SOCIAL CHANGE:

BEYOND THE
INDIVIDUAL

Dr. Kate Murray

Senior Lecturer
Kate.Murray@qut.edu.au
Acknowledgement of
Traditional Owners

QUT acknowledges the Turrbal and Yugara, as the

First Nations owners of the lands where QUT now
stands. We pay respect to their Elders, lores, customs
and creation spirits. We recognise that these lands
have always been places of teaching, research and
learning.

QUT acknowledges the important role Aboriginal and

Torres Strait Islander people play within the QUT

CRICOS No.00213J
community.
Today’s talk: Beyond the individual
• How do individual and interpersonal processes manifest
at organisational levels?
• Systemic oppression
• Defining
• Examples

• Steps for change (beyond the individual)

• Examples
• Approaches
Learning Objectives
• Define institutional racism
• Discuss ways in which prejudice and discrimination may
occur at systemic levels
• Identify ways to monitor and improve equity within
organisations and systems
WHAT IS SYSTEMIC
OPPRESSION?
What does it look like?
Opening Exercise
• Consider the ways in which the world discriminates
against left-handed individuals.
• Take 2 minutes to make a list of all of the challenges
faced by lefties
Opening Exercise
• How many issues and examples are on your list?
• Are you left-handed?
• Is anyone you know left-handed?
• How much time have you spent thinking about people
who are left-handed and these issues before?
Social Determinants of Health (SDH) Physical
Environment
7% Questions to Consider

• Have you heard of the

SDH before?
Medical
Care • If you think about
Individual 11% mental health or
Behaviour health programs you
38% know about, which
social determinants
Genetics & do they target?
Biology
21% • Consider physical
activity campaigns?
Social
What is typically
Circumstances
23% targeted to promote
physical activity?
Individual and interpersonal processes
• Prejudice
• Bias (conscious and unconscious)
• Discrimination

• Focused on individual, overt, and extreme forms of racism

as ‘the problem’
• How do we move to looking at systems of oppression and
how this plays out within policies and programs across
sectors?

What is Institutional Racism (or any ism)?

Structural theory
• “Socioeconomic circumstances of social groups (including
differences in income, wealth, power, environment, and
access), at all stages of the life-course, cause differences
in health outcomes” (McCartney et al., 2013, p. 224)

• People with more resources in any setting or country are

always healthiest

Why do you think this is the case?

 Start this slide with watching this video:
A Gardener’s https://www.youtube.com/watch?v=GNhcY6fTyBM
@6 minutes starts the focus on systems (but you can watch the whole thing :)
Tale
Adapted from Jones (2012)

• What is it that
contributes to a more
healthy and vibrant
pot of red flowers?

• How might our

environments
contribute to more
healthy and optimal
conditions for some
people and not for
others?

• How do the US
examples provided
relate to the
Australian context?
 12

Levels for intervention/change

Society

Organisation

Interpersonal

Individual
SOCIAL SYSTEMS
Some examples of systemic inequities
Employment
• Bertrand & Mullainathan (2004)
• Boston & Chicago help wanted ads
• Whites receive 50% more callbacks for interviews
• Resume quality more influential for white names than for African-
American names
• Racial gap consistent across occupation, industry and employer
size
• ANU study (Booth et al., 2012)
• Anglo-Saxon, Indigenous, Italian, Chinese, and Middle Eastern
names for entry-level jobs
• Consistently ethnic minority candidates needed to apply for more jobs to
be called back for an interview
• Differences across subgroups and gender
 Employment (Booth et al., 2012)
• Male and female applicants
• Significantly more callbacks for Anglo-Saxon (35%) as compared to
Indigenous (26%), Chinese (21%) and Middle Eastern (22%)
applicants. No difference for Italian applicants (32%)
• Female applicants
• Significantly more callbacks for Anglo-Saxon (38%) applicants as
compared to Indigenous (31%), Chinese (21%) and Middle-Eastern
(25%) applicants. No difference for Italian applicants (37%)
• Male applicants
• Significantly more callbacks for Anglo-Saxon (33%) as compared to
Indigenous (22%), Chinese (22%) and Middle Eastern (19%)
applicants. No sig difference for Italian applicants (28%)
Employment
• WGEA Gender Equity Insights report
• Survey covers 40% of Australian workforce
• Increased focus within organisations on gender equity
• 10% increase in organisations with formal remuneration
policy or strategy (to 58.5% in 2016-17)
• 13.7% increase in organisations undertaking pay gap
analysis
• Companies reporting gender pay gaps to Executive and
taking actions to correct for gaps resulted in 3.3%
reduction in gap
• Combined actions most effective

Source: https://www.wgea.gov.au/data/wgea-research/gender-equity-
insights-inside-australias-gender-pay-gap
 Employment
Study in 2018 identified lack of diversity in leadership within
major Australian companies

Cultural Number % senior % Australian % over/under

background leaders pop. rep (+/-)
Anglo-Celtic 1890 75.9 58 +17.9
European 474 19.0 18 +1.0
Non-European 116 4.7 21 -16.3
Indigenous 10 0.4 3 -2.6
Total 2490

Source:
https://www.humanrights.gov.au/sites/default/files/document/publication/Leading%20for%20Change_Blueprint2018_FINAL_Web.pdf
Employment
Recap: Systematic differences
• Across industries
• Across aspects of employment
• Likelihood of call-backs for interviews
• Pay gaps
• Moving into leadership roles
• Interpersonal processes at play, but what could be
happening systemically to drive ongoing trends?
 19

Health care
• Aboriginal and Torres Strait Islander people have 2.3
times the disease burden of non-Indigenous people

Average life expectancy at birth

(2015)
ap 85
G
he 80
T
s e 75
lo
C 70

65
Source:
Japan Australia OECD avg Indigenous
https://www.humanrights.gov.au/sites/default/fi Australians
les/document/publication/CTG%202018_FINA
L-WEB.pdf
 20

Health care
Social
Questions to Consider Determinants of
• What is happening at a systems Health (SDH)
level to create such major
differences
• Across countries?
• Within countries?

