Marie McInerney reports:
Indigenous health leader Pat Anderson will today warn that Australia’s Aboriginal medical services risk being driven away from their roots and original missions by growing pressure to chase specific purpose funding for “technical ‘interventions’”.
Anderson will tell the Lowitja Institute’s biennial conference that having to continually chase after tied funding “chips away at one of the key foundations of the community controlled health sector – the holistic definition of health and the need for comprehensive public health to support it.”
“There is a sense that the sector is being driven away from its roots in the community and its radical visions for better health and wellbeing for all of our peoples.”
Anderson, who is the chair of Lowitja Institute – Australia’s national institute for Aboriginal and Torres Strait Islander health research – said the development of a strong and vibrant Indigenous health sector means it is more able now than in the past to address the issue.
But she said:
“We need to remind ourselves: pills and vaccinations can’t cure poverty. They can’t get kids to school. They can’t politicise young people to stand up for their rights and take pride in their Aboriginality. They can’t combat racism. The social determinants of health…are still there, placing profound limitations on what health services can achieve….”
See an edited version of her speech in the last section of this post.
The two-day Congress Lowitja 2014: Many mobs, one vision: creating a healthy future was always likely to be topical, particularly after the election of the Federal Government late last year.
Participants are keen for insights on where Indigenous health will fit in the Government’s priorities in today’s keynote address by Warren Mundine, Chairman of the Prime Minister’s Indigenous Advisory Council, on the Future of Aboriginal and Torres Strait Islander Health.
The race row inflamed by shock columnist Andrew Bolt will add interest to speeches by academic Marcia Langton and Race Discrimination Commissioner Tim Soutphommasane and to a comedy event – ‘Is racism the new black?’ – featuring Charlie Pickering and Libbi Gore, that intends to “start a conversation about racism by using humour to break through barriers”.
Langton this week apologised to Bolt for offending him, which she explained in a 19-page essay. Soutphommasane continued to campaign against the Federal Government’s proposed dismantling of Section 18 of the Racial Discrimination Act, warning it “may license racial hatred”.
Mundine this week stepped in to that row, reportedly advising the Prime Minister to reverse the plan to remove the provision. The Indigenous Liberal MP Ken Wyatt has also warned that he could cross the floor if his party moves to repeal laws that make it unlawful to offend, insult or humiliate a person on the basis of their race or ethnicity.
The deputy chair of the Indigenous Advisory Council, Professor Ngiare Brown, will also attend the conference, chairing a session on Culture, Identity and Health.
See the full program and also Lowitja’s new report, The Shape of Things to Come: Visions for the future of Aboriginal and Torres Strait Islander health research (previously reported at Croakey here).
The photograph to the right was taken at the report’s recent launch.
***
Here’s an extract of Pat Anderson’s speech
Today, I want to talk about the future in Aboriginal and Torres Strait Islander health.
I want to talk about how we can contribute to making that future a positive one.
But before I look forwards, I’d like to take a look back to see where we’ve come from.
I’d like to celebrate the fact that today, as Australia’s First Peoples, we are living in a world that was unimaginable a few decades ago.
For example, when I was at school in Darwin in the early 1960s, we were not aware of a single Aboriginal person with a university degree.
It was unheard of.
How could I have foreseen that within 50 years over 25,000 of Aboriginal and Torres Strait Islander people would have tertiary qualifications, so that today we can now draw upon a growing number of Aboriginal and Torres Strait Islander health researchers?
This is one example of how unknowable, and how surprising, the future can be.
Another example is the extraordinary success of the Aboriginal community controlled health services over the last four decades.
As we all know, the first Aboriginal Medical Service was set up by the people of Redfern in 1971.
In the heady days of the 1970s and 1980s, many other AMSs were set up around the country.
Despite the diversity of the Aboriginal communities that created them, they shared a few key principles.
First and foremost, although they came to be government funded, they were emphatically under the control of the local community through elected boards of management.
Second, they embodied a broad, holistic view of health.
They rejected a narrow, individual-focussed ‘medical model’, to advocate for comprehensive approaches to health care that included action on the drivers of ill health.
They explicitly recognised the importance of social and emotional health, spirituality and community wellbeing.
