NACCHO Aboriginal Health #closingthegap debate 1 of 3 : Give Indigenous services the respect and funding they deserve says experts


” I endorsed all six ( Indigenous Advisory Council Members ) because of their qualities as leaders” — but stresses the need to see leadership as a devolved, organic process, with regular input from com­munity leaders being just as crucial as formal meetings at the top.

I always find it frustrating that there is an assumption that the national (Indigenous) leaders that the media often refers to are the only leaders with an authoritative voice on any issue at all, when every time I walk into a community I see natural leaders who are doing things, who are guiding ­people,”

“They’re working to make a difference on the ground but they’re never recognised, nor are they ever involved in providing input into what’s needed in the way of reforms and change.

There’s some continuity of thinking in terms of what the previous body did .But in her own right I have ­always been impressed with Dr ­Ngiare Brown deep thinking and the way in which she’ll reflect on what’s being said, and then she will go to a very salient point that sometimes others have missed, or that contributes to a solution or a way forward.”

Ken Wyatt, Indigenous Health Minister  ” Aboriginal health and wellbeing is close the my heart  Aboriginal Health Newspaper see advert below

 “But people in health who understand the data know that progress is being made.We’ve got to report the improving trends as well, and we need to revisit that in next year’s report.”

Sandra Eades, head of the ­Aboriginal Health Program for the Baker Institute in Melbourn­e, laments that any gap exists between indigenous and non-indigenous child deaths.

“Do something differen­t after 30 years of failed policies. Really fund the Aborig­inal-controlled organisations and let them show what they can do.”

Aboriginal child health and trauma specialist at Notre Dame University’s Broome campus Professor Juli Coffin has advice for the government about how to close the gap: See article 2 below

Article 1 New day dawning as Turnbull pushes grassroots agenda

From the Weekend Australian

The first task for Malcolm Turnbull’s band of hand-picked Indigenous advisers will be to wind back the damage caused by Tony Abbott’s “bromance” with his former chief counsellor, Warren Mundine.

The new six-person indigenous advisory council’s first meeting, shortly after the Prime Minister delivered a disappointing ninth Closing the Gap statement in parliament this week, was cordial, constructive and largely ego-free, according to some who were there.

But mending community disaffection over the performance of the previous 12-member body, announced in chaotic circumstances at the Garma festival in northeast Arnhem Land in late 2013 and then presiding over the widely panned introduction of Abbott’s signature $4.8 billion Indigenous Advancement Strategy the next year, will be a priority.

“Out on the ground, with our mob, the council has in the past been regarded as operating by itself,” new member Roy Ah-See tells Inquirer. “We need to build some credibility with people on the ground, with our people. We need to re-engage.”

Ah-See knows a bit about engagement. He chairs the NSW Aboriginal Land Council, the nation’s largest such member-based organisation, and while professing surprise at his selection on the new panel (“it was a whirlwind, totally unexpected”) concedes that serving three elected terms on his 20,000-member body “has given me some good foundation skills”.

Neither he, nor anyone involved in putting together the streamlined advisory body, thinks Abbott or Mundine were anything but well-intentioned in how they went about pursuing indigenous affairs policy reform. The pair’s passion for indigenous economic advancement, rather than seeing Aboriginal and Torres Strait Islander Australians as irrevocably mired in disadvantage, is acknowledged and Mundine says he’s determined to continue in a private capacity the push away from this “old-world thinking” approach.

But it’s not just community disquiet at the nadir that had been reached — report after report in the past 12 months alone — from the Productivity Commission, the Nat­ional Audit Office, a Senate committee — has picked holes in the government’s indigenous affairs approach.

Educationalist Chris Sarra, another of the new body’s six members and the man credited with coining the phrase now so beloved of the Prime Minister when it comes to indigenous affairs — “do things with us, not to us” — is adamant that change is at hand.

“I feel like there’s something different in the air,” he says. “It’s a new day dawning — there’s an enthusiasm for change that I wasn’t feeling before.”

