Leading change in First Nations health

Alongside her role as Professor of Indigenous Health with the UTS School of Public Health, Professor McMillan is seconded to the Department of Health and Aged Care as the National Deputy Commissioner of Allied Health and First Nations health within the Office of the National Rural Health Commissioner.

Tell me about yourself and the work you do.

I’m a Wiradjuri woman from Trangie in central west New South Wales, and still very fortunate to live and work on Wiradjuri country. I'm a practicing community pharmacist, and I’ve just been made a Fellow of the Pharmaceutical Society of Australia. There are only 265 Fellows in the country out of all of the pharmacists, so that’s a real honour. 

I am also an Atlantic Fellow for social equity with the Atlantic Institute and seven other Atlantic hubs around the globe looking at various issues that are impacting First Nations and people of marginalized and under underserved communities, and a Senior Fellow of the Advanced Higher Education Academy for my work within Aboriginal and Torres Strait Islander health. In 2021, I was made a member of the Order of Australia for my services to Indigenous mental health and the tertiary higher education sector.

You were recently awarded the 2023-24 Australian Harkness Fellowship. What is the focus of the research you will be undertaking in the Unites States?

I'll be researching rural and remote health workforces and the importance of First Nations perspectives in different health disciplines, with a focus on pharmacy. I have been looking at the similar statistics of First Nations Native American and Alaskan Native people in the professions within the US and Australia, and the question of how we can increase the number of First Nations peoples within the health professions.

If we don't have First Nations leadership, it's very hard to change the narrative that gets taught about First Nations peoples in the tertiary sectors that lead to professional careers. My focus is working out how we can have First Nations people at every leadership point – universities, accreditation councils, working with the professional bodies, etc. – to ensure that Aboriginal and Torres Strait Islander and First Nations perspectives are embedded into every discipline. So that First Nations people around the globe engage more with the health sector. Looking at the lessons we can learn across Australia and the US that might change health policy so that we can get improved outcomes.

What excites you about your work?

As an academic, I love teaching. Every day, I’m motivated by the opportunity to change someone's life, to ignite a passion and expose people to perspectives they haven't encountered before. I teach what can be a really complex area of study – understanding where we've come from, where we are right now and the aspirations that First Nations peoples have for themselves. Witnessing how individuals integrate these perspectives and transform their practices and inform others, brings me great joy.

As Deputy National Rural Health Commissioner, I love living in a rural community and cherish the valuable work that rural and remote areas contribute to our overall health and wellbeing. Whether that's providing more than 70% of our nation’s food, or the opportunity for innovation and entrepreneurship, we should celebrate the unique strengths of rural and remote communities. I’m also passionate that everyone in Australia should have the same level of access to quality health care and health services. It should be predicated only on need, irrespective of postcode. 

As a Wiradjuri woman, it’s an honour to know that the work I do is my cultural obligation. Generations that have gone before me didn't have the same opportunities, and while I still face challenges, I don't face the same challenges that they faced. Through their struggles and through their staunchness I’ve really seen what it means to say, “you live in a society, and you have to do something for that society you live in – it's not all about you”. I really value that my mother, my grandmother, and my great grandmother all made significant sacrifices that allow us to be in the place that we are now.

How does your research inform the policy-based work you do?

My research is rooted in listening to communities and understanding what is important to them. By collaboratively researching and co-designing with communities, we can create evidence that drives policy change. By understanding the unique needs of rural and remote communities, we can challenge the existing funding models and advocate for more flexible approaches that cater to specific requirements.

It's important to listen to communities to learn what things are most important to them to have researched. Because only through collaboration will we successfully change policies in the right way so that the health outcomes improve as well. I take that responsibility very seriously because I know that there will be generational change if we can get it right.

In my work with the National Rural Health Commissioner, we've recently launched the Ngayubah Gadan Consensus Statement, a reference document outlining what rural and remote multidisciplinary teams mean for the rural and remote people that actually do the work. The statement has been downloaded over a thousand times since it was launched at the end of June, and it's already being referenced by those applying to governments and health organisations to change the way that rural and remote people are able to access services. 

