‘Culture, Relationships, Health: Human Rights in Practice’

Acknowledgements

[Introduction in Bunuba]

Yaningi warangira ngindaji yuwa muwayi ingirranggu, Whadjuk yani u. Balangarri wadjirragali jarra ningi – gamali ngindaji yau muwayi nyirrami ngarri thangani. Yaningi miya ngindaji Muwayi ingga winyira ngarragi thangani.  Yathawarra, wilalawarra jalangurru ngarri guda.

I stand here today on the lands of the Whadjuk People. There are many of us that have come from afar, we come speaking different languages, and we are strangers to these lands. The ear of this land is hearing our different languages and we reassure that we gather and talk together with good feeling.

I acknowledge the Whadjuk people, their elders both past and present and I thank them for hosting us today.

I am a proud Bunuba woman from Fitzroy Crossing just a few thousand kilometers up the road, and it gives me great pleasure to be here with you all at the National Conference for Indigenous Allied Health Australia.

Some may remember that I was at the IAHA conference in Canberra last year and it has been a big 12 months for me since we last got together – as I now stand here, as the first woman to be appointed as Aboriginal and Torres Strait Islander Social Justice Commissioner at the Australian Human Rights Commission.

I want to start by acknowledging your wonderful CEO and Wiradjuri woman Donna Murray. I work closely with Donna on the Close the Gap Campaign and in her role as Deputy Chair of the National Health Leadership Forum. Thanks Donna for the invite to come and join you here again.

I also acknowledge your board, chaired by Kamilaroi woman Nikki Turner. I know you have some talented men on the Board and working in the Secretariat, and crucially out in the health system – serving our people everyday, but it is great to see so many strong women up front and leading this important organisation in the service of our peoples.

It is particularly pleasing for me to see younger women like Tracy Hardy and Dr Danielle Dries taking steps to contribute in leadership capacities in organisations like IAHA. I hear that Dani Dries is a good chance to become our first Aboriginal Prime Minister one day!

I loved being part of your conference in Canberra last year and was so impressed with all the work that you are doing around Australia. It was a good, early reminder just before I started in this role, of the importance of health.

You should hopefully be an easy crowd to convince just how important Allied Health is specifically, to the good-working of our health system at large. I know from first-hand experience just how critical your work is to the health of our people – and the many non-Indigenous peoples you treat and care for across this country.

One of my first jobs was as a dental nurse, nowadays it would be some hybrid of a dental assistant and a dental hygienist. I worked for an older Kartiya man and he was openly racist and antagonistic.

It was a challenging introduction to the health system and, despite the cranky dentist, I enjoyed helping people as I started to learn the connections between the different elements of healthcare.

One of the big lessons from that job was that I can have a big impact in helping to improve the health and wellbeing of my people – regardless of the challenges that arise such as entrenched bigoted attitudes.

Another job I had back in those days was as an outpatient clerk at Fitzroy Crossing District Hospital .It was one of my favourite jobs and we had a team that was mostly made up of Aboriginal staff. It was great fun. Among my administrative responsibilities, I also got to take temperatures, pulses and other medical procedures as well as providing interpretation services for my people coming into the hospital. 

These early experiences gave me an appreciation of the good and bad parts of our health system… and fundamentally, how critical it is that more Aboriginal and Torres Strait Islander people work in health to make things better for our people.

Some 30 years later, in my role as Social Justice Commissioner, it is now my job to work with you all to champion a human rights-based pursuit of our health and wellbeing.

A human rights-based framework is critical to understanding how to tackle the health disparities in our communities.

The Universal Declaration of Human Rights, the bedrock of rights internationally for the last 70 years says that:
‘Everyone has the right to a standard of living adequate for the health and well-being…'

The United Nations Declaration on the Rights of Indigenous Peoples also speaks to the rights of Indigenous peoples, like all other peoples to enjoy the same rights to life, liberty and security. It highlights the particular need for the rights of Indigenous elders, women, children and people with disability to be protected.

These human rights frameworks are a critical starting point for all peoples. But for Aboriginal and Torres Strait Islander peoples, we know that the reality of our existence falls far, far short of these standards. We know that particularly in the remoter parts of the country that our peoples are living on top of each other and sometimes without the benefit of running water. We know the reality of some town camps where, cut off from basic services our people sleep outside, go hungry and struggle to keep warm.