• What might be happening across all

areas of SDH and within systems,
and not just for an individual patient
and provider?
 21

Dimensions of diversity:
Addressing Model
• Age
• Developmental disability
• Disability (acquired)
• Religion and spirituality
• Ethnicity and Culture
• Socioeconomic status
• Sexual Orientation
• Indigenous Heritage and Colonisation
• National Origin, Immigration, Refugee Status & Language
• Gender and Sex
Recap
• Many, many other examples (incarceration rates, child
protection, health care access and quality, etc.)
• Systematic differences in outcomes across subgroups of
the population
• Social determinants of healthà influence across many
different layers of identity and isms
• Approaches to change at an individual level have not
proven sufficient
• Systemic reform needed to effect change
HOW DO WE ADDRESS
SYSTEMIC
OPPRESSION?
What steps are needed to create change?
Approaches to Cultural Diversity
(Adapted from: Downing, Kowal and Parades, 2011)

Focus on process of cultural identity

formation and one’s own identity/positioning

Individual
Health health
system worker

Focus on developing cultural

knowledge
Reading review of research (King et al., 2012)
• Diversity training important for addressing systematic
differences and gaps
• Discrimination relates to financial costs, dissatisfaction,
turnover, etc. (direct and indirect effects)
• Study: Diversity training in 395 healthcare organisations
within NHS (UK), n = 155,922
• Typically evaluated as post-program changes in
attitudes and knowledge
• What is the impact on minorities’ experiences of
discrimination and job satisfaction?
Reading review of research (King et al., 2012)
• Organisational factors
• Org-level prevalence of discrimination
• Numbers of ethnic minority employees
• Org-level prevalence of diversity training
• Individual factors
• Minority status
• Personal experiences of discrimination
• Diversity training
Reading review of research (King et al., 2012)
Diversity training related to decrease in experiences of discrimination
for minority employees
• Non-minority experiences stay low
• Minority experiences decrease
Experiences discrimination

15

10
Minority
5 Non-minority

0
Low High
Diversity Training
Reading review of research (King et al., 2012)
• Significant, large effect: experiencing more job
discrimination was related to lower job satisfaction
• The negative effect of discrimination is less when
prevalence of discrimination in the organization is higher
• Where there are more minority employees, the effect of
experienced discrimination is greater on job
dissatisfaction

ØDiversitytraining has positive effect

ØAchieving diversity within the workforce is not sufficient
 29

Evaluating systems

What is
happening
Society within broader
society?
Who does your Federal and
org reach? How Organisation state-based
do outcomes programs and
vary? How do policies
your staff
Interpersonal Pay attention to
represent your patients
diverse
and your
communities? impact on them
What changes
can you make?
Individual Know thyself
Evaluating systems

Short-term Intermediate Long-term

Outcomes Outcomes Outcomes
• Changes in • Changes in • Greater reach
knowledge, behaviour, of services,
attitudes, practice, increased
skills, etc. policies, etc. funding for
services,
more cost-
effective
programs,
etc.
Evaluating systems
Tracking
• Prevalence What’s missing from
• Incidents current tracking
• Processes systems?
• Outcomes
• Pay How does that then
• Benefits relate to programs,
• Satisfaction policies and
• Leave services?
• Longevity
• Promotions
 “It has been well said that we do not see
things as they are, but as we are ourselves.
Every man looks through the eyes of his
prejudices, of his preconceived notions.
Hence, it is the most difficult thing in the
world to broaden a man so that he will
realize truth as other men see it.”

Samuel Silas Curry, 1891

QUESTIONS?
kate.murray@qut.edu.au
References
• Bertrand, M., & Mullainathan, S., (2004). Are Emily and Greg more
employable than Lakisha and Jamal? A field experiment on labor market
discrimination. American Economic Review, 94(4), 991-1013.
• Booth, A.L., Leigh, A., & Varganova, E. (2012). Does ethnic discrimination
vary across minority groups? Evidence from a field experiment. Oxford
Bulletin of Economics and Statistics, 74(4), 547-573.
• Downing, R., Kowal, E., Paradies, Y. (2011). Indigenous cultural training
for health workers in Australia. Intl J for Qual in Health Care, 23, 247-257.
• Jones, C. P. (2000). Levels of racism: A theoretic framework and a
gardener's tale. American Journal of Public Health, 90(8), 1212-1215.
• King, E.B., Dawson, J.F., Kravitz, D.A., & Gulick, L.M.V. (2012). A
multilevel study of the relationships between diversity training, ethnic
discrimination and satisfaction in organizations. J of Org Behav, 33, 5-20.
DOI: 10.1002/job.728
• McCartney, G., Collins, C., & Mackenzie, M. (2013). What (or who)
causes health inequalities: theories, evidence and implications?. Health
Policy, 113(3), 221-227.
• Williams, R. (1999). Cultural safety—What does it mean for our work
practice? Aus NZ J of PH, 23(2), 213-214.