The "symbolic infrastructure" of the Howard Government in Australia needs to change in order for Indigenous Health in Australia to progress, says a Special Report in this week's edition of The Lancet.
The Special Report, authored by journalist Margaret Harris Cheng, quotes Ian Anderson, Professor of Indigenous Health at the University of Melbourne, who refers to the Howard Government's refusal to sign the UN treaty on indigenous people's rights, saying: "There is a mounting body of evidence that good health is not achieved if you take away people's control of their lives. Australia would not sign the indigenous people's treaty because of the self-determination clause and the idea that it threatens a nation state."
Anderson also comments on the Howard Government's refusal to apologise to indigenous people for the damage wrought on them by European colonists. Cheng says: "This, says indigenous leaders, has symbolically obstructed reconciliation at all levels of society. Both these issues are in the Labor party platform, which says a Labor government will sign the indigenous people's treaty and formally apologise to indigenous people. If they win office on Nov 25, the strength of those promises will be tested." Anderson believes the promises will be kept, concluding: "The best thing that John Howard could do for reconciliation is to leave office."
According to The burden of disease and injury in Aboriginal and Torres Strait Islanders, cardiovascular disease and mental disorders were the major disease categories for these people, accounting for 32% of the disease burden. Cancer made up just 8%, compared to 19% in the non-indigenous population -- but this is because indigenous people are dying earlier, from other causes. There is also a 17-year gap in life-expectancy between indigenous and non-indigenous Australians.
The Special Report also criticises the Howard Government's response to Little Children are Sacred -- a report detailing widespread child abuse in Northern Territory indigenous communities and neglect of the issue by authorities. The Howard Government interventions, which were supported by the Labor party -- included sending police to indigenous communities, tying welfare payments to school attendance, banning alcohol and instituting compulsory child health checks (later made voluntary). Vasantha Preetham, president of The Royal Australian College of General Practitioners, says: "While we support the availability of health checks the RACGP would be very concerned at the introduction of a fly-in, fly-out model of health assessments for children. Aboriginal people need an ongoing and trusted source of high quality health care, not stop-gap measures."
However, the Special Report is not all doom and gloom in relation to indigenous health, with Anderson saying that indigenous life expectancy has improved. In the Northern Territory, it has increased from 52 years for men and 54 years for women in the late 1960s, to 60 years and 68 years respectively, largely due to reductions in home overcrowding and the incidence of infectious diseases. He adds that statistics show the indigenous population in Australia in growing at 2% at year, with 40% of indigenous Australians aged under 15 years, while the Australian population as a whole is aging. He acknowledges, however, that indigenous Australians as a group are much less healthy than non-indigenous Australians. He says: "In terms of the health gap, 50% of it is due to the fact that when indigenous people get sick they die much more quickly. The other 50% is due to risk factors. We need to provide access to quality care, focus prevention around tobacco control and diet, and invest in a health workforce."
He adds: "We also need aboriginal doctors and nurses, we did not have any aboriginal medical graduates until the 1980s…we have had a very poor history, we need to create a critical mass." Cheng says that training many more indigenous health workers will lead to more indigenous people inside the health system able to make it respond more effectively to their needs."
The different paths of indigenous and non-indigenous children through the Australian school system are also explored, especially the higher suspension rates for younger indigenous children. The Special Report says: "There is, indeed, plenty that can be done to improve aboriginal health by focusing on education, community involvement, and improvement of the structure of the health service, particularly staffing and the provision of primary care."
The paper associated with this release can be found at
http://multimedia.thelancet.com/pdf/press/Specialrpt.pdf
Journal
The Lancet