Rights for all: Building
inclusive communities for all generations

Sax Oration delivered by Chris
Sidoti, Human Rights Commissioner to the Public Health Association of
Australia, Canberra, 18 November 1999

Thank you to the
Public Health Association for inviting me to deliver the Sax Oration this
year. I am honoured to follow so many distinguished speakers who have
delivered the oration over the years. I am honoured too to be able to
commemorate the work of Sidney Sax, one of the most significant people
shaping health care policy and practice in Australia.

Unlike Sidney Sax
and the Sax Oration before me, I am not a health expert but a lawyer and
human rights advocate. That is why my focus tonight is 'Rights for all:
building inclusive communities for all generations'.

I chose this topic
for a couple of reasons. The first is that this year presents a unique
opportunity to celebrate two important events in international human rights:
the celebration of the International Year of Older Persons and the 10th
anniversary of the Convention on the Rights of the Child. So I
will speak about older people and children in particular.

The second reason
is that I have met with rural communities all over Australia during the
past 18 months or so and I want to tell you some of what they told me.

IYOP and CROC

The International
Year of Older Persons is an opportunity to reinvigorate our commitment
to value and respect older persons and their many and various contributions
to society. Although there are no human rights treaties specifically for
older people, the Principles on Older Persons were adopted by the
United Nations General Assembly in 1991. These principles are grouped
in five main themes: independence, participation, care, self-fulfilment
and dignity. They recognise that some older people need particular care
and security. At the same time they acknowledge that older people continue
to contribute to society. The Principles and the framework for IYOP emphasise
integration and inclusion.

Likewise for children
and young people, the Convention on the Rights of the Child, which
Australia ratified in 1990, both protects children in need of special
care and assistance and guarantees their rights, including their right
to participate in decisions affecting them.

Human rights belong
to every person by virtue of birth. They are not only for majority groups
or for minority groups but for everyone equally and without discrimination
based on youth or age or other grounds.

It is also important
to appreciate that human rights are not granted to us by others or by
the government. They are ours to be enjoyed simply by reason of our common
humanity and innate dignity as human beings. For that reason we cannot
agree to give them up and they cannot be taken away from us.

Most people are aware
of their civil and political rights, for example the right to freedom
of expression. These are, of course, fundamental human rights. But matters
relating to people's social, economic and material well-being are equally
matters of human rights. These include the right to an adequate standard
of living. The enjoyment of this right requires, at a minimum, adequate
food and nutrition, clothing, housing and necessary care and support such
as health and medical services. Human rights also include the right to
work, the right to benefit from social security and the right to education.
They impose an obligation on government to give assistance and support
to families in need.

These rights are
acknowledged in one of the most important of human rights treaties, the
International Covenant on Economic, Social and Cultural Rights.
Australia is a party to this treaty. It is perhaps not as well known as
the International Covenant on Civil and Political Rights but it
is no less important.

Economic, social
and cultural rights are admittedly difficult to accomplish. The approach
of the Covenant is to encourage governments to measure their achievements
and failures and to commit themselves to progressively attaining realisable
goals. Each state party commits to achieving the rights progressively,
but this does not mean that they are not achievable. And importantly,
governments must guarantee that these rights are protected and enjoyed
without discrimination of any kind.

Bush Talks

The importance of
creating a society where the rights of both young and old are respected
has been highlighted for me by the Commission's Bush Talks Program.

Over the previous
18 months the Commission has been conducting consultations on human rights
in regional, rural and remote Australia. I have visited over 50 communities
in all States and Territories from large regional cities like Cairns and
Bunbury to small towns like Bourke and Peterborough, to remote communities
like Boulia, Papunya and Yuendumu, listening to the human rights concerns
of rural communities.

I am sure that none
of you will be surprised to hear that many communities in country Australia
we spoke to are under siege: they have declining populations, declining
incomes, declining services and a declining quality of life.

To quote one resident
of a small country town

As we head
for the year 2000 my greatest concern is for the viability of small rural
towns which are slowly being obliterated by loss of services, institutions
and medical care ... We all need to fight this insidious process or there
will be only ghost towns where busy and fruitful communities once flourished.¹

In many areas people
were greatly concerned that their fundamental human rights, especially
in health and education, were not being upheld by governments at all levels.

There is no doubt
that the concerns about health care are well founded. The general health
of country Australians is poor in comparison to urban Australians. Country
Australians have a lower life expectancy, higher rates of avoidable injury,
higher suicide rates and higher rates of illnesses such as heart disease
and cancer than urban Australians.

Despite the greater
need, the availability of health services is considerably less in many
rural areas than in urban. For example, the number of medical specialists
is substantially lower, especially in small rural centres and remote areas,
compared to metropolitan centres.²

The decline of health
services and accompanying infrastructure has a particularly extreme effect
on older people and children in the country.

