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Community Affairs Legislation Committee

AH CHEE, Ms Donna, Acting Chief Executive Officer, Central Australian Aboriginal Congress

BOFFA, Dr John, Public Health Medical Officer, Central Australian Aboriginal Congress


CHAIR: Our next witnesses are from the Central Australian Aboriginal Congress. Welcome. Thank you, as always, to congress for coming. I don't think we could have a meeting in Alice Springs without having congress; it just would not happen. You have information on parliamentary privilege and the protection of witnesses and so on. I expect that you have some opening statements, after which we will go to questions. We have plenty of time.

Ms Ah Chee : The Central Australian Aboriginal Congress is a large community-controlled comprehensive primary healthcare service in Alice Springs providing services to around 7,000 Aboriginal resident people along with around 2,500 visitors each year. It provides a range of services and programs as well as advocacy on key public health issues. As a part of this role we have for a long time been active on the issue of petrol sniffing. Congress played a very active advocacy role to assist with the introduction of lower aromatic fuel, with many media interviews where we pointed out that petrol sniffing was affecting over 400 people in Central Australia at any one time and leading to about eight deaths per year. Since the introduction of Opal unleaded there has been only one death, and the number of sniffers at any one time has been dramatically reduced to around 20. This has been one of the great supply-reduction-measure success stories, and we think it has great parallels in terms of what needs to be done in alcohol policy.

Congress has also been involved in various research projects and studies that have looked at the impacts and the economics of petrol sniffing. It is clear that in spite of the cost of subsidy of low-aromatic fuel it is very cost-effective in terms of the prevention of long-life disability and the need for long-term supported accommodation.

Low-aromatic fuel works well. Current evidence is that its use has led to around a 70 per cent reduction in the prevalence of petrol sniffing across all sites. In Central Australia, where the rollout of low-aromatic fuel has been more comprehensive, this reduction in fact looks more like 94 per cent. Prior to the introduction of Opal unleaded in Central Australia in 2007 there were about eight deaths per year attributed to petrol sniffing; there has been only one death in the five years since its introduction. In addition, the number of people newly brain damaged due to petrol sniffing has also reduced dramatically, representing a huge saving in human suffering and disability as well as in the expensive supported accommodation services needed to care for these people.

Further evidence of the effectiveness of Opal unleaded fuel is provided in the recent article 'Cheap, easy, fatal: scourge of sniffing returns to remote northern landscape' by Nicolas Rothwell. The article reveals that all of the current petrol-sniffing hotspots are remote Aboriginal communities in the north that either do not have the benefit of Opal fuel, such as Katherine, or have regular access to non-Opal fuel outside of the community, such as Lake Nash, the Urandangi pub, Yirrkala and Nhulunbuy. If this story had been written in days prior to the rollout of Opal fuel in Central Australia, when there were over 400 active sniffers at any one time, it is sniffing in Central Australia that would have been the feature. The number has dropped to about 20, and this is why the story chose to focus on the north but did not acknowledge the success in the Centre, which is very unfortunate. It is clearly not true, and it is poor journalism, to claim:

All that is clear is failure: after millions of dollars, reports, studies and programs, the combined efforts of the commonwealth and NT governments to stop the plague have come to nothing.

On the contrary, the rollout of Opal unleaded in Central Australia demonstrates that supply-side strategies can achieve. This should be celebrated, rather than undermined by poor journalism. Low-aromatic fuel works best to reduce petrol-sniffing prevalence when rolled out comprehensively. While this rollout has worked very well, petrol-sniffing has proven to be a stubborn and recurring issue in many regions which have not had the benefits of comprehensive Opal rollout. This is an ongoing need to ensure that the rollout of Opal fuel is more comprehensive and complements the supply-side strategies with demand reduction measures, especially early childhood programs.

Although petrol-sniffing is not the headline grabbing issue it once was, a major challenge for government at this point is to maintain its interest and commitment to seeing this issue through. This includes a commitment to putting in place the types of early childhood programs that will assist children in ways where they have better control, are less impulsive and have better cognitive, language, social and other development scores at the beginning of their school learning years. This will optimise the possibility of good school learning and retention and create young people who are much more resilient to the development of addictions of all types, including petrol-sniffing. As things stand now, even in Central Australia a number of retail outlets refuse Opal fuel and in some cases this is thought to be linked to sniffing in nearby communities. It should not be left up to individual retailers to decide whether sniffing continues in nearby communities and whether they should or should not provide Opal fuel.

