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How would the Voice make a difference for health? Let us count the ways…

The wide-ranging health issues at stake in the Voice referendum were canvassed during a #CroakeyLIVE webinar this week, as Australians were urged to vote for “love and hope”, rather than “fear and rage”.

At least 218 health and medical organisations have publicly asserted their support for a constitutionally enshrined Aboriginal and Torres Strait Islander Voice to Parliament and the executive, according to a list compiled by Croakey.


Marie McInerney writes:

Whatever the outcome of Saturday’s Voice referendum, the Yes campaign has showcased outstanding Aboriginal and Torres Strait Islander leadership, scholarship and creativity, along with grassroots momentum towards Indigenous equity and justice, a #CroakeyLIVE webinar heard this week.

Panellists at the #VoiceforHealth event, who included Federal Health and Aged Care Minister Mark Butler, talked about the “enormously unifying, uplifting moment” in the nation’s life that a Yes vote could deliver, and hailed the powerful Indigenous intellectual contributions during the long campaign, including the work of Indigenous organisations, scholars, community leaders, journalists and Black media outlets.

However, the one-hour panel discussion also heard that a No vote would fundamentally change Australia for the worse and should prompt “a reckoning” on lies spread by mainstream and social media, as well as the ignorance of many Australians about the country’s history and the ongoing impact of colonisation.

“There’s a lot of racial gaslighting going on which, for me, really highlights the absolute need for historic truth telling,” Lowitja Institute CEO Adjunct Professor Janine Mohamed, a Nurrunga Kaurna woman, told the event.

Dr John Boffa, public health medical officer at the Central Australian Aboriginal Congress and Professor of Primary Health Care with Charles Darwin University, talked bluntly about the devastating blow that a No vote would deliver.

“Some No voters think a No vote is a vote for the status quo or for no change,” he said. “But a No vote will fundamentally change this country.”

“It means Australia is less compassionate, less rational, less able to think about the needs of disadvantaged people, and it will fundamentally change the relationship between Aboriginal people and the state,” he said. “It will be devastating.”

Boffa’s words echoed those also this week from Cape York Indigenous leader Noel Pearson, who said there is a moral dimension to the vote and that Australians should know they are making a “critical historical and ethical choice”.

“Yes is a moral choice and No would be a travesty for the country and we will possibly never live it down,” Pearson told ABC radio.

Pearson on Wednesday was remaining optimistic, saying he was feeling “love in the air”, buoyed by the 45,000 Yes volunteers out on the ground and the many quiet indications of support he received from others, “coming out in very quiet ways, giving us the thumbs up”.

Marcus Stewart, former co-chair of Victoria’s First Peoples Assembly, which offers a state template on a Voice and Treaty process, told Croakey he was also still hopeful as he stopped off at a pre-polling booth in Melbourne.

He spoke about one tough encounter he had with a No campaigner, but said “for every hard conversation you have, there’s about 30 positive ones”.

“We feel the love, we feel the support,” he said, thanking allies.

But Pearson also warned that Australia would pay “a huge cost for No: No is not costless, No will take us nowhere, No will repeat the failures of the past”.

Speaking again on ABC radio, he said we would “find the inner life of our nation with this vote” – either the love and hope that the Yes campaign is drawing on or the fear and rage the No campaign is trying to tap.

“We are going to account for the nation’s soul this weekend, it’s the first time we’ve done it since white settlement,” he said. “My only request is that on Saturday, people vote with their hearts, with a sense of love and generosity…and a sense of hope.”

Tangible difference

The webinar was the second of Croakey’s #VoiceforHealth events in the lead-up to Saturday’s vote. The panel also included Goreng Goreng woman Amy Gordon, First Nations Referendum Director at GetUp!, and was moderated by Professor Bronwyn Fredericks, Deputy Vice-Chancellor (Indigenous Engagement) at the University of Queensland and co-chair of Croakey Health Media.

With just days to go before the vote, Fredericks opened the discussion asking panellists how a Yes outcome would make a tangible difference to their work and roles.

For Mohamed, first and foremost a Yes vote would make a huge difference, because “our spirits would be lifted pretty high, we would feel very supported and valued by the Australian public”.

But more specifically, for the Lowitja Institute a Voice would work towards a community-led research agenda that directed funding where it was actually needed, she said.

“In Aboriginal and Torres Strait Islander health research, so much of the issue is not actually about how much money is spent, because there is actually a lot of money in the system. It’s where it actually gets to,” she said.

A Voice would more efficiently target funds to Aboriginal and Torres Strait Islander researchers and communities to lead research on issues they identified as priorities. That would result in better quality research and knowledge translation, as well as a stream of secondary effects, including investment in local communities, increased research workforce capability, better health literacy, greater awareness about invaluable cultural knowledges and health system savings, she said.

Mohamed gave as an example the Birthing In Our Community project in Queensland, which led to 50 percent fewer pre-term births for our babies and significant health improvements and, as the Lowitja Institute’s report on the economic benefits of a Voice pointed out, saved almost $5,000 per mother-baby pair.

