Most health services are structured to accommodate non-Indigenous providers and users. This cultural specificity is not widely recognised or well understood.
Even those health services that struggle to accommodate their Indigenous patients meet with limited success due to the deeply entrenched institutional barriers to change.
At every level of service planning and provision control is located entirely with (predominantly non-Indigenous) staff - this imbalance of power between staff and patients is evident in every aspect of health care.
These barriers are exacerbated by structural inertia, resistance to change, lack of opportunity, resources and expertise to plan and implement sustainable change.
There is little evidence of the institutional and individual cultural competence required to ensure effective health care for Indigenous Australians.
Attempts to accommodate the cultural and linguistic needs of Indigenous patients and their families are therefore seriously limited.