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Wednesday, 20 February 2019
Page: 14224


Dr PHELPS (Wentworth) (12:34): During my presidency of the Australian Medical Association, I visited many remote Indigenous communities. I wanted to get firsthand information about what affected the health of these people in these communities. I recall a number of stories that made a very strong impression on me.

As we flew into one community in Western Australia and we hit the red dust airstrip—the only way in or out of the community if there was a medical emergency—I was told that the airstrip was unsafe and unusable for many months of the year in the wet weather, when it became a river of mud. A child had recently died from a snake bite; they couldn't be airlifted out because the airstrip was unusable. The solution would have been sealing the airstrip, and the community have been asking for that for some years.

In another community, there was a high rate of chronic renal disease. People needed regular dialysis but they couldn't live on country, so they were forced to either move to the city or die on country. They were forced to leave their families. The medical service eventually did receive a dialysis machine but there was no generator in the community to support it and to power it. It was still sitting in a storage shed behind the health centre. These are the sorts of systemic failures that contribute to the gap we hear about between Indigenous and non-Indigenous Australians.

In 2002 the AMA began to publish its annual Indigenous health report card, under my presidency. It was aimed at highlighting persistent inequalities in health outcomes and longevity. The AMA report cards since then have continued to highlight fundamental issues in Aboriginal and Torres Strait Islander health, from addressing specific health conditions to looking at systemic failures contributing to these poor health outcomes. The medical profession has long and strongly advocated for increased awareness amongst governments, politicians, the media and the general public of the state of Aboriginal and Torres Strait Islander health. The most recent AMA report card identified equitable needs based funding as a gap, and the need for systemically costing, funding and implementing physical and mental healthcare plans. In particular, it identified and recommended options to fill the gaps in primary health care, including addressing environmental health and housing issues and other social determinants.

One example, from 2017, is that the AMA Indigenous health report card called on all governments to work towards ending chronic otitis media, or middle ear infections. Poor ear health disproportionately affects Aboriginal and Torres Strait Islanders, particularly children, and causes a lifetime of hearing loss. It's a disease of poverty. It is directly linked to poorer social determinants of health, including unhygienic overcrowded conditions and inadequate and inappropriate health services.

The medical profession has long demanded proper funding for proven, targeted programs, and for governments to fund and resource services that are delivered in a community-controlled way. However, we're still left with the unacceptable situation that preventable, chronic health conditions are not being well-managed. The promises by successive governments about closing the gap remain illusory. The statistics speak for themselves. A life expectancy gap of around 10 years remains between Aboriginal and Torres Strait Islander people and other Australians. Preventable admissions and deaths are three times higher for Indigenous people. There are matters contributing to these statistics, including prevailing community attitudes, housing, education, an ignorance about culture and indifference about Indigenous culture, and a failure to invest in Indigenous language.

We can't close the gap if we just put money into medical services. There are still many Indigenous Australians who don't have access to proper sanitation, running water or fresh, nutritious food. Health will never improve under these circumstances. The fact is that successive Australian governments have failed to invest in what Indigenous communities actually need. Indigenous people are too rarely consulted about their needs, and many do not have access to basic standards of living, like proper housing.

In a recent positive development, the Council of Australian Governments announced in December 2018 that it would establish a formal partnership with Aboriginal and Torres Strait Islander people to work with governments on finalising a Closing the Gap Refresh. While there's been some opportunity for negotiations with Commonwealth, state and territory governments in the past, this is the first time that COAG has agreed to engage in a joint decision-making process. A coalition of almost 40 Aboriginal and Torres Strait Islander peak bodies from across the nation is now providing legitimate community controlled representation, and will be signatories to the formal partnership arrangements on a refreshed Closing the Gap framework.

Cheryl Axleby, Co-Chair of National Aboriginal and Torres Strait Islander Legal Services, noted:

We must be the architects of policies that affect our lives and the partnership must recognise our right to self-determine if the quality of life for our peoples is to be improved over the next decade.

Ms Axleby continued:

Solutions to end over-imprisonment must be developed holistically alongside other areas of disadvantage in the Closing the Gap strategy - health, education, employment - in order to create real change for future generations. In addition, family violence, child protection, disability and housing targets must be added.

On this subject, it is essential to highlight domestic and family violence, which has a particularly damaging effect on Indigenous women, who are up to 35 times more likely to experience this form of violence than non-Indigenous Australian women. Indigenous women and girls are 31 times more likely to be hospitalised due to domestic and family violence related assaults compared to non-Indigenous women and girls. We must do better to address this horrific situation.

This year's Closing the gap report found that progress on only two goals was actually on track: increasing the number of Indigenous children in early childhood education and halving the year 12 attainment gap. The goals to close the gap in life expectancy by 2013, halve the gap in child mortality rates by 2018, halve the employment gap, halve the gap in reading and numeracy by 2018, and close the gap in school attendance by 2018 are not on track. The mortality rate for Aboriginal and Torres Strait Islander children is still more than double the rate for non-Indigenous children. Homelessness rates for Aboriginal and Torres Strait Islander people are double the rate of non-Indigenous Australians.

Ms Axleby noted:

The Commonwealth Government has never had a deadline for ending the over-incarceration of Aboriginal and Torres Strait Islander people - this is why we need a national justice target to make progress to end this human rights injustice.

Aboriginal and Torres Strait Islander people are 17 times more likely to be in prison than non-Indigenous Australians. In the last 10 years, the incarceration rate of Aboriginal and Torres Strait Islander women has increased by 80 per cent, with 34 per cent of the women's prison population being made up of Indigenous women.

The Aboriginal and Torres Strait Islander community's failure to be heard by governments has long been at the crux of the disappointing progress in closing the gap. Many Aboriginal and Torres Strait Islander organisations participated in good faith in the consultations led by the Commonwealth in the first stage of the Closing the Gap Refresh conducted in 2018. However, the consultations were only superficial, and draft targets were developed later without any involvement of the Indigenous stakeholders. It is this lack of genuine partnership which we must change if we are to deliver much better results in the next phase of Closing the Gap.

Mr John Paterson, a spokesman for the National Aboriginal Community Controlled Health Organisation suggests:

You are not going to get kids to go to school if they haven't had a decent night's sleep because of an overcrowded house, you are not going to get kids to go to school if they haven't got food in their tummy … you ain't going to get kids to go to school if parents are not encouraging them to go to school due to lack of support services for parents.

Aboriginal and Torres Strait Islander people want to have a say over their lives and matters that impact on them. We should invest in building the capacity of Indigenous Australians within their communities. That's why it's so disappointing that the government has decided to ignore the Uluru Statement from the Heart. It is only through continuing to address the systemic inequalities that exist in all areas of the lives of Aboriginal and Torres Strait Islander people that we will be able to begin to have a real influence on health outcomes.