Part 4: Healthy and engaged lives

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We all have this need collectively [for self-care]—for me it is a strong belief that every time I feel like I have a healing moment it will help my daughter etc. but will also help my ancestors. Strong belief that they are heavily invested in my doing well. This is the most powerful thing I have done—to be honest about my life and experiences. All the women that have gone before us—they were enough. We have to believe that we are enough. Hobart women

Our plan for change is we saw the real need for truth-telling, real, honest truth-telling. This country doesn’t own its history; we are constantly having to try [to] educate around us. I guess it’s mainly having to try [to] educate within mainstream western structures ... it needs to be national, collective truth-telling of the history, that shapes our policies, the institutions themselves, from you know, kindergarten through to the tertiary sector, government agencies and just everyone in this nation needs to know the history, and then we might find that we can have better negotiations around our land, our rights, our sovereignty and our recognition ...
Sydney women

Summary

Chapter 12 Health

Health is a fundamental human right. Whilst Australians today enjoy one of the highest life expectancies in the world, Aboriginal and Torres Strait Islander peoples do not share in this enjoyment. Life expectancy, health and wellbeing outcomes for Aboriginal and Torres Strait Islander peoples are inextricably linked to interconnected socio-economic and cultural factors. Throughout this chapter, women and girls share their frustration at the systemic failure to adequately address these interconnecting determinants, including the intersection of health with poverty and housing, the importance of culture, the experience of racism and discrimination when engaging with the health system, and the impacts of trauma. Women and girls relay their experiences with health services and hospitals and discuss the need for culturally appropriate care and preventative health education.

Throughout this chapter, women describe the need for self-determination over their health and wellbeing. They emphasise the need for socio-economic determinants to be addressed alongside culturally responsive health services and are clear that their voices must be included if the gap in health outcomes between Indigenous and non-Indigenous Australians is to change.

Chapter 13 Social and emotional wellbeing

Aboriginal and Torres Strait Islander wellbeing includes the physical, mental, emotional, spiritual, social and cultural aspects of a person. Social and emotional wellbeing is significantly impacted by the strength of identity and experience of personal and intergenerational trauma, as well as the level of control we have over the social, economic and cultural outcomes in our lives. Throughout this chapter, Aboriginal and Torres Strait Islander women discuss how mental distress is often compounded by the disproportionate responsibility that women take to care for family and manage community stressors. Women and girls relay their experiences of mental health and illness, including diagnosis and assessment, the connection between distress and mental illness, access to adequate services and programs, youth and mental health, and suicide.

Throughout this chapter, women and girls emphasise that their health and wellbeing cannot be considered in isolation from their social, economic and cultural lives, and that the determinants of health and wellbeing must be addressed urgently. Women and girls describe the importance of culturally responsive, community-controlled services staffed by Aboriginal and Torres Strait Islander people that respond holistically to the social and emotional health needs of Aboriginal and Torres Strait Islander communities. They also describe the need for a fundamental shift from a system focused on crisis responses to prioritising early intervention and preventative measures to promote positive mental health. Women and girls are calling for systems to reflect their voices, priorities and strengths. As women, they see and understand the needs and aspirations of everyone within their communities. It is through empowering the voices of women that change will occur.

Chapter 14 Learning and education

Education is a transformative and empowering mechanism. Throughout this chapter, women and girls describe that it is through education that they and their children will be empowered to realise a full spectrum of economic, social and cultural rights. Women and girls are, however, unwilling to see their formal education come at the cost of their cultural identity and knowledge. Emphasised throughout this chapter, is the need for the education system to be responsive to Aboriginal and Torres Strait Islander people through culturally inclusive curriculums and programs, truth-telling and inclusive history, language, trauma-informed staff, Aboriginal and Torres Strait Islander support workers, academic support, and engagement programs.

Aboriginal and Torres Strait Islander women want to raise their children with a strong grounding in culture and identity and a good formal education, for them to thrive in the modern world. Women and girls are frustrated that there remains a perception that lower educational attainment for Aboriginal and Torres Strait Islander people is normal. They feel there is a failure to recognise that the education system is not providing equal opportunities for Aboriginal and Torres Strait Islander people. Education curriculums and educational environments do not effectively take into account Aboriginal and Torres Strait Islander knowledges and must broaden their values and measures of success beyond the Western model. Women are clear that recognition of Aboriginal and Torres Strait Islander cultures in institutions, not only empowers Aboriginal and Torres Strait Islander students, but exposes non-Indigenous students to a rich history and systems of knowledge and culture, and positively influences national society and identity.

