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Deplorable omissions in NCD declaration, as government fails to back Indigenous quest for visibility

The declaration arising from next month’s UN High Level Meeting on NCDs is unlikely to make specific mention of the needs and priorities of Indigenous peoples.

It’s a conspicuous omission, given the disproportionate burden of non-communicable disease carried by First Nations members all over the world, and the United Nations’ strong stance on the rights of Indigenous peoples.

As a Member State and a sworn defender of Indigenous human rights, the Australian government is in a good position to support Indigenous peoples in their quest to be recognised in this important document, but will they?

Croakey asked the question, as advocates reiterated their deep concerns that real health gains are unlikely while Indigenous peoples remain “invisible” in key international health forums.


Marie McInerney writes:

The Australian Government made five pledges in its successful campaign last year for election to the United Nations Human Rights Council.

One was to “advance the human rights of Indigenous peoples around the globe,” including undertaking to support the UN Declaration on the Rights of Indigenous Peoples “in both word and deed” and to increase the participation of Indigenous peoples in all relevant UN processes and mechanisms.

Yet its failure to publicly back a campaign to include specific reference to Indigenous peoples in a critical upcoming UN agreement – the Political Declaration on Noncommunicable Diseases (NCDs) – raises doubts about the Government’s commitment to this pledge.

In a seven paragraph statement issued through the Department of Health that could best be described as mealy-mouthed – the Government also failed to respond meaningfully to Croakey’s questions about any efforts it had made on behalf of Indigenous peoples in the drafting of the UN declaration.

Indigenous health and human rights advocates say the lack of a specific reference to Indigenous peoples in the Declaration as it is currently drafted is “shameful”, given that Indigenous people are disproportionately burdened by non-communicable diseases (NCDs), and that Nation States need to be “held to account” on health disparities.

They say Indigenous peoples have not been meaningfully engaged in the global NCD discourse to date and have had little formal participation in UN meetings on NCDs, underscoring their “invisibility” in international forums and efforts.

“Our voice is not heard in the UN system, it’s drowned out,” said Les Malezer, chair of the Brisbane-based Foundation for Aboriginal and Islander Research Action (FAIRA) and a member of the UN Permanent Forum on Indigenous Issues, which meets twice yearly.

Missing the mark on a slow motion public health emergency

Non-communicable diseases (NCDs), including cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of death in the world, representing 63 per cent of all annual deaths.

The UN’s 2030 Sustainable Development Goals (SDG) include a specific target to reduce by one-third premature mortality from NCDs, which have been described by former UN Secretary General Ban Ki-moon as “a public health emergency in slow motion”.

But the UN is worried that current global action on NCDs is insufficient to meet the SDG target.

The UN High-Level Meeting (HLM) of Heads of States and Government, set down for September 27 2018, is designed to reinvigorate action that began in 2011 with the first Political Declaration on NCDs.

That declaration did explicitly recognise the disproportionate impact on Indigenous peoples and the need for community-led solutions (see screenshot below).

The latest draft of the 2018 Declaration does not.

Desperately seeking visibility

Adjunct Associate Professor Carmen Parter, from the Poche Centre for Indigenous Health at the University of Sydney, was among those sounding the alarm in Geneva in May at the launch of the World Federation of Public Health Associations (WFPHA) first Indigenous Working Group, which she co-chairs.

Attending a session of the World Health Assembly, she tweeted:

How will Indigenous issues be considered in the 2018 UN High-Level Meeting on NCDs? This is a critical question when we know that NCDs are the major contributing factors to the health and wellbeing of Indigenous people globally. #enoughNCDs #NCDs #IndigenousWFPHA @_PHAA_

Sadly the NCDs panelist was unable to respond to my question about Indigenous issues included in the high-level Mtg on NCDs so very disappointed because this demonstrates how invisible our issues are at the global level #NCDs #enoughNCDs #IndigenousWFPHA @WFPHA_FMASP @OnTopicAus

In June, Summer May Finlay, co-vice chair of the WFPHA Indigenous Working Group (and a contributing editor at Croakey) and Kate Armstrong, founder & president of CLAN, founded the #IndigenousNCDs movement to try to put the issue on the agenda.