You were the first Indigenous Australian to hold a Western degree in pharmacy in Australia. What inspired you to pursue pharmacy as a career?

When I was 20, I was working as a shop assistant and dispensary technician in my local pharmacy, so I saw the role that the community pharmacist played in the everyday lives of people within the community. Witnessing the integral role of community pharmacists in people's lives, where they offered trusted advice and support beyond just dispensing medications, inspired me. I saw the opportunity to make a significant difference in people's health and wellbeing, especially in rural areas where access to healthcare can be limited. 

I always specify that I was the first Aboriginal person to complete a Western pharmacy degree because we know that First Nations peoples around the globe have practiced pharmacology and understanding medicinal properties long before it was made into a profession. Though I never anticipated becoming the first Indigenous Australian to complete a Western pharmacy degree, this honour has allowed me to create positive changes and embed Aboriginal and Torres Strait Islander perspectives into pharmacy education. 

When you say you still practice as a community pharmacist, what does that look like?

I still regularly work in a local pharmacy, dispensing and providing advice. This helps me keep my skills current, maintain my clinical relevance, and stay connected to the community. The interactions with people allow me to understand not only their medical needs but also the broader challenges they face, particularly in rural areas where access to healthcare might be limited. It's a joy to be part of people's lives and offer health advice and support.

How did your pharmacy career evolve into including academia and policy work?

My journey into academia and policy was somewhat accidental. The number of Aboriginal and Torres Strait Islander peoples in academia is still lower than it should be – but when I graduated twenty years ago, it was much smaller still. However, there was a desire by universities to engage more Aboriginal and Torres Strait Islander peoples. I started off in an industry relationship between the pharmacy profession and universities, looking at experiences for students, particularly in rural and remote areas. I started by collaborating with pharmacy students in rural and remote areas, and this experience evolved into opportunities in academia where I discovered a passion for teaching and engaging with the next generation of health professionals. 

Over time I gained further academic qualifications, a Master’s and then a Doctorate. This has meant I can truly say that I have legitimacy in both worlds. I engage in my cultural activities and my cultural responsibilities, and I’m also committed to my academic responsibilities. I make sure to find ways to have synergies between the two.

What have been some of your most rewarding career achievements?

One of the most rewarding aspects of my career has been the unwavering support of my family, especially my mum, nan and siblings who have always had faith in me, even when I doubted myself. I have so many things to be proud of, but I know that I can only be proud of those things because I've had so many people supporting me. But it’s also important to note that for every successful thing that's out the front, there's probably a dozen failures that sit behind that. Those very same people supported me then too. And that shows that it really does take a village, and the value of people who aren't in the limelight too. 

Has anything surprised you about your research or teaching experience along the way?

Yes, there have been some positive surprises, and those WTF moments too. The challenge is always to continue to look for the positives, because sometimes those WTF moments can take you away from moving forward. Over the last two decades, I have witnessed a significant shift towards recognising the value of First Nations peoples' knowledge is not just for the benefit of First Nations peoples, but for all of us.

Twenty years ago, when I started out it was very much a sandpaper environment, where I was constantly being rubbed with responses such as, “Why do we have to do this?”, “I don't really want to do this”, “I'm being forced to do this”. Whereas now, many people genuinely want to actively engage in Aboriginal and Torres Strait Islander health and to consider the impact of First Peoples around the globe. And so, it no longer feels like sandpaper, it's more often a mixing of fluid. And that's been a welcome change. I'm not saying it's perfect, and the recent outcome of the Voice referendum has shown us that there is still work to be done. Whilst the outcome was hard to process, the five million allies that voted YES showed that we do have support and that is important to remember as we continue to do this work. 

What advice would you give someone considering a career in pharmacy?

Just keep going. Be mindful that it's your journey and no one else's, and it will look completely different for another person because we're all unique. There are lots of people out there that want to support you. 

Also, find where you feel you’re a good fit. Because sometimes you will work for places or be in places that you don't feel you belong. And belonging is a really important thing to how you then feel about doing the work. For me, UTS creates that space by not only saying they want to do something, but they also match that with the intention and the practice.