Dispossession and Aboriginal health
By Dr Ben Bartlett
Aboriginal adult mortality rates are the highest in the world, apart from regions gripped by war. In the Northern Territory, infant and child mortality remains three times that of other Australians, but this has dropped from four to six times since 1979.
The improved infant/child mortality reflects improved health care services, and particularly primary health care services to Aboriginal people and the efficacy of medical interventions directed particularly at communicable disease.
However, over the same period, adult (particularly young adult) mortality has worsened. The persistently high adult mortality rates reflect:
1. excess preventable deaths from a number of causes, but particularly undiagnosed ischaemic heart disease; and
2. the prevalence of substance abuse, community violence and poor nutrition, and the poor impacts medical interventions have on these.
It can be argued that the stresses of being Aboriginal (poverty, racism, etc) alongside nutritional and so-called "life-style" factors are underlying causes of the first, but it is the second category that are more clearly related to these stresses, and particularly to the issues of land (native title and Wik) and the histories of the stolen generations.
Historical issues
With colonisation came the introduction of new infectious diseases that travelled across the continent more rapidly than the British colonists, as well as violent confrontations between Aboriginal people and the colonists when they did arrive.
Governments then embarked on a policy of "protection of Aboriginal people". This policy was partly a humane attempt to limit the extreme violent behaviour of settlers and pastoralists on the frontier. It was also based on an assumption that Aboriginal people would "die out" and that good governance would "smooth the pillow" of the dying. It was also about facilitating dispossession.
However, the policies of protection were predominantly policies of control. Aboriginal people were forced into settlements — controlled by either government or church. Their movement was restricted.
This protection was also seen (particularly in the Northern Territory) as essential to securing white settlement. Thus Aboriginal people were, predominantly, brought under the control of the authorities. This, along with high rates of imprisonment and incarceration in psychiatric institutions, has contributed to a type of institutionalisation of Aboriginal Australia.
Impact on Aboriginal society
The decline, from a most conservative estimate of a population of 251,000 at the time of the invasion to a 1930s figure of 65,000 Aborigines, indicates that over 150 years the population was reduced by nearly 75%. It does not take much imagination to understand that this has meant enormous disruption to the community.
On top of these calamities were the assimilationist and genocidal policies of children being taken away from their families and communities. Many people have experienced a profound sense of loss of identity, and continue to do so.
These histories are also about the dominance of a social engineering or social Darwinist view at the time, which engulfed Aboriginal policy as well as policies of social welfare generally.
These past calamities have caused damage to family and community cohesiveness, and new calamities build on the despair set by the old.
One Aboriginal leader has described the current period as one of "postwar reconstruction". However, the process of reconstruction, in the context of being militarily defeated, numerically overwhelmed and economically and socially marginalised, is an enormous task. It requires a national commitment, dollars and patience.
Some notion of community control or Aboriginal self-determination in health has been supported in every major writing on Aboriginal health over the past 20 years. The failure of governments to implement a comprehensive strategy to achieve this partly reflects the difficulties bureaucracies have in understanding and interacting with community initiatives, and their, at times, unpredictability.
Native title
The current debate around the High Court's discovery of native title in common law, its Wik decision asserting that native title can coexist with pastoral leases and the Wik legislation based on Howard's 10-point plan illustrate the struggle that Aboriginal Australians must continue if the conditions for better health are to be achieved.
It also highlights the contradictory policy stance of the Howard government. On the one hand, the Coalition government has asserted that it will put increased effort into Aboriginal health and education strategies. On the other hand it is prepared to affirm the dispossession of Aboriginal people through the Wik legislation.
Reducing the strategies for better health to health services alone reduces Aboriginal people to patients/clients. This implies a passivity which is contrasted with the community activity required for change — especially to the social and emotional well-being issues which underlie the high young adult mortality rates.
How do Wik, racism and the debate around the stolen generations impact on Aboriginal health? There are three ways this can be understood.
1. For some Aboriginal people, continued access to their land has an economic component. Hunting and gathering continue across many parts of the continent, and much of this occurs on pastoral leases. Restricting access by extinguishing Aboriginal people's common law rights will remove this part of an Aboriginal economy.
2. This will impact on the nutrition of some people. Less access to land and the consequent reduced access to bush foods will push people into greater reliance on store food, which is nutritionally inferior to bush foods.
3. Land has a fundamental spiritual meaning for Aboriginal people. Restriction of access to sacred sites (whether formally registered or not) is likely to result in worsening of health status through increased substance abuse and other destructive behaviours.
The first two points probably only directly affect a small proportion of Aboriginal people. Many have already lost most access to land so that the economic and nutritional advantages have also been lost. However, this is not the case in regard to spiritual issues as many people have maintained connection with place for these purposes.
There is also the impact of the national debates involving the characterisation of a people already marginalised in this society, and this impact is generalised to the whole Aboriginal population with the inevitable stereotyping. This impact is negative for many people and makes the issues of lack of self-esteem, identity and a vision for a better future more difficult.
The attack on Aboriginal common law rights impacts on the health of Aboriginal people who have no chance of directly benefiting from the High Court's decision because of their almost complete historical dispossession.
The impact on people's health, while hard to demonstrate epidemiologically, is nonetheless obvious. Oppression, the denial of human rights, is likely to cause people to metaphorically cringe — to remain unobtrusive for fear of attack.
Young people see a more introspective, cautious community leadership. To be Aboriginal is to be abused, is to be seen as less than human. These factors are likely to result in more self-destructive behaviour.
We are now in a time when the highest elected office in the land denies that generalised stereotyping of a racial group is racist, and fails to assert leadership to ensure acceptance and respect of minority groups. It is a metaphor for pushing Aboriginal people back to the fringes of our society. If that is allowed to continued, we can expect adult mortality to rise.
The public health community needs to promote a broad environment in which the following can be incorporated:
- reconciliation based on acknowledgment of the grief and distress experienced;
- cessation of all acts of dispossession;
- allocation of resources at a level needed to make a difference;
- development of comprehensive primary health care systems incorporating community-based clinical services, management and education support, and special preventive programs driven by the community;
- provision of appropriate community infrastructure, including health and hardware (shelter, water, waste disposal systems);
- assurance of an appropriate education strategy for children and adults;
- support for community access to 'country' and cultural and sporting activities; and
- changes in the practices of incarceration of Aboriginal people.
Community control of these programs is essential to the project of reconstruction. The delivery of programs to passive recipients does not build the relationships and understandings that help to overcome the underlying problems experienced by many communities.
On the other hand, all citizens have the right to adequate living conditions, food and health care. The provision of these things should not be dependent on communities taking control.
The NAHS and the Royal Commission into Aboriginal Deaths in Custody detailed the situation in Aboriginal communities, and remain the most appropriate and relevant guides on how to proceed.
[Dr Ben Bartlett has worked in the area of Aboriginal health for 10 years. This article is abridged from Djadi Dugarang, the newsletter of the Indigenous Social Justice Association.]