People power is a force in this country: Celebrating the 5^th anniversary of the Close the Gap Campaign for Aboriginal and Torres Strait Islander Health Equality

 

Co-chairs of the Close the Gap Campaign for Indigenous Health Equality - Dr Tom Calma, National Coordinator Tacking Indigenous Smoking, and Mr Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner

National Press Club, Canberra

10 March 2011

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Dr Tom Calma

I begin by thanking Aunty Agnes for her warm welcome to country and to acknowledge the Ngunnawal peoples, the traditional owners of the land we are meeting on today, and pay my respects to their elders and ancestors.

I also acknowledge my distinguished fellow speaker and co-chair, Mr. Mick Gooda, and the distinguished company in the room.

And as an Australian, and an Indigenous Australian, I acknowledge my Indigenous brothers and sisters here today, and also my non-Indigenous brothers and sisters, and particularly those who have been partners in the Close the Gap campaign.

I also thank the National Press Club for hosting this address.

It’s too easy for Australians to think of ‘people power’ as something that happens overseas. People power is something we, as a nation, tend to locate in Tunisia, Egypt or Libya - but not something relevant to a ‘comfortable’ nation like ours.

But I am here to show you how people power has played a significant role in this country as manifested in the Close the Gap Campaign, and its success in placing Indigenous health high on the national agenda.

The campaign, in common with other ‘people power movements’, stemmed from despair and anger at the status quo.

That status quo is the ongoing national disgrace of the first peoples of this nation dying up to 20-years younger than other citizens; something that would not be tolerated in other parts of the population.

Of course, for us, health inequality has always been a very, very personal issue: it’s the duration and the quality of our lives, our children’s lives, our parents’ lives that are at stake.

Do you know that when I was born in some missions it was reported that 200 in a 1,000 of our babies were dying before they even reached the tender age of one? That is in my lifetime.

And, yes, we have of course come a long way since the 1950s and 1960s, but even today we are still dying decades younger than we need to; and our infants continue to die in our arms at three times the rate of other Australian infants.

Do you know how many funerals my family has attended? Do you know how many leaders, parents, brothers, sisters, children and friends from our communities we have helped bury - before their time?

Of the almost 10,000 Indigenous Australians asked in the 2002 Australian Bureau of Statistics’ social survey what the greatest ‘stressors’ in their lives had been in the previous 12 months - 46% reported the death of a family member or close friend. It was the single biggest stressor recorded. That’s almost 5000 grieving, upset and – dare I say - angry people.

And among those living, health is generally poor. In the 2006 health survey of over 10,000 Indigenous Australians, 65% reported a long-term health condition of some sort.

But this is more than a health issue for us.

It is our leaders who are dying - and not just at the national level. Every year in Australia our communities unnecessarily lose trusted Elders, Aunties and Uncles; people you won’t necessarily read about, but who were sources of stability, governance, order and counsel in the places they lived.

And our cultures die with our leaders too. Every time you hear of an Aboriginal language dying out, remember: it is not ‘a language’ that is dying – it is the people who speak it.

And, of course, poor health compounds the poverty that too many of our people endure.

So why and how are we allowing health inequality to continue?

Let us be very clear on a few points:

Health inequality is not a secret; we’ve known about it for decades.

One of the goals of the 1967 referendum was to enable the federal government to address our health issues. That was almost 45 years ago.

Health inequality is occurring for reasons we understand, and that are within our control.

There is, for example, no genetic ‘X factor’ that inclines us to poor health.

To use the language of human rights, equal standards of health for us mean that we have equal access to doctors and health services as other Australians. It means providing us with equal standards of 'health infrastructure’ - making sure we have access to healthy food, sanitary conditions and healthy housing. 

And as has been reported for decades now, Aboriginal and Torres Strait Islander Australians do not enjoy these things to the same standard as non-Indigenous Australians and their health is poorer as a result.

Our peoples want to be healthy.

It is an insidious myth that we do not care enough about our health, and are therefore solely responsible for what is happening to us.