Mohamed was a co-author, along with Indigenous and non-Indigenous colleagues, of an article this week in The Lancet Global Health, that outlined how a Voice would mean greater progress globally in wellbeing and health.

“It is consistent with public health principles and backed by the evidence that policies and programmes that work for communities require listening to such communities, working with them, following their empowered leadership, and enabling their self-determined control,” they wrote.

The authors said the Voice would “create the conditions needed to boost housing, education and health outcomes for Indigenous Australians and, in turn, help advance global health equity.”

An editorial by the journal implored Australians “to look beyond political point-scoring, fearmongering, and frustration and recognise the symbolic nature of a constitution change to formally recognise the First Nations people of Australia and their unique knowledge and understanding of what is needed to improve their health and wellbeing”.

“A ‘no’ vote will effectively deny this recognition and set Australia back as a nation. In 2016, British people voted to leave the European Union largely on the basis of misinformation and fear and are now living to regret it. Australians must not make the same mistake,“ the journal said.

Focus on social determinants

The panel also highlighted the importance of the Voice for action on the social determinants of health.

Boffa also said a Yes vote would deliver a meaningful boost to individual and collective self-esteem, major determinants of health, and would go some way towards addressing the racism that many Aboriginal people experience in their day to day lives.

The other major tangible benefit would be in addressing failed and neglected needs in education, employment and housing, he said.

Reflecting on his 35 years’ experience of working in Aboriginal community health services, Boffa talked about efforts over decades to put Aboriginal health in Aboriginal hands in the Northern Territory. These are now finally delivering substantial improvements in health, including seeing the median age of death for Aboriginal men improve from 45 to 58 years and for women from 55 to 66 years.

That improvement hadn’t come, he said, until a legal framework required the Commonwealth and Northern Territory governments to sit at the table with Aboriginal health services “in a way where no one could walk away”.

“Now we need that structure for the other social determinants of health,” he said.

“[With a Voice], we won’t see good programs dismantled and replaced by non-evidence based rubbish, which so often happens…because Aboriginal people themselves will be at the table in a structured way and they’ll say to government ‘don’t do this’, ‘where did this idea come from?’.

Asked about the tangible impacts of a Voice, Minister Butler spoke first as a citizen, saying a Yes vote had “enormous potential just to lift the country up and to give us all a sense of having righted a very, very longstanding wrong that this (nation) was somehow vacant land when the British arrived…the only of the British colonies to be declared ‘terra nullius’”.

“This for me would be an enormously unifying, uplifting moment as a citizen,” he said.

As Health Minister, he agreed with Mohamed that a good health professional listens carefully to their patient, “and a good government and wise Parliament should listen to a group in the community that has experienced more disadvantage than any other group”, he said.

That was simply a good way to make policy: bringing with it a level of accountability and responsibility to show evidence and show results that’s not being talked about much in the Voice debate, he said.

A Voice would also deliver the capacity to build on and scale up the extraordinary work of community controlled health, but the “game changer” would be where it could knock down the silos in public policy, and bring together different government portfolios to address the social determinants.

Rheumatic heart disease was a clear example, Butler said, where health responses were important but also needed were responses addressing poverty, housing, environment and sanitation.

“… that is hard to get in policymaking….joining up those solutions is not as easy as it sounds”, the Minister said, echoing similar comments made at a Lowitja Institute Voice webinar last week by Indigenous health expert Dr Mark Wenitong.

Butler paid tribute to health professionals and organisations seeking to treat issues like RHD, “but they’re doing it with one hand tied behind their back”, when there was a need for more responsive joined-up approaches.

Toxic media landscape

At a National Press Club event on Wednesday, Senator Patrick Dodson, the Government’s special envoy for the implementation of the Uluru Statement from the Heart, issued a powerful warning about the consequences of the misinformation and disinformation unleashed in this debate, with division and acrimony that “goes to the very fabric of our civil exchanges as a democratic nation”.

Dodson, who had to step away from the campaign while undergoing medical treatment, said this is not just an issue for the referendum, “this is about the nature of our civil society” and will affect us in the future, in the way public discourses are conducted.

“There’s no baseline here,” he warned. “You can say anything (and) it’s deemed to be truth, it’s seen to be of value. There’s no weighting of the arguments, there’s no real analysis…there’s no historical dimension, there’s no acceptance of history, there’s no acknowledgment of the legacy history has created.”

This toxic environment is an issue that Get Up has also been reflecting on, amid “the first referendum that has played out largely online,” Amy Gordon told the Croakey webinar.

Gordon has been part of the Passing the Message Stick research project designed to shift public narrative in support of First Nations justice and self-determination. Its 2021 research supported leading from strengths and expertise, as a “critical antidote to the pervasive deficit language that harms us and holds us back”.

A positive for her in the referendum campaign has been the growing role of independent and Black Media, which needs to be bolstered.

But she said a reckoning is needed on how disinformation and misinformation have been able to thrive, particularly driven by Murdoch outlets, with commentators spilling out “absolute lies” in ways that spread on social media, while voters become trapped by algorithms in their own echo chambers.

