Not a year passes without another report revealing the appalling state of indigenous health in Australia. In some way, it has become accepted by most in this country, including by indigenous people, that this is the norm. Indigenous Australians are world record holders in some of the most preventable and treatable illnesses, including rheumatic heart disease, streptococci infections and end stage renal failure.
While non-indigenous Australians have amongst the highest standard of health in the world, indigenous Australians have a life expectancy less than that of many developing countries. This health emergency is not confined to remote or regional communities. We know what the underlying causes are and there is a wealth of knowledge of the effective intervention and prevention of these diseases. According to the World Health Organisation (WHO), there are four social determinants of health.
- Social gradient - a person's social and economic circumstances strongly affect their health throughout life. People who are poor, the least educated, who live in inadequate housing or are unemployed, are more likely to suffer poor health.
- Early life - research suggests children born with low birth weights and who experience poor growth in early childhood are much more likely to be predisposed to suffer from chronic diseases such as diabetes and ischaemic heart disease as adults.
- Social exclusion - the poor, homeless, minority groups and those who experience racism and discrimination are more likely to experience poor health.
- Unemployment - job insecurity and unemployment is a chronic stress and this increases the longer a person is out of work.
Make no mistake, the state of indigenous health in this country is an abuse of human rights.
The right to health requires governments to put in place policies and plans that will lead to accessible health care for all in the shortest time possible. Creating this situation is the challenge facing both the human rights community and public health professionals. In May 2000, the Committee on Economic, Social and Cultural Rights adopted a General Comment on the right to health.
The Comment recognised that the right to health is closely related to, and depends on, the realisation of other rights, such as to food, housing, work, education, participation, non-discrimination and equality. Prohibiting discrimination does not mean differences should not be acknowledged, only that different treatments must be based on objective and reasonable criteria which are intended to rectify imbalances within our society. This is particularly the case for indigenous Australians who suffer a disproportionate burden of ill health and premature death, at the same time as they have less access to general practitioners, the Pharmaceutical Benefits Scheme and primary health care services.
Although spending on indigenous health is increasing, the Commonwealth Government still only spends 74 cents on indigenous Australians for every dollar it spends on the rest of the population. It has been estimated that an additional $300 million annually is needed to provide an equitable allocation of health care resources to Indigenous people.
Central to bringing about improvements in indigenous health is self-determination. If indigenous Australians are not engaged as the primary agents of change, the root causes of their ill health will not be addressed. Good health cannot be "delivered" to indigenous Australians: It must be developed and continued from within. Experienced practitioners’ attest nothing else will work.
Past and present policy paradigms have failed indigenous people, and current administrative arrangements and cost shifting between the commonwealth and state governments is inefficient and inequitable. If we are to get indigenous affairs beyond the political fray there has to be a fundamental change in the nature of the politico-legal relationships between indigenous and non-indigenous Australians.
Contrary to what some believe, the recognition of indigenous rights in law does not threaten the fabric of our society and poses no threat to national sovereignty. Negotiated arrangements or treaties have the potential to play a constructive and useful role in addressing the substantive issues that underpin indigenous socio-economic disadvantage and powerlessness. With the gap in life expectancy between indigenous and non-indigenous people continuing to widen (the median age of death is just 47 years in the East Kimberley) we cannot afford to allow the status quo to prevail.
By providing new institutional arrangements with adequate resources to ensure the provision of health and other services we might begin to make a real and sustainable difference.
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