Now first things first, of course individuals and communities must take responsibility for their health, and no state can ‘force’ good health behaviours.

However, it is the job of the state to provide health information and other supports (‘stop smoking’ messages and patches, for example) state to enable real choices to be made by people on the ground. And for decades now, until very recently, health promotion and prevention programs were not reaching us.

Nor is it possible to separate health behaviours from social contexts: healthy behaviours are supported by ‘healthy’ communities: that are economically, socially and culturally healthy. And this is the broadest context of the challenge ahead and one in which governments must play a role in partnership with us.

They must work with us to harness the desire for better health, and lives, in our peoples. We want to enjoy the same opportunities to take responsibility for our health as other Australians.

We can remedy this.

To focus on health services, providing adequate primary health care services can bring about dramatic results.

Just look at some overseas examples: the life expectancy of Native Americans increased by about nine years between the 1940s and the 1950s after such services were provided. In New Zealand, the life expectancy of Maori increased by about 12 years over the two decades from the 1940s to the 1960s , attributable to the same reasons.

And did you know, for example, that death rates from cardiovascular disease in the general population have fallen 30% since 1991, and 70% in the last 35-years?

Remembering that cardiovascular disease is the single biggest killer of Aboriginal and Torres Strait Islander people, it’s exciting to think of seeing the same decrease among our peoples.

Another related killer is smoking. As National Coordinator for Tackling Indigenous Smoking I am tasked with leading and mentoring a dedicated workforce to significantly reduce the rate our peoples smoke. And with one in five premature deaths linked to smoking, this is an area that must be addressed with priority.

This is a vital effort: one in five premature deaths are linked to smoking.

We have the resources and the capacity to do it.

Last year, we had the fourth highest overall life expectancy in the world. We have managed this for the majority of Australians for decades now.

Is it unreasonable to ask that this become a shared reality for the 2.5% of the Australia population who are Aboriginal and Torres Strait Islander peoples?

We are one of the per capita wealthiest nations in the world.

The missing ingredient for change, when we started back in 2006, was political will.

The campaign’s challenge back then was to harness what political will was there, as well as community support (for example: in the reconciliation movement), and to build on it.

And so it was in January 2006 that the intellectual foundation of the campaign: achieving Aboriginal and Torres Strait Islander health equality within a generation was first published as a chapter in the Social Justice Report 2005 and transmitted to the Australia Parliament.

The chapter used the language of human rights to analyse the Indigenous health crisis as a human rights issue. And it laid out a human rights approach to achieving health equality.

It called for a catch up – that the health opportunities and gains that were made by the general population in the 100 years of the 20^th century needed to be extended to the Indigenous population within a generation.

And the result was an approach people could rally behind.

We knew for us to succeed, we also needed a national plan and we needed targets. We needed the focusing of minds and resources that plans and targets, when used intelligently, can harness. And we needed to be partners, with Australian governments, in this national effort.

And (at last count) more than 20-peak Indigenous and non-Indigenous health, and health professional, peak bodies coalesced around this approach to drive the campaign.

 

• Australian Human Rights Commission
• Australian Indigenous Doctors’ Association
• Australian Indigenous Psychologists’ Association
• Congress of Aboriginal and Torres Strait Islander Nurses
• Indigenous Allied Health Australia Inc.
• Indigenous Dentists’ Association of Australia
• National Aboriginal Community Controlled
• Health Organisation
• National Aboriginal and Torres Strait Islander
• Health Workers’ Association
• National Association of Aboriginal and Torres Strait Islander Physiotherapists
• National Indigenous Drug and Alcohol Committee
• Australian General Practice Network
• Aboriginal Health and Medical Research Council
• Australian Medical Association
• Australians for Native Title and Reconciliation
• Australian Peak Nursing and Midwifery Forum
• Bullana – the Poche Centre for Indigenous Health
• The Fred Hollows Foundation
• Heart Foundation Australia
• Menzies School of Health Research
• Oxfam Australia
• Palliative Care Australia
• Royal Australasian College of Physicians
• Royal Australian College of General Practitioners
• Professor Ian Ring (expert adviser)

The campaign’s day-to-day operations, including the maintenance of a secretariat, are self-funded, and while all have contributed funds, I would particularly like to acknowledge the generosity of Oxfam Australia in that regard.

