Thanks minister, but don't mention the 'p' word

Health Minister Tony Abbott’s speech last week (pdf file 44KB) to the Australian Institute of Health and Welfare (AIHW) Conference created quite a stir, particularly for his suggestion that “a form of paternalism based on competence rather than race” is needed for some Aboriginal communities facing social problems.

The minister’s concern is significant and important. He made some good points in his speech, such as acknowledging the need for improved information on local community needs and matching government funding and programs to address these needs. He also recognised that health status is determined as much by social conditions as by health services and highlighted the importance of creating good governance in Indigenous communities.

On these points we agree, and these are issues I have been raising for some time.

However, by using outdated and unworkable concepts such as “paternalism” to describe what he is really talking about the minister has blurred the central message - the need for good governance structures and accountability in government service delivery.

He also misses a critical ingredient - Indigenous participation. In doing so, he misses the point of self-determination. Self-determination is about Indigenous people making decisions about issues which affect their lives. It is about participation in program development and delivery. Self-determination as a concept hasn’t failed, but has been unsuccessful in the way it has been applied to Indigenous peoples.

There is no doubt that self-determination policies have been poorly applied in some Indigenous communities. Control over administration and service delivery has been handed to communities without the required training and capacity existing. Therefore, it should be no surprise that it has resulted in a mess in some places.

However, much is being done to rectify this situation, such as the Registrar of Aboriginal Corporations appointing administrators where there are concerns, and positive research work being conducted on the elements of strong Indigenous governance, being led by Reconciliation Australia.

The minister's comments on paternalism, worded as they are, are a distraction and lead us away from focusing on better governance standards for all service delivery, including by governments. The COAG trials demonstrate that there is a long way to go in this regard.

The minister also failed to mention that there are government-appointed administrators in place in troubled communities such as Wadeye and Palm Island, where there is no clear evidence of success, at least using the measures purported by Mr Abbott.

My latest Social Justice Report to Federal Parliament also notes that a major concern in the current approach is an absence of transparent decision-making processes by government, and absence of clear monitoring and evaluation systems. The government needs to clean up this situation, not consider creating new processes which may further cloud accountability in Indigenous communities.

My Social Justice Report 2005 also proposes a campaign to achieve Indigenous health equality within a generation. This is particularly relevant following the release of AIHW’s biennial report, Australia’s Health 2006, launched by Minister Abbott, which showed the poor health of Australia’s Indigenous population compared to other Australians.

The report showed that death rates for Indigenous infants remains about three times higher than those of other Australian infants, and about 70 per cent of Indigenous Australians are dying before they reach 65, compared with just over 20 per cent for other Australians. Definitely not good news when you are an Indigenous man in his mid-50s like me.

There are major challenges in this area which need to be led by the health sector. To date, we have seen very poor implementation of the National Strategic Framework on Aboriginal and Torres Strait Islander Health, which identifies ways forward on the issues raised by the minister.

Any campaign to improve Indigenous health will require a focus on specific diseases and conditions, an address to social determinants of health, such as income, housing, education, employment and functional communities, and an address to the position of Aboriginal and Torres Strait Islander peoples in Australian society.

My office recently hosted a visit to Australia by Sir Michael Marmott, chairperson of the World Health Organisation's Commission on Social Determinants and Health, who noted the importance of social circumstances in improving health status in the long term, and the importance of empowerment and participation in achieving this outcome.

Ironically, reducing Indigenous participation and responsibility could work against the objectives stated by the minister and leave Indigenous peoples worse off - if that is possible.