Recent articles at Croakey have highlighted efforts to decolonise healthcare practice and HIV research.
How might policy-making be different – in both process and outcomes – if efforts were made to decolonise what remains a heavily colonised system?
This and other questions are raised by Dr Tim Senior’s sixth Wonky Health column, which examines the Forrest Review into Indigenous Jobs and Training.
He suggests that non-Indigenous Australians “need to talk about how our own cultural world-views are constant re-colonisers, stamping all over any good intentions we had”.
****
By Tim Senior
We need to talk about Twiggy. He recently published his report into Indigenous Jobs and Training, known as The Forrest Review. He tells us that if “Implemented in full, it will end the disparity between Indigenous Australians and other Australians and comprehensively build our society.”
I must say, that’s pretty impressive. Surely, on that strength alone, this is a must-read document that tells us something crucial that we’ve been missing. What has Andrew Forrest seen that no one else has?
Despite Andrew Forrest warning against cherry-picking parts of the report, Tony Abbott hasn’t taken up the invitation to implement it in full. It would presumably be quite easy to point to all the evidence and previous projects that make the case for this supreme confidence. Eva Cox, Professorial Fellow at Jumbunna IHL, University of Technology in Sydney, makes a compelling case that the report doesn’t even take a peek at the evidence.
Health, and particularly, disability arising from poor health, is both a cause and consequence of unemployment and welfare and limited training opportunities. Would implementing the Forrest Review “end the disparity between Indigenous Australians and other Australians” in health outcomes?
The recommendations, summarised here, go from the uncontroversial support of early childhood and pre-school, to the much discussed (and outside the terms of reference) Healthy Welfare Card.
All the recommendations are supported by a website, Creating Parity, for reporting outcomes. The other recommendations routinely talk about incentives and the obligations of job seekers to do what they are told to do by Centrelink, Government and businesses, with the removal of discretion and exemptions from the system (which in other circumstances might be called flexibility).
What sort of evidence might we draw on in developing policy on training and employment if we want to improve health outcomes?
It turns out that insecure or precarious employment has a range of adverse health effects, including higher mortality. This is particularly true in Anglo-Saxon countries, like Australia. There is also some evidence that welfare policies have effects on health, which, though complex, tend to show that generous welfare policies might improve infant mortality or old-age mortality figures.
It’s difficult to find evidence, though, as to whether these particular recommendations will have a positive benefit on health. The best we can do is work from principles about what we know works.
There’s a useful comparison, perhaps, in the only other major document that sets out a comparable goal: “to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians by the year 2031.” That’s the National Aboriginal and Torres Strait Islander Health Plan.
The plan was developed as a partnership between government and Aboriginal and Torres Strait Islander peak health bodies, through the National Congress of Australia’s First Peoples National Health Leadership Forum. Since then, while Andrew Forrest is asked to write a report on Indigenous training and employment, the Congress has been notified it will not receive further funding.
The two documents are working towards slightly different goals, both have a recognition that the ability to make choices about healthy lifestyles has a profound impact on other choices you get to make about the way you live. There’s a general agreement on the importance of antenatal health, early childhood impacts and education. Acting effectively at these points in life is pretty uncontroversial.
On the face of it, there’s also agreement that “These reforms will work only if first Australians themselves are involved in the design and implementation of the reforms” or “There is a full and ongoing participation by Aboriginal and Torres Strait Islander people and organisations in all levels of decision-making affecting their health needs.”
Fine words like that need to be backed up by the way you work. Those are easy words to type out, but over 200 years of history tells us they are hard to do.
Aboriginal and Torres Strait Islander people can be forgiven for rolling their eyes each time they hear this in a report and then see how, for example, the Northern Territory intervention was (and is) implemented.
I know people who will open the Forrest Report with a sense of trepidation – “will this be another non-Indigenous person who thinks they have a solution to which we are the problem?” It’s the same feeling many Aboriginal and Torres Strait Islander people have seeing a health care provider!
It’s not too hard to read a report like this and work out whether First Australians have been “involved in the design of the reforms.” Who are the people and organisations in the submissions? Who is thanked in the acknowledgements? Who is quoted in the report?
The submissions to the Forrest review are handled quite well. We get a breakdown of Indigenous people and organisations by number and a breakdown of submissions by geography. Marcia Langton is thanked in the acknowledgements, with more mentions going to the big banks, the Department of Prime Minister and Cabinet and Fortescue Metals. The majority of quotes seem to come from Andrew Forrest himself.
The summary of “What First Australian leaders told us they should do” quotes Fiona Stanley, a fine advocate, but not an Indigenous one.
We are told that Indigenous Australians used words like “idleness” about their young people. Perhaps I’m speaking to the wrong people, but I hear words like “racism” mentioned much more often than “idleness.”
