Introduction by Croakey: When infectious diseases specialists gathered for their annual scientific meeting in Canberra recently, a senior Indigenous medico Dr Louis Peachey urged them to prioritise action on child poverty, a problem that “shames and diminishes us all”.
In his presentation to the Australasian Society for Infectious Diseases Annual Scientific Meeting, Peachey said the work of the new Australian Centre for Disease Control must address the impact of poverty upon illness.
He also spoke of the importance of precision and consideration in language to avoid unkindness and cruelty to junior colleagues.
His speech, published below, is a reminder of how few politicians have even mentioned the importance of addressing poverty during this federal election campaign. Imagine if they spoke about ‘poverty’ as often as ‘cost of living pressures’.
Louis Peachey writes:
I would like to acknowledge the Ngunnawal and Ngambri people, and am grateful for Aunty Violet’s welcome yesterday. My roots are in the Girrimay and Djirribal people of the Djirribaligan Language Group, being the Rainforest people of Far North Queensland.
I am aware that I am among friends, and many of the people here already have relationships with Aboriginal people and communities.
Since the success of the No Campaign of the 2023 Referendum, a portion of the population has been emboldened to whine about enduring Welcome to Country ceremonies. The common complaint is, “I don’t need to be welcomed to my own country”.
Of course, the folks saying that demonstrate their lack of familiarity with the English language.
The word “Country” is context specific. Country may refer to an area or district, it may be used as an antonym to the word city, it can indeed mean a Nation. Some of these folks will assert that Welcome to Country was only invented by Ernie Dingo for the 1976 Perth Arts Festival.
Feel free to invite those folk to go to the website of the National Library of Australia, into the Trove search engine, and look at page 15 of the Adelaide Observer, from Saturday the 9th of January, 1869.
There they can read the account of the Welcome to Country that was given to Prince Alfred (fourth child, second son of Her Majesty Queen Victoria), which occurred on Monday the 11th of November 1867, at the twin lakes at the mouth of the River Murray.
The account includes most of what you would witness at a Welcome ceremony for a football grand final. It even included a banner, held by Aboriginal people, with the words “Welcome to Our Country”.
Drawing connections
This presentation will be considerably less scientific than much of the rest of this conference. I have no PowerPoint for you to watch. My people are a story telling people. Stories connect us, one to another, and to Mother Earth. Stories are the roadmaps we use to locate our soul.
Being an Aboriginal man in my profession is to spend every day walking in two worlds simultaneously. Despite my beginnings as an outsider, my profession embraced me.
Walking simultaneously in these two worlds for 40 years means that every day I will observe something which is both astonishing, and yet at the same time not surprising.
On a regular basis, I will hear friends and colleagues use Friedrich Nietzsche’s aphorism “What doesn’t kill you, makes you stronger”. I most commonly hear this as an accommodation for our cruelty to our junior staff and students.
In fairness to Fred, he wrote this in the first person, rather than the second “What doesn’t kill me, makes me stronger”, which puts a slightly different spin to it.
Nevertheless, it has always intrigued me how many of my colleagues will hold tight to the notion, and never examine the substance of the suggestion.
Imagine this, I am a member of the constabulary, and cranky Harry charges at me holding a very large Bowie Knife. I draw my sidearm, and administer a double tap to the chest. As it turns out, Harry survives the two 9mm holes in his chest.
Does anyone actually believe that since Harry is not actually dead, he is now stronger as a result of the two holes in the chest?
Given Nietzsche’s well known use of opium and chloral hydrate, maybe the onus is on us to question the value we give to that saying.
I was watching a YouTube Podcast the other day, with Trevor Noah speaking with comedian and script writer, Neal Brennan. Trevor was talking about the way that Europeans turn these sayings into Wisdom. He coined the term, “Creating reality on a Fiction”.
My other favourite saying to ponder, is “If you can’t stand the heat, get out of the kitchen”.
Even in medicine this saying is used to shame our junior staff insisting that they should toughen up.
This is apparently despite the 19 years of formal education which they endured just to become a Junior Medical Officer. Among the things they endured every day, was us telling them, “No one gives a damn how well you did yesterday, it only matters how well you do today”.
Despite all of their achievements to date, we still treat them with scepticism as to whether or not they have the prerequisite intelligence and resilience to join our august club.
But let us look briefly at the logic supposedly on display. What is the purpose of the kitchen? Evidently it is specifically an accommodation to facilitate human beings preparing nutrition for other human beings. The kitchen is inanimate, it holds no feelings or opinions.
If the temperature inside the kitchen is such that the cook cannot focus on their goal of preparing nutrition for other human beings, then why would we expel the cook (a human being) in the vague hope that the next cook will be more tolerant of the unedifying environment of this terrible kitchen.
Surely a more logical saying would be “If you can’t stand the heat, renovate the kitchen”.
Economy before people
As an Aboriginal man I often find myself bemused at the condescension of my non-Indigenous fellow citizens, who find it quaint how my people speak of our Mother Earth, seemingly unaware the Anglosphere brought us the concept of Corporate Personhood.