The government's own report into this issue says that low-aromatic fuel mandating legislation is feasible and would save $1.3 billion over 25 years in public health and justice system costs. These savings could be better directed upstream to preventative measures such as early childhood programs. The proposed legislation mandating the sale of Opal could be applied so that it just targets strategic points. There is no need to declare large zones encompassing many retailers. In Central Australia, such an approach will not create a very big increase in demand for Opal. As things stand, it would just target known problematic sites that have refused to sell Opal. Most outlets in any given area will do the right thing and agree to stock Opal, as has occurred here in Central Australia.

However, the success of this strategy cannot be held to ransom by a few retailers who have an ideological position against government intervention in their business in cases where there is a clear public good at stake. The reality is that some of the most successful public health measures taken by government have required intervention in the marketplace—beginning with the famous government removal of the privately owned and operated cholera-infested water pump in London in 1853. This resulted in the dramatic decline in deaths from cholera. And there are many other examples where this type of government action is necessary to promote the health of the community.

The proposed legislation would provide extra incentive to retailers to stock low-aromatic fuel voluntarily in order to avoid being subjected to a compulsory regime. As things stand, the retailers know well that the government has no capacity to force them to stock low-aromatic fuel and appear to be stringing negotiations out. Currently all retailers in Alice Springs use Opal voluntarily. This is crucial to the success of low-aromatic fuel in the Central Australian region. Australian However, if any one retailer decided to stop stocking the fuel, it is likely that they would all follow suit. The proposed legislation would be a deterrent to this happening and would provide a path for action should this happen in Alice or in any other crucial site.

There is wide support for this legislation. Supporters include stakeholders on the ground, like CAYLUS, the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, the Northern Territory government and the Western Australian government. The 2009 Senate inquiry into petrol-sniffing examined this issue and made a clear recommendation endorsing legislation and providing a time line for the government to move on this issue. This time has now well past. It is worth also noting the way the proposed legislation would work. This is that it bans standard unleaded and can place controls on the way premium fuel is sold in declared zones. This would effectively force retailers to either not sell unleaded fuel at all or to stock Opal. The proposed bill provides a fair and transparent process for the declaration of zones, including the periods of consultation where the views of all stakeholders can be taken into account. In order for a zone to be declared, it needs to be established that doing so is reasonably likely to help reduce potential harm to the health of people living in that area from sniffing fuel.

Congress understands that the committee is primarily concerned with the Low Aromatic Fuel Bill itself; however, it is important that the underlying issues that create the demand for sniffing fuels in the first place are also addressed. Congress has in recent years become much more aware of the importance of early childhood and the need to promote parenting that reduces the risk of young children becoming impulsive and lacking self-control, as these are the major precursors to the subsequent development of addictions, in adolescence and beyond. This is an area where we now know there are some effective programs, but a lot more needs to be done in this space to ensure that there is a bottom-up approach to the primary prevention of petrol sniffing, which can be complemented by a more top-down supply reduction policy.

To guide the committee in this regard, I provide the committee with a copy of congress's Rebuilding family life paper and the recent submission from the People's Alcohol Action Coalition to the current inquiry into foetal alcohol spectrum disorder. The demand reduction issues are the same, irrespective of the substance of addiction. Both of these documents outline what congress believes is needed, especially in early childhood but also in other areas, to reduce the demand for petrol, alcohol and other drugs.

Finally, I think it is important to recognise the contribution that CAYLUS has made to addressing petrol sniffing in Central Australia. In other regions where petrol sniffing is a problem, a similar needs analysis process, along with the establishment of an interagency collaborative organisation specifically to address petrol sniffing, will also make a significant contribution and be a critical reference point for the implementation of the proposed bill. For example, regional CAYLUS-type organisations could advise the government as to which outlets need to be considered for mandated Opal as well as on the need for youth programs and other interventions. Thank you.

CHAIR: Thank you, Ms Ah Chee. Dr Boffa, have you got anything to add at this stage?

Dr Boffa : I am happy just to take questions.

Senator SIEWERT: Thank you for your comprehensive set of papers and opening statement. I am going to play devil's advocate. I agree with you that the rollout of Opal fuel has been very successful, so why do we need mandating legislation? If we have reduced the numbers to the point that they are now—fewer than 20—why do we need to go to the extent of being able to mandate low-aromatic fuel where necessary?

Ms Ah Chee : It has not fully removed petrol sniffing in Central Australia. Even though there has been a dramatic decrease, we know that there are pockets of communities where it is still an issue. My understanding is that, where that does exist, it is linked to where Opal fuel is not sold. I think the issue also relates to other parts of the country where we are seeing significant petrol sniffing happening in communities. We need to see some action happening for those communities as well. It does not look like that is moving along as quickly as it should be.

