Speech: 6th Indigenous Environmental Health Workers Conference

Opening address

6th Indigenous Environmental Health Workers Conference,

Cairns

 Tom Calma

Aboriginal and Torres Strait Islander Social Justice Commissioner

Human Rights and Equal Opportunity Commission

 23 May 2007

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Introduction

I begin by acknowledging the Gimiy Walubara Yidinji people, the traditional owners of the land where we meet today, and paying my respects to their elders. I also thank the National Indigenous Environmental Health Forum, the Conference Organising Group and Queensland Health for organising this event and inviting me to open this conference. And thank you to Shane Nicolls for his opening words and introduction.

For those of you who don’t know, in July 2004, I took up my appointment as the Aboriginal and Torres Strait Islander Social Justice Commissioner at the Human Rights and Equal Opportunity Commission. This role was created in 1992 to provide an ongoing monitoring agency for the human rights of Indigenous Australians.

Functions of the Social Justice Commissioner

I am conscious of the relatively short period of time I have here, so of the various functions I have, I want to highlight that I am required to report annually to the federal parliament on the status of enjoyment and exercise of human rights by Indigenous Australians. This is called the Social Justice Report.

I was pleased to be offered the chance to open this conference because it gives Indigenous Environmental Health Workers and others ‘at the coal face’ in Indigenous communities a forum to have their voices heard and from which to influence policy and decision-making that touches on the vital issue of the environmental health.

Forums such as this one should not be taken for granted in the current post-ATSIC Indigenous affairs era -- with the Office of Indigenous Policy Coordination in Canberra, and the Indigenous Coordination Centre network, as well as things like Shared Responsibility Agreements. After four years of tracking these so-called ‘new arrangements’ through the Social Justice Report, to me there is no more apparent flaw in the way things are organised now than in relation to processes for engagement – or more accurately, the absence of these - with Indigenous peoples, both at the national and regional levels, but increasingly at the community level.

Since ATSIC was dismantled, the Australian Government has consistently emphasised that engagement with Indigenous peoples is a central requirement for the sustainability of the ‘new arrangements’. And yet, there has been little progress to ensuring that appropriate forums and mechanisms exist to facilitate this. Policy is being developed in a vacuum at the national level, with no connection to Indigenous experiences at the local and regional level and without applying the ‘reality test’ that comes with Indigenous participation and local engagement.

So I commend you – the participants in this forum - not only for the vital work you do in communities, but also your commitment to keeping this channel for engagement open. My acknowledgment also goes to the various state health departments and the enHealth Council for maintaining their commitment to the forum over the years and for publishing the excellent reports from these conferences which are an invaluable resource to anyone working in, or interested in, Indigenous environmental health, or Indigenous health generally.

Main health recommendations of the SJR 2005

Indigenous health has been a major focus of my time as Aboriginal and Torres Strait Islander Social Justice Commissioner. Many of you may know that in the 2005 Social Justice Report I recommended to Australian governments that they commit to a campaign to achieve Indigenous life expectation and health status equality within 25 years.

Further, that this overall commitment be supported by further commitments to achieve equality of access to primary health care and health infrastructure within 10 years for Aboriginal and Torres Strait Islander peoples. And it is this health infrastructure aspect of my recommendations that I want to focus on today.

I am pleased to tell you that there has been a tremendous positive response to the recommendations in the report.A coalition of over 40 Indigenous and non-Indigenous organisations have begun working in partnership to progress a rights based approach to Indigenous health by Australian governments.  And naturally, I would be hoping to get as much support as possible for the campaign from forums like this one.

Now, the health campaign was built around the right to health, which is of direct relevance to health inequalities Indigenous peoples suffer in Australia today, and hence to the policy environment within which Indigenous Environmental Health Workers operate. So I thought it my be useful for you to hear what the right to health is, and how it may touch on your work and the recommendations that you feed from the conference back up the chain, so to speak.

Right to health

So what is the right to health? Well, it is found in article 12 of the International Covenant on Economic, Social and Cultural Rights. The Australian Government ratified this treaty in 1966 – that is, agreed it applies to all Australians – but has not made it domestic law.  What this means is that you cannot go to a court in Australia and enforce your right to health. However, it can be expected that it would guide policy-making within Australia.

