“We are calling for better and more effective engagement with Aboriginal leadership in dealing with this crisis
AMSANT’s offer to partner in brokering solutions still stands and we urge Territory Families to engage with us and other Aboriginal leaders more closely.
Moving to a youth development approach within these facilities, as recommended by the Royal Commission, is not being approached with the urgency required.
More should be occurring by this stage down the track, such as the establishment of an elders visiting and mentoring program, which is an obvious gap at present
We need the government to work in partnership with us.
Ultimately, a stronger focus on Aboriginal-led programs that support children and their families in communities, so they don’t end up in detention in the first place, is where we need to be
” It has been twelve months since the Royal Commission handed down its report into the protection and detention of children in the Northern Territory.
This week’s disturbing events are further proof that locking children and young people up in places like Don Dale does not prepare them for life as a responsible adult.
Incarceration is not a road to rehabilitation.
Aboriginal children and young people represent upwards of 95% of detainees in NT youth detention facilities. In recent times Aboriginal children and young people made up 100% of detainees in Don Dale.”
Making Justice Work Press ReleaseDownload read in full
“The Royal Commission final report recommendations aligns with the path of reform that we have undertaken since coming to Government, including sweeping alcohol reforms announced yesterday.”
217 of the recommendations relate to action by the Northern Territory Government, which have been mapped into a framework of 17 work programs.
There are another 10 recommendations which we accept the intent and direction of, however they require actions by the Commonwealth Government and other organisations.
“We need coordinated effort to make effective, meaningful and generational change to our youth justice and child protection systems. Now more than ever, we need the support of the Commonwealth Government working in collaboration with the Northern Territory Government and the Aboriginal-controlled and non-government sector.”
March 2018 Minister for Territory Families Dale Wakefield announced that the Territory Labor Government will accept the intent and direction of all 227 Royal Commission recommendations, delivered in its final report late last year.
Part 1 Media Coverage background from the Guardian
Another violent incident at the Don Dale detention centre has sparked widespread criticism of the Northern Territory government for continuing to operate the maligned facility, a year after the royal commission called for its closure.
The NT government said on Wednesday it couldn’t guarantee there wouldn’t be a repeat of the previous night, after young detainees allegedly attacked a staff member, stole keys and burned down the facility’s school room.
It was the second time in three weeks that young detainees had stolen keys and caused damage, and was the latest in a long line of violence at the centre in recent years.
All 25 young people are now being held in the Darwin police watch house, and their lawyers are applying for immediate bail, saying it is an unsafe environment, the ABC reported.
Reports that the centre has been closed indefinitely were incorrect, Guardian Australia has confirmed, and it’s understood police are likely to return the unburned majority of the centre to the control of Territory Families once inspections are completed.
AMSANT today called for urgent change to the Northern Territory Government’s approach to youth justice reform following another serious incident at the Don Dale Detention Centre.
“AMSANT is extremely concerned about the welfare of the children and staff currently held or working in the detention facilities”, said AMSANT CEO, John Paterson.
“The fact that police were called and tear gas was used and that the children are now languishing in the Darwin Watch House indicates that what is currently being done at Don Dale is not working.
“At present there are serious questions over whether the Northern Territory Government has in place the capacity to manage the change processes required for these reforms.
“There remain significant issues around the training and numbers of staff, and an ongoing situation of children being subject to long periods of lock-down.
“It’s a pressure cooker situation that will keep resulting in serious incidents such as occurred this week .
“Of the children in detention at least half are in the child protection system and many are on remand.
“We call for urgent action for the release of young people held on remand (not yet sentenced) with non-serious offences to be returned to community and families as a matter of priority.
“Moving to a youth development approach within these facilities, as recommended by the Royal Commission, is not being approached with the urgency required.
“More should be occurring by this stage down the track, such as the establishment of an elders visiting and mentoring program, which is an obvious gap at present.
“With new facilities not due to open till 2021, this is too long to wait for the changes needed.
“AMSANT is also concerned that the government has decided to plan for only two, expensive, urban based facilities in Darwin and Alice Springs.
We have advocated for smaller, regionally based facilities that will enable the engagement of families in the development of their children.
“Investment and support from our local organisations, employers and governments will ensure the success of the Northern Territory Aboriginal Health Academy (NTAHA)
Schools, students and community need to know this will be a secure and sustainable approach to building our local workforce, many of whom will stay in our communities’ long term
A key principle of the National Aboriginal and Torres Strait Islander Health Plan is Aboriginal and Torres Strait Islander community control and engagement, with culture the main overarching priority.
The NT Aboriginal Health Academy has been unsuccessful in gaining the financial support it requires. However, we have had strong support from key stakeholders such as NT Department of Education, NT Department of Health, Charles Darwin University, Flinders University and the Industry Skills Advisory Council NT “
AMSANT CEO John Paterson
Picture above‘Creating a strong pathway for their 20 deadly Indigenous youth in to health‘
” This partnership with AMSANT to grow and develop the nation’s future leaders in health is critical to the success of the Academy. Growing the Aboriginal and Torres Strait Islander allied health workforce is critically important in providing sustainable, culturally-responsive holistic healthcare.
An increase in the number of qualified Aboriginal and Torres Strait Islander health professionals is needed to positively address workforce shortages in rural and remote communities across the NT.
Already, we are seeing students and their families engaging, and young mothers re-engaging in education through the Academy. They see it as a more flexible and meaningful pathway to sustainable employment in our communities .
If Governments are truly committed to Closing the Gap then there needs to be greater support shown for community-driven initiatives like the NT Aboriginal Health Academy,”
IAHA CEO Donna Murray.
Indigenous Allied Health Australia (IAHA) and the Aboriginal Medical Services Alliance Northern Territory (AMSANT) launch the Northern Territory Aboriginal Health Academy (NTAHA).
The Health Academy will increase the number of young Aboriginal people completing year 12 and entering into the health workforce.
This project is an innovative community led learning model that is about re-shaping and redesigning how training is delivered to Aboriginal students in high school years.
The model is strengths based and centered on ensuring training and education is delivered in a way that embeds the centrality of culture and has a holistic approach to health and wellbeing.
The model is designed to work collaboratively across health disciplines and sectors. There is an urgent, real need for health professions in sectors such as primary health care, disability, mental health, allied health, medicine and aged care; for providing a sustainable education, training and workforce development approach in the Northern Territory.
From Wednesday opening
“If Governments are truly committed to Closing the Gap then there needs to be greater support shown for community-driven initiatives like the NT Aboriginal Health Academy,” said Ms Murray.
ENDS
Indigenous Allied Health Australia is a national member-based Aboriginal and Torres Strait Islander allied health organisation.
AMSANT is the peak body for Aboriginal community-controlled health services (ACCHSs) in the Northern Territory and has played a pivotal role in advocating for and supporting the development of community-controlled health.
“Aboriginal and Torres Strait Islander men experience a number of additional challenges compared with non-Indigenous youth and have much higher rates of high/very high levels of psychological distress.
The 2017 Aboriginal and Torres Strait Islander Health Performance Framework report paints a disconcerting picture of mental health issues among Aboriginal men, highlighting the need for holistic and culturally appropriate programs to tackle the epidemic,”
John Patterson, Executive Officer, Aboriginal Medical Services Alliance of the NT (AMSANT), said Australia is currently in the grips of a suicide epidemic, which disproportionately affects young Aboriginal men :
Pictured below with the Indigenous Health Minister Ken Wyatt and Conference Facilitator Dr Mick Adams
see John’s full speech part 2 below
“ Ochre Day aims to raise awareness of issues in Aboriginal men’s health, celebrate the work being done by Aboriginal medical services on the ground in our communities, and encourage indigenous males to have their health checked and seek support,”
Addressing gaps in male Aboriginal health is a key step in reaching the seven targets set by the Council on Australian Governments (COAG) to close the gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians,”
Patrick Johnson, Leadership Project Officer, Aboriginal Medical Service Alliance NT said he hoped the two-day policy summit would assist in identifying gaps in male Aboriginal health care and the development and adoption of a national men’s health strategy
NTGPE Senior Cultural Educator Richard Fejo conducted the Welcome to Country.With Onemobdance group linking arms acknowledging their support of eliminating violence against women.
Pictures Normie Gee
Hundreds of Aboriginal and Torres Strait Islander men and health leaders from across Australia will be meeting in Darwin for a two-day policy summit on the 4th and 5th October to raise awareness of the suicide epidemic and a plethora of other issues in Aboriginal male health.
Mental health and suicide prevention will be among the key issues addressed at this year’s Ochre Day Policy Summit, which will hear from a number of prominent policy makers and public health experts.
The 2017 Aboriginal and Torres Strait Islander Health Performance Framework report cites the 2015 Youth Survey which found that 18% of Aboriginal and Torres Strait Islander young people surveyed had high levels of concern about suicide (compared with 11% non-Indigenous), 18% were concerned about discrimination (compared with 10% non-indigenous) and one in five reported bullying and emotional abuse as a concern.
The same survey found that young Indigenous males were more likely to report very low levels of happiness (10%) than Indigenous females (5%) or non-Indigenous youth (1.2%).
“Aboriginal people are six times likely to commit suicide than non-Aboriginal people, with the Kimberley region in Western Australia recording one of the highest suicide rates in the world.
“We are talking about whole generations of young Aboriginal men and women who are born into families where suicide is normalised and where the grief from suicide persists across multiple generations,” said Mr Patterson.
The first Ochre Day was held in Canberra in 2013.
This year’s Ochre Day, will feature a major address from The Hon Ken Wyatt MP, Minister for Aged Care and Indigenous Health, who will present on the five most serious health problems facing Aboriginal men today and what needs to be done to readily address them.
Other presentations at the policy summit include an overview of Aboriginal men’s health, sexual health, intergenerational trauma, family violence, anger management, youth detention, addiction solutions and healing circles.
Mr Johnson said he hoped the two-day policy summit would assist in identifying gaps in male Aboriginal health care and the development and adoption of a national men’s health strategy.
“Addressing gaps in male Aboriginal health is a key step in reaching the seven targets set by the Council on Australian Governments (COAG) to close the gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians,” said Mr Johnson.
“Aboriginal men must have the same access to health care as other Australians and in particular, tailored, culturally appropriate programs must be developed to address mental health, social and emotional well being and suicide prevention.
“We need to invest more in grassroots programs delivered by Aboriginal people, for Aboriginal people, if we want to have a fighting chance to turn around the harrowing statistics which have seen too many of our sons, fathers and uncles die young.
“We have made great strides already, however there is much more work to be done before we reach the point where a new generation of young Aboriginal men emerges where issues such as suicide are no longer entrenched and normalised,” said Mr Johnson.