Dr Boffa : I think the answer is that we have achieved a comprehensive rollout here which has largely been because of CAYLUS and the interagency collaboration and the partnerships and the constant talking to outlets and educating them, which has got people to do the right thing voluntarily, but there are still a few outlets that have not. But in other parts of the country they have got nowhere near that comprehensive commitment. They do not have anything like CAYLUS. But you should not have to rely on a bottom-up process of acquiring goodwill all over the place. Voluntary is great but, as we know, there are a lot of people out there who take ideological positions on this sort of thing. You can see that in Yirrkala. It is unacceptable. We went from 400 to 20 with a comprehensive rollout. In places like Yirrkala, where they have petrol 20 kilometres away at Nhulunbuy, there is no hope of achieving that outcome without doing something about Nhulunbuy. It is the same with Lake Nash.

It is possible to do a hell of a lot better. The answer is that you need a comprehensive approach. You cannot just attack outlets on Aboriginal land; you have to be able to attack outlets that are not on Aboriginal land, which cannot be covered by state or territory statute. We can achieve more. It should not be acceptable anywhere to have as much petrol sniffing as there is. It is such a devastating problem. From my point of view, it does not cost taxpayers anything. It is like the argument for a floor price: we cannot wait forever for the industry to come on board. It is the same here. I think it is quite extraordinary, in some ways. The level of voluntary support for this in Central Australia has been amazing, but you would not want to try and replicate that in Nhulunbuy and all around Australia. It would take 10 or 20 years and you still would not achieve it.

Ms Ah Chee : Picking up on that point about the success of the voluntary goodwill in Alice Springs and Central Australia, you would only need a couple of people to change, and what would happen then? The domino effect, which is a reality. It could happen. Do we want to go back to what it was like before, if we do not have this legislation to allow us to act quickly and decisively?

Senator SIEWERT: I will come back to the rest of Australia shortly, but I want to focus a bit on Central Australia at the moment. I think you have seen the map that CAYLUS produced in their submission. Is that consistent with your understanding of who does not stock non-sniffable fuel at the moment?

Ms Ah Chee : Yes. We are guided by it.

Dr Boffa : Yes.

Senator SIEWERT: I asked our previous witnesses this question as well. If there are a few people sniffing, what is your experience of how that affects other members of the community? Some of the anecdotal evidence we have had suggests that it may encourage others. It provides an environment where other people start sniffing as well. Is that your experience? We now have a situation where there may be fewer than 20 sniffers, but if there is an outbreak in a particular community or a few young people start sniffing, is there a contagion effect where it spreads to others?

Ms Ah Chee : I think that was the case when we did not have the supply reduction strategy in place. We have been able to maintain it at around 20 at the moment because of the work of CAYLUS and the coordination of services locally in town. That allowed us to manage it and keep a close eye on it to keep those numbers down.

Dr Boffa : Yes, I think that is very true. Young people almost need to see someone sniffing. It is a learned behaviour. It is not something you would think about, left to your own devices. If there has not been any sniffing in your experience in the community you have grown up with your whole life, it is quite unlikely that you will think of sniffing or even know how to do it properly.

Tristan Ray made this point very well in an article in today's Australian, which is a much more balanced article than the Rothwell attempt. He made the point that one of the problems happening at Lake Nash now is that the young people who sniff travel around and show other people how to sniff. They might go to communities where there has been no sniffing for five years. As soon as someone turns up who does it regularly, who knows how to do it, who is still relatively well, who is not brain damaged yet who and says it gives you a high, people think, 'I could start this. I could do it for a year or two.' It is a very powerful way of inciting people to do it.

I worked in Tennant Creek from 1988 to 1994 and I know that Tennant Creek did not have a sniffing problem at that time, when there was a big sniffing problem in remote Central Australia. But every now and again a sniffer would come to town and then from one sniffer you would get three, four, five, six or seven. So people would jump on that first sniffer, and that would work. If you had that situation, you would jump on the first person and you would not get that copycat effect. It makes a big difference. So I think there is an issue with even a few sniffers; if they are travelling around to communities where there is not sniffing, other young people get into the habit from seeing it done.

Senator SIEWERT: I know that your experience is more around Central Australia but I am interested in looking at the usefulness of this particular piece of legislation to Northern Australia—the Northern Territory, Western Australia and Queensland. Looking at the comments you made, it seems to me that one of the reasons it has been so effective in Central Australia is the commitment of organisations to work together, and CAYLUS—having an organisation that was very focused on this. I interpreted what you said earlier as meaning that we do not have similar sorts of coordination and a key agency driving work on this in other areas. I think that would then slow down the rollout, even though the government is making Opal, or lower aromatic fuels, available in these other areas. So it is not the fact that it has not been made available; it is that you do not necessarily have the same level of coordination and cooperation and a lead agency driving it. Would that be a fair comment?

