Good house, good clinic and being able to buy a feed

Native title rights, good
house, good clinic and being able to buy a feed

Speech by Barb Flick, Aboriginal
and Torres Strait Islander Social Justice Director at the Millenium Hotel,
Sydney, 21 August 1998

I pay my respects
to the Traditional Owners of this country and honour their children.

Mick Dodson, the
former Aboriginal and Torres Strait Islander Social Justice Commissioner
said in his First Report that "A decent standard of health and a life
expectancy equivalent to others is an entitlement. Social justice is not
primarily a matter of the relief of suffering. It is a matter of the fulfilment
of a responsibility. To draw this distinction is not to deny that the
facts by themselves speak out for a remedy. Nor is it to deny that compassion
is a proper response. But compassion is an insufficient foundation for
the delivery of rights".

So, I speak to you
today not from a lack of compassion, but from the perspective of drawing
out the facts - the nuts and bolts behind the reality of Indigenous health
- and how these facts speak for the ways in which the human rights of
my people are being systematically denied in Australia today.

Recently I spent
some time in a remote part of this country trying to identify the ingredients
needed to improve the health status of the people and to put forward some
recommendations about how this might be addressed.

I occupied some of
my time looking at the infrastructure, government policy, workforce issues
and the medical aspects of service delivery. It is all very difficult
as many in this room will tell you. Although most of the clinics have
been replaced, the dilapidated ones remaining are a stark reminder of
the difficulty encountered by our managers to access the funding and to
convince government that these clinics are, themselves, a health hazard.
Given the present political climate which will have you all believe that
we get far too much, the task is even more difficult.

Indeed it is a measure
of the gross misinformation in this country that many people actually
believe that we do receive 'special' treatment but when faced with the
facts there is no room for argument.

So let's take a moment
to examine the facts.

The results recorded
in the recent report Expenditures on Health Services for Aboriginal
and Torres Strait Islander People found that:

• per person, total
  spending (on health) for and by Aboriginal and Torres Strait Islander
  people was $2,320, a mere 8 per cent higher than that for or by other
  Australians, (even though Indigenous Australians have much higher
  morbidity and mortality rates than other Australians)

• nearly 80 per
  cent of all the services to Aboriginal and Torres Strait Islander people
  were managed by the States and Territory

• the ratio of Indigenous
  to non-Indigneous expenditure per person varied considerably across
  the States and Territories. In general, it was highest where the proportion
  of the Aboriginal and Torres Strait Islander population living in remote
  areas was highest, especially in Western Australia and the Northern
  Territories - at least some of the difference may thus be explained
  by the costs of isolation

• only a small proportion
  of these expenditures were through services aimed specifically at Aboriginal
  and Torres Strait Islander people

• the largest single
  source of the Commonwealth's expenditure was through OATSIHS grants
  to community-controlled Aboriginal Health Services. Aboriginal and Torres
  Strait Islander people received very little from the two largest Commonwealth
  programs of Medicare and the Pharmaceutical Benefits Scheme. The total
  of Aboriginal Health Service grants, Medicare Benefits and Pharmaceutical
  Benefits was still about $100 per person less than other Australians
  received from Medicare and Pharmaceutical Benefits alone

• in total, hospital
  expenditures dominated spending on both Indigenous and non-Indigenous
  people. Outside of hospitals, Aboriginal and Torres Strait Islander
  people used very few of the specialist medical services and specialist-prescribed
  drugs which represented nearly 20 per cent of all non-Indigenous outlays

• the pattern of
  service use by Aboriginal and Torres Strait Islander people was thus
  quite different to the average for other Australians. They relied much
  more on publicly-provided hospital and community health services than
  the typical non-Indigenous person and spent much less on private doctors,
  private hospital care, dentistry, medicines and ancillary services.
  In fact, public expenditure on the health of Aboriginal and Torres Strait
  Islander people appears to have been very similar to those for other
  Australians in the same income category. However, their health status
  was almost certainly much worse.

And this is "special
treatment".

Last year I was invited
to participate in a briefing to delegates from the World Bank. I talked
to them about the difficulties of delivering health services to Australians
who live in the rural and remote areas of this country. One of the delegates
from India followed me outside at the end of the presentation and said
to me "all of the things you talked about are interesting - but don't
you realise that none of them are achievable without political good will".

I wondered what he
meant by "good will". Was it the "good will" of the Australian political
system to Indigenous peoples? Is this what we had to rely on in order
to achieve equity in health outcomes for our people?

Let's look at the
"good will" demonstrated to our peoples in recent years.

Let's look at the
Native Title debate.

The First Social
Justice Report states the position clearly. The High Court of Australia's
judgement in the Mabo case was delivered on the 3rd June, 1992. This judgement
did not change the law. The judgement was in itself an act of reconciliation
between the laws. It declared the common law of Australia and recognised
what has always been true in the law of Indigenous Australians.

