Native title rights, good house, good clinic and being able to buy a feed
Speech by Barb Flick, Aboriginal and Torres Strait Islander Social Justice Director at the Millenium Hotel, Sydney, 21 August 1998
I pay my respects to the Traditional Owners of this country and honour their children.
Mick Dodson, the former Aboriginal and Torres Strait Islander Social Justice Commissioner said in his First Report that "A decent standard of health and a life expectancy equivalent to others is an entitlement. Social justice is not primarily a matter of the relief of suffering. It is a matter of the fulfilment of a responsibility. To draw this distinction is not to deny that the facts by themselves speak out for a remedy. Nor is it to deny that compassion is a proper response. But compassion is an insufficient foundation for the delivery of rights".
So, I speak to you today not from a lack of compassion, but from the perspective of drawing out the facts - the nuts and bolts behind the reality of Indigenous health - and how these facts speak for the ways in which the human rights of my people are being systematically denied in Australia today.
Recently I spent some time in a remote part of this country trying to identify the ingredients needed to improve the health status of the people and to put forward some recommendations about how this might be addressed.
I occupied some of my time looking at the infrastructure, government policy, workforce issues and the medical aspects of service delivery. It is all very difficult as many in this room will tell you. Although most of the clinics have been replaced, the dilapidated ones remaining are a stark reminder of the difficulty encountered by our managers to access the funding and to convince government that these clinics are, themselves, a health hazard. Given the present political climate which will have you all believe that we get far too much, the task is even more difficult.
Indeed it is a measure of the gross misinformation in this country that many people actually believe that we do receive 'special' treatment but when faced with the facts there is no room for argument.
So let's take a moment to examine the facts.
The results recorded in the recent report Expenditures on Health Services for Aboriginal and Torres Strait Islander People found that:
- per person, total
spending (on health) for and by Aboriginal and Torres Strait Islander
people was $2,320, a mere 8 per cent higher than that for or by other
Australians, (even though Indigenous Australians have much higher
morbidity and mortality rates than other Australians)
- nearly 80 per
cent of all the services to Aboriginal and Torres Strait Islander people
were managed by the States and Territory
- the ratio of Indigenous
to non-Indigneous expenditure per person varied considerably across
the States and Territories. In general, it was highest where the proportion
of the Aboriginal and Torres Strait Islander population living in remote
areas was highest, especially in Western Australia and the Northern
Territories - at least some of the difference may thus be explained
by the costs of isolation
- only a small proportion
of these expenditures were through services aimed specifically at Aboriginal
and Torres Strait Islander people
- the largest single
source of the Commonwealth's expenditure was through OATSIHS grants
to community-controlled Aboriginal Health Services. Aboriginal and Torres
Strait Islander people received very little from the two largest Commonwealth
programs of Medicare and the Pharmaceutical Benefits Scheme. The total
of Aboriginal Health Service grants, Medicare Benefits and Pharmaceutical
Benefits was still about $100 per person less than other Australians
received from Medicare and Pharmaceutical Benefits alone
- in total, hospital
expenditures dominated spending on both Indigenous and non-Indigenous
people. Outside of hospitals, Aboriginal and Torres Strait Islander
people used very few of the specialist medical services and specialist-prescribed
drugs which represented nearly 20 per cent of all non-Indigenous outlays
- the pattern of service use by Aboriginal and Torres Strait Islander people was thus quite different to the average for other Australians. They relied much more on publicly-provided hospital and community health services than the typical non-Indigenous person and spent much less on private doctors, private hospital care, dentistry, medicines and ancillary services. In fact, public expenditure on the health of Aboriginal and Torres Strait Islander people appears to have been very similar to those for other Australians in the same income category. However, their health status was almost certainly much worse.
And this is "special treatment".
Last year I was invited to participate in a briefing to delegates from the World Bank. I talked to them about the difficulties of delivering health services to Australians who live in the rural and remote areas of this country. One of the delegates from India followed me outside at the end of the presentation and said to me "all of the things you talked about are interesting - but don't you realise that none of them are achievable without political good will".
I wondered what he meant by "good will". Was it the "good will" of the Australian political system to Indigenous peoples? Is this what we had to rely on in order to achieve equity in health outcomes for our people?
Let's look at the "good will" demonstrated to our peoples in recent years.
Let's look at the Native Title debate.
The First Social Justice Report states the position clearly. The High Court of Australia's judgement in the Mabo case was delivered on the 3rd June, 1992. This judgement did not change the law. The judgement was in itself an act of reconciliation between the laws. It declared the common law of Australia and recognised what has always been true in the law of Indigenous Australians.