Ms Ah Chee : Yes, I think so. I think you do need that level of coordination on the ground. But my recollection of the initial introduction of it was a combination of CAYLUS and a number of other key organisations across Central Australia and also getting that economics study done that showed what the benefits were of introducing—

Senator SIEWERT: The 2006 one?

Ms Ah Chee : Yes. So I think it certainly makes a contribution to the mobilisation, at a local level, to have an organisation like CAYLUS in other parts of the country, but I do not think you could suggest that it is just an organisation like CAYLUS that can—

Senator SIEWERT: No, I meant that there is also that coordination across other agencies. My question then I suppose is: not having that interagency coordination at the level it happens at in Central Australia or an agency that is dedicated to it, would that mean, therefore, that having legislation that enables the government to mandate where necessary would in fact speed up the rollout, given that you do not have civil society doing that level of coordination that happened here?

Ms Ah Chee : Yes, I think so, unless government wants to make the decision, because of all the evidence that suggests so far that it does work, that you do need those sorts of organisations on the ground to make it happen.

Dr Boffa : The other thing that would affect it is: I think the government, through mandating, could have a dramatic impact on sniffing, but CAYLUS has also had a big impact on preventing substitution to deodorants, to paints and other sniffable things. They have done a great job in this community of getting retailers on board.

Senator SIEWERT: Which is harm reduction.

Dr Boffa : Yes, it is harm reduction. While I think it is still worth doing without a CAYLUS in other regions, because you will still get that outcomes family have now, you will get even better outcomes if you have got that civil society commitment—if you have got people watching all the time to see what young people are switching to. This idea that it is a never-ending thing and you cannot do something about it is not right. You can address substitution. It is the same with alcohol: you can work out what people are going to substitute for it and address it. It is not a never-ending thing. There are only certain things that do become popular, and in Alice they have done a great job of working with Coles, Woolworths and other retailers to get things off the shelves. That is why, though, in the longer term, we keep saying, 'These things are good, but we have to do more to create resilient young people who are retained in education and who are then going to get employment.' That is the answer.

But we look at the AEDI scores now, in this region, and we know that, 10 years from now, we are going to have a problem because we have five-year-olds now who are so disadvantaged entering the school system that they are going to be very susceptible to addictions when they are 15. There is not a lot that can be done to stop that now. A little bit could be done but, even if we did what we could do to stop that, probably 80 per cent of those young people are going to be very susceptible to addictions when they are 15. So we still have a long period of time before we are not going to need the sort of regulatory environment that we are putting in place now to create a safer environment for a cohort of young people who are very susceptible to addictions of all types.

Senator SIEWERT: Thank you.

Senator SMITH: In the previous evidence we heard about mental health issues, and the word 'resilience' was used in that submission also. Here you talk about early childhood. I am thinking about mental health issues particularly amongst young men in those formative years coming out of being a teenager and becoming a young adult. I am wondering what work you might have done with regard to that or what observations you may have with regard to mental health issues amongst young Aboriginal men and how that might be a predeterminant to petrol-sniffing behaviour.

Ms Ah Chee : I think it is following on from what John has spoken about from a primary prevention point of view. We have been running a program called the Australian National Family Partnerships program. It is a nurse home visitation program. Enrolment is for women prior to 28 weeks of pregnancy and follows the child through to the age of two, working with the mother as well as the extended family on milestones of the child and ensuring that the trajectory of the child enables them to participate in early childhood like preschool and then on to primary, secondary and, hopefully, university without dealing with those sorts of risky behaviours around alcohol and substance misuse.

The other program we are promoting is early childhood learning centres, which have shown that that can be complementary to the nurse home visitation program where the child is getting intensive nurturing and cognitive stimulation in an early learning centre environment. In the context of looking at secondary prevention and having what we have always advocated for—social health teams within comprehensive primary health care—those social health teams dealing with mental health issues from a secondary prevention point of view are looking at a three-pronged approach of pharmacotherapy, cognitive behaviour therapy and support through social support programs. In terms of life course we are looking at trying to prevent it at a very early stage of a person's life: right from he beginning of antenatal care up until the child is two. If we do miss those opportunities to set that child on a trajectory of not having risky behaviours in adolescence, as John has mentioned, then at least we have a secondary prevention program that is dealing with mental health issues for young people.

We also run a headspace service as well. It is for both Aboriginal and non-Aboriginal young people.

