Receiving culturally safe care can be a matter of life and death, according to the acting CEO of the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), Trevor Pearce.
"Racism, or perceived racism, and cultural ignorance are the barriers for Aboriginal people of not feeling comfortable. Therefore we leave it longer before getting treatment and then it's often more complicated, more expensive, more drawn out," Mr Pearce says.
"It's often too late, and it can even lead to death in some instances."
Last year, VACCHO released a study which polled Aboriginal and Torres Strait Islander Victorians about their experiences of racism at hospitals and GP clinics. It found high levels of everyday racism in the health sector.
"In Victoria, Aboriginal people are four times more likely to discharge against advice from a doctor and that says volumes to us as a community that they do not feel safe when walking into a hospital," Mr Pearce says.
"You know, it's like you need to leave your culture at the door."
Aboriginal health professionals also warn that if a patient has a bad interaction with a hospital or clinic, valuable data which records a person's Indigenous status may be lost.
One program has attempted to address some of these experiences - through encouraging GPs to work closely with Aboriginal Community Controlled Services, and train staff in cultural safety.
The Ways of Thinking and Ways of Doing program started to take shape in 2008 after the Close the Gap strategy was launched.
Its goal, like many Close the Gap strategies, is to reverse Indigenous peoples experiences of racism in the health system and improve early detection of chronic disease and illness, particularly through increasing the number of patients taking advantage of the 715 Health Assessment.
Chief Investigator of the project, Phyllis Lau, said it has evolved over the years to adapt to our understanding of "cultural awareness" versus "cultural respect and safety".
"We wanted to reduce the barrier, not just for community but also for the mainstream. A lot of doctors and nurses will say 'I don't know what to do,'" she said.
"This program is one way of saying, 'this is what you can do.'"
A review of the program, released Monday in the Australian Medical Journal, suggests more than 12 months may be needed to determine its efficacy, which so far has not shown improvement in staff cultural respect levels.
Ms Lau said the findings were "slightly concerning", but she hopes to see the program continue with changes that reflect the findings. In particular, she wants to see a framework for the Indigenous "cultural mentors" which the program encourages to engage with mainstream services.
"There needs to be a framework that guides the person doing the mentorship. And reimbursement, so it can give back to the community," she said.
Other studies, such as Australian National University's longitudinal study of culture, health and wellbeing for Indigenous people, are currently underway and aim to address the same issues.
Mayi Kuwayu will survey hundreds of thousands of people over a 50 year period looking into how a connection to country and culture influences Indigenous peoples health and well-being. One branch of the study will examine partnerships between the peak body for Aboriginal Community Controlled Health Services and pharmacists.
Mr Pearce says more work needs to be done before considerable progress is made, but strides are being made in the right direction.
"There needs to be a cultural change of hospitals from not just the front desk, but from the board down. It needs to happen at a governance level, it needs to happen at a practice level, and it needs to happen at the patient interaction level."
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