,” https://www.closingthegap.gov.au/priority-reforms; Australian Government Department of Health, How We Support Aboriginal and Torres Strait Islander Health,” https://www.health.gov.au/health-topics/aboriginal-and-torres-strait-islander-health/how-we-support-health.
27 ARC Discovery Grant, “Architectural Design to Improve Indigenous Health Outcomes” (2016–2021).
28 For further details see: “Exploring the contribution of Indigenous Cultural Practices for Health and Wellbeing in Indigenous young people,” The University of Melbourne, January 13, 2022. https://msd.unimelb.edu.au/research/projects/current/exploring-the-contribution-of-indigenous-cultural-practices-for-health-and-wellbeing-in-indigenous-young-people.
29 Bringing Family, Community, Culture and Country to the Centre of Healthcare: Culturally Appropriate Models for Improving Mental Health and Wellbeing in Aboriginal and Torres Strait Islander Young People, ID 1179461.
30 Murdean Marshall, Albert Marshall, and Cheryl Bartlett, “Two-Eyed Seeing in Medicine,” in Determinants of Indigenous Peoples’ Health in Canada: Beyond the Social (2015): 16–24; A.L., Wright, C.M. Gabel, M. Ballantyne, S.M. Jack, and O. Wahoush, “Using Two-Eyed Seeing in Research with Indigenous People: An Integrative Review,” International Journal of Qualitative Methods 18 (2019), https://doi.org/10.1177/1609406919869695.
31 Timothy O’Rourke, Daphne Nash, Michele Haynes, Meredith Burgess, and Paul Memmott, “Cross-Cultural Design and Healthcare Waiting Rooms for Indigenous People in Regional Australia,” Environment and Behaviour 2020, https://doi.org/10.1177/0013916520952443; Daphne Nash, Timothy O’Rourke, Paul Memmott, and Michele Haynes, “Indigenous Preferences for Inpatient Rooms in Australian Hospitals: A Mixed-Methods Study in Cross-Cultural Design,” HERD: Health Environments Research & Design Journal 14:1 (2020): 189, https://doi.org/10.1177/1937586720925552.
32 Timothy O’Rourke and Daphne Nash, “Making Space: How Designing Hospitals for Indigenous People Might Benefit Everyone,” The Conversation, December 6, 2019, https://theconversation.com/making-space-how-designing-hospitals-for-indigenous-people-might-benefit-everyone-122550.
33 Nancy Fraser, “Rethinking the Public Sphere: A Contribution to the Critique of Actually Existing Democracy,” Social Text Footnote25/26 (1990): 64–65.
34 Details about Aboriginal Controlled Community Health Services can be found at National Aboriginal Community Controlled Health Organisations (NACCHO), https://www.naccho.org.au/.
35 Royal Commission into Victoria’s Mental Health System, Australia, “Final Report,” Final Report: Royal Commission into Victoria’s Mental Health System (blog), February 2021, https://finalreport.rcvmhs.vic.gov.au/.
36 Details about Aboriginal Hostels can be found at Australian Government: Aboriginal Hostels Limited, https://ahl.gov.au/.
37 Katherine Gottlieb, “The Nuka System of Care: Improving Health Through Ownership and Relationships,” International Journal of Circumpolar Health 72:1 (2013): 21118. See also https://scfnuka.com/.
38 Linda Archibald and Jonathan Dewar, “Creative Arts, Culture, and Healing: Building an Evidence Base,” Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 8:3 (2010): 1–25.
39 Janet McGaw and Anoma Pieris, Assembling the Centre: Architecture for Indigenous Culture, Australia and Beyond (London: Routledge, 2014), 1–2.
40 Janet McGaw, Alasdair Vance, Aunty Margaret Gardiner, Uncle Gary Murray, Aunty Esther Kirby, Sue-Anne Hunter, Moira Rayner, Selena White, Sharon Mongta, “(Not) Royal Park: Recovering the Enduring Importance of a Kulin Nations Gathering Place for Culture, Health, Wellbeing and Healing,” paper presented at SAHANZ Conference 2020: What If? What Next? Speculations on History’s Futures, https://www.sahanz.net/wp-content/uploads/3A_419-426_MCGAW-ET-Al.pdf.
41 Aunty Margaret Gardiner and Janet McGaw, “Indigenous Placemaking in Urban Melbourne: A Dialogue Between a Wurundjeri Elder and a Non-Indigenous Architect and Academic,” The Handbook of Contemporary Indigenous Architecture (Singapore: Springer, 2018(, 581–605.
42 Michel de Certeau, The Practice of Everyday Life (Berkeley: University of California Press, 1984).
43 Emily Potter, “Programme: Dreaming, Timekeeping, Becoming,” in Assembling the Centre: Architecture for Indigenous Cultures Australia and Beyond (2014): 100–120.
44 Barbara Adam, “Time,” Theory, Culture and Society 23:2–3 (2006): 119–38
45 Stephen Muecke, Ancient and Modern: Time, Culture and Indigenous Philosophy (Sydney, NSW: UNSW Press, 2004): 17.
46 Potter, “Programme,”: 100.
47 Paul Hirst, “Foucault and Architecture,” AA Files 26 (Autumn 1993): 52–53.
48 de Certeau, The Practice, 131–32).
49 Michel Foucault, Discipline and Punish, trans. A. Sheridan (Paris: Gallimard, 1975).
50 de Certeau, The Practice, 131–32).
51 State Government of Victoria, First Peoples – State Relations, “Truth and Justice in Victoria,” October 5, 2021, https://www.firstpeoplesrelations.vic.gov.au/truth-and-justice.
52 The Truth, Justice and Reconciliation Commission in South Africa (1996–2003) and The Truth and Reconciliation Commission in Canada (2008–2015).
Additional information
Notes on contributors
Janet McGaw
Janet McGaw, Ph.D., is an associate professor of architectural design and a registered architect. Her research, teaching, and creative practice investigate ways to make urban space more equitable. She explores the relationship between place, identity, and health using methods that are discursive, collaborative, and sometimes ephemeral. McGaw led an ARC Linkage Grant: “Indigenous Placemaking in Melbourne: Representations, Practices and Creative Research” (2010–2014) and is currently an investigator on the Elder-Governed Indigenous Cultural Practices Project within the NHMRC Million Minds research program grant (2019–2024) (ID 1179461).
Alasdair Vance
Alasdair Vance is an associate professor of child and adolescent psychiatry in the Department of Paediatrics at the University of Melbourne and consultant child and Adolescent psychiatrist at The Wadja Aboriginal Family Place, Royal Children’s Hospital, Melbourne. He has matrilineal Northern Wathaurung heritage. Alasdair has been coleading a proposal for an Elder-led statewide Aboriginal Mental Health Program. Alasdair is the leader of the Elder-Governed Indigenous Cultural Practices Project within the NHMRC Million Minds research program grant (2019–2024) (ID 1179461).
Uncle Herb Patten
Uncle Herb Patten is a Gunai-Kurnai, Wiradjuri, and Yorta Yorta Elder who serves on the Governing Board of Elders/Senior People for the Elder-Governed Indigenous Cultural Practices Project within the NHMRC Million Minds research program grant (2019–2024) (ID 1179461). He is an internationally renowned musician (gumleaf player), a painter whose work is in the collection of the National Gallery of Victoria, and an esteemed leader within the Aboriginal community of Melbourne.