Last, they saw their role as having two faces: the delivery of health services to the community, yes, but also they were the voices of the community, active advocates for their health, and ultimately vehicles for self-determination.
It is hard now to recall just how radical this model was, or the hostility with which these services were often met.
Speaking up for their community and the right to health often had them branded as trouble-makers.
But today, the key ideas of the sector – the importance of comprehensive primary health care, of community control, of addressing the social determinants of health – are now accepted by everyone (at least in theory).
This, in my view, is a great achievement of the community controlled health sector: at a national level they changed the way the health of Aboriginal and Torres Strait Islander people is seen, and how it is to be addressed.
Another great success has been the expansion and resourcing of the sector.
From that first AMS in Redfern in 1971, other communities created their own local organisations, until there was a network of community-controlled health services in every state and territory across the nation.
This was supported by key policy documents such as the National Aboriginal Health Strategy (1989) and the Royal Commission Into Aboriginal Deaths in Custody (1991).
By the early 1990s there were – I am speaking from memory here – around 80 or so community controlled health services across the country.
Despite this, they were still held back by the piecemeal and low level of government funding.
ATSIC had been given the responsibility for Aboriginal health funding – but was never given anywhere near the resources to adequately address it.
A determined campaign during the mid-1990s, initiated and led by the community-controlled health sector, led to a number of significant changes.
This included the creation of the now defunct Office of Aboriginal and Torres Strait Islander Health, and most importantly, steady and significant increases in funding for Aboriginal health in general and for the AMS sector in particular.
This allowed a further increase in the number of Aboriginal communities served by an AMS over the last twenty years – now there are over 150 such services.
They are much better resourced now – some are very large comprehensive services, with dozens and in some cases hundreds of staff.
So, from their beginnings as fringe-dwellers on the edge of the mainstream system, they have become absolutely integral to the Australian health system as it relates to Aboriginal and Torres Strait Islander people.
Of course, there is a lot more work to be done – many communities do not have access to a community controlled service, and the challenge of service delivery in an environment of high need is always there.
But the success of the sector is, in my view, something to be celebrated.
It really has been a case of communities and activists, and their supporters from the non-Aboriginal world, coming together, dreaming big dreams of a better future, and getting down to the hard work of bringing that imagined world into existence.
….But with that success has come new challenges.
Today, in my view, community controlled health services face continual pressure to return to a narrower, more medical model of service delivery.
This pressure is reflected in how government funds our health services.
Much funding is provided for specific programs, often focussed on particular conditions.
These funds come with very strict guidelines on how they are to be spent, not to mention complex reporting and administration requirements (the cost of meeting which are rarely incorporated into the funding provided).
And many funding programs are short-term, replaced every few years with a new focus on a new health priority, to be delivered in a new way.
As a result, health services often find themselves caught running after specific purpose funding in a never-ending cycle.
This chips away at one of the key foundations of the community controlled health sector – the holistic definition of health, and the need for comprehensive primary health care to support it.
It foreshadows a return to a narrow, individually focused medical model, where better health for our peoples is simply to be gained through the application of a discrete number of technical ‘interventions’.
But we need to remind ourselves: pills and vaccinations can’t cure poverty.
They can’t get kids to school.
They can’t politicise young people to stand up for their rights and take pride in their Aboriginality.
They can’t combat racism.
The social determinants of health – what we used to call the underlying causes of ill health – are still there, placing profound limitations on what health services can achieve in terms of outcomes for the communities they serve.
The danger is that we will all continue to acknowledge these deep drivers of ill health – but then turn back towards doing what we get funded for – the delivery of a narrow suite of government-approved ‘interventions’.
And the danger is that this pattern of events will serve to disconnect Aboriginal Medical Services from their communities.
They threaten to undermine genuine and vibrant community control, as services are forced to retreat to a much narrower view of their role that excludes advocacy and (let’s face it) the beneficial effects of strategic trouble making.
This, it seems to me, is the real conundrum facing many Aboriginal Medical Services today.
I say this as someone who is no longer directly part of the community controlled health sector.
And I say it in the spirit of asking a difficult question to which there is inevitably no easy answer.
But I get a strong sense of unrest from those friends and colleagues within the sector, who face this dilemma on a daily basis.
There is a sense that the sector is being driven away from its roots in the community and its radical vision for better health and wellbeing for all of our peoples.