I even had some fun counting the number of times these words occurred in the Forrest Review and the National Aboriginal and Torres Strait Islander Health Plan – yes, it’s a crude measure!
| Word | No. times in The Forrest Review (246 pages) | No. times in The National Aboriginal and Torres Strait Islander Health Plan(66 pages) |
| Culture (or derivative) | 57 | 96 |
| Racism | 6* | 23 |
| Partnership | 18 | 40 |
| Idle/Idleness | 4 | 0 |
*(5 relate to “racism of low expectations”)
It may be that Andrew Forrest is right in his solutions, though I’d argue that using pejorative terms, such as idle, don’t help the working-in-partnership that he’s trying to promote.
Reading the report, it looks to me like a fine example of a rich non-Indigenous entrepreneur philanthropist being unable to see beyond their own cultural worldviews – or indeed that they even have a cultural worldview. The world of health and medicine has been grappling with mixed success with this for a while, and it is currently expressed in terms of decolonisation.
This worldview does (at least) two things. It looks at Aboriginal and Torres Strait Islander people as being “other” – those strange people over their possessing culture, in the form of dot paintings and corroborrees. Meanwhile, it views “us” as being culture-free, operating in the world as it is – in this case, that’s the world of business and markets.
In this mindset, it is up to Aboriginal and Torres Strait Islander people to do all the changing, without any examination of what non-Indigenous institutions might be doing to keep people away. Those changes usually require people to become just a little bit more like “us”. You can make your own decisions, as long as it’s the decision I would have made. (We see this play out in terms like “poor choice,” “better choice,” and “rational choice.”)
It also means you can do culture, as long as it’s out of hours. This makes the mistake of understanding culture as cultural artefacts, rather than as the way life is lived. This attitude can lead to some profoundly silly statements that slip by, until you realise how culturally based they are.
Examples in this report include:
This might be news to the many Indigenous people who lived across the land we now call Australia for 60,000 years before colonisation.
“…only employers and the market can deliver real jobs.”
This might be a surprise to those people employed in all those pretend jobs in the police force, the armed forces, state schools and health services – especially as health services are the largest employer of Aboriginal and Torres Strait Islander people. (Yes. Larger than the mining sector.)
It’s as if the report exists in a vacuum. There’s no mention of Gonski or Constitutional Recognition. Throughout the report, we see the assumption that people make decisions about alcohol, gambling or drugs based on ignorance of a particular set of facts, which completely misunderstands the effects of poverty on being able to make choices about your future, even when given appropriate advice.
We see no appreciation of the social circumstances that determine people’s behaviour, just a mentality that wants to tip their decisions in a different direction, not through discussion, not through an understanding of their circumstances, but through a technological solution, the “Healthy Welfare card.”
There’s no discussion as to whether the amount on the card is sufficient, or any appreciation that people may need some cash to get on a bus or buy a stamp to actually get a job. There’s only a celebration that people with the card can’t get cash or porn or go gambling, even if this wasn’t something they were going to do anyway.
There’s also not any appreciation that there may even be unpleasant historical parallels for those using the card. You just don’t know if you don’t ask those affected by the policy.
So I think Andrew Forrest is completely wrong to say this is the solution that will end the disparity in Australia between Indigenous and non-Indigenous Australians. It’s not that there are no good ideas there. It’s not that there is nothing worth discussing. There may be.
It’s that, once again, a rich non-Indigenous person has demonstrated pretty conclusively that they don’t get it – that real engagement with Aboriginal and Torres Strait Islander peoples is about recognising our own cultures for what they are, and wondering if there might be other ways of doing things.
“The situation is so awful, we need to do something,” people say. That should be an argument for not doing the wrong things, the things that makes it worse. I think a prime non-Indigenous cultural methodology is diving in with solutions at the expense of ever listening. I try to acknowledge and correct for that in my work.
So when I say we need to talk about Twiggy, keep in mind that I have so much in common with Andrew Forrest. We are both white male Australians. We both earn above the national average, we are both in very privileged positions. We both work in Indigenous affairs in some way, and neither of us are anthropologists!
Like me, I suspect Andrew Forrest is absolutely genuine about wanting to improve the lives of some of Australia’s most deprived communities.
We need to talk about how our own cultural world-views are constant re-colonisers, stamping all over any good intentions we had. That’s what non-Indigenous Australians need to talk about.
• Tim Senior and Croakey thank and acknowledge all those who contributed to the crowd-funding campaign to support Wonky Health – more details here.
• This link compiles Wonky Health columns.
While it may be true that Andrew Forrest genuinely does want to improve the lives of Indigenous Australians, it is also well noted that he is another white ‘Australian’ privileged male. The healthy welfare card that Forrest proposed is a rebranding of the intervention in the Northern Territory. It is, in the most pure sense of the word, an intervention into the lives of the Indigenous. Even without knowing true figures, I can be certain that a large portion of white Australia buys porn and gambles. Where is the intervention for white Australia? If we are going to provide Indigenous Australians with a welfare care then we also need to provide one to white Australians. The response to the abuse of welfare money needs to be fair and equal. It is not right to paint a picture of Indigenous Australians spending their welfare money on gambling instead of their children’s education when, at the same time, this is happening in white communities.