Everyone involved in providing health services can be pleased that Australians’ life expectancy is among the top five countries in the world. Over the past two decades, the infant death rate has almost halved; the death rate for children under 15 has halved; and the death rate for people between 15 and 24 has fallen 30 per cent. By contrast, Indigenous life expectancy today is about the same as Australians’ life expectancy 100 years ago. On average, Indigenous people die 17 years younger than other Australians.
Although health spending per Indigenous person is 18 per cent higher than health spending generally, on almost every indicator Indigenous people’s health outcomes are dramatically worse. Indigenous people have twice the rate of hospitalisation for injury or poisoning, Indigenous children are three times as likely to have ear and hearing problems and Indigenous people have three times the general rate of diabetes. Fifty per cent of Indigenous people smoke tobacco (compared with 17 per cent for Australians generally). Indigenous people are one-and-a-half times as likely to be physically inactive and are twice as likely to have experienced victimisation, with 24 per cent reporting physical or threatened violence in a 12-month period.
These statistics have not lost their power to shock but hardly come as a surprise. Regardless of people’s cultural or ethnic background, poorer health and lower life expectancies are generally associated with low educational attainment, high unemployment, poor housing and high levels of substance abuse.
It seems the fundamental problem is not lack of spending (although it could always be higher) but the culture of directionlessness in which so many Aboriginal people live. It is estimated the Federal Government alone spends nearly $6,000 a year on every Aboriginal person and that each Aboriginal household receives $70,000 a year in Federal Government services and transfer payments.
Since 1996 the government has increased Indigenous-specific health spending from about $100 million to over $350 million a year. Indigenous utilisation of Medicare and the Pharmaceutical Benefits Scheme has increased by nearly 80 per cent. Federally-funded Aboriginal health services are providing 86 per cent more consultations than ten years ago. Since 1996, thanks in part to the Puggy Hunter Scholarships, there's 50 per cent more Indigenous doctors and 30 per cent more Indigenous nurses. In the recent Budget, the government committed an extra $40 million to provide an extra 80 health professionals to work with Indigenous people in Aboriginal and mainstream health services and to convert 130 part-time into full-time jobs for Aboriginal health staff. There was also $20 million to provide mental health training to over 1,200 Aboriginal health service staff. Perhaps most importantly, there was $55 million to combat petrol sniffing in central Australia and other remote settlements designed to remove and to rehabilitate addicts and to extend the roll-out of Opal fuel.
Poor Indigenous health has as much to do with social factors as inadequate facilities. There are no magic bullets here. It’s easy to spend money but hard to make a difference improving services to deprived people in depressed places.
There is much evidence that the extremes of Indigenous ill health result from social conditions that no amount of improvement in health services can ever really deal with. For instance, the Alice Springs Crown Prosecutor, Nanette Rogers, has recently pointed to the endemic violence afflicting central Australian Aborigines, particularly women and children.
Rogers’ account of the routine sexual abuse of children and horrific violence against women was, as she said, “beyond most people’s comprehension”. Aboriginal people’s incapacity to address these issues was the result of constantly being overtaken by new tragedy, she speculated. “It might be the suicide, it might be the fatal car accident, it might be the death of the 20-year-old from heart disease because of diet, failure to thrive, lots of grog, petrol or whatever. All of those tragedies … overtake a community,” she said. “So yes, it was a dreadful thing that the six-year-old was anally penetrated and killed but then something new takes its place within a very short time.”
Rogers is just the latest highly credible witness to attest to the gothic horror of aspects of life in some remote Aboriginal settlements. It can be misleading to use the term “community” to describe these places, which often comprise traditionally antagonistic clans congregated in a particular locality because this was where the nearest mission station distributed its goods. In at least some of them, thinly assimilated notions of universal obligation struggle against grog, traditional concepts of pay-back and deference to “big men”.
Nanette Rogers’ statement has sparked a new flurry of interest and a new bout of concern about the plight of Aboriginal people. My colleague Mal Brough, Federal Minister for Indigenous Affairs, has convened an important summit on violence prevention in Aboriginal communities. Plainly, Wadeye, a strife-torn Northern Territory town of 2,200 Aboriginal people currently with eight police, is at a disadvantage compared to (say) Walgett, in NSW, which has 32 police for 2,300 people, half of whom are Aboriginal.
Northern Territory Chief Justice Brian Martin’s sentencing of an Aboriginal man to just one month’s detention for repeated rape of a 14-year-old promised him in marriage has come to symbolise the triumph of political correctness over justice. To the extent that traditional Aboriginal culture enshrined exploitation and violence it must change. Freedom from rape is not a Western invention but a universal standard of decency. Enforcing it is no more imposing arbitrary Western values on Aborigines than it was cultural imperialism to outlaw widow burning in India and foot binding in China.
Modern Australians are understandably embarrassed about our forebears’ failings towards Aboriginal people. British settlement of Australia meant that Aboriginal culture was bound to change. It meant tragedy for hundreds of thousands of people and their descendants. In the long run, however, modernity - with its benefits as well as its excesses - has been as inescapable for Aborigines as for the rest of us.
This is an edited version of a speech given for the launch of Australia's Health 2006 at the Australian Institute of Health and Welfare's conference on June 21, 2006. Read the full speech here (pdf file 44KB).