Implementation of the United Nations Declaration on the Rights of Indigenous Peoples:

Discussion on the rights of Indigenous Peoples to health

7-18 May 2012

Agenda Item 4 a: Implementation of the United Nations Declaration on the Rights of Indigenous Peoples: Discussion on the rights of Indigenous Peoples to health

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Joint Intervention Delivered by Mr Justin Mohamed on behalf of:

NACCHO

National Aboriginal Community Controlled Health Organisation (NACCHO)

Turkindi – Indigneous Information Network of South Australia

Aboriginal Legal Service of WA (Inc.)

Marninwarntikura Women’s Resource Centre Aboriginal Corporation

Gugu Badhun Limited

Aboriginal Legal Rights Movement (ALRM)

Victorian Aboriginal Legal Service (VALS)

Queensland Culture Heritage and Native Title Management Services

National Aboriginal and Torres Strait Islander Legal Services (NATSILS)

Secretariat of National Aboriginal and Torres Strait Islander Child Care (SNAICC)

Koort Marr Kaart – Aboriginal and Torres Strait Islander Social Workers of Western Australia

National Indigenous Higher Education Network (NIHEN)

New South Wales Aboriginal Land Council (NSWALC)

Foundation for Indigenous Recovery and Development Australia (FIRDA)

National Congress of Australia’s First Peoples

Aboriginal Rights Coalition (ARC)

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Thank you Mr Chair

Firstly, I’d like to congratulate you on your appointment as Chairperson of the Permanent Forum and acknowledge the traditional owners of the land upon which we are meeting.

The Indigenous People’s Organisation of Australia and The National Aboriginal Community Controlled Health Organisation (NACCHO) present the following recommendations to the Permanent Forum.

We recommend that the Permanent Forum:

1. Urge States to investigate and promote models of community control for health, social, legal and other sectors and service providers;
2. Urge States that do not already do so to identify senior Indigenous political and bureaucratic positions and develop capacity building pathways into those positions in health and other portfolios
3. Encourage the World Health Organization (WHO) to revisit the report of the WHO Commission on the Social Determinants of Health to address the cultural determinants of health – such as land, language, ceremony and identity – which are essential to the health and wellbeing of Indigenous Peoples;
4. Requests that States, as part of their reporting activities, provide information on progress towards national/regional/local systems which respect, protect and promote the principles of the right to health.

We appreciate the opportunity to address the Permanent Forum as to the need for ways of ensuring better health outcomes for Indigenous peoples of the world, including Aboriginal and Torres Strait Islander Peoples of Australia.

Due to the treatment and experiences of Indigenous peoples across the world, the United Nations has worked over many years to develop and gain endorsement at the General Assembly on the Declaration on the Rights of Indigenous Peoples (DRIP). Although endorsed in September 2007 Australia only became a signatory in 2009 and therefore is only in its infancy of implementation. The Australian IPO Network broader intervention outlined the need for the Australian Government to honour their responsibilities to implement this UN instrument. Several articles are highly relevant to the health and social determinants of Indigenous Peoples. Article 21(1) states that:

Indigenous peoples have the right, without discrimination, to the improvement of their economic and social conditions, including, inter alia, in the areas of education, employment, vocational training and retraining, housing, sanitation, health and social security.

Furthermore, the ability of Indigenous peoples to determine their own health priorities incorporates a strength-based and self-determination approach. Importantly, Article 23 (rights to self determination) of the UN DRIP outlines a position consistent with what we have developed in Australia Aboriginal Community Controlled Health Services whose governance structure and service provision is the embodiment of the right to self-determination. Article 23 states:

Indigenous peoples have the right to determine and develop priorities and strategies for exercising their right to development. In particular, indigenous peoples have the right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own institutions.

This is expanded in Article 24(1), which also acknowledges Indigenous peoples’ rights to traditional medicines and health practices. It states that: “Indigenous individuals also have the right to access, without any discrimination, all social and health services”. Part 2 of Article 24 then outlines the responsibilities of States to enable these rights to be realised:

Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.

Further to this, Article 29(3) then states that:

States shall also take effective measures to ensure, as needed, that programmes for monitoring, maintaining and restoring the health of indigenous peoples, as developed and implemented by the peoples affected by such materials, are duly implemented.

It also underpins the creation of the Aboriginal Community Controlled Health Sector itself. In fact, a human rights-based approach is what Aboriginal Peoples have promoted and advocated for this since working to create the first Aboriginal Community Controlled Organisations, e.g. the establishment of the Aborigines Advancement League in 1931. It is well documented that Aboriginal Community Controlled Health Services not only achieve improvements in our Peoples health outcomes and reach those in our population who are in most need of health services but also serve as a place of gathering and pride in our communities.

Within the health sphere, there are two seminal documents from the World Health Organisation. The Alma Alta Declaration from the 1978 International Conference on Primary Health Care that sought to articulate a commitment and approach to addressing the inequalities in health status between and within nations, as is the case in Australia. It starts with the following statements:

I: The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

II: The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

At the 1986 First International Conference on Health Promotion, the Ottawa Charter for Health Promotion was developed and endorsed. It names ‘social justice and equity’ as one of several fundamental conditions and resources for health. Six commitments were made at the conference, two of which were:

To move into the arena of healthy public policy, and to advocate a clear political commitment to health and equity in all sectors….

To respond to the health gap within and between societies, and to tackle the inequities in health produced by the rules and practices of these societies.^[1]

Although the Ottawa Charter has been built on by several further WHO Declarations, it remains the defining document for all health promotion practice. It is consistent with the approach to community control, the delivery of holistic comprehensive primary health care and respect for Indigenous Leadership.

In any process of decision-making and possible negotiation with Indigenous Peoples, States must ensure that Indigenous peoples leadership have sufficient time and information to make decisions.  Whether these decisions are made through traditional authorities or other frameworks. Such a process is consistent with Free, Prior and Informed Consent (FPIC). In the absence of such processes we will continue to suffer from a well documented high burden of mortality and morbidity and a life expectancy gap of approximately 17 years less than the rest of our nation.

Therefore, as described by these international instruments, Indigenous voices and leadership are required at all decision-making levels to address the poor health status of Indigenous Peoples. Community control supports this concept, however our presence is not sufficiently reflected nor ensured in State structures. It is for this reason we propose States create senior Indigenous political and bureaucratic positions.

Furthermore while there have been well intentioned national strategies in the past, more of the same approach will not improve Aboriginal and Torres Strait Islander health outcomes.

Within Australia there is currently a national plan to address Indigenous health. Its being developed to ensure alignment of the Council Of Australian Governments ‘Closing the Gap’ actions, along with broader Australian health reforms.

Previous Australian government strategies and plans have documented both risk factors and service level approaches that have been the core focus. The key challenges to addressing Indigenous health in the new plan revolve around ensuring there is real structure for the development and implementation of new strategies, which ensure both high level Indigenous leadership and accountability of government structures tasked with implementation.

Indigenous health leaders must be equal partners with government in both driving and evaluating the new plans for all nation States.