“This isn’t like an election, this isn’t about political parties or about political personalities, this is about our communities,” she said.

Butler agreed that one of the positives of the Voice campaign had been the proliferation of Indigenous voices in mainstream media, an advance that has been “a long time coming”.

Broadly though, he said, the role of media has “not been a terrific story”, with mainstream outlets continuing to increasingly take broad editorial positions versus straight reporting, and a proliferation of social media platforms that allow “extraordinarily toxic harmful misinformation” to spread pretty quickly.

Raising also the issue of potential foreign interference via social media, Butler said “these are all things for us to consider deeply after Saturday”.

The commercial determinants of health are also in play, with an ABC report investigating the links between wealthy business owners, a conservative lobby group and conspiracy theorists, with one of the major backers of the No campaign involved with a private company seeking to raise more than $50 million to invest in joint ventures with Indigenous landholders.

Mental health toll

Butler acknowledged the toll of the campaign on the mental health and wellbeing of Aboriginal and Torres Strait Islander people, noting that the 13YARN helpline had experienced more than 100 per cent increase in their call numbers. And, he said, it was not just the numbers that were the worry, but “the complexity and the duration of their calls”.

The Federal Government had allocated $10 million through the National Aboriginal Community Controlled Health Organisation (NACCHO) to provide additional mental health support services through the community-controlled sector and would “obviously look at anything further that needs to be done after Saturday, depending on the result,” Butler said. But he added, “even if there’s a positive result, I think this has been a painful process for so many Indigenous results”, with a likely “long tail” of harm and distress to come.

(See this short video message from Labor Labor Senator Jana Stewart, a Mutthi Mutthi and Wamba Wamba woman, who urges Aboriginal and Torres Strait Islander people to look after themselves in the final days before the vote).

According to health policy expert Professor Stephen Duckett, the Eastern Melbourne Primary Health Network had allocated an extra $300,000 to Aboriginal Community Controlled Health Organisations for extra support services. “It’s entirely legitimate to run a political campaign in the referendum. What’s not legitimate is how No campaign incited division, hurting First Nations Australians,” he said on X/Twitter on 9 October.

Asked how she would manage with a No vote, Mohamed said she would take some time out with Lowitja Institute staff, and would probably go quiet for a couple of days. But after that, she said Aboriginal and Torres Strait Islander people would be “dusting ourselves off and getting on with the work” as they have in the face of so many rebuffs since colonisation.

Mohamed said she would look to the states and territories for leadership on Voice and Treaty, and noted the significance of the result for Australia internationally. She would also look for accountability from those who have spearheaded the No campaign, asking for their solution for a reconciled Australia “because as far as I’m concerned…they’ve never done any serious work in community to reconcile us”.

Professor Bronwyn Fredericks said the 170 or so Indigenous staff at the University of Queensland would also take time out, regardless of the outcome, to go off campus, work with Elders, come together over food and music, and access emotional wellbeing support. There would be heartbreak if No prevails, she said.

On Sunday, Boffa will join CAAC staff and community at a major cultural event that will mark the organisation’s  50th anniversary.

It would get a huge boost from a Yes vote, but it would also be important chance to come together if the vote is No, to celebrate what has been achieved historically and in the campaign, “in spite of an Australian population that still doesn’t recognise the history of the country, the struggles that Aboriginal people are going through, the extreme poverty and disadvantage that uniquely Aboriginal people experience unlike any other group in the country”, he said.

Boffa hailed the significant outpouring of inspiring and intellectually strong writing through the campaign that he hoped would be collated, including a recent article by Professor Ian Anderson and Laura Rademaker on self-determination that “was just amazing”. (And many more articles are compiled at Croakey’s Voice portal).

Many people are going to be angry with a No result, he said. The challenge will be to channel that anger into positive activism for change, rather than letting it be internalised or externalised in destructive ways.

That’s also the big hope for Gordon, whose First Nations justice team at Get Up has been working on multiple justice issues, including fracking and the killing of Kumanjayi Walker at Yuendumu.

They had never had a moment like this before, she said, where the political and media classes and general public were talking about issues that First Nations communities had been raising for decades.

That moment is of course about the referendum, she said, but it’s also about the power of millions of Australians saying the status quo isn’t working, being willing to have really hard conversations, and about First Nations communities saying they have their own solutions.

No matter what happens on October 14, she said “we’ve built this incredible base and community of people who will be fighting on October 15th, and I think that’s really crucial, because we’re going to need it no matter what the outcome is”.

“We’re going to need it to fight for all of these things that communities have been demanding, and so building on that movement of First Nations justice is really important.”

• See also this X/Twitter thread from the #CroakeyLIVE, by Marie McInerney for @CroakeyNews.

Declaration: Marie McInerney is a Croakey editor who also provides communications services to a range of not for profit organisations, including the Lowitja Institute


From Twitter



Rally in Adelaide

Rally in Mparntwe/Alice Springs

Concert in SheppartonPat Farmer makes the finish line

 


See Croakey’s portal on the Voice, compiling articles, resources and statements

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