Dr Boffa : I can complement that. Donna has focused on the interventions that make a difference; but, if you go back to the basic science about the link between the development of mental health programs and addictions and chronic disease, they are all linked to what happens in early childhood in a very dramatic way. You can take three major studies. Look at the Californian adverse early childhood study. Over half of the incidence of depression in adults was attributed to adverse events for children to three. I mean exposure to violence, living in fear, growing up in a family where there is domestic violence or where there is a parent that is addicted to alcohol. That is what causes adult depression more than 50 per cent of the time. Those children were also much more likely to develop addictions and much more likely to develop diabetes, coronary heart disease and renal disease. So that is one study.

There have been many studies now proving the same thing. There was the recent publication of the Dunedin longitudinal study from New Zealand which showed a direct correlation between the level of self-control that children have at age four and the subsequent development of addictions, mental health problems and chronic disease later in life. Then there is Michael Marmot's Fair society, healthy lives: a strategic review of health inequalities in England post-2010, where he undertook a cohort study of all babies born in the same week in 1970, followed them through for 30 years and was again able to show that there is a huge difference that opens up if children do not have in the first three years of life regular, routine sleeping, physical exercise and caring parenting. You then get the subsequent development not only of mental health problems but also of addictions and chronic diseases.

When I say 'over half', there are still other factors that cause these things, but this is a massive contribution that is happening and is programmed in early childhood that is very difficult to reverse. Once the brain has been through critical periods, once they have passed they are gone and not to be recovered. So I think it is an area that needs a lot more attention. Donna has highlighted that we know there are interventions that can make a big difference here in spite of an unequal social environment and in spite of all the other problems. We know there are unemployment, lack of education and all these things out there and they have to be addressed, but there are good programs that support parents with young children that can make a big difference even in quite alienating, adverse social environments. And they are not being implemented. Apart from Alice Springs, where one of those programs is happening, it is not happening anywhere else in the Northern Territory. We are not doing what we could be doing in early childhood right now which would help prevent a generation of susceptible young people in 10 years time. So I think they are challenges as well for the committee to think about beyond the legislation.

Senator SMITH: So, in summary: a greater emphasis on early childhood development.

Ms Ah Chee : Up to the age of three, a real emphasis. Anything beyond that is sort of missing the boat. Is that right, John?

Dr Boffa : Yes. Well, two years of preschool is important too, but prior to three is it by far. Eighty per cent of brain development is all over by age three and 92 per cent by age four.

Ms Ah Chee : To pick up on John's point about the nurse home visitation program: there are only three sites in the country at the moment, one of which is congress.

Dr Boffa : We should rebrand it an anti-petrol-sniffing program and maybe it'd get funding!

Ms Ah Chee : I bet it would!

Senator BOYCE: For the sake of completeness, could you tell us where the other two are?

Ms Ah Chee : Victorian Aboriginal Health Service—VAHS—and—

Dr Boffa : Wachopa.

Ms Ah Chee : Thank you.

Senator BOYCE: I want to go to the question of brain damage per se. You made the point that you went from eight deaths a year to only one over the past five years and that there had been a reduction in brain damage caused to people who survived being petrol sniffers. Can you put some more detail around that for us in any way? Can you tell us more about how you know there has been a reduction in brain damage? Has there been a reduction in people?

Dr Boffa : The mortality one is easy because that is publicly-available data. In terms of the reduction in brain damage—

Senator BOYCE: That is why I was asking; it is not easy.

Dr Boffa : That is more difficult, but I think the general practitioners in the congress clinic basically were treating all the brain damaged petrol-sniffing young people, because they all end up living in Alice in supported accommodation services. If you go back 10 years it was really common that these people would present in wheelchairs. You could not tell the difference between them and someone who had had cerebral palsy from birth. That is how disabled they were. They could not speak, they could not feed themselves, they could not move properly. They were in wheelchairs wheeled in by attendants. Now, what has been really good is that slow-stream rehab has worked, so even people who were that brain damaged 10 or 15 years ago have made substantial improvements. Some of them have got out of wheelchairs. That scenario that I painted just does not happen anymore. There are a few people left who are like that—most of them have got better—but we are not seeing new ones like that. It is really obvious that all the people we are seeing we have been seeing for quite long periods of time. We have not seen any new people in that category at all; and, if they existed, they would end up in town in supported accommodation services because there are no facilities in the remote communities that can care for these people. So I think that is why we can be really confident that are just not seeing the newly brain damaged people that we used to see—which is a great thing.

Senator BOYCE: You also mentioned the people who are in supported accommodation because of brain damage caused by petrol sniffing. Can you give me some numbers around that from 10 years ago, now et cetera?