Health of older
people in the country

The health needs
of older people may be difficult to meet simply because they are often
unable to travel the great distances necessary to obtain the care that
they need. They may also be poorer than many others in the community and
unable to fund themselves for private health care or to move to a town
with better services.

This means, for instance,
that it is more critical that they have access to GPs who bulk bill. Yet
in some towns we visited not one GP would bulk bill, in some instances
not even for health care card-holders.

One man from Mudgee
in NSW described how all the medical centres in town had refused to bulk
bill and how his wife had been turned away for a regular prescription
for heart medicine because she could not pay for the consultation, even
though she offered to pay on the next pension day. The pattern is inconsistent.
Travelling across north west NSW, for example, I found that all doctors
in Bourke, Brewarrina and Walgett bulk bill but not a single doctor among
the 12 in nearby Moree, by far the largest town in the region. Though
inconsistent from town to town, the pattern is replicated throughout country
Australia, in all states and territories.

Besides access to
regular health services, many frail older people need to receive specialist
attention in residential care.

According to the
Australian Institute of Health and Welfare, large rural centres and metropolitan
centres have more than 400 nursing home beds per 100,000 persons aged
70 and over. However this supply drops sharply in rural and remote areas,
by a third to less than half the rate of nursing home beds in capital
cities.³

Yet older people
in rural and remote areas can have the greatest need for residential care
because they have no family in the town any more to support them at home
and because home care services are stretched to the limit where they exist.

Bush Talks
heard of several rural and remote communities without adequate aged care
facilities. For example, in Tennant Creek we were told that the aged care
home only had 20 beds as against a need for almost double that number.
Elderly people are being sent to Alice Springs because the nursing home
is unable to care for them. This is unsatisfactory as it forces people
to move away from their family and community support structures.⁴

In one town in north
western NSW Bush Talks was told, 'you have to leave town to
die'.

Elderly people whose
home care situations break down for some reason may find that the only
place to go is the local hospital. This can put pressure on a rural hospital
and staff who may not be trained to provide aged care. One submission
to Bush Talks from Batemans Bay in NSW outlined how this affects
treatment of elderly people in care.

Some rural
hospitals, which do not have extended care facilities, view themselves
as acute institutions only, providing "acute" care to Medical and Surgical
and Maternity cases and do not tolerate well the care of the disabled
and frail aged who often need to be in their care for extended periods
of time while they await the availability of full-time care in an appropriate
Nursing Home. I have been told that 'These people waiting for Nursing
Home are "bedblockers" and we have to get them out'.

It is distressing
to hear of frail older people being viewed only as burdens within the
health system.

Health of older
Indigenous people

Whatever indicator
you choose, the situation of Aboriginal people is much worse that that
of any other Australians. For Aboriginal Australians

• life expectancy
  is 20 years less than for non-Aboriginal Australians
• Aboriginal boys
  born today have only a 45% chance of living to age 65 (85% for non-Aboriginal
  boys) and Aboriginal girls have a 54% chance of living to age 65 (89%
  for non-Aboriginal girls)
• although over
  the last 40 years the Aboriginal infant mortality rate has declined,
  it is still over three times the national average; over the same period,
  adult mortality in the Aboriginal population has increased.⁵

The lack of accessible
dialysis for kidney disease, which is very common among Indigenous people,
is deplorable. Wongai residents of the Ngaanyatjara Lands and other people
in the Central Desert region of WA must go to Kalgoorlie or Perth for
dialysis. In the NT they must go to Darwin or Alice Springs. This means
that they have to be separated from their traditional lands and community
support.

Being separated from
family, community and traditional lands can be devastating for rural Aboriginal
people. One person described it as follows:

People can't
bear to be away from their land and family and some have chosen to return
home. It really breaks a Wongai's heart when he has to go away. But without
dialysis, patients will die.⁶

Many choose to die
rather than leave family, community and land. And when they do go, they
see it as a life sentence, for they can never come back except to die.
Support in the towns for those on dialysis is almost non-existent. Many
live in the river beds or, if they are given accommodation, their families
who accompany or visit them are not.

Some communities
raised with us the lack of culturally appropriate facilities for older
Indigenous people. For example, in Alice Springs we were told that

every single
strategy and every single approach taken to aged care issues is developed
by Europeans, and is virtually useless in this particular region.⁷

The lack of appropriate
health services for older Indigenous people in remote areas is compounded
by the lack of other services, such as transport and adequate housing.

Mental health of
young people in the country

When communities
break down, or access to essential services begins to decline, some of
the first to feel the effects are young people, especially adolescents
who are grappling with complex decisions about their futures.