The first two years of the campaign were about getting the message out. We used posters, gave hundreds of speeches, took out full-page advertisements in national newspapers, and created publications and community guides. We took advantage of the internet and social media.

The annual National Close the Gap Day – this year on 24 March - is a vital part of that awareness raising and support gathering process –around 570 community-level events that took place last year. And that looks to be exceeded by over a hundred events this year.

And to date, almost 150 000 Australians, and many other organisations, have formally pledged their support for the campaign.

We are particularly pleased that Australia’s National Rugby League has joined the campaign, dedicating an annual round of matches to Close the Gap ‘branded’ matches with messages about Indigenous health broadcast to millions along with their matches.

This was the people power that we used that leverage to help secure political support and we’ve been very successful in laying the foundation that will, it is hoped, bring the national shame of health inequality to an end by 2030. And I highlight:

In December 2007, COAG adopted the target of achieving Indigenous health and life expectancy equality within a generation and to halve our under-five’s mortality rate within 10-years.

In March 2008, the campaign held a national Indigenous health equality summit, at which the then Prime Minister, Kevin Rudd, other key ministers, and then Opposition Leader Brendan Nelson, signed the historic Close the Gap Statement of intent that commits the Australian Government to developing a National Health Equality Plan supported by the partnership I have already referred to.

And since then almost every State and Territory government and opposition have signed the statement of intent, giving it national status

And of course we’ve seen almost $5 billion of ‘closing the gap’ branded programs from Australia governments of which the $1.6 billion national partnership agreement on closing the gap in Indigenous health outcomes is a highlight.

Other great initiatives have seen the establishment of the National Indigenous Health Equality Council, the appointment of the first ever Minister for Indigenous health, and the Prime Minister’s annual report to Parliament on closing the gap, to which the campaign produces a shadow report each year.

I hope I have left you with a sense of hope; of what can be achieved if we work together to a common end: Australians working together can make a difference.

The challenge for the future is to build on the foundation in place so our children can enjoy the same long, healthy and prosperous lives as all Australia kids, and within our lifetimes.

And I’ll pass you to Mick for some words on what’s needed in that regard.

Thank you.

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Commissioner Gooda

Thanks Tom, and can I also thank Aunty Agnes for her welcome and acknowledge the Ngunnawal elders and distinguished others among those here today.

It seems like only yesterday that I was speaking here, setting out my agenda as Aboriginal and Torres Strait Islander Social Justice Commissioner.

Last November, I said my agenda was underpinned by two unshakeable and personal commitments: the first one is my commitment to addressing the disadvantages still faced by Aboriginal and Torres Strait Islander peoples today and the second is my commitment to doing all in my power during my term as commissioner to achieve a truly reconciled Australia.

And I am particularly pleased to co-chair the Close the Gap Campaign because it succeeds at both measures.

I am driven by the possibilities of change and at its core is people and their relationships. So whereas Tom has spoken of the campaign in terms of ‘people power’, I will talk about it terms of ‘relationship power’.

People power only works, after all, if people are talking to each other, and working to a common goal.

Back in November last year I said that at the centre of my priorities is the belief that we need to:

First, develop stronger and deeper relationships between Aboriginal and Torres Strait Islander peoples and the rest of the Australia.

Second, develop stronger and deeper relationships between Aboriginal and Torres Strait Islander peoples and all levels of government.

And, perhaps even more importantly, we need to develop stronger and deeper relationships between ourselves as Aboriginal and Torres Strait Islander peoples.

And as I look at the campaign and how it has evolved it seems to me it has succeeded in all three areas: it has laid the foundation in terms of relationships, policy and programs in the past five years that we hope to see translated into results on the ground in the next five.