The human rights context

All people have the right to lead happy, healthy and engaged lives. This right extends to the right to know, maintain, practise and identify as a part of one’s own culture. These rights are clearly articulated within the international human rights framework.

Aboriginal and Torres Strait Islander peoples have rich and diverse knowledge systems that have sustained life for tens of thousands of years. Maintaining and exercising these knowledges and practices and weaving them into the fabric of broader society is critical to creating empowering educational environments and to ensuring the health and wellbeing of our peoples.

The right to the highest attainable standard of health

The International Covenant on Economic, Cultural and Social Rights (ICESCR) recognises the ‘right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (Article 12).[i]

The right to health extends not only to timely and appropriate healthcare, but also to the underlying determinants of health. This includes: access to safe and portable water; adequate sanitation; an adequate supply of safe food, nutrition and housing; healthy occupational and environmental conditions; and access to health-related education and information, including on sexual and reproductive health.[ii]

The right to health contains the following interrelated and essential elements:

Availability: Functioning public health and healthcare facilities, goods and services, as well as programs, have to be available in sufficient quantity within the country.
Accessibility: Health facilities, goods and services have to be accessible to everyone without discrimination. Accessibility has four overlapping dimensions:
- Non-discrimination: Health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalised sections of the population, in law and in fact, without discrimination.
- Physical accessibility: Health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalised groups, such as indigenous populations. Accessibility also implies that medical services and underlying determinants of health, such as safe and potable water and adequate sanitation, are within safe physical reach, including in rural areas.
- Economic accessibility (affordability): Health facilities, goods and services must be affordable for all. Payment for healthcare services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups.
- Information accessibility: Accessibility includes the right to seek, receive and impart information and ideas concerning health issues. However, accessibility of information should not impair the right to have personal health data treated with confidentiality.
Acceptability: All health facilities, goods and services must be respectful of medical ethics as well as respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.
Quality: Health facilities, goods and services must also be scientifically and medically appropriate and of good quality.

Governments also have immediate obligations in relation to the right to health. These include the guarantee that the right will be exercised without discrimination of any kind and the obligation to take deliberate, concrete and targeted steps towards the full realisation of the right to health (known as ‘progressive realisation’).

The UN Committee on Economic, Social and Cultural Rights has noted the right of indigenous people to specific measures:

These services should be culturally appropriate, taking into account traditional preventive care, healing practices and medicines. States should provide resources for Indigenous people to design, deliver and control such services so that they may enjoy the highest attainable standard of physical and mental health.[iii]

The right to education

Article 13 of the International Covenant on Economic, Social and Cultural Rights recognises the right of everyone to education, while Article 28 of the Convention on the Rights of the Child, similarly recognises the rights of all children to education.

The right to education ‘is both a human right in itself and an indispensable means of realizing other human rights’. As the UN Committee on Economic, Social and Cultural Rights describes it:

As an empowerment right, education is the primary vehicle by which economically and socially marginalized adults and children can lift themselves out of poverty and obtain the means to participate fully in their communities.[iv]

The UN Committee on the Rights of the Child has noted the importance of education of Indigenous children as follows:

The education of indigenous children contributes both to their individual and community development as well as to their participation in the wider society. Quality education enables indigenous children to exercise and enjoy economic, social and cultural rights for their personal benefit as well as for the benefit of their community. Furthermore, it strengthens children’s ability to exercise their civil rights in order to influence political policy processes for improved protection of human rights. Thus, the implementation of the right to education of Indigenous children is an essential means of achieving individual empowerment and self-determination of indigenous peoples.[v]

The right to education, at all levels, has been defined as including four key elements, similar to the right to health:

Availability: Functioning educational institutions and programs have to be available in sufficient quantity within the jurisdiction of the country.
Accessibility: Educational institutions and programs have to be accessible to everyone, without discrimination, within the jurisdiction of the country. This includes that education should be:
Accessible to all without discrimination
Physically accessible (within safe physical reach, either by attendance at some reasonably convenient geographic location or via modern technology)
Economically accessible and affordable to all.
Acceptability: The form and substance of education including curriculums and teaching methods, have to be acceptable (e.g. relevant, culturally appropriate and of good quality).
Adaptability: Education should be flexible so that it can adapt to the particular needs of students within diverse social and cultural settings.[vi]

Each of these requirements is relevant when considering the adequacy of standards of education for Aboriginal and Torres Strait Islander peoples in Australia.