National Ochre Day Opening Remarks – AMSANT CEO, John Paterson
Darwin, 4 October 2017
Firstly, I would like to acknowledge we’re meeting today on Larrakia traditional land and thank Richard and Tony for their welcome.
I would also like to welcome participants to this national Ochre Day event, and to acknowledge dignitaries here with us today
This is an important gathering as it is too seldom that we are able to come together as a group of Aboriginal men to work on how we want to address the health challenges that continue to confront Aboriginal men in Australia today.
NACCHO is to be congratulated for developing Ochre Day as a national opportunity for us to do this.
Over the next two days we will explore our theme “Men’s Health, Our Way. Let’s Own It!” The theme reminds us that we do have to take ownership of our health and, just as importantly, provide leadership in telling government what is needed to bring the health of Aboriginal men up to where it should be.
I don’t need to tell any of you that the state of Aboriginal male health is not good. The gap in life expectancy alone remains far too great. Nationally, while life expectancy for Aboriginal men has increased from just over 67.5 years in 2005-07 to 69.1 years in 2011-12, the gap between Aboriginal men and non-Aboriginal men is still too large at 10.6 years. However, if we look at the gap between Aboriginal men in the Territory and national male life expectancy, the gap is 16.4 years!
It’s important, gathering where we are here in Darwin, in the Northern Territory, that we acknowledge just how significantly worse the health of Aboriginal Territorians is than the health of Aboriginal people nationally. For Aboriginal men in the Territory this translates to a life expectancy that is on average 4 years less than for Aboriginal men nationally.
Overall, the mortality rate for Aboriginal Territorians is 50% higher when compared with Indigenous people interstate, and 85% higher than non-Aboriginal Territorians.
And for Aboriginal men in the Territory, we experience a 10-15% higher mortality than our Aboriginal women.
Clearly, there is a long way to go in closing the health gap for Aboriginal men and achieving the standard of health and wellbeing that we would all like to see.
This raises an important issue. Beyond just the statistics, what does health and wellbeing mean for us as Aboriginal men?
The Aboriginal concept of health is not just an absence of illness. It is not just the physical well-being of an individual. It refers also to the social, emotional, spiritual and cultural well-being of the whole Community. It means each individual being able to achieve their full potential as a human being and contributing to the total well-being of their Community. It is a whole of life view and includes the cyclical concept of life-death-life.
So, when we talk about “Our way” and about “Let’s own it”, we’re talking as much about our spiritual and psychological health as we are about our physical health.
For us to achieve our full potential as human beings, we must deal with the legacies of our own lives, and also the lives of our fathers and grandfathers and the generations before them. Some of these are heavy legacies.
Aboriginal men have been wounded by the impacts since colonisation which devalued our cultures, dispossessed and dislocated our families and communities and introduced diseases.
Our elders lost their roles with authority and status, and young males lost their role models.
This has diminished the status, self-esteem and sense of purpose of Aboriginal males and contributed to alcohol abuse, self-harm and violence.
It has caused trauma to successive generations, and that trauma continues.
The impacts of trauma will be discussed later this morning, but I wanted to raise here one source of impact from recent years that has impacted heavily on Aboriginal men in the Territory – the NT Intervention.
This top-down, punitive attack on Aboriginal communities in the NT, maliciously targeted Aboriginal men as child abusers, as corrupt and devoid of basic humanity. It was used to strip us of our dignity and as an excuse to subject us to coercive controls on our lives and on our communities.
The extent of the damage to communities caused by the Intervention will probably never be fully known, but I do know that every Aboriginal Territorian man in this room will have felt its impact in some way.
As a policy, its failure is perhaps most evident in the billions of dollars spent with so little to show in terms of positive outcomes.
And only in the last couple of years has the tide begun to turn, with governments at both Commonwealth and Territory levels starting to recognise the need to positively re-engage and to work with us. To bring us back into engagement over policy design and decision-making, and hopefully increasingly into delivering our own services to our communities. As we are doing successfully in the Aboriginal community controlled health sector.
Such rethinking by government I’m sure is also mindful of the ongoing failure of recent policy approaches and funding to improve the structural and social factors or the social determinants of health, that underlie poor health outcomes. Housing, education, employment, access to services, unacceptable rates of imprisonment and children in care.
The inescapable fact, as evidenced by the painfully slow progress on Closing the Gap targets, is that a fundamental change in approach must occur. Such change must start with improving support for the positive social determinant enablers: control, empowerment, and the strength of culture and connection with land.
Being healthy builds on strengths and Aboriginal men have many strengths. We are fathers, husbands, brothers and our communities rely on us. We are resilient and we have the opportunity to use that resilience both for the current generation and for young males and the next generations.
It is important that Aboriginal males continue to be active participants in defining our social roles, both within our own communities and in the broader Australian society.
We need to take back responsibility for traditional practices, parenting and spirituality, as these will contribute to better health.
We have to find ways to contribute our knowledge, skills and authority to initiatives and interventions that concern our health.
Events like Ochre Day and putting together Aboriginal Men’s health strategies are one way we can do this.
We will have a significant focus during this Ochre Day conference on issues related to trauma, social and emotional wellbeing and suicide. These are not easy issues to talk about but they are so important to men’s health. Suicide continues to be a major and avoidable cause of death for Aboriginal men and an issue that we must talk about. Aboriginal and Torres Strait Islander men between 25 and 29 have the highest suicide rates in the entire world, according to a study of youth health released last year.
If anyone is feeling upset or distressed about these conversations, staff from Danila Dilba Health Service are here and you can talk to them about any support you might need. Joseph Knuth is the best person to approach if you need any support at all.
The Conference though will be positive, we will be working on solutions and ideas for the future. We will be taking control!
Today we will hear about men’s health issues and about some of the services that have been developed here in the Northern Territory to bring men into health services in appropriate ways and to empower men to take control of their own health.
We will hear from the top Aboriginal and non-Aboriginal experts in men’s health.
Tomorrow, we will take what we have learned today and start to work towards the future, towards our own solutions and strategies.
We are fortunate to have Dr Mick Adams with us to facilitate discussions towards developing a national Aboriginal men’s health strategy.
This has been a long-held aim in Aboriginal health and has met with considerable difficulty in getting government buy in and commitment.
But we won’t give up, a national strategy is a necessary first step in closing the health gap and building on the strengths of Aboriginal men, families and communities.
I look forward to Dr Adams’ advice and direction on how we might move forward to achieve this.
There will be a lot of opportunity to work together and for all voices to be heard so I encourage everyone to take these opportunities and speak up over the next two days.
” NACCHO has long recognised the importance of an Aboriginal male health policy and program to close the gap by 2030 on the alarming Aboriginal male mortality rates across Australia.
Aboriginal males have arguably the worst health outcomes of any population group in Australia.
To address the real social and emotional needs of males in our communities, NACCHO in 2013 proposed a positive approach to Aboriginal male health and wellbeing.”
At the National Male Health #OCHRE DAY in Darwin October 4-5 Dr Mick Adams will be facilitating discussions around strategies to increase positive Aboriginal Male Health outcomes locally , state/Territory and nationally : see below for full program or
Stuart Mc Minn- Interrelate- The Health and Formation of Adolescent Males
Nathan Rigney- Cancer Council S.A. –
Professor James Ward – S.A Health and Medical research Institute
Glen Poole- Australian Men’s Health Forum –
Nick Espie- Royal Commission into the Protection and Detention of Children N.T.
Joe Williams – Enemy With In – Suicide Prevention and Wellbeing Education
Background to NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030
NACCHO, its affiliates and members are committed to building upon past innovations and we require targeted actions and investments to implement a wide range of Aboriginal male health and wellbeing programs and strategies.
At the 2013 NACCHO OCHRE DAY in Canberra the delegates called on State, Territory and Federal governments to commit to a specific, substantial and sustainable funding allocation for the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030
This blueprint as set below highlighted how the Aboriginal Community Controlled Health Services sector could continue to improve our rates of access to health and wellbeing services by Aboriginal males through working closely within our communities, strengthening cultural safety and further building upon our current Aboriginal male health workforce and leadership.
We celebrate Aboriginal masculinities, and uphold our traditional values of respect for our laws, respect for elders, culture and traditions, responsibility as leaders and men, teachers of young males, holders of lore, providers, warriors and protectors of our families, women, old people, and children
The NACCHO 10-Point Blue print Plan is based on a robust body of work that includes the Close theGap Statement of Intent and the Close the Gap targets, the National Framework for the Improvement of Aboriginal and Torres Strait Islander Male Health (2002),NACCHO’s position paper on Aboriginal male health (2010) the 2013 National Aboriginal and Torres Strait Islander Health Plan (NATSIHP), and the NACCHO Healthy futures 10 point plan 2013-2030
These solutions have been developed in response to the deep-rooted social, political and economic conditions that effect Aboriginal males and the need to be addressed alongside the delivery of essential health care.
Our plan is based on evidence, targeted to need and capable of addressing the existing inequalities in Aboriginal male health services, with the aim of achieving equality of health status and life expectancy between Aboriginal males and non-Aboriginal males by 2030.
This blueprint celebrated our success so far and proposes the strategies that governments, NACCHO affiliates and member services must in partnership commit to and invest in to ensure major health gains are maintained into the future
NACCHO, our affiliates and members remain focused on creating a healthy future for generational change and the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030 will enable comprehensive and long-term action to achieve real outcomes.
To close the gap in life expectancy between Aboriginal males and non-Aboriginal within a generation we need achieve these 10 key goals
1. To call on government at all levels to invest a specific, substantial and sustainable funding allocation for the, NACCHO Aboriginal Male Health 10 point Blueprint plan 2013-2030 a comprehensive, long-term Aboriginal male Health plan of action that is based on evidence, targeted to need, and capable of addressing the existing inequities in Aboriginal male health
2. To assist delivering community-controlled ,comprehensive primary male health care, services that are culturally appropriate accessible, affordable, good quality, innovative to bridge the gap in health standards and to respect and promote the rights of Aboriginal males, in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal male health and well-being
3. To ensure Aboriginal males have equal access to health services that are equal in standard to those enjoyed by other Australians, and ensure primary health care services and health infrastructure for Aboriginal males are capable of bridging the gap in health standards by 2030.
4. To prioritise specific funding to address mental health, social and emotional well-being and suicide prevention for Aboriginal males.
5. To ensure that we address Social determinants relating to identity culture, language and land, as well as violence, alcohol, employment and education.
