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Using Constitutional change to improve Indigenous health

Could special recognition for Aboriginal and Torres Strait Islander people in the Parliament and in the Constitution bring benefits for Indigenous health?

In the article below, Dr Enrico Brik, the pseudonym of a self-employed consultant and sometime writer and blogger who has worked for over a decade in various roles in health services policy and planning, suggests these are measures that should be considered.

***

How the Parliament could help improve Indigenous health

“Enrico Brik” writes:

Australian society is a beautiful youth with a disfiguring scar. It is a scar that shames us most because it was inflicted by our forebears.

Yet our gaze will not be averted: repeated surgery has failed to fade it; no amount of make-up or finery conceals it. We are on show with it to ourselves and the world.

That scar is the problem of Aboriginal health.

It is not the only wound on the Australian body politic, but it is surely the one that most disturbs and disgraces us.

If ever there was a case study for the social determinants of health, Australia’s failure over Aboriginal health is it: a young, rich, successful, first world nation-state, with an enviable health, medical and scientific system.

And what do have? By far the worst Indigenous health of all the OECD nations built on colonising occupation.

In reality, the problem of Aboriginal health is strictly neither an Aboriginal problem nor a health problem. It is a malaise much deeper and wider than that.

It’s as much a calamity of obstinate unemployment, woeful literacy and education, lamentable housing, destructive drug and other addictions, dire child abuse and neglect, and incorrigible violence, crime and incarceration rates – in short, a compound of underclass social indicators. It’s just that atrocious health will do as the key exemplar and proxy for all Aboriginal ill-being.

As a function of colonisation it is at bottom a social problem. And as a social problem it has been tackled principally through economic and technical means – by pouring resources into it.

Nevertheless the Aboriginal health glass remains neither half full nor half empty; after decades of filling and refilling, of overflowing the sides and soaking coasters, it contains only dregs.

Clearly it is not the right type of receptacle to satisfy the thirst for wellbeing.

This is not to deride the hard won advances in some areas – many good people, black, white and otherwise, have worked hard for decades with small but encouraging improvements in their area of Aboriginal health, often only to see them falter and regress as attention is diverted to other initiatives.

But as an overall program Aboriginal health has been an almost unmitigated failure, indeed quite literally a tragic one. It is a tragedy not simply because of its origins but because of the tolerance of it by non-indigenous Australians and our refusal to root out the deeper causes.

Those causes ultimately are ones of attitude – their resolution thus can occur only by social, political and legal means; by us changing the way we look at ourselves and each other.

We need a gestalt shift; we need to see the course of history not as a scar but as a birthmark. This can happen only if we recast the origins of the Australian nation as a birth that blends the qualities of two peoples – Indigenous and non-Indigenous.

Perhaps to that end, Australia now has before it a report, Recognising Aboriginal and Torres Strait Islander Peoples in the Constitution: Report of the Expert Panel, by the Great and Good to the Prime Minister recommending a referendum to amend the Constitution so that, inter alia, it recognises Aboriginal people as the first Australians.

Why then do many people long concerned about this issue feel palpably underwhelmed?

By way of explanation we need a little recent history.

After the 1967 referendum, the most important events for Indigenous Australians were the Mabo and Wik decisions of the High Court in the 1990s. They went some distance in specific ways regarding land law and the status of Aboriginal legal systems and by dispensing with the legal fiction of terra nullius, and even then excited such conservative reaction as to sour those sweet little victories.

Paul Keating’s Redfern speech in 1992 and Kevin Rudd’s apology to the stolen generation in 2008 were good and worthy gestures too, though limited in effect and historically ephemeral: they had no legal and institutional significance.

Aboriginal wellbeing demands a bold and enduring change: something like the treaty that has been sought for the 40 years the Aboriginal tent embassy has been pitched on the grounds of old Parliament House.

Yet the lawyers tell us we may not in strictness have a treaty – these are made between separate nations. It is only at the creation of a colony or with the resolution of war that peoples may make treaties (as was the case in Canada and New Zealand).