The work of IAHA members, in all your various allied health occupations, to improve the lives of our people is essential.
I note that IAHA, since inception back in 2009, has looked to:

‘influence generational change, through national allied health leadership, building a responsive workforce, advocacy, partnerships and support across the multiple sectors that influence health and wellbeing’.

It is an established fact that Aboriginal and Torres Strait Islander health professionals play a key role in addressing the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

When you rock up to work on Monday morning, every patient you provide care for, every connection you make, every family member you comfort - you are championing their human rights. For the students and trainees in the room – the career that you are considering is at the coalface of our collective work to close the gap in health outcomes for our people.

Many more Aboriginal and Torres Strait Islander people should consider, and pursue allied health careers.

All health professions are essential and it is notable that the health system, across the board, is the largest employer of Aboriginal and Torres Strait Islander peoples.

But my thinking about Allied Health professions in particular, is that you often provide the glue or connection to the wider health system for our peoples. Your primary role as health providers in your particular fields, from optometry to podiatry, from psychology to speech pathology or pharmacy – is closely followed by your ability to provide a culturally safe link to the other areas of health that your patients need to engage with.

When we talk about social determinants of health, your work is the epitome of understanding all the aspects of a person’s wellbeing that contribute towards their good health. I’ll talk a bit more about social determinants shortly.

But first, I mentioned earlier some of your very talented senior leaders here at IAHA and I want to quickly return to the importance of our women stepping into these leadership roles.

I have spoken in the past of the unique qualities Aboriginal and Torres Strait Islander women hold, they are the quite humble leaders of our homes, the healers, the ones who hold families and communities together. The ones who nurture language, traditional activities, worry for children and care for the sick and distressed.

You Aboriginal and Torres Strait Islander women who sit here today, you are the women who wake up every day with a relentless commitment to your families, and your communities, and those around you. And you, just like me, will always protect those most vulnerable, and you will not stop fighting for what is right. Because of this I am so inspired by the growing presence of female Aboriginal and Torres Strait Islander Health practitioners in Allied Health.  You will lead the way in creating sustainable pathways to good health for our people. Always remember, you are not only the humble leaders at home, you are the humble leaders at work, and the key agents for change and empowerment in this country.

As I said before, I too will protect those most vulnerable and not stop fighting for change in this country. Later this year my team and I will launch a national engagement process with Aboriginal and Torres Strait Islander women and girls - which is being supported by the Department of Prime Minister and Cabinet.

Our aim will be to elevate the voices of our women, assess what their immediate needs are, and to guide and influence governments to implement policies and practices that foster agency within our communities and provide the conditions for positive change.

A key driver for this project was to acknowledge that it is now over 30 years since the landmark Women’s Business report was published in 1986. It has been too long since our collective voice was last heard at a national level.

The original Women’s Business report was conducted by Aboriginal and Torres Strait Islander women and inquired into ‘the involvement of Aboriginal women in land rights, culture, health, housing, education, employment, legal aid, child welfare (with particular reference to adoption and fostering of Aboriginal children)’. Amongst other findings, the report clearly documented the desire of Indigenous women to have agency in their own lives.

The Australian Government must invest in a strengths-based approach to community rebuilding and recovery, and recognise that that our female leaders are the greatest agents for change and empowerment in this country.

There is much to celebrate when we consider the great work being done by Aboriginal and Torres Strait Islander women, and also by our non-Indigenous sisters who have made changes within themselves, supported our aspirations and partnered with us in building a better tomorrow. As we begin to unlock our collective potential, I know that there is so much more yet to come.

I hope that over the next 18 months, I will be able to meet with many of you again as we go around the country speaking with Aboriginal and Torres Strait Islander women and girls about the priorities and issues we face in 2017 and beyond.

One of the pillars of our good health is the strength of our culture and our connection to our culture, our land, and our old ways.

I have already mentioned your role as champions of human rights in the workplace, but I should have started with champions of our cultural heritage. Never underestimate the value of your work in contributing to the protection and promotion of our unique cultural practice.