The UN Committee has also noted that the following factors should be considered when determining whether Australia is meeting its human rights obligations to provide the right to education:

Temporary special measures to bring about equal enjoyment of the right to education for men and women and for disadvantaged groups including in some circumstances, separate education systems or institutions. Such measures are not a violation of the right to non-discrimination.
Governments must closely monitor education systems—including all relevant policies, institutions, programs, spending patterns and other practices—so as to identify and take measures to redress any de facto discrimination. Sharp disparities in spending policies that result in differing qualities of education for persons residing in different geographic locations may constitute discrimination.
The obligation to ensure education is acceptable includes taking positive measures to ensure that education is culturally appropriate for minorities and indigenous peoples.[vii]

The Convention on the Rights of the Child also sets out specific elements of the right to education for Indigenous children as follows:

Article 29 of the Convention sets out that the aims of education for all children should be directed to, among other objectives, the development of respect for the child’s cultural identity, language and values. This should be adequately reflected in educational curriculum, content of materials, teaching methods and policies.
In accordance with Article 2 of the Convention, governments are responsible for protecting children from all forms of discrimination and for actively combating racism. In order to effectively implement this obligation, States Parties should ensure that the curriculum, educational materials and history textbooks provide a fair, accurate and informative portrayal of the societies and cultures of indigenous peoples.
Article 28 of the Convention requires that primary education be compulsory and available equally to all children. The UN Committee on the Rights of the Child has noted that ‘in practice, indigenous children are less likely to be enrolled in school and continue to have higher drop out and illiteracy rates than non-Indigenous children’ and ‘have reduced access to education for a variety of factors’.[viii]

These above obligations are also reflected in the United Nations Declaration on the Rights of Indigenous Peoples. It identifies specific matters that are part of the right to education for indigenous peoples as follows:

The right of indigenous peoples to establish and control their educational systems and institutions providing education in their own languages, in a manner appropriate to their cultural methods of teaching and learning (Article 14(1)).
Access for indigenous individuals, particularly children, including those living outside their communities, to have access, when possible, to an education in their own culture and provided in their own language (Article 14(2)).
The reflection in education and public information of the dignity and diversity of indigenous peoples’ cultures, traditions, histories and aspirations (Article 15(1)).
The obligation for governments to take measures to eliminate prejudice and discrimination against indigenous peoples (Article 15(2)).[ix]

[i] International Covenant on Economic, Social and Cultural Rights, opened for signature 16 December 1966, 993 UNTS 3 (entered into force 3 January 1976).

[ii] UN Office of the High Commissioner for Human Rights (OHCHR), Fact Sheet No. 31, The Right to Health No. 31 (June 2008).

[iii] UN Committee on Economic, Social and Cultural Rights, General Comment No. 14 (2000) The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant), UN Doc E/C.12/2000/4 (11 August 2000).

[iv] UN Committee on Economic, Social and Cultural Rights, General Comment No. 13 (1999) The Right to Education (Art.13 of the Covenant), UN Doc E/C.12/1999/10 (8 December 1999).

[v] UN Committee on the Rights of the Child, General Comment 11 (2009) Indigenous children and their rights under the Convention, UN Doc CRC/C/GC/11 (12 February 2009).

[vi] UN Committee on Economic, Social and Cultural Rights, General Comment No. 13 (1999) The Right to Education (Art.13 of the Covenant), UN Doc E/C.12/1999/10 (8 December 1999).

[vii] UN Committee on Economic, Social and Cultural Rights, General Comment No. 13 (1999) The Right to Education (Art.13 of the Covenant), UN Doc E/C.12/1999/10 (8 December 1999).

[viii] Convention on the Rights of the Child, opened for signature 20 November 1989, 1577 UNTS 171 (entered into force 2 September 1990) art 29, 2, 28.

[ix] United Nations Declaration on the Rights of Indigenous Peoples: resolution / adopted by the General Assembly, 2 October 2007, UN Doc A/RES/61/295, art 14(1), 14(2), 15(1), 15(2).