Australia’s duty of care
November 19, 2007 by Rachel Siewert
Right now for every dollar of Pharmaceutical Benefits Scheme (PBS) or Medical Benefits Scheme (MBS) spent on other Australians, only 40 cents is spent on Aboriginal and Torres Strait Islanders’ health.
During the last decade other nations such as Canada, New Zealand and the United States have managed to achieve major gains in the health and well-being of their first peoples and significantly reduce the gap in life expectancy. The health problems affecting Aboriginal and Torres Strait Islander peoples in Australia are preventable, with most of the diseases leading to high rates of hospitalisation, chronic disability and premature death easily prevented if diagnosed early and treated with affordable medicines.
What is needed is a commitment to better health care on the basis of need, and dedicating more resources to close the gap.
Ultimately one of the most effective ways to ensure the effective delivery of appropriate services is to ensure that we have a greater number of Aboriginal and Torres Strait Islander health professionals, and a much greater level of support is needed to help this take place.
Essentially, we are looking at these drastic problems:
- There is a 17 year gap in life expectancy between Aboriginal and non-Aboriginal Australians.
- Per capita access to primary health care for Aboriginal and Torres Strait Islanders remains at 40 per cent of that enjoyed by other Australians.
- Half of the Aboriginal and Torres Strait Islander population over the age of 15 already show signs of chronic disease.
- Despite the fact that they are three times as sick as other Australians, Aboriginal and Torres Strait Islander access to primary health care, as measured by the Medical Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) is only 40 per cent of that of the general population.
The high rates of many communicable diseases could be prevented if overcrowded housing was addressed and Aboriginal and Torres Strait Islanders had the same access to basic government services like clean water, sewerage and power that other Australians take for granted.
Community-controlled health services consistently deliver health services more effectively to Aboriginal and Torres Strait Islander peoples. All health providers delivering to Aboriginal and Torres Strait Islander people need to commit to providing culturally appropriate services and develop a policy on the recruitment and retention of Aboriginal and Torres Strait Islander staff. The funding agreements with these health providers should specify measurable target outcomes rather than some abstract ‘level of service’.
A key way to turn around the health disadvantage and alarmingly high rates of chronic disease in the Aboriginal and Torres Strait Islander community in the future is to target early childhood development and to make the health of mums and young kids a funding priority.
Education, as with most situations can play a hugely positive role in Aboriginal health. Simply keeping young women in school longer by providing more appropriate and accessible education could have a major impact on the life expectancy and well-being of their children. Better understanding of basics such as hygiene, budgeting, cooking, language and opportunity will be imparted to the next generation with more impact than through traditional means, without the need to overwrite or substitute traditional learnings and culture.
We need immediate action to:
- Close the gap in life expectancy and health outcomes for Aboriginal and Torres Strait Islander people within a generation, with an interim target of reducing the life expectancy gap to less than 10 years by 2015.
- Approve $460 million per annum to Aboriginal and Torres Strait Islander primary healthcare, with an emphasis on community-controlled primary care.
- Ensure that all Aboriginal and Torres Strait Islander peoples have easy access to affordable and culturally-appropriate comprehensive primary health care services by 2012.
- Improve access for Aboriginal and Torres Strait Islander people to all Medicare rebated services and the pharmaceutical benefits scheme (PBS), with a target of equal outcomes by 2012
- Make children’s health and funding a priority, with a focus on community controlled health services and additional community-based Aboriginal and Torres strait Islander child-care services.
- Increase resources for the training of Aboriginal and Torres Strait Islander health professionals, with a target of 2.4 per cent of all health professionals being from Aboriginal and Torres Strait Islander backgrounds by 2012.
- Make Aboriginal community control the preferred option for providing primary health care for Aboriginal and Torres Strait Islander peoples.
- Ensure that all health services which provide specifically for Aboriginal and Torres Strait Islander peoples are designed, developed, and controlled by the communities they serve, in collaboration with mainstream services.