6.To improve access to and the responsiveness of mainstream health services and programs to Aboriginal and Torres Strait Islander people’s health services are provided commensurate Accessibility within the Primary Health Care Centre may mean restructuring clinics to accommodate male specific areas, or off-site areas, and may include specific access (back door entrance) to improve attendance and cultural gender issues
7.To provide an adequate workforce to meet Aboriginal male health needs by increasing the recruitment, retention, effectiveness and training of male health practitioners working within Aboriginal settings and by building the capacity of the Aboriginal and Torres Strait Islander health workforce.
8 To identified and prioritised (as appropriate) in all health strategies developed for Aboriginal Community Controlled Health Services (ACCHSs) including that all relevant programs being progressed in these services will be expected to ensure Aboriginal male health is considered in the planning phase or as the program progresses. Specialised Aboriginal male health programs and targeted interventions should be developed to address male health intervention points across the life cycle continuum.
9. To build on the evidence base of what works in Aboriginal health, supporting it with research and data on relevant local and international experience and to ensure that the quality of data quality in all jurisdictions meets AIHW standards.
10. To measure, monitor, and report on our joint efforts in accordance with benchmarks and targets – to ensure that we are progressively reaching our shared aims.
NOTE 2013 : 1.Throughout this document the word Male is used instead of Men. At the inaugural Aboriginal and Torres Strait Islander Male Health Gathering-Alice Springs 1999, all delegates present agreed that the word Male would be used instead of the word Men. With the intention being to encompass the Male existence from it’s beginnings in the womb until death.
2.Throughout this document the word Aboriginal is used instead of Aboriginal and Torres Strait Islander. This is in line with the National Aboriginal Community Controlled Health Organisation (NACCHO) being representative of Aboriginal People. This does not intend to exclude nor be disrespectful to our Brothers from the Torres Strait Islands.
” Djapiri said Bill and I are in the same canoe and on this issue we certainly are – but we are not alone, we are not alone in the canoe. We are in the same canoe with all of you as well and we need to steer it wisely to achieve our goal, to achieve that goal of Makarrata.
Beyond Constitutional Recognition, that work continues every day. I reflect on the Makarrata discussion of the late 70’s and 80’s. A list of demands was sent to the Minister for Aboriginal Affairs in 1981. It called for rights to land and resources, compensation, the creation of Aboriginal schools, medical centres and an Aboriginal bank.
Despite a final agreement not being reached at the time, we have achieved some of the policies called for. The Commonwealth provided $433 million to 137 Aboriginal Medical Services across the country last financial year.
As Prime Minister I will continue to do all I can to ensure that being an Aboriginal and Torres Strait Islander Australian means to be successful, to achieve, to have big dreams and high hopes, and to draw strength from your identity as an Indigenous person in this great country.
That’s why, as we renegotiate the Closing the Gap targets with the various state and territory jurisdictions later this year, my Government has insisted on a strengths based approach.
Indigenous people are not a problem to be solved.
You are our fellow Australians. Your cultures are a gift to our nation.”
Selected extracts from the full Prime Minister Speech 5 August Garma see Part 2 Full Speech
” Djapirri said, she told me of a dream of a canoe, paddled by the Prime Minister and myself.
That in itself is an arresting image. Two captains. But in all seriousness, we appreciated I think the power of that illusion, the power of that dream.
Here at Garma, on the lands of the Gumatj, we gather to talk about a Yolngu word. Makarrata.
It is not just now a Yolngu word – I put it to you it’s a national test.
Coming together, after a struggle.
And for the first Australians, it has been a very long struggle indeed.
– A struggle against dispossession and discrimination, exclusion and inequality.
– A struggle against violence and poverty, disease and diminished opportunity.
– A struggle for better health, for better housing, for safer communities, more jobs, for longer lives.
– A struggle against injustice and racism: from the sporting field to the courts of our land.
Above all, a struggle for a better future for their children: a struggle to be counted, to be heard, to be recognised.
At Uluru, you gave us the statement from the heart.
A call for:
– A voice enshrined in the Constitution
– A declaration to be passed by all parliaments, acknowledging the unique place of the first nations in Australian history, their culture, their connection.
– And a Makarrata Commission to oversee a process of agreement-making and truth-telling.
All three of these objectives speak to the long-held and legitimate aspirations of our First Australians:
– A proper acknowledgment of Aboriginal histories and the dispossession that followed upon the arrival of the Europeans
– A bigger say in the issues which affect you – no more ‘solutions’ imposed without consultation or consent
And a more lasting settlement, a new way forward, a new pathway including through treaties.
These ideas are not new – but the Uluru statement did articulate these with new clarity, a new passion, a new sense of truth and purpose “
Selected extracts The Hon Bill Shorten speech Garma 5 August 2017 see in full Part 3 Below
When it comes to Aboriginal constitutional reform, picture Malcolm Turnbull and Bill Shorten sitting in a canoe – and the opposition leader thinks he’s the only one paddling.
The Labor leader has backed a referendum question on an indigenous voice to parliament, while the prime minister has failed to commit bipartisan support.
The two politicians are moving together downstream, struggling to balance the boat to achieve reconciliation, Gumatj leader Djapirri Mununggirritj has told Garma Festival in northeast Arnhem Land.
Mr Shorten called it an “arresting image” but said he was disappointed Mr Turnbull dismissed his end of year referendum question deadline as “very ambitious”.
“We support a declaration by all parliaments, we support a truth telling commission, we are not confronted by the notion of treaties with our first Australians,” he said.
Mr Turnbull acknowledged many Aboriginal leaders were disappointed the government didn’t give “instant fulfilment” to the Referendum Council’s recommendations.
He described the Yolgnu elder’s canoe analogy as apt, saying his cabinet will give the matter careful consideration to keep the aspiration of Makarrata, or coming together after a struggle, from capsizing.
An “all or nothing approach” to constitutional change risks rocking the boat, resulting in a failed referendum, and Mr Turnbull called for time to develop a winnable question to put to Australian voters.
“We are not alone in the canoe, we are in the canoe with all of you and we need to steer it wisely to achieve that goal of Makarrata,” he said.
Mr Turnbull said there’s still many practical questions about what shape the advisory body would take, whether it would be elected or appointed and how it would affect Aboriginal people around the country.
Specifically, he questioned what impact the voice to parliament would have on issues like child protection and justice, which are largely the legislative domain of state and territory governments.
But Mr Shorten said debate over Aboriginal recognition in the nation’s founding document has dragged on for the past decade.
“I can lead Mr Turnbull and the Liberal party to water but I can’t make them drink,” he said.
Having led the failed 1999 republic referendum campaign, Mr Turnbull warned that Australians are “constitutionally conservative”, with just eight out of 44 successful since federation.
But Mr Shorten said “Aboriginal Australians do not need a balanda [white person] lecture about the difficulty of changing the constitution”.
Mr Shorten’s proposal of a joint parliamentary committee to finalise a referendum question has been met with cynicism by indigenous leaders.
Ngarra Prime Minister numalagu djal Ngarra yurru wanganharra’wu nhumalangu bukmak’gu marrigithirri.
Ngarra ga nhungu dharok ga manikay’ ngali djaka wanga’wu yirralka.
I acknowledge and pay respect to your country, and your elders.
As Prime Minister, I’m here to talk to you and learn from you.
I acknowledge and respect your language, your song lines, your dances, your culture, your caring for country, and your estates.
I pay my respects to the Gumatj people and traditional owners past, present and future, on whose land we are gathered.
I also acknowledge other Yolngu people, First Peoples from across the country and balanda here today including Bill Shorten, Nigel Scullion and all other Parliamentary colleagues but above all I acknowledge our Parliamentary colleagues, Indigenous Parliamentary colleagues. Truly, voices of First Australians in the Parliament. Thank you for being here today and for the wisdom you give us, you together with my dear friend Ken, so much wisdom in the Parliament.
I offer my deep respect and gratitude to the Chairman of the Yothu Yindi Foundation, Dr Galarrwuy Yunupingu for hosting Lucy and me with your family. It was lovely to camp here last night and the last music was beautiful, serene and like a lullaby sending us all off to our dreams. Thank you. Emily was the last singer – beautiful. And of course we woke here to the beautiful sounds of Gulkala.
I again as I did yesterday extend our deep condolences to the family of Dr G Yunupingu at this very sad time. He brought the Yolngu language to the people of Australia and his music will be with us forever.
I’ve come here to North East Arnhem Land to learn, participate respectfully and can I thank everyone so far I’ve had the chance to talk with. I am filled with optimism about our future together as a reconciled Australia.
Last month scientists and researchers revealed new evidence that our First Australians have been here in this land for 65,000 years.
These findings show that Indigenous people were living at the Madjedbebe rock shelter in Mirarr Country, at Kakadu east of Darwin, 18,000 years earlier than previously thought.
Among the middens, rock paintings, remains, plants and ochre, was the world’s oldest-known ground-edge axe head.
These findings place Australia on centre stage in the story of human origin, including mankind’s first long-distance maritime voyage – from Southeast Asia to the Australian continent.
Our First Peoples are shown as artistically, as technologically advanced, and at the cutting edge of technology in every respect.
Importantly, they confirm what Aboriginal people have always known and we have known – that your connection, your intimate connection to the land and sea are deep, abiding, ancient, and yet modern.
This news is a point of great pride for our nation. We rejoice in it, as we celebrate your Indigenous cultures and heritage as our culture and heritage – uniquely Australian.
As Galarrwuy said yesterday as he spoke in Yolngu, he said: “I am speaking in Australian.” Sharing, what a generosity, what a love, what a bigness he showed there as he does throughout his life and his leadership.
I want to pay tribute to the work of so many of you here today, who are leading the healing in communities, building bridges between the old and new, and looking for ways to ensure families and communities are not just surviving, but thriving.
Particularly the Indigenous leaders who every day wear many hats, walk in both worlds, and yet give tirelessly for their families and their communities. You often carry a very heavy load, and we thank you.
Where western astronomers look up at the sky and look for the light, Yolngu astronomers look also deep into the dark, using the black space to uncover further information, to unravel further mysteries.
So while we are both looking at the night sky, we are often looking at different parts. And yet through mutual respect, sharing of knowledge and an openness to learning, together we can see and appreciate the whole sky.
Those same principles are guiding us toward Constitutional Recognition.
The final Referendum Council report was delivered, as you know, on the 30th of June. Bill Shorten and I were briefed by the Referendum Council two weeks ago. The report was a long time coming and I know some would like an instant fulfillment of its recommendations.
Let me say, I respect deeply the work of the Referendum Council and all of those who contributed to it, and I respect it by considering it very carefully and the Government is doing so, in the first instance with my colleagues, including Ken Wyatt the first Indigenous Australian to be a Federal Minister, and together we consider it with our Cabinet. That is our way, that is our process, that is how we give respect to serious recommendations on serious matters.
And I do look forward to working closely and in a bipartisan way with the Opposition as we have done to date.