Dr Boffa : This is the same question Donna asked me, so in leading up to this I rang Life Without Barriers. They provide carers and they do a great job. They would have a better handle on the numbers. I do not know the exact number that are still in supported accommodation. I see two people as a general practitioner. We could take that on notice and get that information for you.

Senator BOYCE: If you can get it on notice without too much effort that would be helpful.

Dr Boffa : I think we could make an effort to get an estimation of the numbers in this category that are left in supported accommodation.

Senator BOYCE: But you are not seeing people with brain damage going into supported accommodation.

Dr Boffa : Not at all, which is a really big change. If you had worked here, seen those people and had to care for them, you would know that not seeing them is a huge development.

Senator BOYCE: Apart from the success at a human level there is also the cost.

Dr Boffa : The cost, yes.

Senator BOYCE: Is it cost-effective thing to be paying the subsidy?

Dr Boffa : In the NIDAC submission they quote $160,000—that is per year, per person for supported accommodation at that level. It is a significant cost.

Senator BOYCE: Again, if you could give us some numbers on the brain damaged you were seeing going annually into supported accommodation five or 10 years ago, that would be helpful. I was interested in what the two of you were saying before around substitutes for petrol sniffing. I had the sense from evidence that we received to this inquiry that in many ways petrol sniffing is something where there is less likely to be substitution as opposed to other areas of drug abuse. Am I right or wrong there?

Ms Ah Chee : I cannot comment on other drugs. It is an issue in the alcohol arena, but I do not think you want to talk about that.

Dr Boffa : I was really talking at a population level. If you have a cohort of young people susceptible to addictions and then you stamp out petrol, you will still have young people susceptible to addictions. It might not be that the petrol sniffer who stops petrol sniffing shifts to something else, but at a population level there will be young people who will experiment with other substances—although not necessarily taking up a direct substitution for petrol straight away. But there is a reasonable chance that a young person who stops sniffing will, in two years time, try something like inhaling solvent, as other young people do.

CAYLUS has been very good at addressing multiple avenues that could potentially lead to problems for young people in various ways with addictions. They have played an important on alcohol, because there is a correlation between alcohol, petrol and other substances that are used. I think it is fair to say that many young people are susceptible to addictions of all types, a proportion of petrol sniffers will try other substances, and it is good to take a comprehensive approach to all substances, including alcohol.

Senator BOYCE: But there is nothing particularly different about the substitution rates with petrol sniffing?

Dr Boffa : No.

Senator BOYCE: I think I misinterpreted that. Has congress approached formally or informally any of the roadhouses that are not selling Opal fuel?

Ms Ah Chee : Not that I am aware of. I have been away for 12 months.

Dr Boffa : I think the answer is that congress is part of CAYLUS. We are on the advisory committee for CAYLUS and we let CAYLUS take the lead on that. So CAYLUS have been doing that work and we know they are doing that work. Organisations have individually, to my knowledge, also approached the outlets.

Senator SMITH: It appears to me that the complete eradication, or close to 100 per cent eradication, of petrol-sniffing activity in communities might be achievable—and I agree with your comments about the media reporting. How powerful a symbol would be the eradication, or close to it, of petrol sniffing in communities around Alice Springs in demonstrating to Australians, not just Indigenous Australians but all Australians, that adverse health issues in Indigenous communities could be overcome with clear strategies, careful thinking and constant monitoring? On a scale of one to 10, how powerful would the eradication of petrol sniffing be as a symbol of what could be achieved on other health issues in Indigenous communities?

Ms Ah Chee : It would be a good start to show that here you have a condition that has caused a lot of heartache amongst young people in Aboriginal communities and to their families. To be able to eradicate it with the further rollout of Opal fuel would be a very good message to send to the wider community that this difficult condition can be fixed.

Senator SMITH: And, as an extension, other difficult conditions might also be able—

Ms Ah Chee : Can be fixed as well. And there have been many reports and a lot of advocacy done by Aboriginal people across the country about what things need to be put in place—for example, what we continue to advocate from congresses around the issue of early childhood programs. We think that will make a significant difference. We do not think there is an issue with there being enough money in the system to do the sorts of things that can make a difference; it is just whether the people who are in power and who have the ability to make these things happen implement them. We can go a significant way towards improving Aboriginal people's lives in this country if we stick to the evidence base that is out there and listen to what Aboriginal people are saying.

