Equality in health

Australia, like many other countries around the world, seriously binds itself to the obligations of treaties which spell out rights to which our citizens (and those of other countries) are entitled. For many, that is the end of the process, and the treaties, both for domestic politics and international law, are forgotten. However, the treaties usually have seriously under resourced secretariats assigned to them and primitive enforcement mechanisms. By these processes countries, including Australia, can be reminded of the basic standards to which we have committed ourselves and our governments. This piece is about one such recent reminder.

On June 3, 2010, the UN Special Rapporteur on the right to the highest attainable standard of health, Mr Anand Grover, released his final report on the implementation of this human right in Australia. The rationale of the existence and the visit of the Special Rapporteur may be gleaned from the fact that Article 12 of the International Covenant on Economic, Social and Cultural Rights (“the ICESCR”) includes the obligation that “The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.

In a nutshell, the report found that the standard of living and quality of health care in Australia is excellent, except as experienced by Aboriginal and Torres Strait Islander people and those in detention.

The report calls for action by the Australian Government to minimise the impact of poverty and discrimination on the enjoyment of the right to health, particularly in the context of Indigenous health and health care of those in detention, including prisoners, asylum-seekers and refugees.

At the invitation of the government, the Special Rapporteur visited Australia from November 22 to December 4, 2009. During that time, the Special Rapporteur travelled extensively and met with the Minister for Health and Ageing, Nicola Roxon, MP; the Minister for Immigration and Citizenship, Senator Chris Evans; the Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery, Warren Snowdon, MP; and the Parliamentary Secretary for Disabilities and Children’s Services, Bill Shorten, MP. The Special Rapporteur also met with civil society organisations, academics and health professionals, and visited Indigenous communities and met with their representatives.

The report describes the health conditions and outcomes among Aboriginal and Torres Strait Islander people as “a disturbing picture”. Much of the information relied upon by the Special Rapporteur is from published sources in Australia and much of it is from Australian government sources. It is still salutary to have an outsider bring the information together in one place and to draw the observations that the information provokes.

Indigenous Australians are being affected disproportionately by ill-health, disability and death. The life expectancy for Indigenous Australians is 67.2 years for males and 72.9 years for females, compared with 78.7 and 82.6 years, respectively, for all males and females. Indigenous people are hospitalised at 14 times the rate of non-Indigenous people for renal dialysis, and at three times the rate for endocrine, nutritional and metabolic disease. Indigenous Australians are twice as likely as non-Indigenous Australians to report high or very high levels of psychological distress, and are hospitalised for mental or behaviour disorders at twice the expected rate of the general population. Injury and poisoning are large contributors to Indigenous morbidity, especially in younger people.

Unmistakably, the picture is of a striking gap between the everyday lives of mainstream and Indigenous Australians and the existence of stark inequalities. It is indeed disturbing, and worse, disturbingly familiar.

Australian governments have thrown a considerable sum of money and resources at Indigenous health. The average expenditure on health goods and services per person for Aboriginal and Torres Strait Islander people is 17 per cent higher than expenditure for non-Indigenous people and there is, after all, the Northern Territory Emergency Response.

However, through the keen eye of an outsider, recurring stumbling blocks in government responses are obvious: meaningful engagement and informed community participation; mechanisms for monitoring and ensuring accountability; striking the balance between upgrading mainstream services to adequately service the needs of Indigenous Australians and the diversion of resources to community-controlled services.

Equally the Special Rapporteur highlighted as a concern government policies and measures that temporarily address secondary problems but fail to address relevant long term causal factors.

For example, restricting alcohol supply and creating permit systems are measures which address excessive alcohol consumption but overlook the fundamental goal of promoting responsible alcohol use, which is better achieved through education, support, counselling and rehabilitation. As in most policy areas, the attempted quick fix of the symptom (secondary problem) always looks easier than the patience, the resources and the persistence needed to address the underlying causes.