Djapiri said Bill and I are in the same canoe and on this issue we certainly are – but we are not alone, we are not alone in the canoe. We are in the same canoe with all of you as well and we need to steer it wisely to achieve our goal, to achieve that goal of Makarrata. Thank you again Galarrwuy for that word.
We share a sense of the significance of words. I love words and language. There is a great definition. What is the difference between poetry and prose? The best definition of poetry that I have ever found is that which cannot be translated, it can only be felt.
The Referendum Council’s report as Marcia reminded us is the fourth major report since that time and it adds immensely to the depth of knowledge. It gave us the Uluru Statement from the Heart, and I congratulate all those who attended on reaching an agreement. That was no small task.
It tells us that the priority for Aboriginal and Torres Strait Islander peoples is to resolve the powerlessness and lack of self-determination experienced – not by all, but certainly by too many.
I have been discussing it with leaders, the leaders of our First Australians and will continue to do so as we develop the next steps.
But there are still many questions:
What would the practical expression of the voice look like? What would the voice look like here for the Yolngu people? What would it look like for the people of Western Sydney, who are the largest population of Aboriginal peoples in Australia?
Is our highest aspiration to have Indigenous people outside the Parliament, providing advice to the Parliament? Or is it to have as many Indigenous voices, elected, within our Parliament?
What impact would the voice have on issues like child protection and justice, where the legislation and responsibility largely rest with state and territory governments?
These are important questions that require careful consideration. But the answers are not beyond us.
And I acknowledge that Indigenous Australians want deeper engagement with government and their fellow Australians, and to be much better consulted, and represented in the political, social and economic life of this nation.
We can’t be weighed down by the past, but we can learn from it.
Australians are constitutionally conservative. The bar is surmountable, you can get over it but it is a high bar. That’s why the Constitution has often been described as a frozen document.
Now many people talk about referendums, very few have experienced leading a campaign. The 1999 campaign for a Republic – believe me, now, one of the few subjects on which I have special knowledge – the 1999 campaign for a Republic has given me a very keen insight into what it will take to win, how hard it is to win, how much harder is the road for the advocate for change than that of those who resist change. I offer this experience today in the hope that together, we can achieve a different outcome to 1999. A successful referendum.
Compulsory voting has many benefits, but one negative aspect is that those who for one reason or another are not interested in an issue or familiar with it, are much more likely to vote no – it reinforces an already conservative constitutional context.
Another critical difference today is the rise of social media, which has changed the nature of media dramatically, in a decade or two we have a media environment which is no longer curated by editors and producers – but freewheeling, viral and unconstrained.
The question posed in a referendum must have minimal opposition and be clearly understood.
A vital ingredient of success is popular ownership. After all, the Constitution does not belong to the Government, or the Parliament, or the Judges. It belongs to the people.
It is Parliament’s duty to propose changes to the Constitution but the Constitution cannot be changed by Parliament. Only the Australian people can do that.
No political deal, no cross party compromise, no leaders’ handshake can deliver constitutional change.
Bipartisanship is a necessary but far from a sufficient condition of successful constitutional reform.
To date, again as Marcia described much of the discussion has been about removing the racially discriminatory provisions in the Constitution and recognising our First Australians in our nation’s founding document.
However, the Referendum Council has told us that a voice to Parliament is the only option they advise us to put to the Australian people. We have heard this, and we will work with you to find a way forward.
Though not a new concept, the voice is relatively new to the national conversation about constitutional change.
To win, we must all work together to build a high level of interest and familiarity with the concept of a voice, and how this would be different, or the same, as iterations of the past like the National Aboriginal Conference or the Aboriginal and Torres Strait Islander Commission.
We also need to look to the experience of other countries, as we seek to develop the best model for Australia.
The historic 1967 Referendum was the most successful in our history because of its simplicity and clarity. The injustices were clearly laid out – Indigenous people were not enjoying the rights and freedoms of other citizens. The question was clearly understood – that the Commonwealth needed to have powers to make laws for Indigenous Australians. And the answer seemed obvious – vote yes to ensure the Commonwealth gave Indigenous people equal rights.
To succeed this time around, we need to develop enough detail so that the problem, the solution and therefore the question at the ballot box are simple, easily understood and overwhelmingly embraced.
One of the toughest lessons I learnt from the Referendum campaign of ‘99 was that an ‘all or nothing’ approach sometimes results in nothing. During the campaign, those who disagreed with the model that was proposed urged a “no” vote, arguing that we could all vote for a different Republic model in a few years. I warned that a “no” vote meant no republic for a very long time.
Now, regrettably, my prediction 18 years ago was correct. We must avoid a rejection at a referendum if we want to avoid setting Makarrata reconciliation back.
We recognise that the Uluru statement is powerful because it comes from an Indigenous-designed and led process. And because it comes from the heart, we must accept that it is grounded in wisdom and truth.
It is both a lament and a yearning. It is poetry.
The challenge now is to turn this poetry that speaks so eloquently of your aspiration into prose that will enable its realisation and be embraced by all Australians.
This is hard and complex work. And we need to take care of each other as we continue on this journey. We need to take care of each other in the canoe, lest we tip out of it.
Yesterday afternoon was a powerful show of humanity. As we stood together holding hands – Indigenous and non-Indigenous people – we stood together as Australians. As equals.
And we will have the best chance of success by working together. This cannot be a take it or leave it proposal. We have to come to the table and negotiate in good faith, and I am committed to working with you to find a way forward.
Galarrwuy – you gave us your fire words yesterday, thank you again. We will draw on them as we look to light the path forward for our nation.
And when considering how to do that, we are inspired by the success of the Uluru process. The statement that emerged from Uluru was designed and led by Indigenous Australians and the next steps should be too.
To go to a referendum there must be an understanding between all parties that the proposal will meet the expectations of the very people it claims it will represent.
Now we have five Aboriginal members of our Parliament. They will be vital in shaping and shepherding any legislation through the Parliament. They too are bridge builders, walking in both worlds, and their contribution to the Parliament enriches us all.
The Australian Parliament and the nation’s people – Indigenous and non-Indigenous – must be engaged as we work together to find the maximum possible overlap between what Indigenous people are seeking, what the Australian community overall will embrace and what the Parliament will authorise.
I have been learning that the word Makarrata means the ‘coming together after a struggle’— Galarrwuy told us a beautiful story this morning about a Makarrata here in this country. And a Makarrata is seen as necessary, naturally, if we are to continue our path to reconciliation.
But just like the night sky, reconciliation means different things to different people. This complexity convinces me that our nation cannot be reconciled in one step, in one great leap. We will only be reconciled when we take a number of actions, both practical and symbolic.
Beyond Constitutional Recognition, that work continues every day. I reflect on the Makarrata discussion of the late 70’s and 80’s. A list of demands was sent to the Minister for Aboriginal Affairs in 1981. It called for rights to land and resources, compensation, the creation of Aboriginal schools, medical centres and an Aboriginal bank.
Despite a final agreement not being reached at the time, we have achieved some of the policies called for. The Commonwealth provided $433 million to 137 Aboriginal Medical Services across the country last financial year. Indigenous Business Australia provides low interest loans to help Indigenous Australians secure economic opportunities including home ownership with 544 new housing loans made last year. The Aboriginal Benefits Account supports Northern Territory Land Councils and provides grants for the benefit of Aboriginal people living in the Territory.
We now spend $4.9 billion on the Indigenous Advancement Strategy.
And we are empowering communities through our Indigenous Procurement policy.
I am pleased to announce today the Commonwealth has officially surpassed half a billion dollars in spending with Indigenous businesses all over Australia. I am looking forward to sharing the full two-year results in October. This is a spectacular increase from just $6.2 million being won by Indigenous businesses only a few years ago under former policies.
Since 2008 the Commonwealth has been helping improve remote housing and bring down rates of overcrowding, with $5.4 billion to build thousands of better homes over ten years.
And the land is returning to its traditional owners.
More than 2.5 million square kilometres of land, or about 34 per cent of Australia’s land mass is today recognised under Native Title. Another 24 per cent is covered by registered claims and by 2025, our ambition is to finalise all current Native Title claims.
So we are standing here on Aboriginal land – land that has been rightfully acknowledged as yours and returned to you. And we are standing here near the birthplace of the land rights movement. A movement of which the Yolngu people were at the forefront.
As a nation we’ve come a long way.
In the Northern Territory, more than 50 per cent of the land is now Aboriginal land, recognised as Aboriginal land.
Just like the land at Kenbi which, on behalf of our nation, I returned to the traditional owners, the Larrakia people last year.
Earlier this year I appointed June Oscar AO, who has been acknowledged earlier, as the first female Aboriginal and Torres Strait Islander Social Justice Commissioner, who has agreed to report on the issues affecting Indigenous women and girls’ success and safety.
And all of that work contributes to a better future for our First Australians.
But there is much more to be done in not just what we do, but how we do it – as we work with our First Australians. We are doing things with our First Australians, not to them.
Now Galarrwuy – I have read and read again your essay Rom Watungu. It too is a story from the heart, of your father, of his life and when his time came, how he handed his authority to you, the embodiment of continuity, the bearer of a name that means “the rock that stands against time”
But rocks that stand against time, ancient cultures and lore, these are the strong foundations on which new achievements are built, from which new horizons can be seen – the tallest towers are built on the oldest rocks.
You, Galarrwuy, ask Australians to let Aboriginal and Torres Strait Islanders breathe and be free, be who you are and ask that we see your songs and languages, the land and the ceremonies as a gift.
As Prime Minister I will continue to do all I can to ensure that being an Aboriginal and Torres Strait Islander Australian means to be successful, to achieve, to have big dreams and high hopes, and to draw strength from your identity as an Indigenous person in this great country.
That’s why, as we renegotiate the Closing the Gap targets with the various state and territory jurisdictions later this year, my Government has insisted on a strengths based approach. Indigenous people are not a problem to be solved. You are our fellow Australians. Your cultures are a gift to our nation.
There’s so much more work to be done.
But in doing so, Aboriginal and Torres Strait Islander people, and all Australians, continue to connect with pride and optimism – with mabu liyan, in Pat’s language from the Yawuru people – the wellbeing that comes with a reconciled harmony with you, our First Australians, our shared history truthfully told and a deeper understanding of the most ancient human cultures on earth, and the First Australians to whom we have so much to thank for sharing them with us.
Thank you so much.
Part 3 Opposition Leader’s Garma Speech
Good morning everybody.
I’d like to acknowledge the traditional owners of the land upon which we meet, I pay my respects to elders both past and present.
I recognise that I stand on what is, was and always will be Aboriginal land.
I acknowledge the Prime Minister and his wife Lucy.