- Fund health services to achieve specific outcomes agreed by the community.
- Make it part of the accreditation process that all government and private health service providers develop a charter that details their policy on the delivery of culturally appropriate services, employment and retention of Aboriginal and Torres Strait Islander staff, and the level of services they will deliver to Aboriginal and Torres Strait Islander people.
This is not an intractable problem. It is not a case of not knowing what to do, but is a matter of scale and political will. What is needed is a commitment to better health care on the basis of need, and dedicating more resources to close the gap.
Read the Australian Greens’ full policy on Aboriginal and Torres Strait Islander health here.
This policy is an important statement of principle, that indigenous Australians should have equal access to health care. However I believe the health problems of Aboriginal Australia are much more complicated than this principle.
There are two problems with status-quo health services for Aboriginal people. One is underfunding, the other is inappropriate colonial models of health care. Simply increasing funding without radically re-engineering health paradigms will be just throwing good money after bad.
The policy makes no reference to mental health
It is my opinion that mental health is the biggest, by far, unmet Aboriginal health need for two reasons. 1/Because of the sheer volume of sufferers of anxiety, depression and psychosis. and 2/Because mental ill health is the cause of so many other health issues such as addiction, poor diet, poor exercise, injury through violence, etc. Mental ill health is a major factor in people not seeking appropriate treatment from services.
The solution to mental ill health for anyone, but especially Aboriginal people does not lie primarily in medical services. Pills are great, I’m all for them. But they just stabalise symptoms. They do not deal with the environmental issues that perpetuate mental ill health. Pills can help someone cope with any situation, the harsher the environment the stronger the drug. However what is needed is a healing environment where the mind can be resocialised.
Issues such as housing, employment, education, etc. are key factors in good mental health and healing processes. Without these things the provision of medical services is irrelevent, e.g. In Brisbane where there are many of the biggest hospitals in Queensland, G.P.s everywhere and a plethora of community health services, there are still many Aboriginal people whose basic medical needs are not being attended to and suffer many similar health problems to remote Aboriginal communities.
Aboriginal Mental health is different to European mental health because of the differences of culture and consciousness. Mainstream health services, even with indigenous staff cannot deal with Aboriginal mental health.
A very experienced white psychiatrist will not be able to determine if an Aboriginal mind is sick or healthy because they do not understand what the Aboriginal mind is. This is usually very subtle and the proffessional might not realise that they do not understand, but it can be very overt also, for example, an Aboriginal elder may hear spirits talking to them which is quite normal in Aboriginal culture. Yet this phenomenon fits acurately with one of the defining points of schitzophrenia. How would a white psychiatrist know if it was psychotic delusion or spirit?
This issue was highlighted during the Royal comission into deaths in custody and the bringing them home reports.
please consider this from the Bringing them home report - http://www.austlii.edu.au/au/special/rsjproject/rsjlibrary/hreoc/stolen/stolen39.html
Aboriginal healers and healing systems do not fit into the medical model of health, but they do not contradict medicine. There is an important role for medical professionals in indigenous healing paradigms but it doesnt work the other way around, tagging a tokenistic cultural worker onto a white medical system.
John
I agree… we do need a new way of addressing Aboriginal health and I also agree mental health needs to be addressed. I acknowledge the importance of the issue of mental health in the Aboriginal community must be part of the health response, and not drawing adequate attention to it in our initiative was an oversight.
Mental health programs must be included in new funding for Aboriginal and Torres Strait Islander healthcare. We would also emphasise the need for service delivery to be community controlled and culturally appropriate. As you point out, mainstream mental health services are inappropriate and do not at all deal well with the well-being of Aboriginal Australians.
This is an issue we have talked about with the National Aboriginal Community Controlled Health Organisation, and we support their position.
I just got a Greens leaflet in my letterbox at home in Brisbane. It is titled “Greens commitments to peace, justice and human rights”.
