Calma, Tom --- "Setting the Challenge: Achieving Health Equality in a Generation" [2006] IndigLawB 44; (2006) 6(21) Indigenous Law Bulletin 2

Setting the Challenge: Achieving Health Equality within a Generation

by Tom Calma

It seems every week there is new research outlining the chronic health situation of Indigenous Australians.

In April, The 2004-05 National Aboriginal and Torres Strait Islander Health Survey,^[1] involving 10,000 Indigenous participants, found that two-thirds had at least one long-term health condition, one-third reported eye problems, and around 12 per cent had heart and circulatory diseases.

The headlines scream out statistics of despair and injustice and then fade out of peoples’ consciousness just as quickly. Some examples from the last six months include: ‘Boil cases on the rise in NSW Indigenous community’ and ‘National Heart Foundation research shows Indigenous rheumatic fever on the rise.’

In the 1994 Social Justice Report,^[2] Social Justice Commissioner Mick Dodson noted:

We have all heard them – the figures of death, and of disability. Every few years, [the] figures are repeated and excite attention. But I suspect that most Australians accept them as being almost inevitable. A certain kind of industrial deafness has developed. The human element in this is not recognised. The meaning of these figures is not heard – or felt.

Evidence suggests that Indigenous Australians today experience a similar state of health as non-Indigenous Australians did almost a century ago. Over the twentieth century, the non-Indigenous population gained opportunities to be healthy that were not extended to Indigenous peoples. As a result, life expectancy for Australian women increased 26.7 years, while for males it increased 28.7 years. Indigenous people were simply left behind. Today, there is still a 17-year gap in life expectancy between Indigenous and non-Indigenous Australians.

There are a number of disturbing trends among Aboriginal and Torres Strait Islander peoples that reveal an entrenched health crisis. These include:

• chronic diseases such as cardio-vascular diseases and diabetes;

• poor health among infants;

• poor access to primary health care, resulting in high rates of sexually transmitted infections including HIV/AIDS; and

• risky behaviour, including substance abuse and alcohol use.

On top of this, I fear that Indigenous peoples face substantial health problems which are often left undiagnosed and untreated. This is particularly the case with mental health, as well as oral/dental health problems.

Most of these chronic diseases are preventable. Dramatic improvements in health status can be achieved within a short time frame. So why has there been so little progress in Indigenous health in Australia?

There are three main failings of governments in their response to Indigenous health issues. First, there have been no specific timeframes set to achieve goals; second, commitments have not been matched with action, that is, funds and program support. Thirdly, there is no holistic approach to Indigenous health.

Each year I produce the Social Justice Report for Federal Parliament on the status of Indigenous human rights. This year, I have set out a campaign for Aboriginal and Torres Strait Islander health equality within our lifetime. This seeks to build on existing policy frameworks and to learn from current successes and failings.

The campaign recommends that governments commit to ensuring:

• an equitable distribution of primary health care and equitable standards of health infrastructure (such as water and sanitation) within 10 years;

• equality of health status and life expectation within the next generation (25 years).

This will require a focus on specific diseases and conditions; an address to social determinants of health such as income, education and functional communities; and changes to the position of Indigenous peoples in Australian society.

I have developed this framework within a human rights based approach to health, creating an empowering environment for Indigenous peoples and focusing on the accountability of governments to achieve improved outcomes within a reasonable time period.

My campaign recommends that the goals of the National Strategic Framework for Aboriginal and Torres Strait Islander Health^[3] be incorporated into the operation of new, post-ATSIC, arrangements for Indigenous affairs. The whole of government structures and regional coordination approaches that have been developed can be built upon.

Since releasing this framework, my Office has developed partnerships with organisations from the areas of health, human rights and reconciliation to advance the campaign. It has gained the formal support of the National Aboriginal Community Controlled Health Organisation (‘NACCHO’) and over 130 Aboriginal community controlled health organisations NACCHO represents. We have received valuable support from Oxfam Australia, Reconciliation Australia, Australians for Native Title and Reconciliation (‘ANTaR’), Australian Indigenous Doctors Association, and various professional medical associations such as the Australian Medical Association, the Royal Australasian College of Physicians and the Australian Division of General Practice.

Addressing inequality in health status is not insurmountable, although it will require long term action and commitment. It is not credible to suggest that one of the wealthiest nations in the world cannot solve a health crisis affecting less than three per cent of its citizens. If funding is committed in the short term, then the expenditure required is likely to decline thereafter.

If we do not rise to the occasion, things could get worse. The Indigenous population is younger and growing faster than the non-Indigenous population. Unless we act now, there is the risk that this generation will inherit the burden of ill-health.

It is quite clear – there is no greater challenge to this country’s sense of decency, fairness and egalitarianism than the current status of Aboriginal and Torres Strait Islander health.

Tom Calma is the Aboriginal and Torres Strait Islander Social Justice Commissioner with HREOC. He is an elder from the Kungarakan tribal group and the Iwaidja tribal group. He has been involved in Indigenous affairs at a local, community, state, national and international level and worked in the public sector for over 30 years.

^[1] Australian Bureau of Statistics, The 2004/5 National Aboriginal and Torres Strait Islander Health Survey (2004-5) <http://www.abs.gov.au> at 20 September 2006.

^[2] Social Justice Commissioner, Social Justice Report 2004 (2004) <http://www.hreoc.gov.au/Social_Justice/sj_reports.html> at 20 September 2006.

^[3] Department of Health and Ageing, National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003) <http://www.health.gov.au> at 20 September 2006.