Indigenous health: sorry is not enough

Work is more than income. For Indigenous people the loss of traditional occupations like hunting and fishing all too easily resulted in an existence without meaning or sense of pride. Occupation absorbs the largest amount of active time in adult life, but “Indigenous Australia is still significantly located in the welfare economy”.

This reviewer recalls an isolated Aboriginal group discovered in the 1970s living in the desert as they had for thousands of years: unclothed, no buildings, finding food and water where others would starve, sleeping during the day, walking great distances by night. Extraordinary knowledge. Then into their world came somewhat similar creatures who covered their bodies, moved on noisy, god-like machines, found their food in boxes and bottles, and forced Indigenous folk to move into compounds, issuing some meaningless material called money.

One can only imagine how they would experience “anomie”, a sense of alienation and purposelessness caused by a breakdown in the culture, which, it is argued, can lead to suicide.

It’s not difficult to understand the temptation to ease the pain of so many frustrations with drugs, sniffing, grog.

The importance of this book is that it brings together not only environmental and physical factors like chronic poverty and environment but also social and emotional conditions like unequal chances in life, hopefulness and pessimism, all affecting the physical body, the individual’s state of health and ultimate life-span.

In this whole saga Australian politicians are largely missing in action. They seem much more likely to criticise Indigenous people than seriously examine the social processes they are involved in for which political leaders are ultimately responsible. Government has clearly not invested in communities in such a way that not only do people have a chance to survive economically and provide the wherewithal for their children’s health, but also can create an atmosphere of hope.

It is still surprising to recall Indigenous Australians were not counted in the population Census until after the 1967 Referendum, which also belatedly entitled them to award wages and Commonwealth welfare benefits. However, “progress” can have a paradoxical downside, such as losing a job because the employer refuses to pay a higher wage, or, worse still, insistence on award wages on a cattle station resulting in a worker not only losing his job but the family being forced to leave their traditional country. And “Country is frequently asserted as a fundamental determinant of health and well-being for Indigenous Australians”.

Underlying the research, scientific data and professional judgments in this collection are ethical issues: what is right and just in dealing with fellow human beings, not only in the past but now?

It is not easy to be optimistic when you read in the chapter on human rights: “Given the approach of the Australian Government to date, it is highly unlikely that it will choose to consider itself bound either by an international legal obligation to consider the role of violations of human rights in creating and perpetuating poor health, or by the human rights implications of its public health and social policy”.

The editors of this excellent collection refer to their “next edition”. I encourage them to consider adding a companion volume telling the same story but with translation of some language into forms more accessible to a less highly educated readership. This is not a criticism, more a tribute to the book’s importance and the hope it will be read widely.