Now can I address a common misperception that it is some abstract ‘right to be healthy’ - no state can guarantee the health of it citizens in an absolute sense against the forces of old age and so on.

What the right to health does say, however, is that the state has an obligation to provide opportunities for its citizens to be as healthy as possible. What this means in practice is that the Australian state provides, or ensures, two things:

• The first is directly relevant to your work, what is called ‘health infrastructure’ that lays the foundation for good health: safe drinking water, hygienic conditions (with sewerage and garbage safely disposed of), healthy housing, and a supply of healthy food. The right to health requires that these things are both established and effectively maintained at a standard that supports good health.

• The second are health goods and services. And, in particular, primary health care services. Now, I won’t be speaking to this part of the right today, apart from noting that it obviously covers a vital part of any overall approach to Indigenous health and you can read more about this in the Social Justice Report.

Further, the right to health obliges a state to ensure that everyone – regardless of sex, race, age, sexuality and so on – has an equal opportunity to be healthy.

For health infrastructure, this means that communities across Australia (whether Indigenous or non-Indigenous) should enjoy a similarly healthy standard of drinking water, can access fresh vegetables, fruits and meat, and have their sewerage and garbage removed. It also means that they enjoy – from a health perspective – the same standard of housing, that is in good repair, with functioning sanitation, and not overcrowded.

And we all know that -- despite some areas where real improvements have occurred (such as water supplies in many communities) -- this is still not the case. And I’m not going to list off the well-known statistics that highlight the glaring inequalities particularly in relation to housing stock – in terms of its condition, and that it is far too often overcrowded, and the impacts this has on sanitation and so on. I am sure this is something which everyone here has directly experienced.

Now a key component of the right to health is planning. And the right to health requires that if gross inequality exists, there should be a plan to reach equality as soon as possible.

And this is the first point that I want to make about the poor standard of health infrastructure in communities - there is no overall plan for specifically addressing this.

While the Indigenous component of the National Environmental Health Strategy, the Eat Well Australia strategy; and the Building a Better Future Strategy, as well as programs such as the now defunct Community Housing Infrastructure Program (the CHIP – now replaced with the Australian Remote Indigenous Accommodation Program) are to be welcomed,  there is still a need for a comprehensive intersectoral and intergovernmental approach that aims to coordinate all these strategies into an overall plan with the explicitly stated, time-limited goal for securing equality for Indigenous communities in relation to health infrastructure.

As noted, in my Social Justice Report, I have recommended that this goal be set within a time limit of 10-years.

Now, I note that there is a National Indigenous Environmental Health Strategy under development by the National Indigenous Environmental Health Forum, following a recommendation made by the 5th National Conference of Indigenous Environmental Health Workers - a recommendation I commend the conference for making.

And I am pleased to hear that the National Indigenous Environmental Health Strategy aims to be as a holistic as possible in relation to Indigenous environmental health, and that it looks to integrating as much as is possible of these other strategies into something approaching what I am suggesting here.

However, what I am talking about here is - in a sense  - beyond the Forum to initiate – it is ultimately dependent on an agreement at the level of the Australian Health Minister’s Conference.

So why do I link such plans to time limits?  It is because according to the right to health, governments have an obligation ‘to take steps’ to progressively achieve the full realisation of rights like the right to health and to do so without delay. Steps must be deliberate, concrete and targeted as clearly as possible towards meeting the obligations recognized in the Covenant.

Such an approach also uses benchmarks that should be:

• Specific, time bound and verifiable;
• Set with the participation of the people whose rights are affected, to agree on what is an adequate rate of progress and to prevent the target from being set too low; and
• Reassessed independently at their target date, with accountability for performance.

And this links into my second point, that a national Indigenous health infrastructure strategy aside, there is a failure to set targets and benchmarks even within existing sub-strategies: for housing, sanitation, food supplies and so on. Certainly, beyond broad brush goals of ‘equity’ and ‘environmental health justice’, there are no clear targets in the National Environmental Health Strategy, Eat Well Australia or Building a Better Future.