I wish to thank Gallarwuy and the Gumatj for hosting us – and on behalf of my Labor team who are here, Senator Pat Dodson, Senator Malarndirri McCarthy, the Hon Linda Burney, the Hon Kyam Maher, supported also by local Members of Parliament the Hon Warren Snowden and Luke Gosling, and Territory Minister Eva Lawler.
We are very grateful to be part of this gathering.
Also Clementine my daughter asked me to thank you for letting her join in the bunggul yesterday afternoon, she loved it.
At the opening yesterday, we were privileged, all of us, to be at a powerful ceremony, where we remembered Dr G Yunupingu, a man who was born blind – but helped Australians see.
From his island, his words and his music touched the world.
But I also understand that the words of our host were about setting us a test, reminding all of us privileged to be here that there is serious business to be done.
Here at Garma, on the lands of the Gumatj, we gather to talk about a Yolngu word. Makarrata.
It is not just now a Yolngu word – I put it to you it’s a national test.
Coming together, after a struggle.
And for the first Australians, it has been a very long struggle indeed.
– A struggle against dispossession and discrimination, exclusion and inequality.
– A struggle against violence and poverty, disease and diminished opportunity.
– A struggle for better health, for better housing, for safer communities, more jobs, for longer lives.
– A struggle against injustice and racism: from the sporting field to the courts of our land.
Above all, a struggle for a better future for their children: a struggle to be counted, to be heard, to be recognised.
In 2015, the Referendum Council was created with a very clear mission.
To consult on what form Constitutional Recognition should take – how it should work.
To listen to Aboriginal people and to be guided by their aspirations.
And to finally give them a say in a document from which too long they been excluded.
Since then, thousands of the first Australians have explained to the rest us what
Recognition means – for all of us, for our children and indeed for all of our futures.
We asked for your views, we sought your counsel – and, in large numbers, it was answered.
At Uluru, you gave us the statement from the heart.
A call for:
– A voice enshrined in the Constitution
– A declaration to be passed by all parliaments, acknowledging the unique place of the first nations in Australian history, their culture, their connection.
– And a Makarrata Commission to oversee a process of agreement-making and truth-telling.
All three of these objectives speak to the long-held and legitimate aspirations of our
First Australians:
– A proper acknowledgment of Aboriginal histories and the dispossession that
followed upon the arrival of the Europeans
– A bigger say in the issues which affect you – no more ‘solutions’ imposed without consultation or consent
– And a more lasting settlement, a new way forward, a new pathway including through treaties.
These ideas are not new – but the Uluru statement did articulate these with new clarity, a new passion, a new sense of truth and purpose.
And let me speak truthfully on behalf of Labor, the Opposition.
I cannot be any more clear than this: Labor supports a voice for Aboriginal people in our Constitution, we support a declaration by all parliaments, we support a truth-telling commission.
We are not confronted by the notion of treaties with our first Australians.
For us the question is not whether we do these things, the question is not if we should do these things but when and how.
The Parliament needs to be engaged.
The Parliament needs to be engaged now.
The Parliament needs to start the process of engaging with the people of Australia now.
It does not come as a surprise to me, that following upon a report of the
Referendum Council, the Parliament’s next step must be to consider this report.
And in doing so, we must carry its message from the heart of Australia into our hearts as parliamentarians. With optimism, with understanding, not with a desire to find what is wrong, but to find the desire to make these concepts work in the interests of all.
If we were all gathered here now, back in 1891 and 1894 and 1897 to write the Constitution, we would never dream of excluding Aboriginal people from the Census.
But in 1901, they did.
If we were starting the Constitution from scratch, we would not diminish the independence of Aboriginal people – with racist powers.
But in 1901, they did.
And if we were starting on an empty piece of paper, we would, without question, recognise the First Australians’ right to a genuine, empowered voice in the decisions that govern their lives.
Now as you know, we cannot unmake history. We do not get the change to start all over again – but it doesn’t mean that we are forever chained to the prejudices of the past.
The Prime Minister’s observations though are correct about the difficulties of constitutional change. But I ask also that we cannot let the failure of 1999 govern our future on this question.
Voting for a constitutional voice is our chance to bring our Constitution home, to make it better, more equal and more Australian.
A document that doesn’t just pay respect to the weight of a foreign crown, but also recognises the power and value of the world’s oldest living culture, recognises that
Aboriginal people were here first.
And of course, let us reject those who say that symbolic change is irrelevant because dealing with these questions does not mean walking away from the real problems of inequality and disadvantage.
– Talking about enshrining a voice does not reduce our determination to eradicate family violence
– It doesn’t stop us creating good local jobs, training apprentices, treating trachoma or supporting rangers on country.
– It doesn’t distract us from the crisis in out-of-home care, youth suicide or the shocking, growing number of Aboriginal people incarcerated for not much better reason than the colour of their skin.
Aboriginal and Torres Strait Islander peoples don’t have to choose between historical justice and real justice, you don’t have to choose between equality in society and equality in the Constitution – you have an equal right to both.
The Uluru Statement has given us a map of the way forward – and today I finally want to talk about how we follow it, how we take the next step.
Not the obstacles ahead, not the problems, real as they are.
Aboriginal Australians don’t need a balanda lecture about the difficulty of changing the Constitution, our inspiration friends, should not be the 1999 referendum, it should be the 1967 referendum.
You have lived that struggle, every day.
Let me be very clear. In my study of our history, in my experience, nothing has ever been given to Aboriginal people – everything that is obtained has been fought for, has been argued for, has been won and built by Aboriginal people.
Think of the Freedom Riders
Think of the Bark Petition, which Gallarwuy was witness to
Think of the Gurindji at Wave Hill
Eddie Mabo and his fight for justice
Nothing was ever sorted by simply waiting until someone came along said let me do it for you. It is not the way the world is organised.
Every bit of progress has been driven by pride, by persistence by that stubborn refusal to not take no for an answer when it comes to the pursuit of equality.
Now making the case for change and encouraging Australians to vote yes for a recognition, reconciliation, and truth – this is not easy.
But before we can do that we surely must agree on the referendum question that has to be the long overdue next step.
I have written to our Prime Minister, we’ve proposed a joint parliamentary committee – which they’re taking on board, having a look at – to be made up of Government, the Opposition and crossbench MPs – to work with Aboriginal leaders right across Australia.
This committee will have two key responsibilities.
One – advising the Parliament on how to set-up a Makarrata Commission and create a framework for truth-telling and agreement making, including treaties.
Two – what would a voice look like. Whilst there are many questions, none of these are insurmountable.
And three, as a matter of overdue recognition – to endeavour to finalise a referendum question in a timely fashion. There’s no reason why that couldn’t be done by the end of this year.
The issues have been traversed for a decade.
Now friends this is not a committee for the sake of a committee, it’s not another mechanism for delay. It is the necessary process of engagement of the Parliament.
But we have had ten years plus of good intentions, but it is time now perhaps, for more action.
The Parliament does have a key role to play here, in setting the question.
The Parliament could agree on the question this year if we all work together so that the people could vote not long after that.
Voting to enshrine a voice in a standalone Referendum – free from the shadow of an election, or the politics of other questions.
It may seem very hard to imagine, it may seem very hard to contemplate.
But it is possible to imagine a great day, a unifying day, a famous victory, a Makaratta for all.
As I said yesterday, we’ve heard plenty of speeches, there are many fine words… but perhaps people have a right to be impatient after ten years – indeed after 117 years.
So the test I set isn’t what we say here, in this beautiful place.
It’s what we do when we leave.
It’s the honesty of admitting that after the event, what is it that we do.
The test I set for myself is can I come here at future Garmas and look you in the eye and say I have done everything I can, because if I cannot say to you that I have done everything I that I can, then I can’t be truthful with my heart.
Yesterday Gallarwuy spoke with a tongue of fire, he told a powerful truth.
He said that for more than two centuries we had been two peoples – living side-by-side, but not united.
I think that is the challenge for politics too.
Djapirri who just spoke up before me, she’s talked about hope. There is the hope that you refer to, you have the Prime Minister and the Leader of the Opposition. We are here side-by-side, and now we need to be united, not to kick the can down the road, but united on a process that says this parliament will respect what we have heard from Aboriginal people.
Not just at Uluru, but for decades.
In 1967, Aboriginal and Torres Strait Islanders were counted. In 2017, you are being heard.
There is no reason why we can’t enshrine a voice for Aboriginal people in our Constitution.
Djapirri said, she told me of a dream of a canoe, paddled by the Prime Minister and myself. That in itself is an arresting image. Two captains. But in all seriousness, we appreciated I think the power of that illusion, the power of that dream.
My party is ready.
I think Australia is ready.
The fine words that we heard at the opening yesterday, they remind me of the fire dreaming symbol, which is in the front of the Parliament of Australia.
Fire.
That fire dreaming symbol is from central Australia but it is connected isn’t it, by the word of Djapirri yesterday.
Again, that spirit of fire it is a gift from Indigenous people to all Australians and I sincerely will endeavor to make sure that spirit of fire infuses our Parliament.
” The total costs resulting from Indigenous health inequality in the NT during 2009–2013 were estimated to be about $16.7 billion, equivalent to nearly one-fifth of the NT gross state product (GSP) for this period (Box 4).14
This result suggests that eliminating the Indigenous health gap could potentially save $745 million each year in direct health costs alone.
In the medium and long term, closing the gap would save $13 billion in indirect and intangible costs over 5 years; savings in direct health costs would be less than one-quarter of the total long term financial benefit of closing the gap.”
The Northern Territory covers one-sixth of the Australian landmass, but includes only 1% of its population. Aboriginal and Torres Strait Islander (Indigenous) people constitute about 27% of the NT population (compared with 2.5% nationally) (Box 1).1
Compared with the rest of the population, Indigenous Australians have disproportionate levels of social isolation, poverty, unemployment, lack of education, and inadequate access to health care.2 They also suffer poorer health; for Indigenous people in the NT born between 2010 and 2012, life expectancy at birth was 63 (men) and 69 years (women),3 17 and 14 years less than for non-Indigenous Territorians.
There is consensus that closing the health gap between Indigenous and non-Indigenous Australians requires concerted efforts by all sections of society. In 2009, Australian governments announced a vision for eliminating this gap within a generation: that is, by 2031 (“Closing the Gap”).4 The main focus was on broad consultations with Indigenous people about a range of measures, including health, childcare, schooling and economic participation.4
In this regard, two important questions were asked but remained largely unexplored:
How much does the Indigenous health gap cost society?
What are the potential economic benefits if the gap were to be eliminated?