Sarra, a forceful presence who has no hesitation in pushing an agenda, nonetheless sees himself as a facilitator, not a dominator. He believes Turnbull is serious when he declares that policy must come from the grassroots, not from Canberra, and wants the council to be more of a clearinghouse than a central committee.

“I’m not a gatekeeper,” he says. “I’m interested in making things work. I’ll say to this person, you need to go talk to Congress” — the National Congress of Australia’s First Peoples, the elected peak body stripped of funding last year and disparaged by Indigenous Affairs Minister Nigel Scullion at the time as being unrepresentative — “or this person, you need to talk over here.

“The last thing we want is another bromance,” he says. “I like Malcolm Turnbull a lot, but I see no value for Australia in there being another relationship like that.”

Even Ken Wyatt, Australia’s first indigenous minister with responsibility in the Turnbull government for indigenous health, concedes the Abbott council was perceived as too autocratic and that policy suffered as a result.

“There were some excellent people around that table,” he says. “But you can’t keep taking advice from the same group of people. And the Aboriginal community viewed it that it was from one or two (people).”

Wyatt is also a keen supporter of a re-energised Congress, saying that co-chairs Jackie Huggins and Rod Little “have provided good advice to the Prime Minister and to myself, and I will include them in certain aspects of the work I do”.

Huggins and Little say that, rather than the despondency they felt a year ago when Abbott refused to even meet them, they now see progress.

Addressing a Congress-led coalition of around 50 groups known as the Redfern Alliance on Tuesday, Turnbull declared a need for “more community-driven local decision-making models”. Advisory council member Andrea Mason notes to Inquirer the “vast amount of corporate memory, not just historical figures” in the various groups making up that very alliance, and the clear value of that to government.

The Prime Minister also made a point this week of praising the Murdi Paaki Regional Assembly, a policymaking body stretching over 16 northwestern NSW communities, and the eight-member Empowered Communities model of local governance, whose several architects include Mason and Cape York leader Noel Pearson.

And he announced the appointment of University of Melbourne pro vice-chancellor Ian Anderson to run indigenous affairs, making Anderson Australia’s most senior indigenous bureaucrat. He will conduct a root-and-branch review both of policy generally and of the Closing the Gap project specifically.

There will also for the first time be an indigenous productivity commissioner’s role, with a wide-ranging brief and a $50 million budget.

So the signs are positive, and in Sarra’s view it’s down to Turnbull simply being “smart enough to know there’s a need for something different. He can see the great value for all Australians to see blackfellas not just going from surviving to complying, but from surviving to thriving”.

Sarra, Ah-See and Alice Springs-based Ngaanyatjarra, Pitjantjatjara and Yankunutjatjara Women’s Council chief executive Mason are joined as newcomers on the council by Derby-based Winun Ngari Aboriginal Corp CEO Susan Murphy. Yolgnu leader and artist Djambawa Marawili, from East Arnhem Land, and Wollongong University health academic Ngiare Brown carry over from the Abbott body, a link Wyatt — himself a career health bureaucrat — sees as invaluable.

Anthropologist and geographer Marcia Langton is deeply weary of regularly being given the “indigenous leader” tag, telling Inquirer: “I’m a public intellectual; I’ve been voted onto public intellectual lists over the years at one number or another, not that one takes any notice of this, but it just means I’m a thinker”.

In her powerful essay of almost a decade ago, Trapped in the Aboriginal Reality Show, Langton warned of the folly of seeing “First Peoples … as virtual beings without power or efficacy”, where “political characters played by ‘Aboriginal leaders’ pull the levers that draw settler Australians to them in a co-dependent relationship. The rhetoric of reconciliation is a powerful drawcard — like the bearded woman at the old sideshow. It is a seductive, pornographic idea, designed for punters accustomed to viewing Aborigines as freaks.”

