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Launch of the Health and Welfare of Australia's Aboriginal and Torres Strait Islander people, Darwin, 2 April 1997: address.

Your Honour, the Administrator, and Mrs Conn, Senator Herron, Mr Dondas, Mr Burke, Mr Djerrkura, Mr Dodson, Mr Yunupingu, Professor Reid, Mr Skinner, Distinguished Guests.

At the outset I acknowledge the Larrakia people, on whose ancestral lands this wonderful Museum and Art Gallery stand.

A predecessor of mine, Sir Zelman Cowen, once commented that perhaps the most important task of a Governor-General is to interpret the Australian nation to itself. That is something which I have, in the period of more than 13 months since I became Governor-General, earnestly endeavoured to do in a non-political way. In particular, I have sought to hold up a mirror in which the people of our country can see the extent of the 2 most important problems confronting our nation, namely, unemployment, particularly youth unemployment, and the plight of the Aboriginal and Torres Strait Islander peoples. With the launch today of"The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples", we take an important further step towards defining, understanding and publicising the nature and extent of the latter of those 2 grave problems.

This new Indigenous Health and Welfare Report is the first of what will be a biennial publication of the National Centre for Aboriginal and Torres Strait Islander Health and Welfare Statistics which is, in turn, a joint venture of the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. The establishment, in Darwin, of that centre and the publication of the Report are of truly national significance. I shall explain why subsequently in these comments. For the moment, it suffices to note that the Report provides cogent confirmation of the general proposition that Aboriginal and Torres Strait Islander disadvantage in our country is devastating in its extent and entrenched in its nature. It extends across the whole spectrum of human life.

Realistically, the different areas of indigenous disadvantage are all inter- connected and must, on a long-term basis, be approached together. Hopefully, we will progressively remove them all. We cannot, however, adopt the approach that we will ignore addressing any of them until we find some universal panacea. In particular, as any caring Australian who reads this Health and Welfare Report must recognise, nothing can justify any delay in our doing whatever we can to address the overwhelming health problems of Aboriginal and Torres Strait Islander Australians.

Much work has, of course, already been done to identify those problems. Thus, in this Northern capital, one must acknowledge the trail-breaking work of the Menzies School of Health Research and the landmark Reports of the Public Accounts Committee of the Northern Territory Legislative Assembly on the provision of School Education Services and Health Services to Aboriginal Communities in the Territory. In a series of speeches since I became Governor-General, I have relied on specific briefings by the Menzies School and the Office for Aboriginal and Torres Strait Islander Health Services in the Commonwealth Department of Health to draw attention to what I see as basic figures demonstrating the gap between indigenous and non-indigenous lives. The Health and Welfare Report provides a broad statistical "snapshot" of the appalling facts.

A young man in this country is at present almost 3 times more likely to die between the ages of 15 and 24 if he is an Aborigine than if he is not. A young Aboriginal woman within that age group is 31/2 times more likely to die.

The disparity progressively increases in the twenty-five to thirty-four and thirty-five to forty-four age brackets. A 25 year old Aboriginal man is 51/2 times more likely to die before he reaches 34 than is a non-Aborigine of the same age. A 35 year old is almost 8 times more likely to die before reaching 44. A 25 year old Aboriginal woman is more than 6 times more likely to die than her non-Aboriginal contemporary before reaching 34. A 35 year old is more than 8 times more likely to die before reaching 44.

The disparity is even worse if one focuses upon some particular areas of illness. For example, Aboriginal men are 12 times more likely to die from diabetes related illness. Aboriginal women are 17 times more likely to die. In passing, I would add the comment that research at the Menzies School has disclosed that the incidence of rheumatic fever in some Aboriginal communities in the Northern Territory is among the highest, and probably the highest, ever recorded in the world. Indeed, it is roughly six times that of Soweto.

If we turn our attention to the position of a new-born child destined to be raised in an Aboriginal community, it is unnecessary to do more than mention two facts which emerge from the Report. The first is that available figures, which are incomplete, indicate that such an Aboriginal baby can expect to live almost twenty years less than other Australian babies. The second is that an Aboriginal infant is 4 times more likely to die in infancy than a non-Aboriginal one.

The Health and Welfare Report confirms a further alarming fact. That is that the gap between the health levels of Aboriginal and Torres Strait Islander peoples and other Australians is actually widening.

As I have said, the establishment of the new national centre and the publication of the Report which we are launching today are of great significance. Through this and subsequent Reports, the new centre will provide an overall and continuing statistical context within which the results of more specific Aboriginal health research studies and inquiries can be assessed and addressed. Put differently, the present and future Reports will provide historical reference points against which our progress as a nation in addressing the terrible problems of Aboriginal health and welfare can be monitored, measured and assessed. The present Report also provides new and specific information in relation to a large number of particular aspects of Aboriginal morbidity and mortality. Time permits only brief mention of but a few of the important more particular issues and findings which appear from it.

