The importance of environmental health in improving the life expectancy of Indigenous peoples

Speech delivered by Paul Endres on behalf of Commissioner Tom Calma at the International Federation of Environmental Health World Congress, Brisbane, 13 May 2008.

Good Afternoon.

Firstly can I apologise for not being here personally to provide this address as I have just returned from London with an infection that prevents me from speaking without having a coughing fit.  Thank you Paul for delivering this on my behalf.

Can I begin by recognising and acknowledging the traditional owners of the land on which we meet today and pay my respects to their elders past and present.  I would also like to thank Paul Endres and Adam Druce for the opportunity to speak to you today.

I am the Aboriginal and Torres Strait Islander Social Justice Commissioner and national Race Discrimination Commissioner at the Human Rights and Equal Opportunity Commission or HREOC. 

As the Social Justice Commissioner my functions are to monitor the enjoyment and exercise of human rights for Indigenous Australians including human rights as they relate to native title.  

Under the HREOC Act and the Native Title Act, I am required to produce annual Social Justice and Native Title Reports.  These reports are tabled in the Federal Parliament each year. 

The most recent Social Justice Report, tabled in Parliament on 20 March 2008, focuses on issues relating to family violence and child abuse in Indigenous communities.

My Social Justice Report 2005 to the federal Parliament made findings in relation to Indigenous health.  This has manifested in the Close the Gap Campaign that I will talk with you about today.

In recent months I have put a series of challenges to Government for addressing Indigenous issues.

In general terms, I have outlined a series of challenges for Indigenous policy making generally, and for the past two years I have lead the close the gap coalition on health specific activities.  Let me start by outlining some of the key issues and principles for addressing Indigenous policy generally:

First, there is a pressing need to ensure the full participation of Indigenous peoples in policy making processes.  

Much of the failure of service delivery to Indigenous people and communities, and the lack of sustainable outcomes, is a direct result of the failure to engage appropriately with Indigenous people and of the failure to support and build the capacity of Indigenous communities.  It is the result of a failure to develop priorities and programs in full participation with Indigenous communities. 

Effective participation in decision making processes that affect Indigenous Australians has been confirmed as essential to ensuring non-discriminatory treatment and equality before the law.  It is also central to the human rights based approach to development which is now widely accepted and operational across the United Nations and the international development cooperation system.

Second, there is a challenge to build into policy a longer term vision for the well-being of Indigenous communities.  One of the major problems with Indigenous policy making in Australia is that it is not sufficiently targeted to overcome the existing level of inequality and discrimination experienced by Indigenous peoples.  For example Government health funding must be needs-based so that programs are capable of overcoming existing inequalities and are also cognisant of the future needs of particular groups.  For Indigenous peoples this is going to be a major issue with a rapidly expanding youth population over the next decade creating a further pressure on what are already inadequate levels of funding and service.  Also, policy development and program implementation can benefit from understanding community development principles.  

Creating change in communities is a long term process that will ultimately only be achieved by empowering and supporting communities, often small steps at a time, so that they are capable of taking control of their circumstances. This takes time and consistency of effort.  

Of particular importance in the context of policy design and implementation that relates to Aboriginal peoples and Torres Strait Islanders, are the following guidelines:

  • Indigenous peoples have the right to full and effective participation in decisions which directly or indirectly affect their lives;
  • Their participation should be based on the principle of free, prior and informed consent,  and
  • Governments and the private sector (amongst others) need to support efforts to build the capacity of Indigenous communities … so that they can participate equally and meaningfully in the planning, design, negotiation, implementation, monitoring and evaluation of policies, programs and projects that affect them.  

Third, ambitious targets should be set.  

Indigenous policy should not be allowed to simply drift along without ambition and without targets.  It is not good enough to rely on ‘record levels of expenditure’ as the measure of progress.

Such targets and goals should receive bipartisan support and form the basis of inter-governmental cooperation.

We need long term commitments to make real progress in Indigenous affairs.  Much can be achieved if the federal government ensures that the targets agreed are matched with teeth for accountability and implementation.