Dr Boffa : The only thing that I would add is that I think it could be powerful, but it is interesting that the latest report from the Council of Australian Governments on the key indicators in Aboriginal health, which came out three weeks ago, showed that in the Northern Territory there has been a 46 per cent decline in the adult mortality rate in the last 12 years—from 1998 to the end of 2010—and the Northern Territory is the only jurisdiction on target. At that rate of decline, by 2031 there will be no gap. Even though right now the Northern Territory mortality rate is still higher than any other jurisdiction, the rate of decline here is so great compared to anywhere else that by 2031 we will not have a gap. That has not been reported. And the lack of deaths from petrol sniffing is just one part of that good news story. The major contribution to that decline has been the improvements in the health system that have happened in the Northern Territory, and there will be a paper coming out about that. But it is hard to get good news into the media—and this includes the biggest drop since 2009-10, which are the years after the intervention. It is a very interesting new piece of information that has only just come out. It did get an article in the Australian, which is something. I think you have to have an issue that people want to talk about, and maybe petrol sniffing being wiped out would make the news, but there is a lot of other potentially good news there that does not make the news at the moment.

Senator SMITH: In another submission it was suggested that the intervention had made a positive contribution to the reduction in petrol sniffing. Would that be your view?

Dr Boffa : It is really hard to say that. It is really hard to make calls yet either way about what the intervention has done. It is so early and there are so many parts to it. And we already had such a big decline from 2007 when we had Opal—there was just one death anyway. So the two things happened together. It would be very hard to make that call.

Senator SIEWERT: It was more about the police—if it is the comment you are referring to, Senator Smith—particularly monitoring ganja and illegal substances.

Dr Boffa : That could well be true. There are a lot more police out there, and they would be doing that.

Senator SIEWERT: I have a question about data. CAYLUS's submission talks about data and, if I interpreted the submission properly, how it is collected, and also what the federal government believes in terms of data. Do you collect data? Do you contribute to data collection by the government?

Dr Boffa : Yes, we collect a lot of data, and we have in the Northern Territory some standard performance indicators that all primary healthcare services and all government clinics contribute to and that go to a Territory-wide report, which then contributes to official publications from the Australian Institute of Health and Welfare and others. That is one level of data. Even in terms of something like deaths from petrol sniffing, though—we have said there is one—it is tricky. Leading up to this inquiry, we were talking about the fact that we know of a young person that died of leukaemia at the age of 18 or 19 in Central Australia not that long ago, and leukaemia is one of the things that petrol sniffing predisposes to. Questions such as whether that young person was a sniffer for a period of time do not get asked when death certificates get done, so that would be a death from leukaemia without anyone probing any further. So there are a lot of ways in which the current data collection systems are not quite up to the task of answering questions exactly as to what causation is there for deaths that occur. Having said that, we have a lot of data on primary health care and the effectiveness of primary health care. The health system in particular has done a lot of work to get quality data happening over the last 10 years.

Senator SIEWERT: What about the number of people? There seems to be a dispute about the number of people that are still sniffing and which communities they are associated with.

Dr Boffa : Yes.

Ms Ah Chee : Yes. We are guided by CAYLUS.

Dr Boffa : Yes.

Senator SIEWERT: So you are not involved in that data collection.

Dr Boffa : Yes. At the congress we have a code for petrol sniffing and inhaling stuff. We code it. I looked the other day, and we have not had anyone coded under that category for a very long time as a new client. We are not seeing it. CAYLUS is dealing with and case-managing most of the young people that are sniffing. Because of the big decline in numbers, the small numbers of young people that are sniffing can be case-managed and identified, and interventions can be focused on them in ways that mean they do not sniff for that long. That is another useful thing about what has happened.

Senator SIEWERT: I go back to this issue around substitution. Ever since the rollout of Opal or non-sniffable fuel has occurred, it has always been made clear that you need the complementary strategies—the youth diversion programs and things like that. A number of submissions, including CAYLUS's, refer to the different youth diversionary programs. There is Youth in Communities and a number of others, and they are not consistent; they chop and change. What has been your experience there, and how important are those programs in dealing with possible substitution?

Ms Ah Chee : I think the issue of the chopping and changing and a coordinated and ongoing connection with communities is a reflection on the government policy around competitive tendering, where you have multiple providers that are going in and out of communities, which then fragments the service provision on the ground; it is not coordinated well. So I would tend to agree with CAYLUS in terms of that observation given our experience in terms of the development of comprehensive primary health care in remote communities. We have seen that experience of, for instance, mental health money that has been made available and that has been distributed in ways that are not about building the social health team within a primary health care service but rather go to a provider that just flies in and flies out or is there temporarily. So I think that, by not having that sort of coordinated approach and services on the ground that have built relationships within the community, you potentially have that possibility of substitution happening.

