Indigenous health: real solutions for a chronic problem (2007)

Indigenous health: real solutions for a chronic problem

 SOCIAL AND EMOTIONAL HEALTH AND WELLBEING

Speech by Mr Tom Calma
Aboriginal and Torres Strait Islander Social Justice Commissioner
Human Rights and Equal Opportunity Commission

9th Annual Garma Festival of Traditional Culture 

6 August, 2007

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I would like to acknowledge the Yolngu people on whose land we are today. I would also like to thank Charles Darwin University for inviting me to speak at this Garma festival where we celebrate the Yolngu culture and world view.

Today I will be setting the scene of Indigenous social and emotional wellbeing  in a national sense. I will outline the statistics, some of the factors causing social and emotional health problems for Indigenous people, and explain how human rights principles can help to improve the health of our communities. 

(a) Social and emotional health

In the last ten years, social and emotional health has become a hot topic in health policy debates. We now accept that social and emotional health is one of the foundations of strong communities and good mental and physical health. Mental health problems are different from social and emotional health problems, but there is clearly some overlap between them.

We also know that physical health impacts on social and emotional well being. For example, we know that we need to keep our stress levels down so we avoid getting high blood pressure and heart disease.

So what enables a person to enjoy a good social and emotional wellbeing? I think we can safely state in broad terms that:

The basics for survival need to be in place: like shelter, food, income and so on. 

We each need to feel safe in our homes and our communities – we each have a right to live free from violence or the threat of violence.

We also need to feel that we have a level of control over our own life, and the freedom to make choices about how we live our lives. This individual freedom is important so that each of us can develop to our full potential, be active in our families and communities, and lead a rich and fulfilling life.

And as this suggests: political and cultural factors also have an impact. We all know how important our cultures are to every aspect of our lives and how our communities operate – and we need to be able to teach our kids about their cultures and their responsibilities.

Finally there are a number of stressful things that can have a bad affect on our emotional and social health – like deaths in the family, sickness, and unemployment.

(b) Synergies between human rights, social determinants and emotional and social health

In other words, there are many factors that affect our social and emotional well being. A simple way of thinking about social and emotional well being is to it is to compare it to the idea of human dignity that lies at the heart of human rights. This makes human rights a useful tool for looking at social and emotional wellbeing.  

There is also a cross-over between the idea of social and emotional well being and what the experts refer to as the social determinants of health. Social determinants are things like housing, education social networks, physical infrastructure, connection with land, racism and employment – and they can all impact on our social and emotional wellbeing as well.

Of course, there is nothing new for Indigenous people in all of this. I am sure I do not need to remind many people here of the 1989 National Aboriginal Health Strategy’s definition of health as: “Not just the physical well-being of the individual but the social, emotional, and cultural well-being of the whole community”.

(c) Indigenous peoples’ social and emotional health

So what do we know about Indigenous peoples’ social and emotional health?  The truth is we don’t know much for sure because the research has not been done. This is starting to change though.

The 2004-05 National Aboriginal and Torres Strait Islander Health Survey collected information on the health – including the social and emotional health -- of approximately 10,500 Indigenous adults (aged 18 years and over).

Now I welcome this aspect of the survey because it was the first Indigenous-specific survey by the Australian Bureau of Statistics that aimed to measure the emotional and social health of Indigenous adults. And I congratulate the ABS and the National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data who worked hard to get the social and emotional well-being questions included in the survey.

The survey used questions drawn from two established health and well-being questionnaires developed in the United States.

In response to the questions, more than half the adult Indigenous population reported being happy (71%), calm and peaceful (56%), and/or full of life (55%) all or most of the time. Just under half (47%) said they had a lot of energy all or most of the time. And Indigenous people in remote areas were more likely to report having had these positive feelings all or most of the time, than were Indigenous people living in non-remote areas, and this is set out in the slide.

On the other hand, about 15% of the total number of adults who were asked felt these things only a little of the time, or none of the time. Results again were better for Indigenous people in remote areas.

The survey also included five questions designed to highlight psychological distress. Responses showed that almost one in ten Indigenous adults reported feeling nervous all or most of the time. When asked how often they felt without hope, 7% said that they had this feeling all or most of the time. Similarly, 7% said that they felt so sad that nothing could cheer them up, all or most of the time. A higher proportion of the Indigenous population reported feeling restless (12%) and/or that everything was an effort all or most of the time (17%).

On the other hand, the majority of those surveyed said they felt these things none of the time. And again, remote living Indigenous people faired better.