We can however have a compact – a special sort of agreement with institutional gravity, in standing somewhere between a treaty and a contract – that may form part of the Constitution.

But alas, in the proposal now before us, we don’t have the option even of a compact. We have just proposed amendments to constitutional provisions with three new sections.

Meritorious though these proposals may mostly be, they are not enough. Fine words about first Australians are still just words.

Aboriginal people are not just the first Australians, they are the quintessential Australians.  It is an ineluctable historical truth that without Aboriginal people preceding us we would not be the Australians we are; we would be some other colonising mob.

There thus needs to be a practical recognition of the standing of Aboriginal Australians; one by which we say not only, ‘you were here first’, but ‘you are special’.

Indeed Aboriginal people are special: when they talk of being of (not just in) the land, or being one with the land, they are not being wholly metaphoric. The term ‘indigenous’ emerged in English in the 1640s, having come originally from the Latin, indigena, meaning “sprung from the land”.

As a nation of blow-ins and boat people, we struggle with this idea. But we shouldn’t. After all, ultimately we all come from stock indigenous to somewhere or other.

It is ironic that the Australian ‘no-special-cases’ view of fairness as a crude and basic equality – born of tough times in a hot, hard land – impedes a subtle understanding of equity that treats people in the light of their peculiar circumstances and history.

But special cases demand special treatment: average Aboriginal life expectancy is almost two decades shorter than that of non-Indigenous Australians, more than double the gap experienced by indigenous peoples in comparable countries like New Zealand, Canada and the USA.

No more money, no more effort, but much better health outcomes elsewhere. What could be the variables driving this substantial difference in life expectancy?

Constitutional status and recognition, matched by dedicated political representation.

What is needed is a compact with Aboriginal Australia as part of the Constitution bolstered with material political symbols of that compact.

We should adopt the approach of New Zealand with Indigenous seats in Parliament – in Australia this could be readily accommodated by two senate seats (as were added for the ACT and the Northern Territory) for whom Indigenous people could vote as an alternative to their state or territory senators.

Would it work? Who knows?

Will it help improve Aboriginal health? It might, if the life expectancy and health outcome experiences in New Zealand, Canada and even the USA are any guide.

We’ve tried everything else imaginable and none of it has worked. Maybe this will.

What’s the harm in trying? It beats fine words.

***

Previous blogs by this author include:

• The role of doctors in health services planning and management
https://croakey.org/the-role-of-doctors-in-health-services-planning-and-managementaltruism-expertise-and-lack-of-engagement-as-perceptual-disorders/

• Opportunities for the cunning health bureaucrat in the proposed NSW Mental Health Commission
https://croakey.org/the-proposed-nsw-mental-health-commission-opportunities-for-the-cunning-health-bureaucrat/

• Who are the real doctors in health?

Why Mary, Kylie and I may prefer to be known as Doctor….

Note to readers: Gremlins in the system are affecting some of the links and formatting. Apologies for any inconvenience.

Comments 2

  1. Mal White says:

    This blog starts off well and gives an honest explanation of the reasons for the tragic state of Indigenous health.
    However it jumps to an “Indigenous Rights” based solution without a flow of logic explaining how this would substantially solve the health problems they suffer.
    The giveaway line is at the end.
    ” We’ve tried everything else imaginable and none of it has worked. Maybe this will”.
    Unfortunately I don’t think it will.

    I am all for more Indigenous rights for reasons of justice, but I just don’t think it would make much difference to their health.

  2. Enrico Brik says:

    Mal, it is not an essay in logic but in exploring options that are relatively uncostly. The examples by analogy with Canada, New Zealand and even the USA should be sufficient to show that it is a proposition worthy of further investigation. Otherwise, what would the reasons be for the much closer gaps in those three jurisdictions be?

    In any event, I may be right, you may be right. There is only one way of finding out. Try it and see if, other things being equal, the gap closes over the next 10 to 20 years.

    Enrico

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