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Rights for all: Building inclusive communities for all generations

Sax Oration delivered by Chris Sidoti, Human Rights Commissioner to the Public Health Association of Australia, Canberra, 18 November 1999

Thank you to the Public Health Association for inviting me to deliver the Sax Oration this year. I am honoured to follow so many distinguished speakers who have delivered the oration over the years. I am honoured too to be able to commemorate the work of Sidney Sax, one of the most significant people shaping health care policy and practice in Australia.

Unlike Sidney Sax and the Sax Oration before me, I am not a health expert but a lawyer and human rights advocate. That is why my focus tonight is 'Rights for all: building inclusive communities for all generations'.

I chose this topic for a couple of reasons. The first is that this year presents a unique opportunity to celebrate two important events in international human rights: the celebration of the International Year of Older Persons and the 10th anniversary of the Convention on the Rights of the Child. So I will speak about older people and children in particular.

The second reason is that I have met with rural communities all over Australia during the past 18 months or so and I want to tell you some of what they told me.

IYOP and CROC

The International Year of Older Persons is an opportunity to reinvigorate our commitment to value and respect older persons and their many and various contributions to society. Although there are no human rights treaties specifically for older people, the Principles on Older Persons were adopted by the United Nations General Assembly in 1991. These principles are grouped in five main themes: independence, participation, care, self-fulfilment and dignity. They recognise that some older people need particular care and security. At the same time they acknowledge that older people continue to contribute to society. The Principles and the framework for IYOP emphasise integration and inclusion.

Likewise for children and young people, the Convention on the Rights of the Child, which Australia ratified in 1990, both protects children in need of special care and assistance and guarantees their rights, including their right to participate in decisions affecting them.

Human rights belong to every person by virtue of birth. They are not only for majority groups or for minority groups but for everyone equally and without discrimination based on youth or age or other grounds.

It is also important to appreciate that human rights are not granted to us by others or by the government. They are ours to be enjoyed simply by reason of our common humanity and innate dignity as human beings. For that reason we cannot agree to give them up and they cannot be taken away from us.

Most people are aware of their civil and political rights, for example the right to freedom of expression. These are, of course, fundamental human rights. But matters relating to people's social, economic and material well-being are equally matters of human rights. These include the right to an adequate standard of living. The enjoyment of this right requires, at a minimum, adequate food and nutrition, clothing, housing and necessary care and support such as health and medical services. Human rights also include the right to work, the right to benefit from social security and the right to education. They impose an obligation on government to give assistance and support to families in need.

These rights are acknowledged in one of the most important of human rights treaties, the International Covenant on Economic, Social and Cultural Rights. Australia is a party to this treaty. It is perhaps not as well known as the International Covenant on Civil and Political Rights but it is no less important.

Economic, social and cultural rights are admittedly difficult to accomplish. The approach of the Covenant is to encourage governments to measure their achievements and failures and to commit themselves to progressively attaining realisable goals. Each state party commits to achieving the rights progressively, but this does not mean that they are not achievable. And importantly, governments must guarantee that these rights are protected and enjoyed without discrimination of any kind.

Bush Talks

The importance of creating a society where the rights of both young and old are respected has been highlighted for me by the Commission's Bush Talks Program.

Over the previous 18 months the Commission has been conducting consultations on human rights in regional, rural and remote Australia. I have visited over 50 communities in all States and Territories from large regional cities like Cairns and Bunbury to small towns like Bourke and Peterborough, to remote communities like Boulia, Papunya and Yuendumu, listening to the human rights concerns of rural communities.

I am sure that none of you will be surprised to hear that many communities in country Australia we spoke to are under siege: they have declining populations, declining incomes, declining services and a declining quality of life.

To quote one resident of a small country town

As we head for the year 2000 my greatest concern is for the viability of small rural towns which are slowly being obliterated by loss of services, institutions and medical care ... We all need to fight this insidious process or there will be only ghost towns where busy and fruitful communities once flourished.1

In many areas people were greatly concerned that their fundamental human rights, especially in health and education, were not being upheld by governments at all levels.

There is no doubt that the concerns about health care are well founded. The general health of country Australians is poor in comparison to urban Australians. Country Australians have a lower life expectancy, higher rates of avoidable injury, higher suicide rates and higher rates of illnesses such as heart disease and cancer than urban Australians.