The purpose of our study was to provide basic information on the potential economic benefits of reducing the Indigenous health gap, by quantifying the magnitude of the economic burden associated with Indigenous health inequality in the NT on the basis of standard cost-of-illness methodology and using the most recent data.5–7
Methods
Life expectancy was calculated using population and death data for 2009–2013. Indigenous and non-Indigenous resident population and death registration data were gathered from the Australian Bureau of Statistics and the Australian Coordinating Registry.8 The cost-of-illness approach was adopted for estimating the costs associated with the Indigenous health gap from a societal perspective; that is, all costs were included, regardless of who paid or received the payment: individuals, health care providers, Indigenous and non-Indigenous populations, or a government.7 This approach casts light on the overall magnitude and distribution of the economic costs of illness. All values were expressed in 2011 Australian dollars to account for inflation.
The total monetary value of the Indigenous health gap was estimated by calculating cost differences between the Indigenous and non-Indigenous populations in three categories: direct health costs (hospital, primary care, and other health services, including public health);9 indirect costs associated with lost productivity (missed income, welfare payments, and missed tax revenue, assuming equal opportunity for employment for Indigenous and non-Indigenous people);7 and intangible costs associated with premature deaths (based on years of life lost, YLL).7
Direct health costs were derived from data on overall health expenditure for Australia and expenditure for Indigenous people specifically;9,10 expenditure for non-Indigenous people was calculated by subtracting Indigenous expenditure from total expenditure. The cost differential (excess cost) for Indigenous health care was estimated by calculating the difference between actual expenditure on Indigenous health care and the estimated expenditure if the per capita costs were the same as for non-Indigenous NT residents.
A workforce supply and demand framework was used to assess the indirect costs caused by lost productivity, based on census data and other sources for employment, taxation and welfare payment data (Box 2).1,7,11 Indirect costs (productivity loss) encompassed excess welfare payments by governments, missed tax revenue, and lost efficiencies for the economy related to inadequate human capital development and human resources utilisation. The estimation of indirect costs is described in the Appendix.
The intangible costs attributable to the higher burden of disease were estimated by multiplying the excess YLLs by the value of a statistical life-year (VSLY).12 The YLLs were calculated using NT death data linked with the age-specific life expectancies from the Australian Burden of Disease (BOD) study.13 Following the BOD methodology, YLLs were not discounted for future years, and were costed at $120 000 per life-year, based on the review by Access Economics.12 Sensitivity analysis was undertaken with VSLY assumed to be $50 000, $100 000 or $140 000 per YLL. General inflation rates were applied to pricing the VSLY between 2009 and 2013.
Ethics approval
This study was endorsed by the Human Research Ethics Committee of the NT Department of Health and the Menzies School of Health Research (reference, HREC-2015-2400).
Results
Between 1 January 2009 and 31 December 2013, 9867 deaths of NT residents were registered; 62% were males, and 47% were Indigenous Australians (mean age at death, 51 years v 67 years for non-Indigenous deaths).
Life expectancy at birth for Indigenous men and women was 64 and 69 years respectively, each 15 years lower than for non-Indigenous residents (79 and 84 years respectively).
Over the 5-year study period, direct health costs totalled $9.3 billion (2011 dollars), of which 58% were incurred by Indigenous patients (Box 3), more than double their proportion of the NT population. Per capita expenditure for Indigenous patients was 3.2 times that for non-Indigenous patients (based on total 5-year estimated resident population numbers: Indigenous, 345 968; non-Indigenous, 819 551). This ratio was slightly higher for hospital (3.5) than for primary care and other services (each 3.1). The total excess direct health costs were estimated at $3.7 billion during the 5 years, equivalent to about 40% of total expenditure (Box 3).
The indirect costs arising from lost productivity were estimated by matching the Indigenous supply–demand balance (equilibrium) with that of the non-Indigenous workforce (Box 2).
The excess costs associated with lost productivity attributable to the Indigenous health gap were estimated to be $1.17 billion in 2011, of which $359 million (31%) were excess welfare payments, $293 million (25%) foregone tax revenue, and $515 million (44%) lost efficiencies (Appendix). The total costs of lost productivity attributed to Indigenous health inequality totalled $5.8 billion during 2009–2013 (Box 4).
Wage responsiveness (elasticity) of demand was 1.8, and responsiveness of supply of the Indigenous workforce was 1.5, indicating that the demand and supply for the Indigenous workforce were respectively 80% and 50% higher than those for the non-Indigenous workforce (each 1.0 for demand and supply; Box 2). Based on Box 2, about 20 000 extra jobs at the average wage level would be required to close the gap, equivalent to a 14% expansion of the NT economy.
The intangible cost (burden of disease) estimates were based on excess YLLs. Over the 5-year period, there were 153 458 YLLs in the NT, 87 439 of which (57%) were attributable to Indigenous people, a rate that was 3.1 times that for the non-Indigenous population. The excess 59 571 Indigenous YLLs was equivalent to a total cost of $7.2 billion between 2009 and 2013 (Box 4). Intangible costs comprised the largest category of excess costs in the NT (43%), substantially higher than either direct health costs (22%) or indirect costs caused by lost productivity (35%) (Box 4).
The total costs resulting from Indigenous health inequality in the NT during 2009–2013 were estimated to be about $16.7 billion, equivalent to nearly one-fifth of the NT gross state product (GSP) for this period (Box 4).14 This result suggests that eliminating the Indigenous health gap could potentially save $745 million each year in direct health costs alone.
In the medium and long term, closing the gap would save $13 billion in indirect and intangible costs over 5 years; savings in direct health costs would be less than one-quarter of the total long term financial benefit of closing the gap.
The results of our sensitivity analysis are included in the Appendix.
Discussion
We present evidence that Indigenous health inequality in the NT is both substantial and costly. The total costs attributable to Indigenous health inequality between 2009 and 2013 amounted to $16.7 billion, equivalent to 19% of GSP, a measure of the size of the NT economy. As a comparison, the costs of health inequalities for African, Asian and Hispanic Americans in the United States were estimated to be US$1.24 trillion during 2003–2006, corresponding to 2.4% of the American gross domestic product (GDP).5 The life expectancy gap between black and white Americans was only 4 years in 2010,15 as opposed to the 15 years between the Indigenous and non-Indigenous populations in the NT. A European Union study showed that the cost associated with socio-economic health inequalities was equivalent to 9.4% of GDP.6
Using the general equilibrium what-if analysis, an earlier Deloitte Access Economics study reported that the Indigenous employment gap imposed a cost of close to 10% of GSP in the NT.2 Our study found that 40% of direct health costs in the NT were associated with Indigenous health inequality, higher than the corresponding figures in the US (30%) and EU studies (20%).5,6
Our findings suggest that there would be enormous financial benefits for the NT in the longer term should closing the gap become a reality. The evidence we have presented implies that the total potential long term benefits would be $3.3 billion annually in real terms, and a boost of nearly 20% of GSP in relative terms (Box 4), double the projection by the Deloitte study (9% over 20 years).2 A possible explanation for this difference may be the different focuses of the studies: the Deloitte analysis concentrated on employment, whereas we assessed much broader benefits from a societal perspective. Closing the gap is feasible: between 1994 and 2008, Indigenous employment in Australia increased by 55–70%.16
There are many contributors to health inequality in the NT. Poverty is a cause and consequence of ill health, and the Indigenous population is particularly vulnerable to poverty, especially in remote areas. For example, the NT market basket survey of food and drink prices found that in 2014 they were 54% higher in remote than in urban areas.17 After adjusting for these higher prices, the real income of the average Indigenous person living in a remote community was only 29% of the overall NT average.
Thirty per cent of NT Indigenous people are located 50 kilometres or more from a primary school and 100 kilometres or more from a health clinic. Remote areas lack economies of scale; 87% of NT Indigenous communities have populations of less than 100 people. Strategies for redressing health disparities should consider how the impact of remoteness might be ameliorated. Solutions may include ensuring access to essential government services for people residing in remote areas, and facilitating resettlement for those who wish to move to larger population centres.18 Overcoming the effects of remoteness, improving public housing, and raising living standards are necessary prerequisites for closing the gap,19 and will also allow economies of scale and a larger population base, which mean that education and health services can be provided more efficiently. This, in turn, will facilitate better access to labour markets for Indigenous people.
“In devolving decision making, Labor will be guided by the principles outlined in the Aboriginal Peak Organisation’s Partnership Principle, which recognises the critically important role that control over life circumstances plays in improving Indigenous peoples lives.
Control is also central to a further fundamental determinant of our health and wellbeing—that of culture.
Culture is a universal aspect of human societies that gives meaning and value to individual and collective existence.”
” The new NT Labor government will allow remote Northern Territory schools to choose to implement the Direct Instruction teaching method as part of a broader overhaul aimed at giving local people more control over their affairs.
Chief Minister Michael Gunner will also reinstate so-called community cabinets, whereby all ministers and departmental heads periodically conduct government business in the bush to ensure direct exposure to remote communities’ views.
Visiting Numbulwar, on the Gulf of Carpentaria shore about 550km southeast of Darwin, Mr Gunner yesterday said winning back four of five bush seats Labor lost in 2012 was “crucial to us having credibility” as a government for allTerritorians.”
PHOTO New Arnhem MP Selena Uibo, left, with Chief Minister Michael Gunner and Numbulwar preschooler Relisha Hall, 4. Picture: Ivan Rachman
“Labor’s win at the Northern Territory election will mean a new dawn for Indigenous affairs and policy making in Australia that will see decision making and control given back to Indigenous Territorians.
As such, the Territory is home to some of the biggest challenges in Indigenous affairs, but is also home to a wealth of local policy making nous.
With occasional involvement by the federal government to varying degrees and success, the policy making wherewithal needed to tackle the range of big and complex issues that touch Indigenous Territorians lives largely sits with NT politicians, bureaucrats, academics, land councils, health and education professionals – and of course with Indigenous Territorians.
Progressing reform to better the way government supports and respects the will of Indigenous NT residents.
It is for this reason the newly elected NT Labor government will deliver the most extensive return of local decision making to Indigenous communities since the Territory achieved self-government in 1978.
Labor will introduce a 10 year road map and local decisions oversight board made up of indigenous leaders from the NT that will see Indigenous communities take control over:
Housing;
Local government;
Education and training;
Health;
Looking after children; and
Law and justice.
The shift is huge. But it’s also an obvious step in progressing reform to improve the way government supports and respects the will of Indigenous Territorians.
Put the intervention and its top down policy making approach well and truly where it belongs: into history.