Absolutely nothing about Aboriginal Australia.
Today is the 3rd anniversary of the Palm Island death in custody.
The leaflet says the Greens “will oppose the death penalty, torture and mistreatment” What about opposing these things in Australia?
It says “The illegal invasion and occupation of Iraq is a disaster built on a lie” What about the illegal invasion and occupation of Australia?
This Terra Nullius consciousness allows the Greens to whinge about human rights abuses overseas while ignoring the reality before their white noses here in Australia.
Chris,
Why have the Greens chosen to make this policy the only contribution to the election campaign?
For the reasons mentioned above I think it is an inadequate response to Aboriginal health, but there are many more issues that need to be addressed too.
John Howard put indigenous issues on the agenda in a big way through the NT intervention and the referendum proposal, but the Greens seem to have walked away from the debate.
The health policy was launched on the same day as the official ALP launch and was consequently ignored by the media (in Brisbane at least).
When you compare the Greens campaigning on indigenous issues with climate change, the pulp mill, uranium and industrial relations it is clear that indigenous issues are considered unimportant, or at least treated that way.
The Greens will only ever be relevant to Aboriginal issues when they take the issues up as a priority. In the meantime they are just another white party offering shallow tokenism in their detatched commentary.
For those people who do not know me, I am not an Aboriginal person, my grandfathers country is Tipperary, Ireland.
I am not taking cheap shots at the Greens in support of some other party. I have indeed endorsed Andrew Bartlett in Queensland on my blog because he has done the hard yards in Aboriginal affairs, especially stolen wages and he has made indigenous affairs his prime policy for his election platform.
However much of my above critique of the health policy can be (and has been) equally aimed at the Democrats policy. Bartlett has a much more comprehensive policy platform than the Greens but it is all still just tinkering around the edges of something that needs a radical change of direction.
The Greens have played a brilliant role on climate change. They have provided real leadership in the nation. The Greens started on this issue over 10 years ago when it was a marginalised fruitloop idea and not taken seriously. But the Greens did not back off, they pushed and pushed and pushed. They had education campaigns - active outreach to the community. They consistently included carbon reduction as a key policy platform. Today the Greens can not only say “we told you so!” but have credibility to demand the next obvious step, enforcible reduction targets and the rejection of coal and nuclear, even though it is still unpopular and requires radical social change.
Only the Greens can play such a role on indigenous issues.
Even if the Democrats were to survive this election they couldn’t do it. They can only tinker with the status-quo as they did on the original native title legislation which, even in its original form, was a mechanism for extinguishing, not enforcing Aboriginal rights and interests.
The ALP must entrench the interests of both international capital and a racist and conservative population, they cannot head in the right direction.
ANTAR play an important education role - Their Close the Gap campaign has informed Green, Democrat and Labour health policy this election.
However the real task is self determination - for Aboriginal Australia to be calling the shots. Not just being consulted or giving input into policy frameworks but to be actively managing land, economy, public services and all aspects of Aboriginal life. This will require a change in land law, public service design and delivery and a whole range of social structural re-engineering.
The Greens need a policy for this re-engineering.
A Treaty, self determination, land rights, alternatives to prison, compensation, etc. These are all things that will not flow naturally out of the present indigenous debate. They will require leadership, a leadership that must be willing to, at first, adopt a radical, marginalised, controversial policy framework that is holistic, intellegent and in essence true.
Then push and push and push.
Just like what the Greens did on climate change.
If the Greens do not take this leadership on indigenous issues in parliament and in community education, like they did on climate change, where will this leadership come from?
The Aboriginal leadership - the family and tribal elders, the community councils, the intelectuals and statespeople are all in place ready to go right now but they have no resources to do anything. Where is the point of engagement with white Australia that can bring about the necessary changes?
If not the Greens, who? If not now, when?
It is simply a matter of priorities.