Despite the greater need, the availability of health services is considerably less in many rural areas than in urban. For example, the number of medical specialists is substantially lower, especially in small rural centres and remote areas, compared to metropolitan centres.2

The decline of health services and accompanying infrastructure has a particularly extreme effect on older people and children in the country.

Health of older people in the country

The health needs of older people may be difficult to meet simply because they are often unable to travel the great distances necessary to obtain the care that they need. They may also be poorer than many others in the community and unable to fund themselves for private health care or to move to a town with better services.

This means, for instance, that it is more critical that they have access to GPs who bulk bill. Yet in some towns we visited not one GP would bulk bill, in some instances not even for health care card-holders.

One man from Mudgee in NSW described how all the medical centres in town had refused to bulk bill and how his wife had been turned away for a regular prescription for heart medicine because she could not pay for the consultation, even though she offered to pay on the next pension day. The pattern is inconsistent. Travelling across north west NSW, for example, I found that all doctors in Bourke, Brewarrina and Walgett bulk bill but not a single doctor among the 12 in nearby Moree, by far the largest town in the region. Though inconsistent from town to town, the pattern is replicated throughout country Australia, in all states and territories.

Besides access to regular health services, many frail older people need to receive specialist attention in residential care.

According to the Australian Institute of Health and Welfare, large rural centres and metropolitan centres have more than 400 nursing home beds per 100,000 persons aged 70 and over. However this supply drops sharply in rural and remote areas, by a third to less than half the rate of nursing home beds in capital cities.3

Yet older people in rural and remote areas can have the greatest need for residential care because they have no family in the town any more to support them at home and because home care services are stretched to the limit where they exist.

Bush Talks heard of several rural and remote communities without adequate aged care facilities. For example, in Tennant Creek we were told that the aged care home only had 20 beds as against a need for almost double that number. Elderly people are being sent to Alice Springs because the nursing home is unable to care for them. This is unsatisfactory as it forces people to move away from their family and community support structures.4

In one town in north western NSW Bush Talks was told, 'you have to leave town to die'.

Elderly people whose home care situations break down for some reason may find that the only place to go is the local hospital. This can put pressure on a rural hospital and staff who may not be trained to provide aged care. One submission to Bush Talks from Batemans Bay in NSW outlined how this affects treatment of elderly people in care.

Some rural hospitals, which do not have extended care facilities, view themselves as acute institutions only, providing "acute" care to Medical and Surgical and Maternity cases and do not tolerate well the care of the disabled and frail aged who often need to be in their care for extended periods of time while they await the availability of full-time care in an appropriate Nursing Home. I have been told that 'These people waiting for Nursing Home are "bedblockers" and we have to get them out'.

It is distressing to hear of frail older people being viewed only as burdens within the health system.

Health of older Indigenous people

Whatever indicator you choose, the situation of Aboriginal people is much worse that that of any other Australians. For Aboriginal Australians

The lack of accessible dialysis for kidney disease, which is very common among Indigenous people, is deplorable. Wongai residents of the Ngaanyatjara Lands and other people in the Central Desert region of WA must go to Kalgoorlie or Perth for dialysis. In the NT they must go to Darwin or Alice Springs. This means that they have to be separated from their traditional lands and community support.

Being separated from family, community and traditional lands can be devastating for rural Aboriginal people. One person described it as follows:

People can't bear to be away from their land and family and some have chosen to return home. It really breaks a Wongai's heart when he has to go away. But without dialysis, patients will die.6

Many choose to die rather than leave family, community and land. And when they do go, they see it as a life sentence, for they can never come back except to die. Support in the towns for those on dialysis is almost non-existent. Many live in the river beds or, if they are given accommodation, their families who accompany or visit them are not.

Some communities raised with us the lack of culturally appropriate facilities for older Indigenous people. For example, in Alice Springs we were told that

every single strategy and every single approach taken to aged care issues is developed by Europeans, and is virtually useless in this particular region.7

The lack of appropriate health services for older Indigenous people in remote areas is compounded by the lack of other services, such as transport and adequate housing.

Mental health of young people in the country

When communities break down, or access to essential services begins to decline, some of the first to feel the effects are young people, especially adolescents who are grappling with complex decisions about their futures.

Almost everywhere Bush Talks visited, lack of services for mental health was raised as a pressing issue - including counselling, psychiatric, hostel, in-patient, especially services suitable for young people, and especially suicide prevention programs.

