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Indigenous health: 'Things that work'


Close the GapThe Commonwealth Government and Council of Australian Governments (COAG) have accorded high priority to improving the condition of Indigenous Australians, engendering great interest in the recently released Productivity Commission report, Overcoming Indigenous Disadvantage.

The report revealed that in 80 per cent of the 50 indicators of disadvantage that were measured, there has been a decline rather than an improvement. This negative slide has attracted much media coverage and expert comment.

Two subsets of the 50 indicators are given particular attention in the report. First, COAG's Closing the Gap Targets: life expectancy; young child mortality; early childhood education; reading, writing and numeracy; year 12 attainment; and employment.

Second, the Commission's previously established 'Headline Indicators': post-secondary education; disability and chronic disease; household and individual income; substantiated child abuse and neglect; family and community violence; imprisonment and juvenile detention.

Substantiated cases of child abuse and neglect have received the most attention. They have more than doubled in the Indigenous population between 2000 and 2008, compared to a 20 per cent increase in the non-Indigenous population. As has been noted, the figures are probably partly due to more rigorous reporting of cases, but by any measure these statistics are disturbing. They might even be below the actual rate of occurrence.

However, some perspective is required when considering the grim statistics. Two things are worth noting here.

First, many families are dealing with problems of abuse and neglect, often with remarkable success. I know of many cases in which children are taken by family members away from neglectful mothers/parents.

Just last week, in a desert community, I watched as a great-grandfather carefully made up a bottle of formula, using hot water from a thermos and bottled cold water, and tenderly fed an infant whose mother 'is in town drinking'; the child is in the care of her grandmother and other family members.

Such carers are now likely to be officially recognised, but they need to be supported and enabled, not undermined and denigrated by sweeping claims of neglect and abuse.

Secondly, many matters in the report that deserve attention have been all but overlooked in public discussion.

There was some mention of the worsening gap in imprisonment rates, with ever more Indigenous men and women being incarcerated. Many are juveniles who are sometimes placed in inappropriate adult facilities.

While greater policing of violent crimes is welcome, often offences leading to incarceration are trivial. In Western Australia, for example, a large number of Aboriginal people end up in prison for non-payment of fines or repeated driving offences such as driving without licence or driving an unlicensed vehicle.

Other alarming statistics in the report have been virtually ignored, including the rates of suicide and self-harm, mental illness, and 'avoidable mortality', which is four times higher among female and five times higher among male Indigenous people than in the general population.

These conditions have terrible effects, not only on individual sufferers but on entire families and communities.

A majority of the negative trends documented in the report are health-related. In the remote Pilbara desert communities I know best, obesity and tooth decay are most prevalent.

The former, a major public health concern in the general population, is twice as common in the Indigenous population. Combined with near-endemic diabetes, obesity has catastrophic implications. And while obesity is rare in children, tooth decay is not. Both conditions are most evident among young women.

Tooth decay affects nutrition and overall health, including heart disease to which this population is already highly susceptible. The report points out that poor dental health also has wider implications, affecting speech and language development, school, work, and social wellbeing.

The report eschews claims of cause and effect while noting that 'multiple disadvantage' is characteristic of the Indigenous population, pointing out correlations between poor education, high unemployment and low income. There is ample evidence that poverty and social inequality have multiple consequences, including ill-health.

Attempts to change disadvantage must be multi-pronged and long-term. Social change is often slow, and  entails a degree of risk — human behaviour is not easily predicted or controlled, and there are bound to be surprises when conditions change. Panic responses and sweeping changes can create new problems, even as they correct existing ones — the Northern Territory Intervention is a case in point.

Entrenched harmful behaviours, such as poor nutrition, cannot now be simply undone. Income 'quarantining', for example, may make more money available for food, but does not ensure healthy food choices, crucial to combating obesity, tooth decay and other health problems.

The Indigenous population is far from homogeneous. While there are remarkable cultural continuities across Australia, diversity must be recognised. Urban, rural, and remote locations engender different challenges. Arbitrarily imposed change for which the targeted groups see no rationale, of which they have little understanding, or for which they lack motivation, frequently leads to failure.

Authorities on the issues, such as Tom Calma and Fred Chaney, say that collaborative approaches are best. They also caution that there is no quick fix, and that some failures are inescapable in change projects.

The focus on the sensational is understandable but tends to obscure the positives. Throughout the report, the Productivity Commission gives examples of 'things that work'. This kind of news seldom makes headlines, but is of signal importance. One advocacy organisation, Women for Wik, has picked up this theme on its website

Myrna TonkinsonDr Myrna Tonkinson is an honourary research fellow in anthropology in the School of Social and Cultural Studies at the University of Western Australia who has done research among Aboriginal people in the Western Desert of WA since 1974.

Topic tags: indigenous health, close the gap, Productivity Commission, Overcoming Indigenous Disadvantage, COAG



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Existing comments

Another first rate piece from Dr Tonkinson. Her articles are full both of valuable information and of thoughtful argument. Thanks to ES. I look forward to the next one.

Joe Castley | 08 July 2009  

Thank you for the informative article. We do not read enough in the public press on the plight of the aboriginal people.

How do I find out where the millions of dollars promised is being spent?
Are there good monetary incentives for teachers, health workers etc.to spend time living, working with and learning about the real needs of a people caught between two worlds? To my mind,a problem of our own making, needing not only money, but boundless compassion.

Bernadette Introna | 09 July 2009  

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