Almost everywhere
Bush Talks visited, lack of services for mental health was raised
as a pressing issue - including counselling, psychiatric, hostel, in-patient,
especially services suitable for young people, and especially suicide
prevention programs.

Addressing the mental
health problems of young people is more than providing youth specific
mental health services, although these are essential. It is about creating
a community which responds to young people's needs on many fronts, providing
opportunities and encouraging a sense of 'agency' - the ability to act
for oneself and to have an impact on others. For young people in many
rural and remote areas the educational, recreational and employment opportunities
are lacking. A purely 'medical model' of health care for young people
can only provide a limited understanding of young people's health needs.
The response required is a broad public health response.

The overall attitude
to young people in Australian political rhetoric was also identified as
problematic by many Bush Talks participants.

Young people
are happy to contribute to society but political rhetoric scapegoats them.
The community sees children as problems to be endured, not our future
to be nurtured.⁸

Rural education

Education is a primary
means of developing a child's sense of agency and self-worth, as well
as the fundamental skills needed to participate in society. It is the
foundation for the individual's future well-being and for community building
and growth.

The right to education
is set out in the International Covenant on Economic, Social and Cultural
Rights (ICESCR 1966) and the Convention on the Rights of the Child
(1989). This right must be ensured to all without discrimination of any
kind.

Although the right
to primary and secondary education is guaranteed, the Bush Talks
consultations found that in many rural and remote areas of Australia there
are significant impediments to children's access to educational and cultural
opportunities. In response to this, the Commission initiated an Inquiry
into Rural and Remote Education in March this year. This has given us
the opportunity to hear from a large number of teachers, parents, students
and community members about education in their communities.

We heard that children
in remote and rural Australia are less likely to complete their education
than children in regional and urban centres. Indeed in some rural areas
the participation of 16 year olds in education and training is less than
half what it is in urban areas. We also heard that some of the main problems
are the cost of schooling and the lack of income support for families.

The need for even
very young children to travel long distances daily, the inexperience and
high turnover of many teachers, the inappropriateness of distance education
for many students, the paucity of cultural and sporting opportunities
are all common problems. In some regions young people do not have real
access to secondary schooling. In much of the Northern Territory young
people do not have effective access to any secondary schooling
whatsoever.

There is
a primary school in Papunya, but throughout the whole of Papunya region
there are no secondary education facilities. Students who have completed
primary school therefore have to move to Alice Springs to further their
education. This lack of accessible secondary education facilities is reflected
in the fact that only 1% of Indigenous people in the region aged 15 years
and over participate in secondary education. There is a strong wish for
a regional high school in Papunya but this proposal has not been well
received at a government level so far.⁹

For Indigenous students
in remote communities, one of the most pressing problems is the prevalence
of conductive hearing loss due to otitis media - or middle ear infection.

In Lajamanu in the
Northern Territory the inquiry was told that 80% of the children have
hearing problems. Similarly Aboriginal people at meetings in Nguiu, Billiluna,
Kununurra and in Northern NSW raised hearing impairment due to otitis
media as a key problem affecting the education of Aboriginal children.

This has a very serious
impact on the education of these children, as without adequate teacher
training, health programs and special equipment, including sound proofing
the rooms, these children cannot fully benefit from the regular school
environment.

Some of the comments
to the inquiry on this matter reveal the very close connection between
the right to health and the right to education. Peter Toyne, Shadow Minister
for Education and Training in the Northern Territory pointed this out
to the inquiry

Really,
health and education are very closely interwoven; if you've got bad health,
it will have a major effect on the ability to achieve educational outcomes.¹⁰

A comment by a Bush
Talks participant in Alice Springs also brought this interconnection
to light

Chronic
ear disease, due to unsatisfactory hygiene and malnutrition, can result
in poor hearing and sometimes deafness. This is a big problem, especially
for young Aboriginal people throughout the Northern Territory. The fact
is when you can't hear at school, it is incredibly boring so you stop
going, and when you don't go to school, you have all day in front of you
and you've got to do something! That's when you get into trouble, sniff
petrol, start stealing things and with the mandatory sentencing you end
up going to jail. All this is because of the insufficient access to clean
water and proper food.¹¹

Interconnection
of human rights

These examples of
otitis media in schools teaches us that the basic human rights I have
outlined - to education, health, to work - do not exist in isolation.
They are inter-connected and inter-independent.

The right to education,
for example, is worth upholding not simply because it is an internationally
recognised human right. It is the basic building block for economic, social
and political development. Children in rural areas need to have an equal
education to children in urban areas so that they have the same economic
opportunities.

But education is
not only about economic opportunities - it builds community and identity,
provides students with the language tools to understand their own cultures
and to respect and understand others who share their community. It gives
them the tools to engage with the rest of Australia and work to improve
life in their community.

People in rural communities
are well aware of this interconnectedness. It stares them in the face
each day.

