In an address at a forum which followed Evensong at St Paul’s Cathedral to mark Close the Gap Day on Thursday 20 March, paediatric epidemiologist Associate Professor Jane Freemantle urged participants to take action to address the deep disadvantage faced by Australia’s Indigenous people in areas like health (including life expectancy), education, access to services, and rates of incarceration.

She said, “If you want to challenge this status quo, then dare to be bold, to stand up and to be counted. You will come up against those who do not see redressing this imbalance as a priority and will dismiss or indeed attempt to dissuade you from your commitment.”

The forum was organised by the Diocesan Reconciliation Action Group. Close the Gap day is a national day to raise the awareness of the continuing health disadvantage being experienced by Aboriginal Australians.

Jane Freemantle is Principal Research Fellow at the Centre for Health and Society at the Melbourne School of Population Health at the University of Melbourne. Her career focus is on working with Aboriginal children and communities, and her research has focused on issues of child and infant mortality and the association between previous hospitalisation and mortality.

She is co-author of the recently-published Victorian Aboriginal Child Mortality Study Phase 1: The Birth Report. She  is a member of the Diocesan Reconciliation Action Group and an Examining Chaplain for the Diocese.

The full text of her speech for Close the Gap Day is below and as a PDF.

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The Wurundjeri are the people of the wurun, the river white gum. Most of Melbourne is land which, for the greater part of its history, the Wurundjeri unquestioningly considered theirs.


The land on which we gather this evening is the spiritual and traditional land of the Wurundjeri people, one the five tribes of the Kulin nation. And I acknowledge their leaders and elders past and present.

The past two centuries have witnessed the devastating impact of non-Aboriginal people and institutions on the lives of Aboriginal people. The crisis facing Aboriginal and Torres Strait Islander health has a long and complex history. It continues largely as a result of decades of government inaction and a continuing lack of appropriate services.

Aboriginal people were massacred for their land on a widespread scale up until the 1920s, the health of this population was decimated by the influx of European diseases against which the original inhabitants had no resistance, and thousands of children were taken away from their families, purely on the basis of their Aboriginality, up until 1969.

Aboriginal Australians have inhabited this land for over 60,000 years. It is estimated that the pre-contact Aboriginal population was at very least 315,000 — while recent archaeological evidence suggests a population of 750,000 could have been sustained pre-colonisation.

 Whatever the size of the population, it declined dramatically after 1788 under the impact of new diseases, repressive and brutal treatment, dispossession, and social and cultural disruption. The decline of the Aboriginal population continued well into the 20th century. Current estimates report that the number of people who identify as Aboriginal and/or Torres Strait islander is over 750,000, which represents 3 per cent of the Australian population.

Today is ‘Close the Gap Day’ in Australia. Tonight I want to talk about the ‘gap’ that continues to exist in the social determinants of health outcomes. I would like to challenge you to think about how you will contribute to the Close the Gap initiative and how you will develop a greater awareness, respect and understanding of the history, culture and current status of Aboriginal and Torres Strait Islander Australian community and thus, how you will be a part of the future of a more equitable Australia.

We have not always been able to formally assess the health of Aboriginal and Torres Strait Islander peoples. While the1967 provided a clear mandate to implement policies to benefit Aboriginal people it was the amendment to section 127 in the constitutional change that enabled Aboriginal people to be counted in population statistics. This has led to clearer comparisons of the desperate state of Aboriginal health.

Closing the gap is a strategy that aims to reduce Aboriginal and Torres Strait Islander disadvantage with respect to life expectancy, child mortality, access to early childhood education, educational achievement and employment outcomes. Endorsed by the Australian Government in March 2008, Closing the gap is a formal commitment developed in response to the call of the Social Justice Report 2005 released by Dr Tom Calma, the then Aboriginal and Torres Strait Islander Social Justice Commissioner, to achieve Indigenous health equality within 25 years.

The Council of Australian Governments (COAG) targets, developed by experts in the various areas, are to:
• close the life expectancy gap within a generation (by 2031)
• halve the gap in mortality rates for Indigenous children under five within a decade (by 2018)
• ensure access to early childhood education for all Indigenous four year olds in remote communities within five years (by 2013)
• halve the gap in reading, writing and numeracy achievements for children within a decade (by 2018)
• halve the gap for Indigenous students in year 12 attainment rates (by 2020)
• halve the gap in employment outcomes between Indigenous and non- Indigenous Australians within a decade (by 2018).