It’s no secret that we Indigenous Australians are such a minority that our votes hold little sway at elections. Indeed, it is the relative lack of power at the ballot box that I believe has facilitated our marginalisation, and hence compounded our health issues.

People power is thus a vital force for us. We must gain the support of all Australians if we are to initiate political change. That is why the Close the Gap campaign is not a ‘black’ movement. It looks to ‘people power’, black and white, for change, not votes.

It has brought together, for the first time, Indigenous and non-Indigenous health peak bodies at the national level and asked them to work together. And I won’t lie to you that it has always been an easy process.

Central to the success of the campaign in that regard has been the establishment of relationship ‘ground rules’.

The first of these ‘ground rules’ is the principle of Indigenous leadership.

Central to the human rights approach to addressing disadvantage, and hence the campaign, is empowerment.

Whatever steps are taken towards health equality should empower us as Indigenous peoples and organisations, and not – as in the case of the Northern Territory intervention – make the mistake of presuming that the end always justifies the means.

Empowerment in relationship is what empowerment is. That means that relationship is ultimately about process: listening to, and hearing, Indigenous voices in that process.

So what worked for the campaign?

Clear ground rules - Decision-making was achieved by consensus with the understanding that if there were any serious disagreements it was the Indigenous leadership that would have the final say.

Working within a principled framework - As Tom has indicated, members of the campaign committee had to indicate basic agreement with the human rights approach as set out in achieving Aboriginal and Torres Strait Islander health equality within a generation. This prior agreement ensured that the campaign has not suffered any significant ‘ideological’ disagreement since its inception.

Neutral chairs. Tom and I co-chair the committee in a neutral ‘non-partisan’ fashion.

The second area of relationship building was between Indigenous peoples and Australian governments. And this too has not been easy, and had its ups and downs. But I believe the following are keys to our success in building the relationships that have brought forth so many positive developments.

Governments are formed by people. Almost too obvious to need elaboration, we have set out to build positive inter-personal relationships at all levels of Australian governments, from advisers to ministers.

No surprises. While the campaign reserves the right to criticise Australian governments, and has done so on several occasions, it also works with governments. As such, it does not unnecessarily surprise or embarrass.

This is not just a question of politeness or cow-towing, it is in fact extremely strategic. After all, we are looking to work in partnership with Australian governments. That is, as equals, on a foundation of trust. As such, partnership cannot be simply ‘added on’ at the end of a bruising, punishing relationship process. It’s got to evolve from day one, and that has required our attention on the political engagement process at all stages of the campaign.

Work, as much as possible, in a cross-party, bipartisan fashion that includes the greens and independents. In a campaign with a generational (to 2030) time frame, it is pointless to alienate one side of politics for short term political gain. Again, process and inclusivity is all.

Finally, as above, looking to empower Indigenous Australians in all interactions with government. Thus, for example, in relation to a national health equality planning forum our bottom line is that an Indigenous Australian co-chairs this with a government representative. This would be a real manifestation of partnership.

The final area of relationship building has been among and between Indigenous organisations and stakeholders. And as anyone with much experience in the sector knows, these relationships have not always been smooth-sailing. So what has worked in the context of the campaign?

As mentioned previously, good interpersonal relationships, neutral leadership from the campaign co- chairs, and a clearly defined common goal and broad framework for its achievement have been just as important to maintaining the Indigenous relationships as the Indigenous –non-Indigenous relationships in the campaign.

And I would add to these a willingness to be ‘non-territorial’ in relation to the Indigenous health space as a whole, while – on the other hand – respecting the expertise of members in relation to particular areas.

So how does this look in practice?

Late last year, building on a series of meetings over the previous 12-months, the campaign received a request from Ministers Snowdon and Roxon for advice to progress a national plan for health equality and a partnership.