In the face of this, I ask the question: how can the community controlled health services respond to this situation?
Do we need to have a re-think of the model that was established forty years ago and how it might work in the future we have created?
These are questions of course for the sector itself and its leaders.
But I would suggest that in seeking answers to these questions, we have a number of huge advantages compared to where we were four decades ago.
More of our people are better educated than ever.
We are much more knowledgeable about the health sector and how government works.
And we have, over this last fifty years, grown up several generations of strong and sophisticated health activists – some of whom are sitting in the room today!
So we can’t be so easily blocked by so-called experts with their particular take on the evidence.
We know our stuff.
And what we don’t know we can find out because we have got the Lowitja Institute.
I think we could play an important role here.
As you all know, the Lowitja Institute itself grew out of the actions of the Aboriginal community controlled health sector, through successive iterations of the Cooperative Research Centres for Aboriginal and Torres Strait Islander Health.
Supporting the sector through high quality health research remains central to who we are and what we do.
Over the next two days, I would like to invite you to reflect on the history of the Aboriginal community controlled health sector.
And I would further invite you to consider the question of how we, as Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research, can contribute to their continued success.
Because I think their success will be critical to building a positive future for Aboriginal and Torres Strait Islander people’s health – just as it has been in the past and present.
Thank you.
***
Further reading
Eatock v Bolt [2011] FCA 1103 (28 September 2011)
Article is here.
• See this statement issued by the National Congress of Australia’s First Peoples which says:
“Representatives of the Indigenous, Greek, Jewish, Chinese, Arab, Armenian and Korean communities have expressed their “vehement opposition” to changes that have been mooted to sections of the Racial Discrimination Act which prohibit public conduct that is reasonably likely to “offend, insult, humiliate or intimidate” a person or groups because of their skin colour or national or ethnic origin.
The group of representatives was reacting to a story which appeared in The Australian on Tuesday speculating that the Federal government proposes to remove the words “offend, insult, humiliate” from section 18C, as well as removing the requirement that a defendant must have acted “reasonably and in good faith” in order to be covered by the free speech defences available under section 18D.
“These changes would mean that the Federal government has decided to license the public humiliation of people because of their race”, a spokesperson for the group said.
“It would send a signal that people may spout racist abuse in public, no matter how unreasonably and dishonestly. It would be astonishing if an Australian government in the 21st century was prepared to embrace such a morally repugnant position. It would be utterly indefensible. The suggestion that section 18D might be amended by deleting the threshold of reasonableness and good faith comes as an especially unpleasant surprise to us.”
The group, which has been pursuing a vigorous campaign to dissuade Federal politicians against any repeal or watering down of Australia’s laws against racial vilification, vowed to step up its activities.
“The Racial Discrimination Act is one of Australia’s most iconic pieces of legislation. It goes to the heart of Australia’s identity as a nation that is both democratic and culturally diverse. The law ought not to be changed unless there are truly compelling reasons. The outcome of one contentious case falls a long way short in that regard”, the spokesperson said.
“Australia’s long term national interests in maintaining a harmonious society and the respect of neighbouring countries are being sacrificed on the altar of political expediency in order to score points in the so-called ‘culture wars’. It will leave a lasting stain on the legacy of the present government if they proceed with this.
“The existing sections 18C and 18D were enacted in 1995 after three national inquiries in Australia found that there is a nexus between racially vilifying conduct in public and racially-motivated violence. The two sections strike a careful balance between freedom from racial vilification and freedom of expression.
“Once people understand that the existing law only applies to serious cases and requires an objective test to be satisfied based on community standards, rather than a subject test based on hurt feelings, it becomes clear that the current law is about enabling targeted groups to defend themselves against racial vilification and has nothing to do with limiting free speech.
“The law does not stop anybody from offending, insulting or humiliating others because of their conduct, opinions or beliefs. People can change their conduct, opinions or beliefs. But the current law does prohibit publicly offending, insulting or humiliating others because of their race, which is something people cannot change. Offending, insulting or humiliating other people because of their race is not about persuasion. It’s about attacking their human dignity.”
It is expected that the government will table draft legislation before the Parliament within the next fortnight. “The more extensive the proposed changes are, the stiffer the opposition to it will be”, the spokesperson predicted.”