Fourth, once goals and targets have been set, government processes must be reformed and re-engineered to ensure that they are capable of meeting these challenges.

And fifth, Indigenous policy making should be based on a commitment to human rights.  Fundamental to good policy development is that all legislation, policies and programs developed and implemented by governments should be consistent with international human rights standards.  

A human rights based approach encourages the adoption of proactive measures to create an enabling framework for active participation and engagement of all citizens, and particularly for those who are disadvantaged or powerless.  

Ultimately, human rights are about implementing a sound policy framework. And remember, human rights are for everyone, everywhere, everyday.

Following some rapid developments with the new Government, we are moving towards implementing a human rights based approach to Indigenous Health.

So let me now talk about what is, and how to implement, a human rights based approach to Indigenous health.

Under international human rights standards, the right to health is the right for all people to have opportunities to be as healthy as possible as provided to you by the state.  What this means, in practice, is that the state provides two things:

  • The first is the foundation for good health provided by safe drinking water, hygienic conditions, healthy housing and a supply of healthy food for a start.  I refer to this as ‘health infrastructure’ in shorthand.
  • The second are health goods and services.  That is, hospitals and medicines for when people are ill and primary health care services that aim to prevent ill health or detect it at an early stage so that ill health is nipped in the bud.

The right to health obliges a state to ensure that everyone – regardless of race, – has an equal opportunity to be healthy.  This is where the right to health is of direct relevance to Indigenous people in Australia.

  • It means that from a health perspective, communities across Australia (whether Indigenous or non-Indigenous) should enjoy a similarly healthy standard of drinking water, can access roughly the same standard of fresh vegetables, fruits and meat, and have their sewerage and garbage removed.  It also means that they enjoy, from a health perspective, the same standard of housing that is in good repair with functioning sanitation and not overcrowded.

Indigenous peoples in Australia do not enjoy the same opportunities to be as healthy as the non-Indigenous population in relation to primary health care, medicines and health infrastructure. 

‘Health hardware’ as it is sometimes referred to, along with food supplies have been identified as the key determinants of Indigenous ill health in the National Environmental Health Strategy (DHAC 1999).  There are also many other environmental health factors that influence health such as air quality, noise pollution, occupational health, food quality and pest control.

Despite some areas where real improvements have occurred, particularly the water supplies in many communities, Indigenous people do not have equal access to health information.  Poor infrastructure in Indigenous communities results in many health risks and includes skin infections such as scabies mite, infectious diseases, trachoma and rheumatic fever. 

Overcrowding and poor environments encourage and lead to many vectors such as scabies mite, which according to a report prepared for the Department of Health and Ageing in 2002, have been endemic in many remote communities and the statistics have not improved.  A clean, sufficient and reliable water source is vital as it is required for drinking, hygienic food preparation and washing of people, clothes and bedding.  Access to clean water and functional sewerage requires a combination of both functioning community infrastructure as well as functioning household hardware.  Indigenous people experience higher hospitalisation rates than non-Indigenous people for all diseases associated with poor environmental health.


Poor environmental health in many remote Indigenous Australian communities is one of the main factors responsible for the poor public health outcomes frequently associated with these communities.  As I have mentioned previously without environmental health conditions conducive to good health, such as access to safe food, clean water and adequate sanitation, all other public health programs and clinical interventions will continue to be seriously undermined.  Improving and maintaining basic environmental health conditions in Indigenous Australian communities is central to securing better health outcomes. 

In order for there to be improvements in environmental health infrastructure and living standards, real collaboration must occur with all those working across the different areas of health and social and physical environments.

The ‘environmental health workforce’ plays an integral part in promoting healthy living practices and maintaining infrastructure to ensure long-term, effective use. In order to sustain a healthy environment for Indigenous Australian communities there needs to be adequate support and development of the workforce which manages this infrastructure.  Environmental Health Workers play a central role in Indigenous Australian communities and issues which have been identified as important by this workforce include:  support through on-the-job training, creating career paths, providing effective means for concerns to be heard and promoting partnerships.