Our response was to form, from the Indigenous health peaks on the Close the Gap Campaign Steering Committee, a historic alliance of Indigenous health peaks and key stakeholders including

 

• the National Congress of Australia’s First Peoples
• Aboriginal and Torres Strait Islander Social Justice Commissioner of the Australian Human Rights Commission
• Australian Indigenous Doctors’ Association
• Australian Indigenous Psychologists’ Association
• Congress of Aboriginal and Torres Strait Islander Nurses
• Indigenous Allied Health Australia, Inc.
• Indigenous Dentists’ Association of Australia
• Lowitja Institute
• National Aboriginal and Torres Strait Islander Healing Foundation
• National Aboriginal and Torres Strait Islander Health Workers’ Association
• National Aboriginal Community Controlled Health Organisation
• National Congress of Australia’s First Peoples
• National Coordinator, Tackling Indigenous Smoking
• National Indigenous Drug and Alcohol Committee

 

Working together, we secured the agreement of Ministers Snowdon and Roxon that the former would oversee responsibility for developing a national long-term plan for health equality.

We expect to see a plan to begin to be developed this year.

Also vital, as I have highlighted, is that planning will proceed in partnership. And to date we have secured an agreement that the two sides of the partnership will be led by:

• Minister Snowdon for the Australian government and Australian governments; and
• The National Congress of Australia’s First Peoples with a ‘health caucus’ likely to be operating out of (but not necessarily limited to) chamber three. And there is also a role for the National Indigenous Health Equality Council.

We also met with Prime Minister Gillard as a part of this engagement process.

And I am pleased to report that she has accepted an invitation to an “Indigenous health tour” highlighting the health needs of Aboriginal and Torres Strait Islander peoples and showcasing the services and programs that meet those needs. And we are working with her office on this as I speak.

So I hope this highlights some of the fruits of the campaign’s approach and, more broadly, how a focus on relationships has the potential to transform the Indigenous affairs space.

But it would be naive to suggest that the campaign can rest on its laurels in relation to Australian governments.

The challenge now is how to build on that foundation – how to implement the commitments and agreements we have secured in a comprehensive, integrated and coordinated manner and across all the necessary government portfolios, in a way that addresses not only health but also the many social and cultural determinants of Indigenous health inequality.

I am excited and looking forward to a new dawn not just in health, but in education, in housing and in employment. The stars are aligning.

And I want to finish by reflecting on the potential importance of the upcoming constitutional referendum on our health.

Not surprisingly the campaign supports the recognition of Aboriginal and Torres Strait Islander peoples in the Constitution, and the removal of any lingering racism in our foundation document.

It does this because constitutional change should be seen as an important part of securing health equality for our peoples.

It is more than just symbolism; it is empowerment. The positive effect on our self-esteem, the value of our culture and history, and the respect it marshals from others can make real differences to the social and emotional well being of Indigenous Australians everywhere.

And the Close the Gap Campaign holds many lessons for the constitutional reform process ahead of us.

Constitutional reform must proceed on a basis of positive and healthy relationships.

And it must be a people power movement. At the end of the day, the people will cast their votes one way or another.

And in this we have our work cut out. Key findings of the 2010 Australia reconciliation barometer include some really good news: 87% of all Australians agree the relationship between black and white is important and 48% say it is improving, and there is a growing tide of curiosity and goodwill out there

But we still don’t trust each other. Just 9% of all Australians feel that trust between the two groups is good. And 93% of respondents, particularly on the Indigenous side, felt that there are high levels of prejudice between the two groups.

And of course we too must work to secure bi-partisan support among all levels of all Australian governments, and work with coalitions of Indigenous and non-Indigenous peoples and organisations to see the reforms through.

In this regard, the lessons of the Close the Gap Campaign will be invaluable.

Congratulations to the campaign on its fifth birthday. Can I thank everybody who has been involved to date for their outstanding efforts. May the next five years be as rewarding, and turn a great foundation into health improvements that are felt on the ground.

And may all Aboriginal and Torres Strait Islander peoples in this nation enjoy the high standard of health this nation can provide, and as soon as possible.

Thank you.