Corporate Personhood imbues corporations with the rights of persons, separate from the people who own, or work within that corporation.
Our modern world treats the economy with a form of personhood, even when the economy threatens the lives and existence of human beings. Throughout the second half of the twentieth century, as a part of managing the economy, Australian governments aimed for an unemployment rate of five percent.
The fear was that if the unemployment rate dropped below five percent, it would force employers to compete for their workforce, putting upward pressure on wages.
For half a century we have been sending our graduating high school students into a job market not unlike a very cruel game of musical chairs. In this game, there are 20 players and 19 chairs.
The child who doesn’t get a chair, is then told they are lazy, and a dole bludger.
If that child is inspired to do more education or training to get a chair, we don’t increase the number of chairs, with simply displace another unfortunate young person to a life of marginalisation.
The reason we can’t just bring in the twentieth chair, is for fear of imperilling the economy. To that young person without a job, we send a message that we value the personhood of the economy, over and above that young person’s humanity.
From Fyodor Dostoevsky’s “The Brothers Karamazov” we see Ivan speaking to his brother Aloysha as he poses the following:-
“Tell me straight out, I call on you – answer me: Imagine that you yourself are building the edifice of human destiny with the object of making people happy in the finale, of giving them peace and rest at last, but for that you must inevitably and unavoidably torture just one tiny creature, [one child], and raise your edifice on the foundation of her unrequited tears – would you agree to be the architect on such conditions?. . . And can you admit the idea that the people for whom you are building would agree to accept their happiness on the unjustified blood of a tortured child, and having accepted it, to remain forever happy?”
If Ivan had posed that question to the architects of our economy, unfortunately the answer would have been, “Yeah, no worries cobber”.
Effective vector
As infectious disease clinicians, I would remind you that the most effective vector of infectious disease is poverty.
I hope as Australia develops its own Centre for Disease Control, it does not get distracted from this fact. We were reminded of this fact during the COVID pandemic with risk increasing inversely to socio-economic circumstances.
It is true that when health organisations start campaigning against poverty, it is perceived that those organisations are transforming into political organisations.
For the people who would be concerned about that, I would remind you of the fabulous quote from Rudolf Virchow, “Medicine is a Social Science, and Politics is just Medicine on a Larger Scale”.
Virchow coined this term after writing his report on his investigation into the Typhus Epidemic in Upper Silesia, just a little over 175 years ago. Simply he concluded that the root cause of the epidemic was poverty.
One of the most fascinating things for me reading Virchow’s report is that if I simply changed some of the place names, and geographical descriptions, I could convince a public health physician that it was a description of an epidemic in a remote Aboriginal community.
The population of upper Silesia was ethnically Polish, and yet the similarities with so many Indigenous Australian communities is astonishing. The similarities lay with poverty and the lack of the franchise in the governing of their homelands.
Harmful legacy
Eighteen years ago, the Australian Federal Government rolled in soldiers and the Australian Federal Police into remote Aboriginal communities of the Northern Territory as part of “Northern Territory National Emergency Response”.
This was a response to the Little Children are Sacred Report from Rex Wild QC and Aunty Pat Anderson. Rex and Aunty Pat raised concerns about neglect and the sexual exploitation of Aboriginal Children.
I was intrigued by the language used to describe the response, particularly the word Emergency.
“Emergency” is derived from “emerge”, that is, this is a new thing which just popped up.
The issues in that report had been present for a long time. It was NOT an emergency, the better English word to describe those circumstances would have been a Disgrace, arguably not a National Emergency so much as a National Disgrace.
To enable the intervention, the parliament suspended the Racial Discrimination Act.
The Federal Government was concerned about Aboriginal citizens spending their income unwisely, and wished to introduce income control measures. So they cancelled the Community Development Employment Programs that afforded much of the population work and wages, thus transforming the population from wages to welfare dependence.
Therefore it was easier to have their welfare payments controlled by the government. The intervention also introduced alcohol control measures into these communities.
There is no data that suggests this intervention was successful. The child health checks the feds undertook had already been part of an established program introduced by the Aboriginal Community Control Health Organisations a few years previously. Many of these communities had been begging for the right to introduce alcohol control measures for decades before the intervention.
Two years ago during the referendum campaign, we had political figures visiting the Northern Territory citing the terrible problem they had with youth crime, oblivious that these troubled children were the Children of the Intervention.
The saddest part of that intervention is that the failure of the authorities to consult with the Indigenous population they inflicted their intervention upon virtually guaranteed no lasting good outcome would evolve.
The foundational philosophy of the intervention was a search for blame. Deep in the veins of Judeo-Christianity are the verses in both the books of Exodus and Deuteronomy, which tell us the Sins of the Fathers will be visited upon the children to the third and fourth generations.
For those who would tell me Australia is a secular society, I would simply refer you to the three Christian Crosses in the Canton (or upper left corner) of our flag, and the image of the international head of the Church of England on all of our coinage. I concede we are a soft theocracy, but a theocracy nevertheless.
