When I was 18 I was often angry and often wrong. I’m pleased to say I’m less angry now, though still very, very often wrong. Unfortunately, that mixture of anger and incorrectness lead to something that I’m not proud of. It’s not easy to talk about things we are ashamed of, but there’s one belief I used to hold of which I am now ashamed of that I feel I need to discuss.
One thing that I used to be very angry about was affirmative action, especially around Indigenous Australians. When I was 18 I railed against preferential selection into medical schools for indigenous students and what I saw as a disproportionate focus on Indigenous issues in the curriculum.
Last weekend I heard Brooke Boney (of SBS TV fame) talk about the health of Aboriginal Australians at the AMA National Conference. It was one of the greatest conference sessions I’ve ever been to, and it made me very uncomfortable. I was uncomfortable to think of the views I used to hold. They are not my views now. I like to think I am not a racist person, and that I don’t discriminate on any basis, so how did I so passionately oppose something so good? And was it racism?
Well I didn’t see it that way at the time. Working from the basis that medical school places are finite I saw it as something like this: An Indigenous student of a lower ranking getting in over non-indigenous students is an act of unfairness. I felt affronted for the applicant who missed out by one spot, it was their spot the indigenous entrant took in my mind. I thought I was being pretty fair and neutral about it in my mind, after all it wasn’t self-interest right? I had gotten in to my chosen medical school at the first crack so it couldn’t be, right?
I now realise I was wrong. I made two large errors.
The first error is to look at action in isolation. All affirmative action IS truly unfair when considered in isolation from the problem it is trying to address. When the fire department sprays only one house out of ten on a street with water that seems, and is, unfair if you don’t account for the fact that only one house is on fire. Of course, fire departments are not controversial, it is very easy to convince yourself that they are being fair, because you can see that only one house is on fire. Fire is eye catching.
What I had thought when I was 18 was that medical school selection starts in April the year before. What I now know is that it does not, it starts decades before. But disadvantage is not a fire. There are no leaping flames or cracking heat. Indigenous students finish year 12 a lot less than non-indigenous (around half versus around 4 out of 5), but you may not notice when you’re in year 12 because it’s hard to notice what isn’t there. No flames. Indigenous Australians are jailed 24 times as much as non-indigenous but this just doesn’t develop the traction it might otherwise because being jailed is seen as a moral thing, a simplistic single factor view prevails that simplifies jail as just a punishment for being bad, and thus little outrage materialises. No heat.
These and other disadvantages are not left at the door when you put in an application to medical school. The slate is not wiped clean. There are two things that strike me now that didn’t before. Indigenous disadvantage is so prevalent that without the counter pressure of affirmative action or alternative entry streams we would probably have very few indigenous doctors with a poor representation of indigenous people in medical school for ever forward. Secondly that disadvantage means that that a merit based ranking simply is not merit based, it is a combination of merit, luck and disadvantage. Somebody with a lower score may not actual be less able, or less deserving of a place.
I have now realised the best way to sour your view of affirmative action is to look at the action in isolation. Ignoring the problem makes affirmative action seem unfair, acknowledging it makes anything less seem inadequate.
I said I made two errors. The first was how I understood affirmative action. The second was how I understood myself.
I touched briefly above on the fact I saw myself as a neutral observer, with the dispute between a lower ranking indigenous student and a higher ranking non indigenous student who missed out. I didn’t miss out on selection after all, so I was quite sure I didn’t have a bias in the way I looked at the issue. I was very wrong.
Sir Terry Pratchett wrote about “first thoughts” as instinctive responses, “second thoughts” as the counter argument and “third thoughts” as the thoughts that watch the first two. My first thoughts were that an indigenous student had taken the place of a higher ranking non-indigenous student. My second thoughts were “what if that non-indigenous student had been me”. The third thought that I never had was why I only pictured myself as the non-indigenous student and not the indigenous one.
While I didn’t miss out on selection myself I immediately identified with the theoretical non-indigenous student much more than the theoretical Indigenous one. My response was unconsciously biased because of it. I said at the start I like to think I’m not a racist. Part of the reason I responded so defensively was I saw this as something with the potential to harm, and was blind to the potential benefits at least in part because of what I saw as my race. It’s difficult to look back on that and the way I reached that conclusion and say then that it was not racist.
My views softened and changed and my perspective broadened both throughout medical school (particularly on indigenous placements, on elective in FNQ and particularly spending time with Andrew Macdonald, a paediatrician who was passionate about ATSI issues during paediatrics). I now think that what we do in indigenous medical education is not just needed but is in fact not enough. But it doesn’t take away how uncomfortable I feel about the views I used to hold, and how strongly I used to hold them.
It is in fact more than just discomfort, it is shame and I am sorry.