Reproducing injustice? : the roles of social institutions and policy actors in the persistence of inequalities in Aboriginal and Torres Strait Islander life expectancy

Abstract

Using critical realism as a philosophy and methodology, this thesis seeks to identify underlying social structures, powers and mechanisms that could contribute to the persistence of inequality in the average life expectancy at birth between Aboriginal and Torres Strait Islander peoples and the non-Indigenous population of Australia in the 21st century. In 2018 Australians were among the world’s longest-lived populations. However, the gap in life expectancy at birth between Indigenous and non-Indigenous Australians is ten years (Australian Institute of Health and Welfare, 2018b, p. 29). Social determinants are estimated to be responsible for more than one third (34%) of the gap, health behavioural risk factors are estimated to account for about one-fifth of the health gap, but almost half the gap (47%) is due to unexplained factors (Australian Institute of Health and Welfare, 2018b, p. 32). This is from the ‘in brief Australia’s Health). I begin this thesis with a discussion of ontology and epistemology in order to set the scene for the methods of investigation I adopt. I outline the critical realist method that I adopted in the thesis, based on a six-step framework developed by Bendik Bygstad and Bjørn Erik Munkvold (Bygstad & Munkvold, 2011, p. 5). I then draw on epidemiological and routine administrative data to describe a social phenomenon in the empirical domain – inequalities in the average life expectancy at birth, in health, and in access to social determinants of health between the Indigenous and non-Indigenous Australian populations. Analysis reveals a pattern of statistical regularity – the inequalities are systematic across all the indicators. They have persisted despite the Indigenous and non-Indigenous populations living in the same country, under the same constitution and under the same governments. Contemporary theoretical explanations of determinants of inequalities in the health of populations do not wholly explain reasons for their persistence. They do not identify mechanisms available to people and institutions with political and social power and privilege that are being activated to perpetuate inequalities across generations. I select all public policies (taken together) through which Australia has been governed as events in the actual domain that have contributed to the persistence of the systematic patterns of inequalities reported in the empirical domain. I identify key components of the events that are generalisable across them all. I conduct a critical realist review of transdisciplinary literature. Through the process of abstraction, I develop a theoretical framework of generative mechanisms and structures that could plausibly explain how the events contribute to the persistence of the systematic patterns of inequality described in the empirical domain. From theoretical perspectives on institutionalism, social justice, racism, colonialism, and power I identify candidate mechanisms in the real domain. I assess (and confirm) through an interview study that the mechanisms could be practically adequate indicators of underlying powers being activated by contemporary policy actors to influence public policy decisions (events); and that the contribution of the mechanisms to explanations of the events (and outcomes) could be validated in future research. Social institutions both enable and constrain the formulation of public policies. The worldviews of policy actors shape policy decisions and reproduce or transform the institutions. All policy ideas are filtered through the institutions and actors that have power to govern. The subordinate value ascribed by the colonisers to Indigenous Australian peoples and cultures was used to exclude them from access to power and authority to govern, and from participation as peers in society. The injustices became institutionalised in law, policies and professional practice and normalised in the worldview of the citizenry. Despite some positive progress over time, the hard fact of the inequality in life expectancy that has persisted into the 21st century cannot be ignored. Indigenous peoples have used all possible avenues available to them to resist and reverse injustices and to create positive change – sources of injustice or barriers to change are already clear to them. This research instead seeks to expose underlying mechanisms through which social institutions and policy actors with power and authority to govern perpetuate injustices of the past. The exposed mechanisms are avenues through which to reverse the injustices - working authentically with Indigenous peoples and nations, by sharing power and authority to govern, by achieving representative and cultural justice in all policy spaces. Meeting Indigenous Australians’ demands for power to co-create the policy table, to determine socially just public policies, and to co-create Australia’s future is not only a moral obligation – it is necessary to life itself.