An NT Labor government will provide the backing where it has a central role to play – namely, in direct financial investment in supporting jobs for Indigenous Territorians including:
$4.1m for one off capital grants of up to $100,000 for Indigenous ranger groups to support jobs for Indigenous Territorians on their land;
Establish a land management and conservation fund of $2m per year to improve conservation practices on Aboriginal lands and sea country;
Amend the Territory Parks and Wildlife Conservation Act to specifically recognise the role of Indigenous ranger groups in managing for conservation across large areas of the Territory; and
Provide $500,000 per annum to establish an Indigenous carbon unit within government to deliver carbon abatement and economic development on Indigenous land – this has the potential to unlock tens of millions of dollars of investment and jobs.
Not only does NT Labor’s policy lay important groundwork in the national discussion on constitutional recognition and/or treaty, this policy shift would finally, and thankfully, put the Intervention and its top down policy making approach well and truly where it belongs: into history.
Guiding principles for our research and policy work
Aboriginal Peak Organisations of the Northern Territory (APO NT) is an alliance comprising the Northern and Central land councils, the North Australian Aboriginal Justice Agency, the Central Australian Aboriginal Legal Aid Service and the Aboriginal Medical Services Alliance Northern Territory.
The alliance was formed in recognition of the fact that our interests and responsibilities as organisations representing and governed by Aboriginal communities and organisations are inextricably linked.
Our shared interests are underpinned by an unwavering commitment to the principles of Aboriginal community control and self-determination.
We share an understanding that tackling the plight of our communities can only be achieved through coordinated action across a broad range of policy areas: in housing, employment, education and health; but equally importantly in ensuring that the right conditions are in place for creating strong, resilient communities.
This requires empowering and giving responsibility to govern our communities and control our organisations in determining our futures—to control and manage the delivery of services, to build and maintain community infrastructure and to develop sustainable enterprises and livelihoods on our traditional lands, as well as on those lands that have been alienated from us.
It requires empowering individuals through developing self-esteem and strong cultural identity that can underpin educational achievement, enhanced capacity to obtain and remain in employment, and to avoid destructive behaviours such as interpersonal violence that all too often lead to contact with the criminal justice system.
And it requires strong action in tackling the scourge of alcohol and other drugs, its underlying causes and accompanying burden of unresolved and ongoing intergenerational trauma in our families and communities.
A belief in evidence
Importantly, our belief in these principles is not merely aspirational, but is supported by a strong evidence base: that of the social determinants of health.
The overwhelming body of evidence of the social determinants of health shows that our health and wellbeing is profoundly affected by a range of interacting economic, social and cultural factors. Key amongst these are:
• Poverty, economic inequality and social status;
• Housing;
• Employment and job security;
• Social exclusion, including isolation, discrimination and racism;
• Education and care in early life;
• Food security and access to a balanced and adequate diet;
• Addictions, particularly to alcohol, inhalants and tobacco;
• Access to adequate health services
• Control over life circumstances.
Psychosocial factors, particularly stress and control, are critically important.
Put simply, the less control we have over our lives the more stress we experience. Stress is associated with anxiety, insecurity, low self-esteem, social isolation and disrupted work and home lives. It can increase the risk of chronic illnesses such as depression, diabetes, high cholesterol, high blood pressure, stroke and heart attack.
This evidence demonstrates that there is a social gradient of health that reflects and affects our opportunities to lead safe, healthy and productive lives for ourselves and our children.
Culture matters!
Control is also central to a further fundamental determinant of our health and wellbeing—that of culture.
Culture is a universal aspect of human societies that gives meaning and value to individual and collective existence.
In the context of societies with dominant and minority cultures, such as Australia, the widespread and persistent suppression of minority cultural practices causes severe disruption, making our communities susceptible to trauma, collective helplessness and endemic maladaptive coping practices.
These can be passed on through the generations, as we have witnessed in relation to the processes of colonisation and past government policies such as those of the Stolen Generations.
We believe that we are also witnessing the generation of such impacts in relation to ongoing government policies, for example, the misguided, coercive approaches of the NT Intervention and Stronger Futures.
The final report of the World Health Organization Commission on the Social Determinants of Health highlighted the issues of cultural suppression and loss, social exclusion and lack of consent and control as key factors affecting Indigenous populations.
The above underscores that the control that we seek over our lives, communities and land is far more than a political aspiration that government may interpret as something it can arbitrarily restrict or deny us. It is as fundamental to our health and wellbeing—and hence to the task of Closing the Gap in life outcomes—as it is to our rights and interests as Aboriginal peoples.
APO NT’s work is informed by these principles and the evidence on which they are based and we will continue to communicate with government to ensure that our voice is heard.
Labor will let remote schools choose Direct Instruction: Gunner
The new Labor government will allow remote Northern Territory schools to choose to implement the Direct Instruction teaching method as part of a broader overhaul aimed at giving local people more control over their affairs.
Chief Minister Michael Gunner will also reinstate so-called community cabinets, whereby all ministers and departmental heads periodically conduct government business in the bush to ensure direct exposure to remote communities’ views.
Visiting Numbulwar, on the Gulf of Carpentaria shore about 550km southeast of Darwin, Mr Gunner yesterday said winning back four of five bush seats Labor lost in 2012 was “crucial to us having credibility” as a government for all Territorians.
“It’s really important that we do as much as possible to make sure that locals have meaningful control of their lives. Because when we make decisions in Darwin or when we make decisions in Canberra, we get it a little bit right, but if we get it wrong we get it a lot wrong,” he said.
“If you make decisions locally, occasionally you’re going to make mistakes. But when you get it right you get a lot right, and when you get it wrong you get it a little wrong.
“We will avoid what is often a common mistake and that is, if someone makes a mistake locally, we strip that decision-making power back to Canberra or back to Darwin.”
He visited Numbulwar with incoming local Labor member Selena Uibo, who was until recently a Direct Instruction teacher at the community school. The method was introduced to the Territory by former education minister Peter Chandler under the previous CLP government.
Ms Uibo praised DI and said she would push for broader adoption. “I found that it was doing its job in terms of teaching young people who were not English speakers the system and the context of learning English and breaking down and contextualising English as part of reading as well,” she said.
Numbulwar School Council chairwoman Hida Ngalmi said DI was “working”.
“We need our children to speak English and to learn how to put their sentences together properly … we don’t want them speaking Kriol all the time,” she said. The school also runs a program aimed at revitalising the Wubuy language.
Teachers Lauren Zaharani and Chris O’Neil also said they found the DI method useful.
“It’s my first experience (of DI) and I think it’s working,” said Mr O’Neil. “It’s certainly building their reading capacity.”
Year 8 students Shrell Manggurra and Alphias Numamurrdidi said they looked forward to going to high school and getting jobs.
Mr Gunner said he was pleased with the positive feedback about DI from Numbulwar.
“I’ve had reports from other communities where it hasn’t quite been the right thing,” he said. “We want to make sure that the schools, locally, can develop how they teach in their classrooms as suits their community — we want to give that flexibility.”
Mr Gunner said the priority should be educational outcomes.
“I don’t think anyone in the Territory should be satisfied with our current results. We have to, and must, do better,” he said.
Labor has committed $300,000 for each school to be spent on improvements to the education environment that would not otherwise be possible under the triaged system of maintenance.
Numbulwar School plans to use the money to move sand to create a larger play area and better carpark, and to purchase hydroponic equipment for older kids to use.
“AMSANT welcomes the ongoing commitment and constructive partnership between the Commonwealth and the Northern Territory Government to work with the Aboriginal community controlled sector to address the health and wellbeing issues of Aboriginal Territorians.”
“And we are especially pleased by the launching of a new Framework Agreement for the NT that is coinciding with this Summit.”
Presentation to the Third Aboriginal Health /Health Ministers Summit Darwin, 30th July 2015 Marion Scrymgour, Chairperson, AMSANT
Picture Above : Marion Scrymgour with John Elferink and Senator Fiona Nash celebrating the signing of the agreement
I would like to begin by acknowledging the traditional owners of the land on which we meet, the Larrakia people, and their elders past and present.
I would also like to acknowledge the Assistant Minister for Health, Senator the Hon Fiona Nash; Minister for Health, the Hon John Elferink; the Hon Jack Snelling; the Hon Helen Morton, and other distinguished attendees.
AMSANT is very pleased to co-host this summit with the Northern Territory Minister for Health, the Honourable John Elferink MLA.
It’s particularly significant for AMSANT, having last year marked 40 years of Aboriginal community controlled health services in the NT and 20 years since AMSANT was established.
This is an important opportunity for all of us working to improve the health and wellbeing of Aboriginal and Torres Strait Islander people, to share and collaborate on that journey for the important years ahead.
AMSANT’s Aboriginal community controlled member services provide high quality comprehensive primary health care to our communities across the Northern Territory. We are working with government to progressively transition further services to community control and to continue to build on our shared record of improved health outcomes.
We have achieved a steady and in many ways remarkable health improvement in the NT that Christine will be presenting on shortly.
What I would like to do in my presentation is to briefly reflect the context and history of these health improvements that have laid strong foundations for the road ahead. And also some important lessons from what didn’t work.
An important precursor was the National Aboriginal Health Strategy, or the NAHS, developed in 1989. The NAHS outlined a way forward for Aboriginal health built on the foundation of Aboriginal community controlled comprehensive primary health care. Our sector took a leading role in its development.
It was a good plan with some significant outcomes, but ultimately let down in its implementation.
It resulted in the establishment of the Council for Aboriginal Health; State and Territory Tripartite Forums; a specialised health branch, the Office of Aboriginal Health; and a national Aboriginal community-controlled health organisation, which became NACCHO.
The Tripartite Forums proved to be an unwieldy and unsuccessful model for collaborative health planning, but other initiatives such as a specialised health branch and the establishment of NACCHO have been important developments.
Crucially, the NAHS was never properly funded. $232 million was allocated over five years: $171 million for housing and infrastructure, and $47 million nationally for Aboriginal health services. This was far less than the $3 billion estimated as necessary for full implementation of the NAHS, and states and territories failed to match the Commonwealth funding, resulting in a grossly under-funded health system.
At this time, in 1990, the Aboriginal and Torres Strait Islander Commission, or ATSIC, was established and assumed national responsibility for Indigenous health.
This proved to be a further mistake.
The resulting underfunding of Aboriginal health services meant Aboriginal health continued to languish.
In this era, our health services had to apply every year for their core funding from ATSIC. There were no three-year funding agreements and much uncertainty from year to year, making it very difficult to attract and retain staff. Very few new Aboriginal health services were set up as such services were not considered to be necessary to improve Aboriginal health.
The 1994 evaluation of the NAHS showed that, effectively, it was never implemented.
It was in this climate that AMSANT was formed in 1994 after a 3-day meeting of community controlled health services in Alice Springs. Its key objectives were: expanding community control; increasing resources; and improving training, salaries, and conditions for Aboriginal Health Workers.