The achievement of substantial improvements in the health and wellbeing of Aboriginal and Torres Strait Islander people will depend largely on the effective implementation of these targets as they reflect some of the substantial disadvantages experienced by Aboriginal and Torres Strait Islander people.

There is absolutely no doubt that enormous challenges exist if we are to redress the current disparities and inequalities that exist for the majority of Aboriginal and Torres Strait Islander people. If you want to challenge this status quo, then dare to be bold, to stand up and to be counted. You will come up against those who do not see redressing this imbalance as a priority and will dismiss or indeed attempt to dissuade you from your commitment.

Maybe our greatest fear in accepting challenges is the fear of failure. We all know what we believe can do, what we don’t know and we won’t know until we take the risk of challenging ourselves, is what we are actually capable of. One is not always going to be 100 per cent successful, but at least one is giving it a go, taking some chances, and thinking outside the conventional parameters of life and challenging the status quo.

Let me talk from experience. As a paediatric epidemiologist, I am constantly faced with the enormity of the challenges that face us as we work together to address the continuing and in fact increasing inequalities that exist among the Aboriginal infant, child and youth population. And these challenges are yours, too. It really doesn’t matter who you are, where you come from or what your daily work is, as citizens of the world, you have the power, indeed the obligation, to challenge the status quo of these inequalities. The 21st century is not just a new century, it should be a JUST new century.

It's hard to believe but impossible to deny the life expectancy for Aboriginal males in Australia is nearly 10 years lower for females and nearly 11 years for males. While most women in Australia can expect to live to an average age of 83.1 years, Aboriginal and Torres Strait Islander women can expect to live to only 73.7 years. The situation is even worse for Aboriginal and Torres Strait Islander men whose life expectancy is only 69.1 compared with 79.7 years.

This does not compare favourably with the life expectancy of other first world countries and it is well documented that Aboriginal Australians experience lower life expectancy than their counterparts in comparable countries. In 21st century Australia this is plainly unacceptable.

We should not accept that Aboriginal and Torres Strait Islanders end up in hospitals at twice the rate of other Australians. Nor is it fair that while most Australians can look forward to long healthy lives with access to some of the best healthcare facilities in the world, Aboriginal Australians can expect to die at much higher rates of heart disease, cancer, and kidney failure, to name a few diseases.

It's sad but true that Aboriginal Australians have not shared in the health gains enjoyed by other Australians over the last twenty years. Yet it is inconceivable that a country as wealthy as Australia cannot solve a health crisis affecting less than three per cent of its population.

Aboriginal and Torres Strait Islander people have traditionally viewed health as the physical health of the person as well as the social, emotional and spiritual wellbeing of the whole community. The following include what both the antecedents to and outcomes of, the health and wellbeing of Aboriginal peoples. I am sure that many of you have heard these statistics before, but we need to continue to remind ourselves not only of the disparities, but also what is being done to address them.

Compared with their non- Aboriginal and Torres Strait Islander Australian counterparts, Aboriginal and Torres Strait Islander children are:
• more likely to be still-born, to be born pre-term, to have low birth weight, or to die in the first month of life;
• two to three times more likely to die in the first twelve months of life;
• compared with their non-Aboriginal Australian counterparts, Aboriginal adults bear a grossly disproportionate 2.5 times the burden of disease compared to a non-Aboriginal person, five times the burden of diabetes, 4.5 times the burden of cardiovascular disease, and four times the burden of intentional injuries such as suicide or harm from violence;
• Aboriginal children have double the percentages of otitis media (infection of the middle ear leading to cognitive deafness) in 18 month old infants — this has significant implications for education, for if you can’t hear, you can’t learn, and in addition the associated high rates of hospitalisation also interrupts school attendance;
• The rates of trachoma until recently have remained at the rates seen in developing countries;
• Aboriginal children have higher hospitalisation rates for all diseases associated with poor environmental health.