Three Indigenous representatives, from Canada and the US, attended UN civil society hearings on the NCD Declaration in July, urging Nation States to “prioritise Indigenous communities and the challenges they face addressing NCDs across the globe”, to acknowledge the role of racism and colonialism, and to highlight solutions, such as community controlled health services and cultural safety initiatives.

Making their case in a recent post at Croakey, Finlay and Armstrong said:

As it stands, the draft NCD Declaration, without specifically mentioning Indigenous peoples is not able to guide states or hold them to account for the health of Indigenous people.

We know that many states are currently not collecting adequate data on Indigenous people and without specific language that is inclusive of Indigenous peoples, states are likely to continue to fail Indigenous peoples.”

Deplorable omissions

Indigenous groups are not alone in having grave concerns about the draft NCD Declaration.

The NCD Alliance, which represents 2,000 civil society organisations in more than 170 countries, issued a statement earlier this month that said it “deplored” critical omissions in the draft Declaration which was “not nearly as ambitious, innovative nor groundbreaking as it needs to be.”

The Alliance highlighted the omission of sugar, alcohol and tobacco taxes, the lack of accountability mechanisms, insufficient safeguards against industry interference, and new language about personal responsibility that “fails to recognise that people cannot make healthy choices if the environments in which they live do not provide such choices”

But, to the disappointment of the #IndigenousNCD campaign, although the NCD Alliance did recommend specific inclusion of Indigenous peoples in its original submission on the Declaration, the media release and an earlier statement of concern about the draft did not raise the issue of Indigenous people, nor was it a focus from any non-Indigenous groups at the July civil society meeting.

“To me that says civil society has a long way to go on this as well,” Summer May Finlay told Croakey.

The Alliance later tweeted its support for the campaign (see image), and wrote in a comprehensive statement to Croakey that the issues raised in its media statement “merely scratched the surface” of the problems with the draft Declaration.

Alliance CEO Katie Dain made the point that the 2018 Declaration will reaffirm previous NCD commitments, which means that the specific considerations of Indigenous peoples that all countries have committed to in the UN Resolution signed in 2012 still stand.

“However, we are very disappointed not to see more specific commitments to reduce health inequalities within and between countries now as there has been painfully little progress since 2011,” she said.

“We believe this approach has led to a substantially weaker draft Political Declaration in several areas, including the omission of a specific reference to Indigenous Peoples.”

Unanswered questions

As a Member State, Australia is involved in the High Level Meeting and the negotiations leading up to the declaration. So what is our Government’s position on the new NCD Declaration and how hard have we been fighting for inclusion of Indigenous people “in all relevant UN processes and mechanisms”?

Croakey addressed a series of questions to both Indigenous Health Minister Ken Wyatt (the first Indigenous member of an Australian Cabinet, who campaigners hope will attend the September UN meeting) and the Department of Foreign Affairs and Trade (DFAT), asking:

  • Does Australia agree the Declaration should explicitly acknowledge the “enormous and inequitable burden” that NCDs place on Indigenous communities, and the need to acknowledge the reasons for that (including racism) and ways to address it (including solutions like community controlled services and cultural safety)?
  • Has the Australian Government made any efforts to seek the inclusion of a specific reference to Indigenous Peoples in the Declaration, particularly given its pledges ahead of its election to the UN Human Rights Council?
  • Will any Ministers of the Australian Government be attending the HLM in New York on September 27?
  • What is Australia’s view on the importance of these sorts of instruments for improving the health and wellbeing of Indigenous peoples?

We additionally asked the Minister:

  • Do you believe that Aboriginal community controlled health services could provide a global example for how best to address NCDs in Indigenous and non-Indigenous communities, and are there any other Australian initiatives that you believe could be helpful in global efforts to prevent and control NCDs?