Like all colonised countries, Australia seems to find it too hard to deal with the full history of this country. What do people fear? Is it safe to remain ignorant? The former Prime Minister Paul Keating in his Redfern Park speech said:
"This is a fundamental test of our social goals and national will: our ability to say to ourselves and the rest of the world that Australia is a first rate social democracy, that we are what we should be - truly the land of the fair go and the better chance.
It is a test of our self-knowledge. Of how well we know the land we live in. How well we know our history. ...How well we know what Aboriginal Australians know about Australia".
It would seem the former Prime Minister was being overly optimistic.
Indigenous knowledge of our history - at least in its post-invasion stage - inevitably features the less than savoury elements of the theft of our lands, murder, rape, the kidnapping of our children and genocide. It features the systematic oppression of our peoples, of which reduced life expectancy is a symptom, certainly not a cause.
How can the recognition of injustice leave non-Indigenous Australians bereft of a national identity? Can the blaming of people less fortunate than ourselves somehow uplift us? Do we always need to clamber over the bodies of others in order to feel good about ourselves?
Well, according to the "special treatment" apologists, history is a malleable thing, and seek to ignore or avoid the facts of the past in order to distort the realities of the present.
From the perspective of these people, it was as though on June 3 1992, the Aboriginal and Torres Strait Islander peoples invaded Australia in a landing barge of law contrived by the High Court, thus completely re-writing the history of the boat people who arrived at Port Jackson in 1788.
There is still a belief that Australian history is one of social Darwinism, where inferior races must inevitably give way to that of the superior Europeans who have tamed this wide brown land.
Thus when it comes to issues such as Native Title, everything possible that can be done must be done to provide "bucket loads of extinguishment" in order to re-mould our history away from that proposed by the "black armband" historians.
It is clearly a false view of the history of Australia, and one that clearly lacks the "good will" my Indian friend said was necessary. As Henry Reynolds pointed out recently, better the black armband than the white blindfold.
So, how does history, and the recent ahistorical attacks on Native Title, fit in with the health of Indigenous peoples?
I quoted statistics earlier to demonstrate that, while the health of Indigenous Australians is demonstrably poorer than that of other Australians, relative expenditures on Indigenous health only marginally outpaces that for the general population - and in key areas, fall behind average expenditure on acute care is a disproportionate outlay.
It would seem that "good will" does not extend to seriously tackling the inequities we face.
This is the "special treatment" that we get.
Similarly, when Australian common law, through recent High Court decisions, offers a window of reconciliation in recognition of the simple rights of our people, strenuous efforts have been made - all in the name of equality mind you - to remove and override these rights in favour of wealthy minorities.
This is more "special treatment".
So - for Indigenous peoples - Native Title rights and health rights are indivisible. Not just in the sense that our rights to land and culture are indivisibly part of our health - but the reverse also holds true. Attacks on our Native Title and the lack of "good will" to our health needs are also indivisible. Both are subject to systematic and deliberate ignorance; both are regarded as social and economic burdens to the rest of the nation.
If there are any of you in the audience today who still believe that fixing our physical ailments alone is going to dramatically affect the status of our health - you are sorely mistaken.
Our rights to Native Title are part of the same continuum that include our rights to a good house, a good clinic and being able to buy good food.
It goes without saying that increasing the cost of fresh food in particular can only worsen the health problems for Indigenous Australians. Major reports including the Healthy Food Access Basket, have been written in recent years clearly setting out the importance of good food to Aboriginal health. The largest cause of excess death amongst Indigenous Australians is cardiovascular disease. Recent studies from the United States show that lack of anti-oxidant vitamins from fresh fruit and vegetables explain up to 40% of deaths from coronary heart disease which is not accounted for by risk factors such as smoking and obesity. 20% of adult Aboriginal people over the age of 15 years suffer from diabetes. This rate rises dramatically for the over 35 year olds. 40% of Indigenous Australians over the age of 35 years suffer from diabetes. These diseases are directly linked to diet, food choices and availability.
People with low incomes already find difficulty in providing good nutrition to their families on current costs. It also goes without saying that governments can and should cushion any effect of rises in this area.
Attacks on one set of rights inevitably involve an attack on another - they can't, for bureaucratic or philosophical convenience, be compartmentalised.
So, I go back to the words of Mick Dodson.
The relief of suffering through, for example, improving our health outcomes, is only part of what social justice is about. Delivery of improved health outcomes is only a single, albeit important, element of the human rights outcomes that our society must be responsible for.
Last updated 1 December 2001