Equally relevant to health outcomes:
• The main source of drinking water for the majority of permanent dwellings in discrete Aboriginal communities was bore water (not fluoridation!!)
• Many remote communities still do not have sanitation or access to clean drinking water

However, the rate of Aboriginal infant mortality is decreasing (although slowly and as such the gaps remain), as a result of improved antenatal and maternal and infant programs. Neonatal intensive care and transport services are now more accessible and responsive particularly in rural and remote locations. Through collaborative programs the immunisation rate among Aboriginal children is equal to and in some areas surpasses that of non-Aboriginal children. There has also been increasing recognition of the health benefits through community control of health care services and programs delivered for Aboriginal people by Aboriginal people are resulting in improved health outcomes.

The impact of the removal of children from their families continues to impact on health outcomes today.

It is estimated that 38 per cent of Aboriginal people aged 15 years and older were removed as a child and/or had relatives who had been removed as a child. One in five young people may have had a parent, aunt, uncle or grandparent removed under this policy. Many Aboriginal people still suffer social and emotional loss from having their children taken or from being taken themselves. Without the guidance and wisdom of the Elders and traditional Aboriginal culture, those who were taken away are anchorless, as family and community connections have been shattered for many members of the Stolen Generations. As is now well documented, child development experiences and relationships of attachment within the family, particularly in the first three years of life, significantly impact on an individual’s potential and experiences throughout life. Professor Helen Milroy reports three critical themes that emerge from a psychological analysis of Indigenous history:

• the denial of humanity,
• the denial of existence, and
• the denial of identity.

If we consider some of the relevant data:
• 24 per cent of Aboriginal children were at high risk of clinically significant emotional or behavioural difficulties, compared with 15 per cent in the general Australian population;
• Aboriginal children are significantly over-represented in most statutory child protection systems.

Increasingly, partnerships are being developed and sustained between Aboriginal and Torres Strait Islander communities and mainstream mental health service providers. These partnerships are resulting in the provision of a greater understanding of the complexities that underlie mental health pathologies and the development of relevant and culturally appropriate responses and programs. There are also an increasing number of Indigenous graduates in the social sciences, and in social work and psychology.

• For most people, living in a house with food in the fridge and a safe, warm place to sleep at night is something we take for granted. For many others it’s a reality that doesn’t exist. Research shows Aboriginal young people are more likely to be homeless than other young Australians.
• 25 per cent of Aboriginal and Torres Strait Islander children aged 15 years and over lived in overcrowded houses — and no significant changes to this rate.
• 35 per cent of Aboriginal and Torres Strait Islander households were living in dwellings that had significant structural problems.
• There are significant challenges to build appropriate housing, to provide the capacity for maintenance and also the housing hardware to support maintenance.

However, new initiatives have been successfully implemented in establishing and building sustainable housing in Aboriginal and Torres Strait Islander communities with innovative and culturally appropriate design and living spaces.

Incarceration
We hear a lot about the alarmingly high rates of juvenile detention and incarceration among the Aboriginal youth and adult population. The impact on health and wellbeing of those who experience incarceration is well documented.

• In 2013, one quarter (27 per cent) of the total prisoner population identified as Aboriginal and Torres Strait Islander. Compare this with the fact that the Aboriginal population represents only 3 per cent of the Australian population.
• The median age of Aboriginal and Torres Strait Islander prisoners in Australian prisons 4.5 years lower than for non-Aboriginal prisoners.

Importantly, there are increasing strong collaborations being formed between the police, the Koorie community and the justice system. Positive results are being achieved in reducing the rates of Indigenous incarceration and juvenile detention through the development of diversionary programs and through the introduction of Koori courts.

• It is well believed that the real origins of both Aboriginal and Torres Strait Islander juvenile and adult over-representation in the corrective services are found in broader issues of social justice (or rather social injustice)
• The association between land and health and wellbeing among Aboriginal people is well established. The reclaiming of traditional lands and issues associated with native title have been part of the Australian landscape since the historic Mabo decision in 1992.

There have been inspirational initiatives currently being implemented with regard to land ownership and control through a more enlightened and just legal system.

Education
I believe that education is the most fundamental determinant of health outcomes. In truth Australia's system of public education can never be called a success until Aboriginal Australians benefit from it as much as any other citizens.

