A government's duty of care

Life expectancy in both Australia and Britain today is about 80 years for women and 76 for men.

But Australia’s Indigenous women live more like 63 years and the men 56, remarkably close to Britain’s 60 years for women and 53 for men during its worst economic period of the 20th century, the 1930s. This was the Great Depression when the unemployment rate rose from 2.5 per cent in 1929 to 24 per cent in 1933 and was still 17 per cent in 1939 when World War II provided work.

A Hunger March chronicled by The Guardian of October 27, 1932 consisted of 2,000 “sturdy young men in the twenties … cotton operatives, engineers, miners, seamen, labourers” who walked some 500 kilometres from Lancashire towns to London. They ate and slept where they could, fed by local supporters, and along the way collected a million signatures of support.

Lack of cash was only one aspect of poverty. Another was living conditions, particularly in densely populated industrial towns. Flush toilets were a luxury, many householders used a metal can inside a wooden “thunder-box” located in a tiny outhouse without running water. Local council workers had the unenviable task of emptying these cans into a truck, and would only get chance to wash at the end of the shift, perhaps in a tub next to a coal fire.

But coal was also a health hazard, especially when its smoke, containing impurities, combined with fog to create the deadly London “smog”, until coal was banned by Clean Air Acts in the 1960s.

In a Lancashire town citizens used to fish in an ancient river, but in the 1930s factories lining its banks spewed waste into what had become a king-size open sewer.

Not surprisingly, infectious diseases were common and spread rapidly. Sick children missed school. Parents were hospitalised, their children placed with relatives.

Public health improved when by government order thunder-boxes were ripped out, water closets and bathrooms installed in new houses, smog was eradicated, waterways cleaned up. Infectious disease gradually disappeared and people lived longer. Government created a healthier physical infrastructure.

These changes were not a reward for good behaviour, getting off the grog, attending school, ceasing to scrump apples from orchards. They were government’s duty of care, to ease the burden on health services, enable workers to support their families and the economy.

Around the world today there are many communities without regular paid work, characterised by overcrowding, poor hygiene, sickness, no privacy, addictions, little education, unplanned pregnancies, aggression, sparse health services. Many victims use sex, violence and weapons to overcome poverty, crime and imprisonment are common, the cycle continues. Communities cannot change these economic infrastructures without government leadership and resources.

Indigenous Australia has found food and shelter, reproduced, and lived communally, not necessarily without friction, for some 60,000 years. But following colonial invasion this infrastructure has been undermined. Sometimes physically, by shooting and poisoning to take over traditional sources of food and water.

More recently with attempts to “disappear” the original race by stealing children with lighter skin colours from their families (“Stolen Children”) in the hope of achieving a White (skinned) Australia. This in the 20th century when child psychology authorities strongly emphasised the importance of the human child’s close relationship with mother, in particular, and the dangers of institutional care.

Economic survival was also undermined by not paying Indigenous workers their wages, instead transferring the cash to private pockets or state government coffers - the Stolen Wages atrocity. Even now, when the facts are no longer in dispute, adequate compensation is resisted.

In Social Determinants of Indigenous Health (2007), some 20 Australian professional authorities in the health and social sciences repeatedly emphasise the fundamental part played by both poverty and inequality in the origins of sickness. In her introduction, Lowitja O’Donoghue states:

I have come to realise health is not dependent on the physical well-being of individuals. It is also dependent on key indicators such as education, financial status, adequate housing, sanitation, diet, and access to a range of goods and services. When considering health, you need a model that has a focus on structural inequities, not just on personal stories of misfortune. Also you need a model that acknowledges a history of oppression and dispossession, and a history of systematic racism.

Mudrooroo, in Us Mob (1995), quotes Charles Perkins, Director of the Aboriginal Development Commission in the 1980s: “A sound economic base will help us to cut the welfare umbilical cord that binds us ... We must develop sound economic and social infrastructures … in order to take control of our own destiny.”

It is difficult for a community with meagre resources to take control of its own destiny without genuine support from governments which hold the economic trump cards. Australian governments over the years have shown little interest in the infrastructure needs of Indigenous communities. Even now, they seem to suggest conditions might be improved if community members behave themselves.

What could be done?

Government could invest in training Indigenous workers in the construction trades, with two significant benefits. One, providing workers with skills, therefore income, for a lifetime. Second, using these skills to build and maintain the homes, schools, workplaces, child care centres, health clinics, shops, commercial centres, sports facilities and roads communities need.

Such a building trades project would be expensive, but Australia is a very wealthy country and should invest in skills which could prevent local problems escalating as far as military intervention.

In England I lived in a New Town, built from scratch in open country, complete with everything a small town needs. It can be done.

There are also potentially great employment possibilities for Indigenous Australians in the tourism industry because of their often profound knowledge of the natural world visitors come to see. The Gold Coast with its many tourists has a rich pre-European local history written up by local Aboriginal Rory O’Connor: The Kombumerri: Aboriginal people of the Gold Coast (ngulli yahubai gulli bahn bugal bugalehn- we are still here).

Then there’s education. Many children in the bush won’t attend school but Lawry Mahon of Victoria University has shown for a decade they will do so if school is relevant to their local interests.

And medicine. The Australian Medical Association and other health bodies have been crying out for years for much increased investment in preventive and treatment programs but the past two Federal Budgets have totally ignored them. Some patients have to travel great distances for necessary treatment. It is well known in the medical fraternity that even when there is a permanent doctor in a small community, even when not so isolated, working alone can quickly become exhausting.

There is a very strong argument for a modern health service for distant communities based on fleets of planes and helicopters to ferry staff and equipment to where they are needed and to ferry patients and relatives to treatment centres. Medical staff should be available on shifts, not on permanent full-time call, and medical students should have experience of distance medicine. Sure it would cost but either we have a commitment to health or we don’t, and we are said to believe in equality. It’s a question of values and priorities.

In Indigenous peoples and poverty (2005), Stephen Cornell’s chapter on Australia, New Zealand, Canada and the United States notes these countries are among the world’s wealthiest nations but “the Indigenous peoples within their borders are in each case among their poorest citizens”, the irony being “the wealth of these countries has been built substantially on resources taken from these peoples, whose poverty is a recent creation”.

According to historian Geoffrey Blainey the Indigenous standard of living before English colonisation in 1788 was higher than for most of Europe’s population.

Australia’s political system is based on the economic “religion” of competition, so by definition there are winners and losers, with many Indigenous people among the most disadvantaged of the losers. What does that feel like in your own country? Depression is a psychological as well as economic result.