Too late now, but maybe a indigenous issues could be included amongst the core platform at the next federal election? I am bitterly dissapointed that it was not this time, again.
JT
John, I’m very pleased to read that last contribution.
I think we all agree we could have done better. Rachel’s office have obviously done a tremendous job in the Senate processes in attempting to get more attention paid to the issue, but the criticism you make on the basis of how we have approached climate change is fair.
I’m very glad that the blog has allowed this kind of open discussion, and perhaps after the election, we can work with you - outside the crazy election context - in developing the kind of policies that will actually make that fundamental shift.
John Tracey
If you wanted to me any more obvious that you are a Democrat supporter (or staffer?) with too much time on their hands to attack the Greens - then mission accomplished.
Your accusations that the Greens are not standing up for Indigenous affairs is ridiculous! It’s one issue that they are virtually alone in supporting!
I don’t mean to discredit the Democrats’ work on Indigenous affairs - I also think they are fantastic representatives, and will sadly mourn their loss after Saturday, but don’t shift your anger about this onto the Greens!
Your comments about a Treaty, self determination, land rights, alternatives to prison, compensation - I think you’ll find that these are all things the Greens DO support. (I am not certain - and am happy to be shown otherwise)
But I do know that the Greens DO support Indigenous peoples’ involvement in their own governance. They cried out (very loudly) when the Coalition decided to stomp on the NT with their Intervention Bill, if nothing else but for the lack of community involvement.
Essentially, I can’t understand why you would want to blast the Greens for their Indigenous rights agenda. They’re a voice of reason amongst a sea of (white) politicians who simply don’t care.
I am not a Greens member, and will be voting Green in the Senate and Labor in the lower house - only because I want to see the back of Howard.
Harvey,
I am not a member of the Democrats though I have been in the past - when John Woodley was a senator.
I was also a member of the Greens a few years ago where I held the position of national and Queensland convener of the Indigenous issues working groups.
The Greens do have a good indigenous policy, although a bit too sloganistic and a bit out of date, but it is useless having a policy if you dont campaign on it.
John T
I appreciate that you let me know you belonged to both Democrats and Greens - such openness and transparency is rare when (what I initially assumed was) standard criticism is involved.
I apologise for being so rude - you obviously are very involved in this issue.
I just wanted to make the point that the Greens are one of few voices calling for Indigenous rights in Canberra, so why bag them out? Essentially, they’re doing the best they can.
I agree it’s useless to have a policy if there’s no push behind it, but there is only so much an underfunded, understaffed minority party can do during an election campaign. Everyone is too busy watching the Howard/Rudd battle to take notice of the Greens.
That said, have a look at Senator Siewerts homepage for her media releases, and there are a lot directed at Indigenous Australians… the Greens aren’t treating this as a small issue - the media and the general public are.
After Saturday, hopefully they will have more influence on a Labor government, and we WILL be able to see more of the change that you’re obviously hopeful for.
Harvey,
apology accepted.
There are not a few voices calling for indigenous rights in Canberra. Every party does in one form or another. They all have indigenous policies which have at least a grain of truth in them.
All parties, including the Greens and Democrats, have a mish mash of single issues that have arisen in recent times as flashpoints in the media, collated into a policy.
They all lack a coherent strategy and direction beyond tinkering around the edges.
However, within the limited framework of the staus quo green policy, it would not take much time or energy to include one more dot point in the core election platform. Adjust a few websites, issue a few media releases.
The energy farming policy could have had one more sentence including traditional owners and community councils in the negotiating phase in order to facilitate economic growth in Aboriginal communities as well as just farmers.
Of course people are busy, but as I said above, it is simply an issue of priorities.
The Green campaigns listed on the website are - climate change,health, international relations, work choices, Tas pulp mill, uranium.
I say there is a glaring ommission in this list.
John, I think you are being overly harsh.
Campaigns are about winning and retaining votes in a message clouded atmosphere. The number of bullet points any party can campaign on is limited, everytime they add an issue it dilutes the impact of the others.
