Chris Lawrence

The George Institute for Global Health, Royal Prince Alfred Hospital, New South Wales

As an Aboriginal Noongar person from Whadjuk country (Perth) Western Australia, I have seen first- hand the experiences and devastating impact of poor health and the effects of premature death on loved ones. In my own large family and community, there have been many preventable deaths in young and mature age people, but poor health decisions still occur.

Acquiring diabetes or heart disease is almost like a rite of passage, some sort of “cultural initiation”. “We all die from something eventually” , is the general notion.

It saddens me to hear many Aboriginal and Torres Strait Islander people talk about early death as if it is inevitable and life is not worth living.

Since the first Aboriginal Medical Service was set up in 1972 in Redfern, New South Wales, health care services have improved for Aboriginal and Torres Strait Islander people across the country. There is really no excuse for people to not have regular health checks, or is there ?.

The life expectancy gap between an Aboriginal and Torres Strait Islander and other Australians is still too wide. The Australian Bureau of Statistics (ABS) in 2011 estimated that this life gap is 12 years for males and 10 years for females. These statistics clearly illustrate that Aboriginal and Torres Strait Islander people are still not taking full advantage of these health services or programs. Why is that ?.

I believe there are two fundamental issues to help us understand this disparity. One is about the individual and their health status; the second is about their status as an Australian citizen.

This essay will discuss the association between the health and wellbeing of Australia’s First Peoples and the fundamental legal right of Aboriginals and Torres Strait Islanders to be officially recognised in the Australian Constitution. I acknowledge there are other important determinants of health and well being; however this editorial focuses on health and citizenship status.

Health Status

In 1946 the World Health Organization (WHO) Constitution stated that, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

In Australia in 1989, the first and only National Aboriginal and Islander Health Strategy clearly advocated for a holistic approach to addressing Aboriginal and Torres Strait Islander health : we need to recognize the whole person and their environment and not just treat sick body parts.

It has been widely documented that poor people are more often unhealthy people. The more money you have, the more likely you are to look after yourself (in theory, not always in practice). In research terms this is known as social determinants of health, where socioeconomic factors are often taken into consideration to help explain poor health outcomes.

This journal has consistently published papers and letters on these issues, in particular, the December 2012 issue provided varying commentaries on “Healthy Equity”. For many Aboriginal and Torres Strait Islander people, these social determinants of health are largely related to the legacy of British colonial history and the generations of poor government policies that have continued to have a profound impact on Aboriginal and Torres Strait Islander health and wellbeing.

The 1997 “stolen generations” report Bringing them Home provided detailed information about the forced removal of Aboriginal and Torres Strait Islander children. For the first time, the report highlighted the depth of this legacy and, in particular, the traumatic experiences of childhood issues (often physical and sexual abuse), and the relationship of the social and emotional wellbeing to the health of the person. This report only scratched the surface, and there is a need for a follow-up report that more deeply explores the consequences for long-term health.

As an early career researcher in Aboriginal and Torres Strait Islander health who is exploring ways of reducing obesity, diabetes and heart disease through early intervention methods such as nutritious diets and exercise, I research attitudes and behaviours that influence health decisions. I regularly see data showing conflicting patterns of attitudes and behaviour, a complex array of “mixed messages” shaping how people decisions regarding their own health.

On the one hand, people know that good food and exercise mean good health. However, at the same time people will acknowledge that they smoke, and are diabetic and overweight. In some of our focus groups, research participants will talk about their childhood experiences and relate these to their own poor health status in a direct connection.

Citizenship status

As an Aboriginal person, I often find myself feeling like a second-class citizen, and perhaps this has something to do with my own birth date and where I lived at that time. I was born in 1966, the year before the Australian 1967 Referendum, which was not explicitly about citizenship for Aboriginal and Torres Strait Islander people.

The Commonwealth Electoral Act was amended in 1962 to give franchise to all Aboriginal people, extending the right to vote to Aboriginal people in Western Australia, Queensland and the Northern Territory people in Western Australia, Queensland and the Northern Territory. The Referendum changed sections of the Constitution from 1901 that stated, “in reckoning the numbers of people… Aboriginal natives shall not be counted”.

It also changed sections that said the Commonwealth would legislate for any race except Aboriginal people. This left the power over Aboriginal Affairs with the States. We can take two perspectives of the Referendum : 1) Aboriginal people were counted in the Census and 2) the Commonwealth was given the power to legislate for Aboriginal people; ironic that the Commonwealth government now uses this power to mount the intervention in the Northern Territory.

