3.3. Social considerations by Ian Anderson
Since European colonisation, First Nations people have struggled for rights, including health, employment, housing and the ability to make key decisions about their own lives and cultures. In all these areas the conditions of life of Aboriginal people are far below those of non-Indigenous populations. For example, health conditions are significantly worse in all major categories of illness, including cardiovascular disease, cancers, diabetes, mental health, and various infectious diseases. There have been some significant improvements in Indigenous health outcomes over the last fifty years. Nevertheless, the gap between the health of Aboriginal and non-Aboriginal people has been maintained or in some areas increased.
The battles for rights have sometimes been difficult, at both the personal level and for communities. As an Indigenous, Palawa, doctor and academic I have spent most of my professional life in pursuit of better policies in Indigenous affairs, especially in the field of healthcare. In my experience, better outcomes result when governments and welfare and service organisations engage with Indigenous voices. Indeed, as I shall argue, where advances have been made, it has required Aboriginal people themselves taking control and being able to influence policy, drawing on their experience, history, culture and values.
Historically, the barriers to achieving much-needed changes in the living circumstances of Aboriginal people have been great. They have included provisions of the Constitution, as it came into effect in 1901, which excluded Aboriginal people from the Australian census and prevented the Commonwealth of Australia from passing legislation about them. They have included legal restrictions in multiple jurisdictions on the rights of Indigenous people to vote and on their access to social welfare, including unemployment benefits and the age pension and have included the historical programs to remove Aboriginal children from their families, which have resulted in significant intergenerational trauma.
In 1967, an overwhelming majority of Australians voted to repeal the race clauses in the Constitution, allowing Australian governments to pass laws for Indigenous Australians. However, there was nothing to state that the laws must benefit Indigenous Australians or that there is a requirement to consult or consider Indigenous perspectives. As a result, there are laws and government policies that, rather than reducing inequities and addressing areas of need, have often added to the harms.
These failures have been made even more painful for Aboriginal Australians by repeated promises of cooperation and consultation over the years that have never been delivered. Successive prime ministers, including John Howard, Kevin Rudd, Julia Gillard, Tony Abbott, Malcolm Turnbull and even Scott Morrison, claimed to support Indigenous recognition in the Constitution but failed to achieve it. During this time, Aboriginal people themselves have in good faith repeatedly reviewed the possibilities, contributed to expert panels, parliamentary inquiries, a Referendum Council and a co-design process, which have clearly and unambiguously pointed to the need for a Voice to Parliament.
The Uluru Statement from the Heart was agreed to on 26 May 2017 at a meeting of Indigenous leaders after two years of engagement with thousands of Indigenous Australians on options for constitutional reform. This powerful document expressed the aspirations of many Australians – Aboriginal and non-Aboriginal – for voice, treaty and truth.
The Uluru Statement, therefore, did not emerge in a vacuum, but rather is the result of a long process of discussion and development. Drawing on the knowledge of what has been shown to work and not work, it proposes direct engagement with Aboriginal people in policies and programs that directly affect them.
The experiences in healthcare demonstrate well what can be achieved when effective processes of communication and control are established. Following the establishment of Aboriginal health services in Redfern in 1971 and then in Fitzroy in 1973, nearly one hundred centres have been established to provide specialist services, delivered by Aboriginal health workers, doctors, nurses and other healthcare providers. They have been able to respond to a wide range of issues that had previously been largely neglected, including lack of access to clinical services, increased burden of disease, poverty and formidable cultural barriers. Over the years, these services have grown and been extended, so that they now cover primary and secondary clinical services, child immunisation and developmental monitoring, dental programs, health promotion activities, public health research and evaluation, and the education of healthcare providers on Aboriginal issues.
The health programs that have originated with communities and remained responsive to community needs have been by far the most successful and effective across the country, delivering much-needed care, with proven beneficial results. Even with these obstacles and limitations, the model of community controlled healthcare services has been so successful that it has been adopted around the world, and the principle on which they are based is widely accepted: that is, that the most effective social policies are those that are responsive to community needs and cultural traditions and that are implemented through processes that allow the people affected by them to voice their needs and preferences and to contribute actively to their development and management.
In the health field, Aboriginal boards of management effectively oversee organisational policy development, administration, and development and implementation of programs. Community controlled health services also train and employ Aboriginal health workers, who bring to their work knowledge and expertise about their own communities. Child immunisation, for example, requires adequate follow-up, often relying on senior Aboriginal workers who have the necessary knowledge of local kinship structures and births and can work as ‘culture brokers’, liaising between patients or community and biomedical staff.
There are major lessons to be learnt from the experiences in healthcare where, as mentioned, there have been significant successes but also a great deal left to be done. Health disparities continue, largely because of poverty and other forms of disadvantage. Paternalistic policies continue that both waste money and fail to address the issues of concern to the people themselves. In many cases the solutions are known by the local people who are never asked for their opinions, or at least not heard.
The key, abiding lesson from healthcare is the need for formal processes of consultation and control that extend all the way up to the national parliament. Aboriginal people must be allowed to express their deep knowledge about the problems that exist and to pose possible solutions to address them.
Professor Ian Anderson is a Palawa man and Deputy Vice-Chancellor (Academic) of the University of Tasmania. As an academic and public servant, he has made significant contributions to Indigenous health and education.