Addressing the mental health problems of young people is more than providing youth specific mental health services, although these are essential. It is about creating a community which responds to young people's needs on many fronts, providing opportunities and encouraging a sense of 'agency' - the ability to act for oneself and to have an impact on others. For young people in many rural and remote areas the educational, recreational and employment opportunities are lacking. A purely 'medical model' of health care for young people can only provide a limited understanding of young people's health needs. The response required is a broad public health response.

The overall attitude to young people in Australian political rhetoric was also identified as problematic by many Bush Talks participants.

Young people are happy to contribute to society but political rhetoric scapegoats them. The community sees children as problems to be endured, not our future to be nurtured.8

Rural education

Education is a primary means of developing a child's sense of agency and self-worth, as well as the fundamental skills needed to participate in society. It is the foundation for the individual's future well-being and for community building and growth.

The right to education is set out in the International Covenant on Economic, Social and Cultural Rights (ICESCR 1966) and the Convention on the Rights of the Child (1989). This right must be ensured to all without discrimination of any kind.

Although the right to primary and secondary education is guaranteed, the Bush Talks consultations found that in many rural and remote areas of Australia there are significant impediments to children's access to educational and cultural opportunities. In response to this, the Commission initiated an Inquiry into Rural and Remote Education in March this year. This has given us the opportunity to hear from a large number of teachers, parents, students and community members about education in their communities.

We heard that children in remote and rural Australia are less likely to complete their education than children in regional and urban centres. Indeed in some rural areas the participation of 16 year olds in education and training is less than half what it is in urban areas. We also heard that some of the main problems are the cost of schooling and the lack of income support for families.

The need for even very young children to travel long distances daily, the inexperience and high turnover of many teachers, the inappropriateness of distance education for many students, the paucity of cultural and sporting opportunities are all common problems. In some regions young people do not have real access to secondary schooling. In much of the Northern Territory young people do not have effective access to any secondary schooling whatsoever.

There is a primary school in Papunya, but throughout the whole of Papunya region there are no secondary education facilities. Students who have completed primary school therefore have to move to Alice Springs to further their education. This lack of accessible secondary education facilities is reflected in the fact that only 1% of Indigenous people in the region aged 15 years and over participate in secondary education. There is a strong wish for a regional high school in Papunya but this proposal has not been well received at a government level so far.9

For Indigenous students in remote communities, one of the most pressing problems is the prevalence of conductive hearing loss due to otitis media - or middle ear infection.

In Lajamanu in the Northern Territory the inquiry was told that 80% of the children have hearing problems. Similarly Aboriginal people at meetings in Nguiu, Billiluna, Kununurra and in Northern NSW raised hearing impairment due to otitis media as a key problem affecting the education of Aboriginal children.

This has a very serious impact on the education of these children, as without adequate teacher training, health programs and special equipment, including sound proofing the rooms, these children cannot fully benefit from the regular school environment.

Some of the comments to the inquiry on this matter reveal the very close connection between the right to health and the right to education. Peter Toyne, Shadow Minister for Education and Training in the Northern Territory pointed this out to the inquiry

Really, health and education are very closely interwoven; if you've got bad health, it will have a major effect on the ability to achieve educational outcomes.10

A comment by a Bush Talks participant in Alice Springs also brought this interconnection to light

Chronic ear disease, due to unsatisfactory hygiene and malnutrition, can result in poor hearing and sometimes deafness. This is a big problem, especially for young Aboriginal people throughout the Northern Territory. The fact is when you can't hear at school, it is incredibly boring so you stop going, and when you don't go to school, you have all day in front of you and you've got to do something! That's when you get into trouble, sniff petrol, start stealing things and with the mandatory sentencing you end up going to jail. All this is because of the insufficient access to clean water and proper food.11

Interconnection of human rights

These examples of otitis media in schools teaches us that the basic human rights I have outlined - to education, health, to work - do not exist in isolation. They are inter-connected and inter-independent.

The right to education, for example, is worth upholding not simply because it is an internationally recognised human right. It is the basic building block for economic, social and political development. Children in rural areas need to have an equal education to children in urban areas so that they have the same economic opportunities.

But education is not only about economic opportunities - it builds community and identity, provides students with the language tools to understand their own cultures and to respect and understand others who share their community. It gives them the tools to engage with the rest of Australia and work to improve life in their community.

People in rural communities are well aware of this interconnectedness. It stares them in the face each day.

In some ways the small rural community teaches us best some primary lessons for creating inclusive regions, states and nations.