AMSANT’s first major campaign, alongside other stakeholders, was to have administrative responsibility for Aboriginal primary health care transferred from ATSIC to the Commonwealth Health Department.
This was a very controversial move but was based on the carefully reasoned assessment that Aboriginal health funding would be forever constrained unless funds could be accessed from mainstream health funding, especially MBS and PBS. There was also a need for a specialist department within the health department that understood and had special expertise in Aboriginal primary health care. The Office for Aboriginal and Torres Strait Islander Health Services, or OATSIH, was formed in 1995.
The impact of the transfer on access to increased funds has been very dramatic. In the year of the transfer, in 1995, there was only $70 million available to fund Aboriginal primary health care, however there has been a continuing increase in this funding since then to more than $1 billion per year for Aboriginal health.
Securing increased funding was complemented with a campaign to improve administrative arrangements for Aboriginal primary health care. Setting up a transparent and accountable planning structure was a key objective.
The signing of the Framework Agreement between AMSANT and the NT and Commonwealth governments in April 1998 saw the planning structure come into being—the Northern Territory Aboriginal Health Forum.
It is through the Forum that collaborative needs based planning has occurred enabling crucial improvements to the health system throughout the NT.
And for the first time the Aboriginal community controlled health sector was at the table as an equal with government. AMSANT is the permanent chair of the Forum.
However, inadequate and inequitable funding remained a key problem.
There was a need for a completely new funding model that combined pooled grant funding with access to Medicare and the PBS. AMSANT successfully campaigned for the Commonwealth Government to adopt a new Integrated Funding model as part of the new Primary Health Care Access Program or PHCAP. This required the pooling of all Commonwealth and Territory grant funds as well as access to MBS and PBS, and this mixed mode funding model remains the current way Aboriginal health services in the NT are funded.
AMSANT and Forum secured increased and more equitable program funding for Aboriginal primary health care through PHCAP, which divided the NT up into 21 health zones based on geographic, cultural and social affiliations.
Two successful regional health services were subsequently established through the Aboriginal Coordinated Care Trials: Katherine West Health Board in 1999 and the Sunrise Health Service in 2005. Due to the severe limitations of the Medicare “cash out” approach, these services transited to PHCAP funding agreements in order to help secure their sustainability.
These services demonstrated that regionalised community control can produce better services and improved health outcomes. Rolling out this model across the Territory remains a major objective of the joint planning process under Forum.
Effectively rolling out this agenda required a further critical development that needs mention. Because in order to allocate increased funds effectively and equitably there needed to be a clearer idea of what core services and programs should be funded in each health zone.
Forum set about developing the first version of the Core Functions of Primary Health Care in 2001, and this was used to direct the initial investment under the PHCAP. $30 million new investment over 5 years from 2001 to 2006 took the average investment from $600 per capita on average to about $1800. There was also a marked improvement in equity through the needs based planning process of the Forum compared with the prior heavily politicised funding allocations.
An updated version in 2007 was used in negotiating new investment provided under the Expanded Health Services Delivery Initiative, or EHSDI, that accompanied the NT Emergency Response in July 2007. $50 million in new investment was provided in return for identified core services and corresponding core indicators. This took the system up to the current average of about $2500 per capita.
A third version, developed in 2011, is still to be implemented. In this version there are five domain areas of comprehensive primary health care under which there are more detailed descriptors of key services and programs.
The key gap areas that have been addressed in the third version are in early childhood, family support, alcohol, tobacco and other drugs, and aged and disability services. New funding coming into the NT in these areas is not currently being allocated under a core services approach or within the planning mechanism of the Forum.
The significance of having the NT Aboriginal Health Forum as an effective, high-level health planning body with the Aboriginal sector at the table cannot be understated.
It has delivered demonstrably better outcomes in the NT.
In 2009 an agreement was signed by the Forum partners, committing Government to transition all Aboriginal primary health care services in the NT to Aboriginal community control.
This was a landmark achievement.
And this year the Forum has established the Pathways to Community Control Working Group to progress the regionalisation process.
And in what is a kind of return to the future for AMSANT, we are revisiting one of our founding objectives in developing the Aboriginal Health Worker workforce, now, of course, referred to as Aboriginal Health Practitioners. However, this time it is in partnership with the NT Government through the Back on Track program and with the support of Forum.
AMSANT is greatly heartened by the continuing contributions and commitment of the NT and Commonwealth governments to Aboriginal primary health care and to the Forum.
And we are especially pleased by the launching of a new Framework Agreement for the NT that is coinciding with this Summit.
The final message I want to leave you with concerns the new National Aboriginal and Torres Strait Islander Health Plan. It is a good plan, as was the National Aboriginal Health Strategy all those years ago. History has shown that such plans fail at the implementation stage for three main reasons. Firstly, a lack of long-term commitment of funding. Secondly, a lack of commitment from states and territories to the concept of a national plan. And lastly, a lack of accountability.
We must learn from history and get this right. We need a ten-year funding commitment. We need the draft implementation plan to be endorsed by AHMAC. And we need key performance indicators that make everyone accountable. Annual reports on progress against these indicators should be tabled in Parliament as part of the Closing the Gap commitment.
Anything less would in our opinion be inviting failure.
Pictured above AMSANT CEO John Paterson along with Aboriginal Medical Services Alliance NT chair Marion Scrymgour and Central Australian Aboriginal Congress CEO Donna Ah Chee who will sit on the Back on Track taskforce
Minister for Health Robyn Lambley has today announced the Back On Track taskforce that will lead an action plan to increase the number of Aboriginal Health Practitioners in the Northern Territory.
“It was wonderful to see that the Country Liberals Government’s Aboriginal Health Practitioners Back on Track plan received support from all sides of politics in Parliament today,” Mrs Lambley said.
“In July I announced that we would boost the number of Aboriginal Health Practitioners across the Territory by 10 per cent a year.
“We are also committed to working with five key communities including Wadeye and Papunya to reach specific targets of Aboriginal Health Practitioners working in health clinics
“Today I am pleased to announce that I have so far asked Aboriginal Medical Services Alliance NT chair Marion Scrymgour, AMSANT CEO John Paterson and Central Australian Aboriginal Congress CEO Donna Ah Chee to sit on the Back on Track taskforce.
“I will chair the Taskforce and together we will concentrate on reaching these targets.
“We will work closely with community leaders, health managers and current Aboriginal Health Practitioners.
“I am committed to ensuring that representatives from the Department of Health visit communities that have been left without an Aboriginal Health Practitioner for years, to work with the community to encourage people to train as Aboriginal Health Practitioners.
“We need to know the barriers to successful outcomes. We need to find ways through those barriers, because as far as I am concerned, the result is too important to too many Territorians and their communities.
“We cannot afford to let this fall by the wayside and fail our remote areas as the previous Labor Government did, if we are to see real progress in Indigenous health outcomes and economic opportunity in our remote communities.
“Encouraging more Aboriginal Health Practitioners into health clinics across all areas of remote Australia is an important national health issue for Indigenous people.
“I’m looking forward to standing up in Parliament next year and reporting to the Assembly that we are well and truly back on track in the Territory.”
Opinion article by NIGEL SCULLION Minister for Indigenous Affairs
As published in The Australian March 2014
PICTURE ABOVE from THE STRINGER TONY ABBOTT MUST DO :Inspection of Strategic Indigenous Housing and Infrastructure Programme work in Santa Teresa, Northern Territory, April 2011. Tony Abbott with Adam Giles, Alison Anderson and Nigel Scullion.
The National Partnership Agreement on Remote Indigenous Housing initiated by the former government in 2008, has not delivered on the promise of being a ‘long-term fix to the emergency’ in remote Indigenous housing.
The byzantine national agreement arrangement is unwieldy and does not reflect the very different environments that need to be dealt with across the country. Bilateral agreements with states and the Northern Territory may be a better way to go.
In very remote Australia, housing is central to meeting our priorities of getting kids to school, encouraging adults into work and providing for safe communities where the rule of law applies.
More than $2.5 billion was spent by the Rudd/Gillard government from 2008 through the national agreement. Indigenous Australians tell me that they have not got value for money.
Delivery of housing in remote communities has been marked by delays, cost blowouts and bureaucracy.
New houses can cost more than $600,000 and have an average lifespan of only 10 to 12 years. There have been poor standards of construction, unsatisfactory rental payment arrangements and sub-standard tenancy management.
Despite this massive expenditure there can be no argument that overcrowding remains chronic in remote Australia where there is no regular, functional housing market. There are no private rental options and no home ownership opportunities in most of these places. Most of these communities are dependent on Commonwealth funded public housing and this has been badly managed.
Residents of remote communities need to have the option, as others in Australia enjoy, of private rental and home ownership. Any strategies that we adopt must work towards that goal.
A radical rethink is overdue.
The states and Northern Territory governments must manage remote Indigenous housing just as they do other public housing. Rental agreements should be in place and enforced; rents should be collected; any damage caused by occupants should be paid for by occupants; and, municipal services should be delivered to acceptable standards by the jurisdictions.
This is how social housing operates in non-remote areas. Why should it be any different in remote Indigenous communities?
Why have we come to expect lower standards from housing authorities and residents in remote areas? Is it another layer of passive racism to accept less for Indigenous people in remote Australia?
Why are we building houses in places where land tenure arrangements prevent people from ever buying the house?
One aspect that I will be focusing on is how we can offer housing in a way that encourages mobility for those who want to move to areas with better employment opportunities.
I will be working with the states and Northern Territory governments to reform the current arrangements that are clearly failing residents of Indigenous communities.
In negotiations, I will want to set some conditions that might include:
moving relatively quickly towards building social housing only in those places that have appropriate land tenure arrangements in place for home ownership;
attractive mobility packages for remote residents, including portability of special housing and home ownership eligibility for those who want to move to areas with stronger labour markets;
ensuring rents are set at mainstream social housing rates and requirements of tenants are specified, understood and complied with;
a requirement for states and territories to apply their usual sale of social housing policy, as occurs in urban and regional areas, based on realistic market values; and
priority for the allocation of social housing to families in employment or where children are regularly attending school.
We also need to ensure that people in social housing are not adversely affected when taking up employment opportunities. This however is mainly an issue for mainstream social housing rather than remote Indigenous housing.
I know that a number of jurisdictions are focused on reform and I look forward to working with them.
However, if a state or territory is not up to the task, the Commonwealth might have to step in and take over delivery of social housing or contract providers with significant Indigenous and community involvement to do the job.
You can hear more about Aboriginal health and social determinants at the NACCHO SUMMIT June Melbourne Convention Centre
The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.
The economic benefits of ACCHS has not been recognised at all.
We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.
A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.