The IAHA ‘Cultural Responsiveness in Action Framework’ is a great example of the leadership of our Aboriginal and Torres Strait Islander health peak organisations.

I commend you all for looking to embed the consideration of culture right at the heart of your practice, and it is rightly identified in your framework document which begins with ‘Respect for Centrality of Culture’. I note that respect is about identifying and valuing culture:
…both group and individual, as central to Aboriginal and Torres Strait Islander health, wellbeing and prosperity.’

This is exactly right.

While on the one hand, it is clear that racism undermines our health, it is equally true that our culture bolsters and invigorates our health.

A 2009 study by the Australian Institute of Aboriginal and Torres Strait Islander Studies reported that the more people are connected to culturally activity on country, the better the outcomes for their health and wellbeing’.

We don’t need a study to tell us this, but the evidence only backs up our long stated claims of cultures central importance.

To appeal to the cold hard issue of economics which so often dictates the policy decisions of our governments – if more emphasis is given to the positive power of our culture then millions and millions of dollars will be saved every year and the disparities in health outcomes between Aboriginal and Torres Strait Islander people and non-Indigenous Australians will close far more rapidly.

You are champions of our culture.

For this reason, it is essential that you pursue and take responsibility for your own cultural connection as a priority as it will make you better health professionals but fundamentally and most importantly, it will help you… spiritually, emotionally and physically.
IAHA and the other Aboriginal and Torres Strait Islander health peak bodies are leaders in making culture a part of professional development. Never underestimate the importance of this work. Inch by inch we are changing Australia for the better as strong advocates for our knowledge and our ways.

As keepers of our culture, it is good to remember that our Customary Law and practices which have continued for millennia – leave no room for violence or abuse. We have ancient and abiding systems of law that have dealt with issues between us and leading to reconciliation and restitution.

Relationships are at the heart of our laws and customs.

One of the challenges of your work as both allied health professionals and as protectors of culture is to balance the rights and obligations of both.

We walk two worlds.

One thing that is clear about our traditional ways is that, Aboriginal and Torres Strait Islander peoples across Australia have understood a truly holistic approach to health and wellbeing. We have known this for thousands of years before colonisers starting arriving a few hundred years ago.

To use government’s description of our approach to health, in the National Aboriginal Health Strategy way back in 1989, they recognised that for our peoples, we understand our health:

‘…means not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole-of life view and includes the cyclical concept of life-death-life.’

While Aboriginal and Torres Strait Islander peoples have implicitly understood that everything is connected to our health and wellbeing, it has only been in recent decades that Western thinking has started to catch up and provide language to this holistic understanding – namely, the social determinants of health.

Interestingly, it was only in 2005 that the World Health Organisation established a Commission dedicated to Social Determinants of Health.

Our Federal and State Governments have started to talk more about social determinants too but there is yet to be a thorough shift away from a siloed, body part approach to how we serve our health needs.

Pat Turner, the CEO of the National Community Controlled Health Organisations has said:

‘We have to get everything working together to make the biggest impact on health… where we live, how we learn, our access to jobs, it all has an impact on the wellbeing of our people.’

The work that you do, in all your many fields of expertise, should be taking into consideration the full picture of someone’s health.

One of the hats I have started wearing since becoming Social Justice Commissioner is the Co-Chair role for the Close the Gap Campaign’s Steering Committee. My fellow chair of the Steering Committee is Mr Rod Little, who also Co-Chairs the National Congress of Australia’s First Peoples and we are ably supported by the senior Aboriginal and Torres Strait Islander health leaders from the NHLF – including Donna Murray.

The Close the Gap Campaign began with one of my predecessors, Professor Tom Calma back in 2006. It has been a world first Campaign, strongly advocating to government in Australia to prioritise closing the gap in health inequalities within a generation.

The Campaign is led by Aboriginal and Torres Strait Islander leaders and peaks (such as IAHA) and is well supported by mainstream health and advocacy organisations. We have come a long way in the last decade, with consecutive Federal Governments committing to close the gap and having the Prime Minister provide the annual Closing the Gap Report to Parliament at the beginning of each year.