We were advised that the Department of Health would “take the lead” on responding to our questions and, after nearly a week, received the following statement which did not answer the questions, and revealed little specific detail about Australia’s position or role in the process. It said:

Australia is strongly committed to assisting indigenous peoples, both in Australia and overseas, to overcome social and economic disadvantage, and to improve health outcomes.

The Australian Government has actively engaged in the negotiation process for the Political Declaration of the UN High Level Meeting on Non-Communicable Diseases.

We have advocated for the right of every human being to the highest attainable standard of health, including those who are more vulnerable to non-communicable diseases.

The negotiation process is in the very final stages. The resulting document will be high-level and reflect a balance of the diverse interests and priorities of 193 countries.

Member States interpret Political Declarations in line with national priorities. In Australia, this includes support for Indigenous Australians through Government initiatives such as the Tackling Indigenous Smoking program, which aims to reduce smoking rates and reduce smoking related deaths in the Aboriginal and Torres Strait Islander community.

Background:

The Department of Health is leading, with support from DFAT, Australia’s engagement in the UN High Level Meeting on Non-Communicable Diseases, including the negotiations for the Political Declaration.

Australia’s participation in the High Level Meeting on Non-Communicable Diseases is still being finalised as part of our broader UNGA (UN General Assembly) delegation.

Avoiding accountability and an advocacy void

It was a response that disappointed but did not surprise Finlay, given Australia’s lack of progress in closing the gap in health outcomes for Aboriginal and Torres Strait Islander people, and recent suggestions that the Closing the Gap Refresh may shift away from setting targets.

“I don’t think (the Australian Government) would want to be held accountable for the health of Aboriginal and Torres Strait Islander people on the international stage,” she said.

She expects that other nations also don’t want to be required to report health outcomes comparing their Indigenous and non-Indigenous populations.

“They’re not going to want to highlight what will be seen as their failure,” she said.

Finlay and Armstrong have been invited to meet with Minister Wyatt to discuss the #IndigenousNCDs campaign but Finlay concedes that the meeting and the campaign’s efforts are likely to come too late to achieve any revision of the draft Declaration by September 27, given the many months that have gone into the drafting process by member states.

And that’s a measure, she says, of the demands on Indigenous people who have to fight on many campaign fronts at the same time – a burden in itself, but particularly so given the health, education, and economic disadvantage that they bear globally.

“So it’s really disappointing when a Government like Australia which is well resourced does not support its own Indigenous people by advocating on their behalf,” she said.

The need for empowered Indigenous voices

Malezer says Australia can’t be judged on how well it meets its Human Rights Council pledges until it has completed its full three-year term, but that the above statement to Croakey “provided no evidence that Australia is living up to that commitment when it comes to NCDs”.

It’s part of the reason why countries like Australia need to have more robust engagement with Indigenous groups and communities, he said, asking whether the Federal Government’s Indigenous Advisory Council was consulted at all on Australia’s contribution to the NCD Declaration.

Both Malezer and Parter see the problems with the NCD Declaration as pointing to the need for stronger Indigenous voices in global governance structures in the UN and the World Health Organisation (WHO), as well as within the Australian Government.

Malezer says Australia should be “one of the loudest voices” in advocating Indigenous rights internationally, given its Human Rights Council pledges and failures in Closing the Gap.

But he said the blame does not lie solely with the Member States, but also with the systems of the UN which should ensure the principles of self-determination, if the Declaration on the Rights of Indigenous Peoples is embedded in all its work.

“It’s not just the UN states, it’s the collective system, through the bureaucracy of the UN, that should be pushing for this,” he said.

The failure of the system with the NCD Declaration was “a glaring example” of why Indigenous peoples should have permanent ‘observer’ status at the UN to allow them to participate more fully in its work, he said.

Parter sees similar problems with the WHO, including its planned program of work (2019-2023).

“Again, another example of the poor representation of Indigenous people’s public health issues at the global level. Another shame for the broader public health community,” she told Croakey.

Revised: This article has been revised on 21 August to note that the NCD Alliance did recommend specific inclusion of Indi