The number of stressful events or as they are called life stressors also impacts of social and emotional wellbeing.

The National Aboriginal and Torres Strait Islander Social Survey found that 82% of people asked reported that they had experienced at least one stressful event in the last 12 months – like a death in the family or of a close friend (46%), serious illness or disability (31%) and inability to get a job (27%).

In relation to our children, The Western Australian Aboriginal Child Health survey covered about 5,000 children.  It reported that 1 in 4 Aboriginal children are at high risk of developing serious emotional or behavioural difficulties.  This compares to about 1 in 6 or 7 of non-Aboriginal children. 

Even more disturbing, more than one in six of the Indigenous young people aged 12-17 years had seriously thought about committing suicide in the 12 months. And of this group, nearly 40% had actually attempted suicide during the same period of time1.

One of the really interesting results of this survey was that emotional and social health difficulties were lowest in most remote parts of WA. This suggests that growing up in areas of extreme isolation, where traditional cultures and ways of life were strongest, may protect against emotional and behavioural difficulties in Aboriginal children.

This is very important. It confirms what many Elders have been saying to governments for years – that we need to protect and practice our cultures and make sure that our kids grow up in their cultures – if they are to have the best life chances.

The WACCHS survey found that the factor most strongly associated with high risk of serious health that need addressing.

In terms of causes: it would appear that negative life stressors are impacting in a major way; and that we have work a lot harder to prevent them from affecting our kids’ lives.

Many of you will know about the Indigenous health equality campaign that is being promoted by myself and a coalition of about 40 other organisations. And I think it is worth reflecting on the importance of reducing death rates and illness in Indigenous peoples and the importance this has to emotional and social well-being.

I want to highlight that the two top stressors impacting on Indigenous peoples, at least those reported by the ABS social survey are:

1. Firstly, death of family members or friends; and
2. secondly, personal sickness or disability.

This suggests that in a vicious circle, low life expectation and high death rates and illness among Indigenous people undermines our social and emotional health. But we can do something about this.

Achieving Indigenous health equality – in 25 years, as the campaign proposes – could have a great impact on improving Indigenous emotional and social health on top of the physical health impacts.

But let’s not stop there: being unemployed was the number three stressor; overcrowding at home was number five. So we can see how achieving equality in these key areas will improve Indigenous peoples’ social and emotional well-being dramatically.

The second point I want to make relates to the fact that – in key, but not all, areas -- the data would suggest that emotional and social health and well-being increases with remoteness. And I agree with the WAACHS survey that this is because strong Indigenous families, communities and cultures are protective of Indigenous emotional and social health.

There is also a range of collective(community-wide) health determinants that may also be impacting on Indigenous peoples’ mental health that the general population doesn’t experience. For example, nearly double the proportion of Indigenous people are experiencing high levels of psychological distress, than the rest of the population.

It’s important to remember that the way Indigenous people have been treated over many years by governments has had a big impact on mental health in our communities. Policies that made people leave their traditional country and live on someone else’s land, have taken a toll on generations of families.

So too, the impact of the stolen generations continues to be felt in our communities. The National Aboriginal and Torres Strait Islander Social Survey 2002 found that nearly 40% of respondents had either been forcibly removed themselves and/or had relatives who had been forcibly removed. The stolen generation has created intergenerational health impacts and trans generational trauma. The Western Australian Child Health Survey found that 12% of their sample was looked after by a carer who had been forcibly removed. These children were almost 2 ½ times more likely to be at high risk of clinically significant emotional or behavioural difficulties2 and twice as likely to abuse alcohol and drugs.

Racism is another collective stressor that has been reported to affect our social and emotional well being. The Western Australian Aboriginal Child Health Survey found that nearly a quarter of the Indigenous children under 12 years surveyed had experienced racism in the previous 6 months. This was associated with increased cannabis and alcohol consumption in these under 12 year olds.3 I also hardly need to tell you that substance abuse is one of the biggest scourges in Indigenous communities and leads to poor social and emotional health.

There is also the view that the lack of collective control we currently have over decisions that impact on our communities and how we are live our own lives, is affecting our social and emotional well being. It raises the question, if we were able to have more control about what happens in our communities, and who is allowed to make the decisions or solve the problems – maybe we’d all be better off.  For example, we should not underestimate the good work and valuable role that Aboriginal controlled health services play in delivering holistic health care and building community capacity.

However, there may be wider ramifications still. Aboriginal and Torres Strait Islander peoples, like Indigenous peoples around the world, have long asserted that their health is linked to their collective ability to control their lives and cultures and the recognition of their rights. 