But despite the increased focus, you would be well aware that we have a long way go to close the life expectancy and other health outcomes gaps that persist.

In our 2017 Campaign report this year, Donna is quoted as saying that:
‘After 10 years of Close the Gap, we have seen and accomplished some good things. However, we are now at a critical point where the hard fought gains could be lost if government doesn’t truly commit to partnerships led by Indigenous peoples and their identified priorities.’

Donna is, of course, exactly right.

I am sure you are all aware that the Federal and State Governments, through the COAG mechanism, are currently looking to ‘refresh’ the Closing the Gap Strategy to set the targets and provide the framework for how we work to close the gap over the next decade.

This is certainly an opportunity to redouble government efforts to better serve the health and wellbeing of our people – but it must start with the genuine and meaningful partnership that Donna and others have called for.

All the machinations of government, the policies, strategies, frameworks, media releases, and announcements can all start to sound like ‘white noise’. It can also be disheartening when you see all this going on but hear that we are not making progress to close the gaps…

This is all very understandable but I want to leave you with two thoughts.

Firstly, never give up.

From day to day or year to year, progress can seem non-existent. It can even seem like we are going backwards at times. But I find it helpful to take the long-arch view of our history. Inch by inch we are making gains. Time and again we have shown our incredible resilience and strength. In our communities, in our workplaces, in our schools we have fought for and won changes that have a good impact.

When you step back and see how far we have come in this country, where only 100 years ago our peoples were expected to die out – and yet today we are one of the youngest and fastest growing populations in Australia. We have increasing numbers of kids finishing school, and successfully negotiating the two-worlds that we are faced with.

We have more business leaders, government leaders and political representatives.

And while we still have considerably less than 1 per cent of the total Allied Health workforce, today we have a growing number of social workers, mental health workers, optometrists, audiologists and podiatrists. Taking the long-arch view, it was only three to four decades ago where there were virtually none of us working in these important fields of health. I challenge you all to recruit more of our sisters and brothers to this work.

I take hope and encouragement when I see more of our people working and leading in these areas. I know that you are all continuing to build on the foundations of those uncles and aunts that have come before us. As they were ground breakers, you are now breaking into new areas that we didn’t think possible.

My second and last point to finish on is to reiterate the importance of you all, in the work that you do every day. As I said before, you are champions of our culture and never underestimate the power of this contribution. Every day, every patient, every opportunity to serve or give care – you are championing our human rights. You are opening up a path to self-determination.

So I tell you again to never give up. Never stop turning up. If you are a young dental assistant (like I was once) or a new podiatrist and you are working with difficult people (like I did) – you defy the racism and oppression every day you turn up to serve your people. And things do change.

We live with great expectations placed upon us by our families and communities and society at large, but we are more than able to meet and exceed these expectations.

Thanks again for having me here with you this week. I look forward to speaking with many of you over the next couple of days and also engaging with you in our collaborative work to serve our people.

Thank you.
Yaninyja.


1. UN General Assembly, United Nations Universal Declaration of Human Rights, GA Res 217A, Art 25. At http://www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf
2. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples: resolution / adopted by the General Assembly, 2 October 2007, A/RES/61/295, Art 7 and Art 22. At http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf
3. National Health Workforce Dataset – Allied Health 2015 Data, http://iaha.com.au/release-national-health-workforce-dataset-allied-heal... /
4. Policy Brief: Racism Undermines Health (2008) – The Lowitja Institute. At http://www.lowitja.org.au/sites/default/files/docs/Racism-policy-brief-m...
5. Ganesharajah, Cynthia, Indigenous Health and Wellbeing: The Importance of Country, (April 2009), Australian Institute of Aboriginal and Torres Strait Islander Studies. At https://aiatsis.gov.au/sites/default/files/products/report_research_outp...
6. National Aboriginal Health Strategy Working Party 1989, National Aboriginal Health Strategy,
Canberra.
7. Close The Gap, Progress and Priorities Report, (2017), Australian Human Rights Commission. At https://www.humanrights.gov.au/sites/default/files/document/publication/...
7. Close The Gap, Progress and Priorities Report ,(2017), Australian Human Rights Commission. At https://www.humanrights.gov.au/sites/default/files/document/publication/...