For any Christians among us who may think I am being unkind, I am aware that in Ezekiel 18:20 we are told “The son shall not bear the guilt of the father…”, though it has been my observation that the Exodus verse comes into play for the poor, whilst Ezekiel is used to justify the wealthy.
Tackling poverty
In our general approach to poverty, we look to how we can blame folks for the circumstances in which they find themselves. But surely none of us could genuinely argue that the child is responsible for the circumstances into which they are born.
When I was born in 1966, the Constitution made it illegal for me to be counted in the census. So on the 30th of June, 1966, when the census came to our house, only my father, a third generation free white settler, could be counted on that census.
As a matter of constitutional law, my mother, older brother and myself could not be counted. My big brother Edward was born in September 1962.
In early 1963, Dad, a forestry officer working among falling timber, realised he needed to write a will, in case he got taken by a widow maker. The solicitor had to explain to Dad that neither his wife nor infant son had the capacity to inherit given their Indigenous status.
I tell these stories to illustrate the fact that, at the time of my birth, Indigenous status was virtually synonymous with poverty. The good news is that since then, two-thirds of Indigenous Australians have escaped poverty.
At the time of my graduation from medical school, there were a total of four Indigenous doctors. By the end of this year, we should have tipped the first 1,000.
Of the four founding graduate board members of the Australian Indigenous Doctors Association, three have children who became doctors. Of the first three presidents, all have children who became doctors.
It is my observation that successful middle class Aboriginal people are mindful of the one-third of our kinfolk who remain in poverty. There are around 100,000 First Nations children living in poverty.
Australia’s dirty little secret is the other 800,000 non-Indigenous Australian children in poverty. A fact about which much of the population is entirely sanguine. This is an enigma given our nation’s rhetoric about giving one and all a “Fair Go”.
Costs
The NSW Council of Social Services in 2024 estimated the cost of childhood poverty in NSW is around $60 billion per year; extrapolating that to the whole of Australia, that cost would be about $195 billion per year.
With our current national budget at $734 billion per year, that would mean child poverty costs more than a quarter of our national budget.
The unmet health needs of these children will subsequently result in disproportionate incarceration rates.
The 2017 Pathways to Justice Report, from the Law Reform Commission, advised us that we were using prisons to warehouse folks suffering from mental health disorders, Foetal Alcohol Spectrum Disorder, and also estimated that 80-90 percent of Indigenous inmates had a significant hearing deficit.
Immediately prior to the 2017 Rural Wonca Conference in Cairns, one of the pre conference activities was a visit to the community of Yarrabah, 45 minutes drive from Cairns, or about 10.4km due east as the crow flies. The delegates went to Yarrabah by coach, spending much of the day eating native foods, and learning how to throw spears and boomerangs.
Just before they were due to get back on the coach to return to the hotel, an Aboriginal Health Worker took them into a conference room and had a brief PowerPoint presentation.
A slide came up noting that half of the school age children in that community had chronic suppurative otitis media. The next slide said that the average waiting time to see an ENT Surgeon was five years.
This stimulated the question from the audience, “so are you saying that for half of their school life, half of the children in this community cannot hear their teacher speak?”. To which the health worker responded “Yes”.
Can we be surprised that child’s education is inadequate, can we be surprised they become incarcerated?
State and Territory governments are now talking tough on youth crime, promising to put these children in prison. The Productivity Commission estimates the cost of incarcerating a child is $3,320 per night, or $1.2 million per year.
Is a cage really the best bang for our buck?
Priorities
An interesting feature of human beings is our capacity to be frightened of the wrong things.
We are more frightened of flying than driving, though driving causes many more deaths. We are more frightened of sharks than mosquitoes, although mosquitoes kill many more humans. We are more frightened of being called racist than actually being racist.
We are more frightened that we may give a benefit to a parent we consider undeserving than the consequences of letting their child grow up in poverty. Child poverty shames and diminishes us all.
In primary healthcare, 90 percent of diagnoses can be made just by letting the patient tell their stories. I concede that in tertiary medicine, the need for adjuvant investigations may be a little more.
Within communities around Australia, many day to day folk are capable of explaining what the real priorities are in their communities.
Of the myriad of clinical trials which have been discussed in the last day and a half, one of the most important parts of any trial, is to start with the right question.
When you are trying to reach into the Indigenous community, the best question you can ask is “How can I help?”
Author details
Dr Louis Peachey is from Girrimay, Djirribal, Quandamooka and Badtjala ancestors. He is a highly respected Rural Generalist and medical educator, as well as a mentor for Aboriginal and Torres Strait Islander doctors and medical students. Founding president of the Australian Indigenous Doctors Association, he was awarded Life Fellowship of the Australian College of Rural and Remote Medicine (ACRRM), and was instrumental in establishing the College’s Aboriginal and Torres Strait Islander members group. He is based in the Atherton Tablelands in Far North Queensland. Read more here and here.
See Croakey’s archive of articles on poverty and health