Access to traditional lands can also act as a determinant of wellbeing, particularly where that land is culturally significant and/ or provides sources of food, water and shelter.  Pat Anderson, in her capacity as the former chair of the National Aboriginal Community Controlled Health Organisation sums this up very eloquently:

Our identity and human beings remains tied to our land, to our cultural practices, our systems of authority and social control, our intellectual systems, our concepts of spirituality, and to our systems of resource ownership and exchange. Destroy this relationship and you damage- sometimes irrevocably- individual human beings and their health.4

(d) Current policy responses

So we know about the statistic and causes, but what are the current national policy responses and how do they measure up?

There are quite a few responses – so I will just mention some of the most important ones – and the goals that they have set:

The first is the National Strategic Framework for Aboriginal and Torres Strait Islander Health. Part of this framework is specifically aimed at enhancing the emotional and social well being of Aboriginal and Torres Strait Islander peoples. In particular, it says we must target mental health, suicide, alcohol and substance misuse and family violence issues, including child abuse.

The second is the National Mental Health Plan which emphasises the need for partnerships between mental health services and Indigenous specific health services – with Aboriginal and Torres Strait Islander peoples taking a lead role.

And thirdly, there is a really important one - the Aboriginal and Torres Strait Islander Social and Emotional Well-Being Framework which focuses on the need for a holistic and 'whole of life' approach to achieving the conditions for well-being.

Overall, the Framework supports self-determination and recognises the impact of trauma, grief, loss, discrimination and human rights issues on the social and emotional well being of Aboriginal and Torres Strait Islander communities.

So we have a policy framework that – while I am not uncritical of aspects of it -- to some degree reflects the human rights approaches.

However, in practice things are working out very differently. The policy documents talk of empowerment, yet programs and responses that are likely to harm the strength and culture of communities are being introduced.

I want to conclude by looking at the intervention underway in the Northern Territory as an example of this.

(e) NT emergency response measures

First of all, can I say that I’ve welcomed the Government’s decision to step in to protect our children from abuse.

I think the Government does want to improve the emotional and social well being of our children, and I agree this is a national priority. However, the way it is going about this raises a number of other human rights questions that really concern me – and I have pointed this out to the government.

In particular, in the Northern Territory I am concerned that lack of consultation with communities in rolling out child health checks, and the stripping of power away from communities by appointing administrators is counter to social and emotional health network.

A related point is the damage that is being done to the reputation of Aboriginal communities in Northern Territory that are functional and achieving very positive things, despite the odds. We can’t risk labelling all communities as dysfunctional – or all Aboriginal men being labelled as violent and addicted to alcohol. This will only damage our sense of pride and the undo the great things that communities have built up - when we know that positive cultural and community identity is linked to social and emotional well being.

On the issue of connection and control over land, there is a real risk that the compulsory acquisition of townships and town camps will undermine Indigenous peoples’ ability to make decisions about their land. Most concerning of all – I don’t understand how these particular chages will benefit Indigenous people.

Scrapping the permit system removes one of the fundamental rights of ownership- to decide who can or cannot enter your property. Especially given that there is no link between these measures and child abuse I am very worried about the negative social and emotional health impacts.

The legacy of the stolen generation is still well and truly with us but one of the things that we have learnt is that trauma, grief and loss needs to be addressed holistically and in ways that get to the root cause of the issue. It is for this reason, that I am worried that measures such as alcohol bans without appropriate rehabilitation services, let alone more mental health services, are yet again treating the symptom and not the cause of the problem. If we are serious about increasing social and emotional wellbeing through alcohol reduction, there must be rehabilitation and treatment services. At the moment the vast majority of remote communities do not have access to a substance abuse service.

We have not just an opportunity, but a responsibility, to improve the social and emotional well being of our children, families and communities. We need to draw on the evidence to ensure that the policies put in place are truly best practice and will work for the betterment of all aspects of lives of Indigenous peoples and communities – in a holistic fashion. We should not settle for short term gains that will do nothing to improve the emotional and social health of Aboriginal and Torres Strait Islander peoples.

Finally, I’d like to finish by acknowledging and commending the work of all the health workers who are here today. I continue to be impressed by your hard work in difficult circumstances, your commitment and your capacity to take on the many complex tasks that are required of you.

You are the people who have the critical role in improving the social and emotional well being of Indigenous people and ensuring that we don’t lose sight of the bigger picture, the circumstances that make social and emotional wellbeing possible, in the process.

Thank you

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