While the Referendum provided voting rights for Aboriginal and Torres Strait Islander people, many were still living in conditions shaped by the White Australia Policy enacted at Federation in 1901. The Western Australian Aborigines Act passed in 1905 made the Chief Protector the legal guardian of every Aboriginal and “half-caste” child under 16. Reserves were established, a local protector appointed and rules governing Aboriginal employment were laid down.

My own Aboriginal mother and father were fresh from the Missions and aged 16 and 17 when I was born in 1966. While my mother was allowed to give birth to me in a hospital, I was later taken home to the local Reserve where I am told we lived in tin shacks with dirt floors, overcrowding and no sanitation.

I recall going back to the Reserve during my childhood holidays and it has always haunted me to think that governments segregated Aboriginal people to live this way. In great contrast, also in 1966, the United Nations launched the International Covenant on Economic, social and Cultural Rights which states that, “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world”.

I also become perplexed about my own “citizenship status’ particularly when I listen to discussions about native title and land rights as well as human rights in Australia. We have a long way to go to address the First Peoples’s issues, but watching mainstream TV or listening to radio talk-back shows discussing these topics is disturbing and disheartening.

Most panellists are either ill-informed and  ignorant or are deliberately misleading the audience to gain points for their own political parties. Listening to these programs does not encourage Aboriginal and Torres Strait Islander people to be “proud Australians; rather the discussion can further isolate them from the wider Australian population.

I believe not feeling a proud citizen of your own country can affect your sense of self-worth and directly shape decisions and choices about one’s own health and wellbeing.

The Australian Constitution

For more than 100 years, The Australian Constitution has been providing the basic rules by which Australia is governed. It is of continuing importance to Australia because it is the legal and political foundation on which our nation is built and continues to function.

What does the Constitution represent for Aboriginal and Torres Strait Islander people ?. From my perspective, the Australian Constitution discriminate and does not provide adequate (if any) protection for Aboriginal and Torres Strait Islander people as the First Peoples of this country.

We would need to go to a referendum to make any changes to the Constitution but, in great contrast, the Racial Discrimination Act 1975 has been amended at least three times. All three related to Aboriginal and Torres Strait Islander Islander issues – most recently to accommodate the expansion of the Commonwealth Government’s Northern Territory intervention/response and “therefore, it was ineffective in protecting our peoples from the most fundamental of all freedoms, the freedom from discrimination.

Recognising Aboriginal and Torres Strait Islander people in the Australian Constitution is inherently the right thing to do as we are the First Peoples of Australia. In 1992, Prime Minister Paul Keating addressed the nation from Redfern Park. He said, “complex as our contemporary identity is, it cannot be separated from Aboriginal Australia’ and “the starting point might be to recognise that the problem starts with non-Aboriginal Australians”. Keating went on to discuss the need for constitutional recognition : “It begins with the act of recognition … We have to give meaning to ‘justice and ‘equality’ … We need these practical building blocks of change.

If we change the Constitution to recognise Aboriginal and Torres Strait Islander place in Australia, it will start to deliver and address a wide range of human and Indigenous rights issues. It will also be a unique catalyst to improving the health and well-being of ALL Aboriginal and Torres Strait People and our future generations.

In 2008, when Prime Minister Kevin Rudd delivered a national apology to Aboriginal and Torres Strait Islander people, he said, “We apologize for the laws and policies of successive parliaments and governments that have inflicted profound grief, suffering and loss on these our fellow Australians’ and “We today take this first step by acknowledging the past and laying claim to a future that embraces all Australians. A future where this parliament resolves that the injustices of the past must never, never, happen again… A future where we harness the determination of all Australians, Indigenous and non Indigenous, to close the gap that lies between us in life expectancy, educational achievement and economic opportunity. A future where we embrace the possibility of new solutions to enduring problems where old approaches have failed”.

The monumental legal act of recognising Aboriginal and Torres Strait Islander people in the Australian Constitution will instil a real sense of pride and dignity for our First Peoples and be one of the solutions to closing the life expectancy gap. It will strongly encourage a more robust participation in the health, as well as the education and employment systems to build strong and proud future generations of Australians.

In regards to health, it will particularly benefit Aboriginal and Torres Strait Islander people at the primary health stages, so people will utilise community health programs and embrace health promotion to reduce chronic and preventable diseases rather present with advanced or end-stage disease. This would have the potential to save millions of dollars in health care and social support and, most importantly, save lives.

It is time that we recognise the True First Peoples of this country in our Constitution but more importantly from a health perspective, we need to address these issues as a nation in unity. Health education and funding resources are essential, but recognising one’s own value and worth in the framework of this country as a first-class citizen is vital to taking personal responsibility and addressing one’s own health needs. It has to start with the individual if we as a nation and as health care professionals can truly make any difference.

A healthy Australian is a proud Australian.