It’s an analysis that stands, though the current mood, and Turnbull’s gathering around him of experts with a directive to tell him who and what he should be listening to rather than what he wants to hear, tend to confirm the perception of change that Sarra, Huggins, Little and many others detect. “The previous prime minister put a lot of faith in one or two ­people (but) in the Aboriginal community, we don’t have one leader who speaks on every issue,” Reconciliation Australia chief executive Justin Mohamed says.

“We’ve got many nations within this country, many different ­dialogues, traditional languages, cultures and laws that we all operate in.

“So if someone’s a strong representative, say, of the Kimberley, that doesn’t mean they represent a person from Perth. If you get to understand that, then you’ll say it’s not one voice I need to hear, I need to hear a collective of people.”

And yet the elephant in the room is that Turnbull’s panel remains, as was Abbott’s, hand-picked.

“That original Abbott group had absolutely no legitimacy, but I’m still lukewarm on a hand-picked group of people — not because of the individuals, some of whom I consider friends of the highest order,” indigenous Labor MP Linda Burney says.

“But it must not be like the last council, which was moribund, without transparency, and without accountability back to the community.”

Labor senators Malarndirri McCarthy and Patrick Dodson are equally sceptical of a group that has been appointed from on high, with McCarthy concerned it has no clear brief. “Until there’s clarity as to its purpose it will not be taken seriously,” she says.

Dodson told caucus this week that the “top-down centralised process leaves our indigenous nations on the margins as policy fringe-dwellers … Aboriginal and Torres Strait Islander people are cynical, frustrated and angry”.

“We need to be free from constantly needing you to understand us. We need to be free from explaining ourselves to you. We need to be free to do the things that are important for us,” he told his colleagues, even as they were celebrating the fact that for the first time, all three flags — Australian blue ensign, Torres Strait Islands and Aboriginal — were flanked in the room and will be at all future caucus meetings.

There is another solution to all this, of course, and it’s being discussed at the grassroots level as part of efforts by the bipartisan-­appointed Referendum Council to devise a proposal for indigenous constitutional recognition to take to the parliament by the middle of the year.

Pearson’s proposal of a parliamentary body representing indigenous interests is under debate at community consultations around the country, leading to a major gathering at Uluru at the end of May, marking the 50th anniversary of the referendum that gave the commonwealth powers in indigenous affairs.

The latest of these gatherings is in the western NSW regional city of Dubbo this weekend; last week’s meeting in Broome resolved there should be “an indigenous voice to parliament to give First Nations peoples a greater say in decision-making on matters that affect them and their rights” and that this body “must not be appointed or hand-picked by government”.

Article 2 : Gap crisis: give indigenous services the respect they deserve

This week’s poor Closing the Gap result in child mortality has been met with despair by early childhood experts around Australia.

It is not just because of the tragedy of the deaths of 124 indig­enous children younger than five in 2015, an increase of six deaths on 2014.

Their despair lies in the failure to fully acknowledge the gains made, often by Aboriginal-run organisat­ions, in the wellbeing of indigenous children after nearly a decade of Closing the Gap reports.

Sandra Eades, head of the ­Aboriginal Health Program for the Baker Institute in Melbourn­e, laments that any gap exists between indigenous and non-indigenous child deaths. “But people in health who understand the data know that progress is being made,” she insists. “We’ve got to report the improving trends as well, and we need to revisit that in next year’s report.”

Malcolm Turnbull told parliament this week that just one of seven Closing the Gap targets to reduce indigenous disadvantage is on track, with child mortality rates joining this year’s list of failed­ targets.

The 124 deaths was “four deaths outside the range of the target”, the report noted, adding that it was influenced by a change in Queensland’s data reporting of deaths identified as indigenous. The Northern Territory, with 333 per 1000 deaths, has the highest rate, with experts saying the cause lies only partly in the remote places­ where children live.

Former Australian of the Year Fiona Stanley, who led Australia’s biggest study of indigenous families at Perth’s Telethon Child Health Research Institute, says Professor Eades is right to look to the improvements. “The good news is we’ve halved the indigenous mortality rate from 1998 to 2015, from 13.5 per thousand live births to 6.3 per 1000 live births in 2015” she says. “That’s fantastic.”