Without such benchmarks, Australian governments are simply not accountable for progress – or lack of progress - because there is nothing to measure their commitments against. And as I have advocated, such benchmarks and targets should be based on the indicators set out in the Overcoming Indigenous Disadvantage Framework and the Aboriginal and Torres Strait Islander Health Performance Framework.

Targets and benchmarks also help ensure that the resources needed are devoted to the task. And there is no excuse for the shortfalls we have seen year after year! In federal budget after budget, there have been enormous surpluses – the recently announced budget had a surplus of $10 billion. Yet the Australian Government has not chosen to use these to end a health crisis faced by less than 3% of its citizens.

And finally, (and this takes me back to my earlier comments), it is vital that Indigenous people and communities participate in, and are engaged in, the planning and delivery of services that affect them in planning, including in the setting of targets and benchmarks.

This requirement is more than just a nicety. It is a tenet of international human rights law. It relates to the rights to self-determination, non-discrimination and equality before the law, as well as to the right of cultural minorities to enjoy and practice their culture. But its necessity also comes from practical experience. Bureaucrats and governments can have the best intentions in the world, but if their ideas have not been subject to the “reality test” of the life experience of the local Indigenous peoples who are intended to benefit from this, then government efforts will fail.

FPIC

Specifically in relation to Indigenous peoples, these requirements for participation have been expressed as the principle of free, prior and informed consent.  In brief:

• Free requires no coercion, intimidation or manipulation;

• Prior requires that consent has been sought sufficiently in advance of any authorization or commencement of activities and respects time requirements of Indigenous consultation and consensus building processes;

• Informed requires that information is provided that addresses the purpose, scope, obligations and impact of any proposed activity; and

• Consent requires that consultations be undertaken in good faith; on a basis of mutual respect; and with full and equitable participation.  It also requires that Indigenous peoples can participate through their own freely chosen representatives and customary or other institutions and ultimately it must allow the option for Indigenous people to withhold their consent.

And in relation to this point, it seems that at best what we are seeing now is a winding back of even the potential for Indigenous participation. For example, the federal Government’s decision to abolish the CHIP - and replace it with the Australian Remote Indigenous Accommodation Program looks like an attempt to lock Indigenous people out of planning and management of their own lives and communities by cutting out communal ownership and getting rid of Aboriginal controlled housing.

The recent agreement by the Tiwi people is also a concern. You may have heard that the Tiwi people have bowed to federal Government wishes and gave away their right to control their coastal township of Nguiu by granting the Government a 99-year government head lease over Nguiu. In other words, they will now have only a limited say in what can occur on their land. And in return, they get one million dollars worth of health services, a new school and some improvements to recreational areas.

Now I respect the right of the Tiwi to enter such agreements, if they are conducted according the principle of free, prior and informed consent. However, I visited Nguiu in January this year and asked a community meeting of 150 people whether they understood the 99 year lease proposal, only one person said they did, and yet the federal Government has rushed this plan through.

However, there is another thing that from a human rights perspective is wrong with this agreement. Health services, schools and so on are rights: no-one should have to trade their land for these.

Both these concerns are also relevant to the making of Shared Responsibility Agreements or SRAs. I am sure that many of you are aware of, or may even have been involved with, the making of these.

SRAs provide a significant opportunity to advance infrastructure provision and management within communities and many have proven of benefit to communities: some of the ‘no pool, no school’ SRAs, for example, are entirely appropriate.

My first point is that SRAs must be negotiated according to the free, prior and informed consent principles. And second, there are limits on when they should be used. As I have noted, SRAs, or indeed any other ‘bargaining’ processes should not be used to negotiate the delivery of basic rights, and this includes health infrastructure: essential infrastructure provision –such as water supply, sanitation and sewerage. Now, that doesn’t mean that SRAs have no place in relation to some aspects of these things. But you have to look at the detail to work out if the SRA is acceptable from a human rights perspective.

Guidelines for making SRAs according to human rights principles are set out in the Social Justice Report. I would commend these to you, particularly if the communities you are working in are considering entering an SRA to address some environmental health or health infrastructure issue.

Conclusion

Now I have covered a range of fairly complicated issues in a short period of time. If you want to find out more detail about the health equality campaign, or some of the other issues I have raised here, please read the Social Justice Report online.

Thank you