The first, and one of the most important, particular issues which I wish to mention is the problem of smoking which the Health and Welfare Report both highlights and documents. With the publication of this Report, it surely must be clear to any intelligent person who is prepared to listen and learn that smoking has an enormously damaging impact on the health of Australia's indigenous peoples. The Report deals with a number of aspects of the problem. One aspect is that indigenous Australians generally either fail to appreciate or under-estimate the risks of tobacco smoking. Another is that smoking has a much greater adverse effect upon indigenous Australians than on other Australians in terms of both morbidity and mortality. One reason why that is so is that, as the Report discloses, the estimated percentage figures for smokers among indigenous men (54%) and women (46%) are roughly twice that for all Australians (28% and 22%). Another reason is that Aboriginal living conditions and propensity to ill health are likely to increase the risk of particular adverse health effects of smoking, such as chronic bronchitis, cardio-vascular disease and low birth weight in babies. We will obviously have to wait some time before there is available anything approaching precise information about the contribution which smoking makes to the distressing difference of almost 20 years in the average life span of Aboriginal and non-Aboriginal Australians. The Report makes clear, however, that the contribution of smoking to that statistic of earlier death is a very significant one. I have no doubt that, when it is quantified, it will be measured in terms of years.

Another issue which the Report highlights is that of environmental health. Thirty percent of indigenous people nationally were estimated to be living in private dwellings that were significantly inadequate for reasons such as overcrowding, the need for repair or the poor state of general utilities. In rural areas, lack of toilets, absence of gas or electricity, no running water, baths or showers, and regular breakdown in utilities, are far more common than for other Australians. Of some 80,000 indigenous people living in a range of communities in the Northern Territory, Queensland and South Australia, some 18% were forced to rely upon a water supply that was not fit for human consumption by National Health and Medical Research Council standards.

The Health and Welfare Report is also important in documenting the connection between unacceptable living conditions and disease. For example, between 1984 and 1993, the incidence of Hepatitis A in the Torres Strait area was 17 times the Queensland rate and was clearly related to conditions of poor water supply and poor sanitation.

Even in areas where current statistics and information are particularly inadequate, the Report provides important guidance in respect of areas of future inquiry and action. Thus, the limited evidence which is available suggests that Torres Strait Islanders living in the Strait have particular problems with obesity, diabetes and heart disease. Again, while information on disability among indigenous Australians is scant, a small study of disability among Aboriginal people in the Taree area of New South Wales indicated, consistently with the findings of other small studies, that Aboriginal men and women in that area at least were 21/2 times more likely to have a disability compared with the non-Aboriginal population.

It has often been suggested that indigenous health and welfare are not as great a problem in our capital cities as they are in outback areas. The Report's statistics for Western Australia, South Australia and the Northern Territory go a long way towards negativing that suggestion. They indicate that death rates for indigenous people are not much better in at least 3 of our capital cities than they are in the outback. Put differently, the Report suggests that the problems of Aboriginal health are just as serious in the capital cities as in outback communities.

In our modern democratic community, what governments - whether Commonwealth, State, Territory or Local - and publicly-funded agencies and institutions can do is necessarily controlled or constrained by the limits of what public opinion will welcome, tolerate or permit. This Report will hopefully do much to influence all Australians, both indigenous and non-indigenous, to approach the question of the health and welfare of the Aboriginal and Torres Strait Islander peoples, particularly the children, on the basis of unprejudiced statistical facts. If the Report achieves that, it will hopefully encourage and facilitate the ascertainment and actual implementation of the most effective measures to reverse its story of excessive suffering and disablement and premature dying and death of fellow Australians.

The Report will also, hopefully, bring home to us all the urgent need to face the daunting problems of indigenous education and to encourage young Aborigines and Torres Strait Islanders to devote their studies, their energies and their lives to bettering the health and welfare of their peoples. The problems of indigenous health and welfare will ultimately be resolved only by an effective partnership between the nation as a whole and the Aboriginal and Torres Strait [slander peoples under which the Aborigines and Torres Strait Islanders play the major active role, particularly in the actual supply of health and other services. Yet the Report shows that indigenous people are greatly under-represented in the health and para-medical workforce. In the welfare services workforce, indigenous representation is better but the presence of indigenous staff tends to be in the less highly skilled jobs. The Report also indicates that indigenous under-graduate enrolments in the health and welfare services professions are not increasing to close the gap.

Quite apart from the problem of inadequate indigenous participation in the provision of health and welfare services, such an effective partnership between indigenous Australians and the nation as a whole will only be achieved if non- indigenous Australians as a whole can be persuaded to acknowledge and lend their support to the claims in justice and decency of their indigenous fellow citizens, particularly the children, to acceptable minimum standards of health, education employment, housing, community infrastructure and general welfare and if, for their part, outstanding Aboriginal and Torres Strait Islander men and women can be persuaded to look for and reciprocate goodwill where it exists and to shoulder the heavy burden of responsibility and sacrifice involved in effectively leading their peoples towards the achievement by them of those standards. It is in helping persuade non- - indigenous and indigenous Australians of those things that this Indigenous Health and Welfare Report and those which follow it will hopefully play an important part in achieving what all caring and properly informed Australians must see as critical national goals.