An initiative that is aiming to address the need of Indigenous environmental health is the NSW Health Aboriginal Trainee Environmental Health Officer Program which has been running since 1997.  This now fully funded program identifies that in order to help reduce the impacts of environmental health on Indigenous communities there needs to be a commitment from government to help educate, train and place Indigenous Australians in the positions of environmental health workers. 

As there are very few Aboriginal people working in the profession of environmental health this is an important program to ensure workers can help communities create environments supportive of good health especially in remote communities.

As mentioned earlier, I have made a series of recommendations for achieving Aboriginal and Torres Strait Islander health equality within a generation.  Over the past two years I have worked with a broad coalition of more than 40 peak bodies across the health, Indigenous health, NGO,  reconciliation and human rights sectors to promote the findings of my 2005 Social Justice Report.

The first stage of this work culminated in mid-March when the Prime Minister, the Ministers for Health and Indigenous Affairs, the Opposition leader, Ian Thorpe, Catherine Freeman, and every major Indigenous and non-Indigenous health peak body signed a Statement of Intent for a new partnership to Close the Gap in Indigenous health inequality. 

The Statement of Intent commits the Government of Australia, Indigenous Australians, supported by non-Indigenous Australians and Indigenous and non-Indigenous health organisations to work together to achieve equality in health status and life expectancy between Indigenous and non-Indigenous Australians by the year 2030. The Statement of Intent also outlines that specific measures are needed to improve Aboriginal and Torres Strait Islanders’ access to health services. And crucial to this is ensuring that for Indigenous Australians to have equal access to health services they need to be actively involved in the design, delivery and control of these services. There has been a commitment by those that have signed to:

  • Develop a comprehensive long-term plan of action that is targeted to need, evidence-based and capable of addressing the existing inequalities in health services in order to achieve equality of health status and life expectancy between Indigenous and non-Indigenous Australians by 2030.
  • To ensuring primary health care services and health infrastructure for Aboriginal and Torres Strait Islander peoples which are capable of bridging the gap in health standards by 2018.
  • To ensuring the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs.
  • To working collectively to systematically address the social determinants that impact on achieving health equality for Aboriginal and Torres Strait Islander peoples.
  • To building on the evidence base and supporting what works in Aboriginal and Torres Strait Islander health, and relevant international experience.
  • To supporting and developing Aboriginal and Torres Strait Islander community-controlled health services in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal and Torres Strait Islander health and wellbeing.
  • To achieving improved access to, and outcomes from, mainstream services for Aboriginal and Torres Strait Islander peoples.
  • To respect and promote the rights of Aboriginal and Torres Strait Islander peoples, including by ensuring that health services are available, appropriate, accessible, affordable and of good quality, and
  • To measure, monitor, and report on our joint efforts, in accordance with benchmarks and targets, to ensure that we are progressively realising our shared ambitions.

For those interested in reading the Statement of Intent copies are available on the HREOC website.

In addition to the Statement of Intent there were important targets resulting from the Indigenous Health Equality Summit with one area focusing on improving the environmental health of Indigenous Australians. 

Some of the targets that will be put in place following on from the Health Summit include:

  • Ensuring the development of a set of community level health service facility standards that are nationally agreed.
  • Ensuring that all community level facilities meet the health service facility standards – both of these within 2 years.
  • Ensuring that all community facilities have access to the appropriate equipment and technology necessary to deliver comprehensive primary health care to Aboriginal communities in a timely manner – ie within 5 years.
  • Use a majority of local Indigenous teams for house assessment and maintenance.
  • To ensure that 90% of Aboriginal families can access a standard healthy food basket (or supply) for a cost less than 30% of their available income.

These are just some of the targets resulting from the Health Summit and the completed document outlining all of the Health Summit findings and targets will be made available at a later date.

Friends, many of you play an important role in Indigenous health and I wish you every success in your endeavours and invite you to consider the issues and principles I have outlined today.  

I will close with an important message that we should all reflect on when we work with Indigenous people, or with any of our stakeholders for that matter: from self respect comes dignity, and from dignity comes hope.

Thank you.