In some ways the
small rural community teaches us best some primary lessons for creating
inclusive regions, states and nations.

Creating healthy
community involvement

I have spent much
of the time talking about the problems facing certain sections of rural
and remote Australia. Many of the solutions to these problems are about
government priorities and funding of services. Nursing home places, outreach
services, youth suicide prevention programs, a resident psychiatrist all
require a commitment of resources, of course. Although small rural communities
can be resilient and energetic, governments cannot absolve themselves
of responsibility for them. Regions need outside assistance and resources
to turn plans into realities. Rural communities pay taxes - they are entitled
to as much support as urban communities.

As the Australian
Catholic Social Welfare Commission pointed out in its recent discussion
paper, we need to move beyond the principle of 'do-it-yourself', which
risks being an excuse to abandon those most in need.¹²

However, there is
something more than money which communities also need to become healthy-
whether you live in Papunya, Port Lincoln, Bankstown or Fitzroy.

It is the sense of
belonging which often allows a rural community to survive against all
possible odds. During the course of Bush Talks we came across many
remarkable individuals and communities who, although saddened at the changes
that may have happened, and often seriously considering leaving town,
are happy with where they live and are willing to fight to maintain the
community. It is often inclusiveness which makes people want to stay in
a country town, the sense that everyone belongs in the community.

They told us about
many good initiatives undertaken by their communities to try to address
some of the problems, especially health programs.

For example, the
Community Health Adolescent Murraylands Peer Support project (CHAMPS)
in South Australia enables young people to take action that promotes their
mental health on their own terms and according to their own priorities
through the establishment of regular CHAMPS forums. The forums provide
an opportunity for young people to work in partnership with health professionals
to find ways to create conditions within which young people have good
mental health. For example, CHAMPS conducted a River Project where young
people designed a Youth Recreation Area including a skate ramp in Murray
Bridge. The young people have also organised different working groups
to tackle specific problems or areas of importance to young people and
their community.

This type of project
develops young people's sense of agency and confidence.

Likewise the health
program at Nyirrpi, NT recognises the knowledge and skills which older
people can contribute to solve some of the health problems of the community.

In the Grandmothers'
Women's Health Program in Nyirrpi older women work with health professionals
in creating awareness about health problems and solutions by sharing their
knowledge about women's health business and their knowledge about family
and the law and by teaching the women about their law and culture. As
one woman said,

Before we
had the Grandmothers Program the old ladies just sat around all day. The
women played cards. The young girls didn't have anything interesting to
do.

Involvement in your
community creates a sense of belonging. This involvement is essential
for any community but is especially vital for rural and remote communities
who for a long time have been left out of the loop of local planning and
service delivery.

Participation by
all generations is the key to creating a healthy community, whether
rural or urban. One of the things which impressed me in the Rural and
Remote Education Inquiry and Bush Talks is the genuine concern
for the future of young people expressed by many older residents. And
these were often older people without children of school age or any other
obvious connection to school education.

This interrelationship
between generations has been recognised in the slogan for the International
Year of Older Persons, 'towards a society for all ages'.

Kofi Annan, the United
Nations Secretary-General, when he launched the International Year of
Older Persons, said

A society
for all ages is multigenerational. It is not fragmented, with youths,
adults and older persons going their separate ways. Rather it is age-inclusive,
with different generations recognizing - and acting upon - their commonality
of interest

Healthy communities
are created when people of all generations are included within that community,
without discrimination and with generosity, tolerance and respect.

Thank you.

Endnotes

¹ The
Country Web; A newsletter for rural women and their families, 'Speaking
Personally', Marion Palmer, Jerilderie, No. 16 Winter 1998, page 4.

² Australian Institute of Health and Welfare, Health in
rural and remote Australia, AGPS, 1998, p.viii.

³ AIHW, ibid, p.92.

⁴ Tennant Creek Bush Talks, NT, 6 October, 1998.

⁵ Submission to Bush Talks from Central Australian Aboriginal
Congress, Alice Springs NT.

⁶ Kalgoorlie Bush Talks, WA, August 1998.

⁷ Alice Springs Bush Talks, NT, 5 October 1998.

⁸ Port Augusta Bush Talks, SA, June 1998.

⁹ Papunya Bush Talks, NT October 1998.

¹⁰ Peter Toyne, Shadow Minister for Education and Training,
NT Legislative Assembly, Rural and Remote Education Inquiry, Darwin hearings
10 May 1999.

¹¹ Alice Springs Bush Talks, NT October 1998.

¹² Australian Catholic Social Welfare Commission, 'Regional
Unemployment and the Indirect Employer: Beyond the Principle of Self-Reliance',
Common Wealth,Vol.7, No.2, August 1999.

Last
updated 1 December 2001