Like all colonised
countries, Australia seems to find it too hard to deal with the full history
of this country. What do people fear? Is it safe to remain ignorant? The
former Prime Minister Paul Keating in his Redfern Park speech said:

"This is a fundamental
test of our social goals and national will: our ability to say to ourselves
and the rest of the world that Australia is a first rate social democracy,
that we are what we should be - truly the land of the fair go and the
better chance.

It is a test of our
self-knowledge. Of how well we know the land we live in. How well we know
our history. ...How well we know what Aboriginal Australians know about
Australia".

It would seem the
former Prime Minister was being overly optimistic.

Indigenous knowledge
of our history - at least in its post-invasion stage - inevitably features
the less than savoury elements of the theft of our lands, murder, rape,
the kidnapping of our children and genocide. It features the systematic
oppression of our peoples, of which reduced life expectancy is a symptom,
certainly not a cause.

How can the recognition
of injustice leave non-Indigenous Australians bereft of a national identity?
Can the blaming of people less fortunate than ourselves somehow uplift
us? Do we always need to clamber over the bodies of others in order to
feel good about ourselves?

Well, according to
the "special treatment" apologists, history is a malleable thing, and
seek to ignore or avoid the facts of the past in order to distort the
realities of the present.

From the perspective
of these people, it was as though on June 3 1992, the Aboriginal and Torres
Strait Islander peoples invaded Australia in a landing barge of law contrived
by the High Court, thus completely re-writing the history of the boat
people who arrived at Port Jackson in 1788.

There is still a
belief that Australian history is one of social Darwinism, where inferior
races must inevitably give way to that of the superior Europeans who have
tamed this wide brown land.

Thus when it comes
to issues such as Native Title, everything possible that can be done must
be done to provide "bucket loads of extinguishment" in order to re-mould
our history away from that proposed by the "black armband" historians.

It is clearly a false
view of the history of Australia, and one that clearly lacks the "good
will" my Indian friend said was necessary. As Henry Reynolds pointed out
recently, better the black armband than the white blindfold.

So, how does history,
and the recent ahistorical attacks on Native Title, fit in with the health
of Indigenous peoples?

I quoted statistics
earlier to demonstrate that, while the health of Indigenous Australians
is demonstrably poorer than that of other Australians, relative expenditures
on Indigenous health only marginally outpaces that for the general population
- and in key areas, fall behind average expenditure on acute care is a
disproportionate outlay.

It would seem that
"good will" does not extend to seriously tackling the inequities we face.

This is the "special
treatment" that we get.

Similarly, when Australian
common law, through recent High Court decisions, offers a window of reconciliation
in recognition of the simple rights of our people, strenuous efforts have
been made - all in the name of equality mind you - to remove and override
these rights in favour of wealthy minorities.

This is more "special
treatment".

So - for Indigenous
peoples - Native Title rights and health rights are indivisible. Not just
in the sense that our rights to land and culture are indivisibly part
of our health - but the reverse also holds true. Attacks on our Native
Title and the lack of "good will" to our health needs are also indivisible.
Both are subject to systematic and deliberate ignorance; both are regarded
as social and economic burdens to the rest of the nation.

If there are any
of you in the audience today who still believe that fixing our physical
ailments alone is going to dramatically affect the status of our health
- you are sorely mistaken.

Our rights to Native
Title are part of the same continuum that include our rights to a good
house, a good clinic and being able to buy good food.

It goes without saying
that increasing the cost of fresh food in particular can only worsen the
health problems for Indigenous Australians. Major reports including the
Healthy Food Access Basket, have been written in recent years clearly
setting out the importance of good food to Aboriginal health. The largest
cause of excess death amongst Indigenous Australians is cardiovascular
disease. Recent studies from the United States show that lack of anti-oxidant
vitamins from fresh fruit and vegetables explain up to 40% of deaths from
coronary heart disease which is not accounted for by risk factors such
as smoking and obesity. 20% of adult Aboriginal people over the age of
15 years suffer from diabetes. This rate rises dramatically for the over
35 year olds. 40% of Indigenous Australians over the age of 35 years suffer
from diabetes. These diseases are directly linked to diet, food choices
and availability.

People with low incomes
already find difficulty in providing good nutrition to their families
on current costs. It also goes without saying that governments can and
should cushion any effect of rises in this area.

Attacks on one set
of rights inevitably involve an attack on another - they can't, for bureaucratic
or philosophical convenience, be compartmentalised.

So, I go back to
the words of Mick Dodson.

The relief of suffering
through, for example, improving our health outcomes, is only part of what
social justice is about. Delivery of improved health outcomes is only
a single, albeit important, element of the human rights outcomes that
our society must be responsible for.

Last
updated 1 December 2001