Dr Boffa : Yes, I agree with that, and I would just add that I think that, whatever you substitute for petrol, it is not going to be as harmful. Substitution will happen. The point I was making before is that I would not want government or anyone to think that, because substitution could happen, it is not worth mandating Opal, because it clearly is. Even without CAYLUS addressing substitution, and even if some of these young people went from petrol to paint or other things, it is nowhere near as harmful. That is the first point. The second point is very much along the lines of what Donna said earlier. We think the treatment of addictions needs to be a core part of primary healthcare service delivery across the board. Every health service has to have the capacity to treat young people and adults that are addicted to any substance. And it is the same treatment approach. Irrespective of the substance, it is those three streams of care that Donna mentioned earlier. Pharmacotherapies, psychotherapy—often cognitive behaviour therapy—and social support and advocacy are what you need to do, whether the addiction is paint, petrol, alcohol or marijuana, and I do not think we are very good at that. We fund separate programs for each drug, and then, even within those separate programs, the doctor is sitting over here in the clinic, there are other staff over there dealing with petrol and there are a few other people coming in to deal with some other drug. There are multiple providers, and it is a privatised mess.

The money is there to do much, much better. If we funded according to need and we agreed on a service model, there is enough money now in the Northern Territory to make sure that every primary healthcare service has a permanent addiction service, and it is one of our bugbears that it has taken so long. We have done quite well with the planning for health money, but the moneys that are coming in to fund these sorts of services are coming from FaHCSIA, from Mental Health—from branches of the government that do not come through the Northern Territory health planning forum, do not allocate resources according to need and do not put everything out, as Donna said before, to competitive tender. You do not end up with a good service system that way; you do not even get an agreed service model. There is no consistency in approach or in resourcing according to need. So we could do a lot better than we are, with existing resources.

Senator SIEWERT: Okay. Thanks. When you were talking I was reminded of the Volatile Substance Abuse Prevention Act and the suggestion that it could be used instead of mandating Opal fuel. What is your opinion on that?

Dr Boffa : I do not think either of us want to say anything on that, do we?

Ms Ah Chee : That is right.

Dr Boffa : It is a furphy. If that were the case, you would not have petrol-sniffing in Lake Nash, Yirrkala and Katherine at the moment. If that act were enough, without Opal being mandated, then we would not have that problem. It is a good act, it is an important contribution, but by itself is not enough. It is no reason not to do this as well. Western Australia, South Australia—they should all have a similar act; but, even if they did, it is absolutely not a reason to not go ahead with this legislation as well.

Senator SIEWERT: Thank you. I just want to get your opinion on the record.

CHAIR: I had two questions, and that was one, so I only have one question. We have some evidence, for the first time, from people who live in roadhouses and provide the fuel, and that is really positive because our previous two inquiries did not get that.

Dr Boffa : Yes, I heard that. It was very good to have someone say that.

CHAIR: One of them made the point that the banning strategy just will not work: why don't we ban cigarettes, why don't we ban alcohol, why don't we ban everything—that kind of thing. What would your organisation say in response to that philosophical position?

Ms Ah Chee : Where it is in the common good, in terms of the wellbeing of the community, there has to be an intervention that is going to improve the lives of those affected by it. So, if you have to ban it, then so be it.

Dr Boffa : Also, similar arguments have come up about government legislation, in all sorts of ways, about our behaviours, and I think you can draw a distinction between harm to others and harm to the self. If harm is being done to others, then I do not think that many people would disagree that government have a role to legislate to prevent harm being done to others. But even when harm is being done to the self, in a country that has a universal social insurance scheme, if someone harms themselves and then costs taxpayers $200,000 a year permanently, for life, for supported accommodation, they are actually harming the community. They are harming the social service that the health system provides. But I think in this case, with petrol-sniffing, anyone who has been around someone who is acutely intoxicated knows that they are a danger not just to themselves but to others. They are completely unpredictable. They can be very violent. They can harm others. So I think government do have an obligation, in the first of those two situations, to protect others by making sure that we do not have young people, or anyone, acutely intoxicated on petrol. It is a very dangerous situation for people in the community and for families. But they also do so much damage to themselves; to their brain. They then require so much care from society, care which is ultimately funded by Australian taxpayers because, thankfully, we have a socialised insurance scheme here. But that is another way in which they harm the community. No-one is suggesting that every drug should be banned. You take each substance on its merits and make particular rules for particular substances. That is just an extremist attempt to justify an ideological position. I would say that that same person thinks that government should not intervene in anything.

CHAIR: Thank you very much. It is always important for our committee to put on record our appreciation to the Central Australian Aboriginal Congress, who always give us great cooperation and show great professionalism. Thank you very much.

Proceedings suspended from 12:25 to 13 : 36