And the Gap report notes that fewer babies are being born with low birthweight. “Why is that happening?’’ Professor Stanley asked. “Because maternal health is better, there’s better antenatal care, women are stopping smoking and fetal alcohol exposures are going down. I’m seeing all this when I visit the Eastern Goldfields, Pilbara and Kimberley, and Aboriginal mums should be given a big pat on the back for this.”

Professor Stanley’s message to the federal government is loud and clear, however — it must support the maternal health and child welfare centres, many Aboriginal-controlled, that helped achieve those gains.

She says the Closing the Gap report is accurate when it calls for “better integration of services across health, childcare, early childhood education and school”.

“Many of us are deeply concerned about the future of early childhood and parental support centres around Australia,” she says. “Under changes to federal government funding, they could close, or be underfunded so that parents won’t be able to afford to use them.”

At St Mary’s Primary School in Broome, more than a dozen parents arrive each day to spend time with their children in an early childhood program called Our Mob as First Educators. Aboriginal child health and trauma specialist at Notre Dame University’s Broome campus Juli Coffin praises the program for “investing­ in parents, supporting them in positive relationships between­ each other and with the kids.”

Mother Natalie Graham says she had bad post-natal depression: “Coming here is really helping to build a bond with my son.”

Dad Geoffrey Clark says he feels comfortable visiting, “and it’s fun interacting and learning”.

Professor Coffin says such culturally appropriate services build family strength in the face of the Kimberley’s high rates of child remov­al. In Western Australia, 53 per cent of all 4658 state wards are Aboriginal, despite comprising less than 7 per cent of the popula­tion. The crisis has forced Child Protection authorities to focus resource­s on vulnerable families in a bid to reduce child trauma and removal.

“Our kids are vitally important in our family structure, they are often the only beam of light, the reason for people to get up in the morning,” says Professor Coffin.

What of the grim statistics at the heart of the Closing the Gap report, those 124 children who failed to make it through infancy?

Professor Stanley says the Territory’s high mortality rate “could be related to high rates of preventable things like scabies and rheumatic heart disease, as well as isolation”.

Next year’s statistics are alread­y being made. On Monday, a woman in an indigenous community near a regional WA town gave birth to twins. One died during labour. The attending doctor, who does not wish to be identified, says regular antenatal care in an Aboriginal-run maternal health centre might have saved the child.

Another statistic in next year’s Gap report will be Perth baby Sean. His family ticks many of the boxes that health professionals know are risk factors for infant death, including poverty and parents who grew up in state care and experienced jail time.

And homelessness. Last year, The Weekend Australian reported that the chubby-cheeked infant, who had a stoma bag and was awaiting a bowel operation, was homeless along with his four siblings. Sean’s parents were praised by the hospital for carrying his medical supplies around and keeping him clear of infection.

But it wasn’t easy — after an outbreak of violence at the house where they’d lived, the family had resorted to nights sleeping under a bridge in Perth’s outer suburbs.

Sean died, aged five months, shortly after the family moved into emergency housing provided by a youth service. The Weekend Australian can no longer identify the family because, after the fathe­r became seriously ill, the four surviving children were taken into Child Protection’s care.

Christine Jeffries-Stokes, a pediatrician in the Goldfields town of Kalgoorlie, says the Goldfields region has a much lower mortality rate than the Territory, but trauma and loss in many Kalgoorlie families means fewer relatives to support mothers and children or notice if something is not right, she says.

Dr Jeffries-Stokes says Kalgoorlie’s Ngunytju Tjitji Pirni matern­al and infant health closed down last year, after the federal government reallocated funds to the Aboriginal Medi­cal Service. “Yet it provided intim­ate, supportive care that women trusted; babies were weighed routinely and checked, women were trained as infant health workers and that benefited their own families. I’ve noticed my work is harder now keeping track of patients.

“The lessons we’ve learned are not reaching people, and great indig­enous services are not getting the respect they deserve.”

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