Creating healthy community involvement

I have spent much of the time talking about the problems facing certain sections of rural and remote Australia. Many of the solutions to these problems are about government priorities and funding of services. Nursing home places, outreach services, youth suicide prevention programs, a resident psychiatrist all require a commitment of resources, of course. Although small rural communities can be resilient and energetic, governments cannot absolve themselves of responsibility for them. Regions need outside assistance and resources to turn plans into realities. Rural communities pay taxes - they are entitled to as much support as urban communities.

As the Australian Catholic Social Welfare Commission pointed out in its recent discussion paper, we need to move beyond the principle of 'do-it-yourself', which risks being an excuse to abandon those most in need.12

However, there is something more than money which communities also need to become healthy- whether you live in Papunya, Port Lincoln, Bankstown or Fitzroy.

It is the sense of belonging which often allows a rural community to survive against all possible odds. During the course of Bush Talks we came across many remarkable individuals and communities who, although saddened at the changes that may have happened, and often seriously considering leaving town, are happy with where they live and are willing to fight to maintain the community. It is often inclusiveness which makes people want to stay in a country town, the sense that everyone belongs in the community.

They told us about many good initiatives undertaken by their communities to try to address some of the problems, especially health programs.

For example, the Community Health Adolescent Murraylands Peer Support project (CHAMPS) in South Australia enables young people to take action that promotes their mental health on their own terms and according to their own priorities through the establishment of regular CHAMPS forums. The forums provide an opportunity for young people to work in partnership with health professionals to find ways to create conditions within which young people have good mental health. For example, CHAMPS conducted a River Project where young people designed a Youth Recreation Area including a skate ramp in Murray Bridge. The young people have also organised different working groups to tackle specific problems or areas of importance to young people and their community.

This type of project develops young people's sense of agency and confidence.

Likewise the health program at Nyirrpi, NT recognises the knowledge and skills which older people can contribute to solve some of the health problems of the community.

In the Grandmothers' Women's Health Program in Nyirrpi older women work with health professionals in creating awareness about health problems and solutions by sharing their knowledge about women's health business and their knowledge about family and the law and by teaching the women about their law and culture. As one woman said,

Before we had the Grandmothers Program the old ladies just sat around all day. The women played cards. The young girls didn't have anything interesting to do.

Involvement in your community creates a sense of belonging. This involvement is essential for any community but is especially vital for rural and remote communities who for a long time have been left out of the loop of local planning and service delivery.

Participation by all generations is the key to creating a healthy community, whether rural or urban. One of the things which impressed me in the Rural and Remote Education Inquiry and Bush Talks is the genuine concern for the future of young people expressed by many older residents. And these were often older people without children of school age or any other obvious connection to school education.

This interrelationship between generations has been recognised in the slogan for the International Year of Older Persons, 'towards a society for all ages'.

Kofi Annan, the United Nations Secretary-General, when he launched the International Year of Older Persons, said

A society for all ages is multigenerational. It is not fragmented, with youths, adults and older persons going their separate ways. Rather it is age-inclusive, with different generations recognizing - and acting upon - their commonality of interest

Healthy communities are created when people of all generations are included within that community, without discrimination and with generosity, tolerance and respect.

Thank you.

Endnotes

1 The Country Web; A newsletter for rural women and their families, 'Speaking Personally', Marion Palmer, Jerilderie, No. 16 Winter 1998, page 4.
2 Australian Institute of Health and Welfare, Health in rural and remote Australia, AGPS, 1998, p.viii.
3 AIHW, ibid, p.92.
4 Tennant Creek Bush Talks, NT, 6 October, 1998.
5 Submission to Bush Talks from Central Australian Aboriginal Congress, Alice Springs NT.
6 Kalgoorlie Bush Talks, WA, August 1998.
7 Alice Springs Bush Talks, NT, 5 October 1998.
8 Port Augusta Bush Talks, SA, June 1998.
9 Papunya Bush Talks, NT October 1998.
10 Peter Toyne, Shadow Minister for Education and Training, NT Legislative Assembly, Rural and Remote Education Inquiry, Darwin hearings 10 May 1999.
11 Alice Springs Bush Talks, NT October 1998.
12 Australian Catholic Social Welfare Commission, 'Regional Unemployment and the Indirect Employer: Beyond the Principle of Self-Reliance', Common Wealth,Vol.7, No.2, August 1999.

Last updated 1 December 2001