Considering this, be aware of the following:
• Aboriginal and Torres Strait Islander children are more than twice as likely to have parents who left school early.
• 46.6 per cent of Aboriginal and Torres Strait Islander children aged between three and four years do not have access to regular services such as child care, supported playgroup or preschool.
• 30 per cent of Aboriginal adults lack basic literacy skills.
• Australia has a widening gap in educational outcomes with Aboriginal and Torres Strait Islander children far less likely to achieve benchmark standards for scientific mathematical and reading literacy and thus denied the opportunities to participate in the future workforce or to achieve their full potential and life aspirations.
• There is a significant lack of competent teachers, education programs and well-resourced primary and secondary educational facilities in rural and remote locations.

Bonny Tucker, a Punjima woman from Western Australia, provides a chilling reminder of the ongoing impact on education of removing children: ‘I wanted to go to school but my parents told me, “No they might take you away for good.” So when the authorities came to take the children to school, I ran away in the bush.’

The current government is making school attendance and retention an absolute priority, contributing a large portion of the budget to working with Aboriginal and Torres Strait Islander communities and providing the resources to achieve improved attendance and retention rates.

Language
I wanted to mention language as I believe that language is power and to be denied the right to speak your language is in itself an abuse of a basic human right. A submission to the National Enquiry into the Separation of Aboriginal and Torres Strait Islander Children from their families (1997) reported: My mother and brother could speak our language and my father could speak his. I can't speak my language. Aboriginal people weren't allowed to speak their language while white people were around. They had to go out into the bush or talk their lingoes on their own.

• Language is a critical component of daily life and knowledge and information are only available to people through a language they can understand.
• In the late eighteenth century, there were between 350 and 750 languages or dialects spoken in Aboriginal Australia. At the start of the 21st century, fewer than 200 Aboriginal and Torres Strait Islander languages remain and all except roughly 20 are highly endangered. Of those that survive, only 10 per cent, usually located in the most isolated areas, are being learned by children.
Bilingual education is being used successfully in some communities; in one case recently near Alice Springs, white teachers were required to learn the local language.

These are but a few of the many challenges for all of us. You can now never say … I wasn’t aware/I didn’t know. You now know just some of the cold, hard and irrefutable facts, but you also know that things are being and can be done to change these facts.

So what WILL you do about these glaring inequalities? Richard Eckersley suggests three alternative responses:

• Denial: Don’t change, instead try to prove that change is not necessary or evoke the ‘no data no problem no action’ attitude (John Kenneth Galbraith)
• Avoidance: ‘Don’t underestimate the power of distraction’ (Woody Allen)
• Take responsibility for change: a small group can change the world (Margaret Mead)

The naysayers argue there is nothing to be done. However, I say rubbish and that the naysayers are wrong. I believe that the sceptics are outnumbered by those who would see success and positive change. Stark as these figures seem, there have been some successes in health and education outcomes: success due to people taking up the challenge and working in partnership with Aboriginal and Torres Strait Islander people. The apology to Australia’s Indigenous people on February 13, 2008 by the prime minister of Australia, whilst overdue, was a significant event in ‘honouring the Indigenous peoples of this land’, and recognising them ‘as the oldest continuing cultures in human history’. There are increasing numbers of Aboriginal and Torres Strait Islander leaders in medicine, education, science, drama, music, art, sport, politics and within our community. But nowhere near enough. We need to put more Aboriginal and Torres Strait Islander people into the professions and into the boardrooms.

We must challenge naysayers and spread the good news stores, while we work diligently away to address these inequalities.

The Anglican Church has made a commitment to redressing these inequalities through establishing opportunities for you to contribute to change though many and varied initiatives. We as a community must continue to listen to solid information that is lived and learned and read and heard. There will be existing, learned prejudices, and behaviours within the wider community, and some positions may be too entrenched to be shifted. However, this is your chance to make a choice about how you want to live your life and to commit to the reducing these gaps through your actions and activities.

Closing the Gap will require people to take chances and to recognise opportunities. It will depend on developing and sustaining strong partnerships with Aboriginal and Torres Strait Islander populations and communities. It will take hard work and persistence. The launching of the RAP will be a first, and indeed very important, step.

In Matthew 25:39 and 40, we read: ‘“And when was it that we saw you sick or in prison and visited you?” And the king will answer them, “Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.”’

My challenge to you this evening is to be receptive to the opportunities to redress the disparities in outcomes being experienced by our Aboriginal and Torres Strait Islander brothers and sisters that exist in our society and to seek to make a difference to the inequities in our society, no matter how small.

 

 

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