When I visited greens.org.au, (the top search result from google), a video of Bob launches on the intro page and indigenous issues are mentioned before climate change. Whether this vid has changed in the last couple of days I don’t know, but in any case - impressive.
Aboriginal health has been a problem since white settlement, and will be long after I have been buried and forgotten. It is fine for people to quote only approx 40% spent on remote communites as against major centres, but no Government (State or Federal) will ever be able to service the medical requirement for the aboriginal communites while they are located in such remote areas. It is not only the aboriginal, but even white remote communites. All governments can throw copious sums of money, but how are they going to get the staff to go work, and stay, in the remote communities. As far as I can see all large countries are the same (recently travelled to Canada, and they have the same issues with their remote communities). Probably the best that any government will be able to do, is train aboriginal members to nursing levels, with evacuation plans put in place to a local major hospital. Dental, mental health, etc, will need to be driven from the nearest largest town with the appropriate facilities.
The Rudd government is ignoring the recommendations of the “Bringing them home” report which include monetary compensation for the stolen generation. There has already been one court case that won a half million dollar damages payout. The Tasmanian government has offered a compensation payout.
But Rudd is making an apology and has ruled out any compensation fund.
The Rudd government have said they will sign the U.N. declaration on indigenous rights, but they have ruled out changing any laws because of it.
The principles of the U.N. declaration are land rights and self determination, but Australia’s indigenous policies including Rudd/Macklin’s extending welfare quarantining contravene the principles of the U.N. declaration.
The Rudd government has sacked John Howard’s indigenous advisory group and will replace it with another advisory group that may or may not have some elected members. But it is still an advisory group to inform the white politicians who make all the decisions about policy and funding. This is not a replacement for ATSIC which, despite its many faults, allowed for Aboriginal people to make decisions about programs and funding instead of the white politicians.
The Greens indigenous policy launched during the election campaign is, in general terms, the same as the governments, a singular focus on the rhetoric of health (close the gap etc.) without any reference to structural change such as land rights and self determination that are the only hope of really improving Aboriginal health.
The Greens need to challenge the government on its colonial paternalistic policy framework. Just like the protection laws of the 20th century, today’s indigenous policies are laying the foundation for future suffering and dysfunction and the gap will not close no matter how many reports and press releases proclaim the urgency of closing the gap.
There can be no doubt that the apology on the 13th will be a powerfull event, however it will rapidly dissolve to a white wash unless it is backed up by some real changes instead of just more of the same failed and inadequate policies.
The Greens should challenge Rudd and Macklin’s white wash just like they need to challenge Rudd and Garrett’s greenwash on climate change.
The Aboriginal convergence at the beginning of parliament will give a good opportunity for the Greens to engage with a broad national Aboriginal leadership. It will also provide media and senate opportunities to challenge Rudd’s whitewash.
The following link is an alternative (to court action) model of compensation, presented to the senate enquiry into stolen wages but the model is relevant to stolen generation too.
Kalkadoon.org Submission ……
http://www.kalkadoon.org/index.php/2006/10/04/australian-senate-enquiry-into-stolen-wages/
This is essentially a proposal to do some creative real estate development - eco villages - to provide freehold house and land packages as compensation.
From the submission…….
We advocate a compensation package based on a joint venture of federal, state and local governments.
We suggest that public housing budgets and stolen wages compensation funds be used to engage in real estate developments that supply private house and land packages to
Aboriginal families as compensation for stolen wages and other tragedies of history.
We suggest that an “average Australian family” would have used money such as that stolen from Aboriginal people to secure a family home if they had the opportunity to
do so. We see the provision of family homes as being a realistic compensation to all Aboriginal people who are today living with the consequences of stolen wages and other systematic obstacles to prosperity.
John Tracey - please see the latest post from Rachel Siewert on the Indigenous apology.