IN AUGUST 2016, I stood on the sacred ceremonial grounds of the Yolngu, the people of north-east Arnhem Land, for the annual Garma Festival. I have been to the festival a number of times, but more than any other, this time held a great deal of poignancy for me.
Prior to going I had read Galarrwuy Yunupingu’s beautiful essay in The Monthly, ‘Rom Watangu’. Yunupingu speaks movingly of the story of his land, his culture and the very survival of Yolngu, traversing the ancient and the contemporary, the sacred and the secular, the philosophical and the pragmatic. As he prepares himself for his journey beyond, his worry is whether we – the Australian nation – have it within ourselves to respect the survival of his Yolngu people.
At Garma, against the backdrop of Gulkula – sacred ceremonial ground among the stringy bark forest – I took part in many discussions centred around the brutality, the dehumanisation of young people in the Don Dale facility in Darwin. More than 90 per cent of young people in detention in the Northern Territory are Aboriginal.[i] We struggled to grasp the inhumanity visited upon our young, the utter devaluing of their inheritance, and we shared Yunupingu’s worry for the future.
Days later, with reference to the newly established royal commission into juvenile detention, Louise Taylor, a Kamilaroi woman and lawyer, lamented in an interview with the ABC that ‘we’ve had reviews, commissions, enquiries, reports, recommendations – and yet here we are, watching those images’. Taylor’s words, in the second half of 2016, echo anthropologist WEH Stanner’s 1968 Boyer Lecture, ‘The Great Australian Silence’, in which he reflected on the lack of change in Aboriginal policy: ‘[I] could return to work very much where I had left off without any acute sense of change in the Aboriginal life around me or in their relations with white Australia.’ Stanner noted the absence of Aboriginal peoples from the histories and commentaries he reviewed:
Inattention on such a scale cannot possibly be explained by absent-mindedness. It is a structural matter, a view from a window which has been carefully placed to exclude a whole quadrant of the landscape.
What may well have begun as a simple forgetting of other possible views turned into habit and over time into something like a cult of forgetfulness practiced on a national scale. We have been able for so long to disremember the Aborigines that we are now hard put to keep them in mind even when we most want to do so.[ii]
What price for that silence, for that inattention, that forgetting, that disremembering? What national shame in those images from Don Dale? What damage to the civic life of our nation?
A LITTLE OVER ten years ago, in 2007, sections of the Racial Discrimination Act were suspended in order to allow the Northern Territory National Emergency Response to go ahead. That Australia could enact such an intervention was condemned here and across the world. The re-traumatisation of our people that would follow was entirely predictable and preventable.
A study conducted in Victoria in 2011 involving 755 Aboriginal Victorians found that 97 per cent of those surveyed had experienced racism in the previous twelve months; more than 70 per cent experienced eight or more racist incidents. The results were consistent whether they lived in the city or in rural areas.[iii]
The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 acknowledges that racism is a reality in the health system for our people, with its vision: ‘The Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. Together with strategies to address social inequalities and determinants of health, this provides the necessary platform to realise health equality by 2031.’[iv]
This document was developed by the Labor government under Prime Minister Julia Gillard. It was accepted in its entirety by the Coalition, who in October 2015 launched their implementation plan, which was developed in partnership with the Aboriginal and Torres Strait Islander health leadership of this country.
I would like to reflect on the consequences for the civic life of our nation of not getting this right. A warning was sounded by the Racial Discrimination Commissioner, Dr Tim Soutphommasane, when he said:
We should be concerned about the civic health of Australian society. If we are not careful, we may run the risk of undermining civility and racial tolerance – something that would open up many dangers, not only for Aboriginal and Torres Strait Islander people, but for all Australians. Because the cost of racism is not only about how it diminishes those who are its victims, but also about how it diminishes all of us, and diminishes our social cohesion and cultural harmony as a nation.[v]
The experience of Aboriginal and Torres Strait Islander Peoples in engaging with governments includes the seasonal migration, the caravan to Canberra, the pilgrimage to Darwin, to Brisbane, to Perth, when our leaders – year in, year out, holding heads high – try to convince them of our value. Noel Pearson points to our challenge:
I think non-Indigenous people get a wrong impression of the ability of Indigenous people to get government to work for them. Australians think we hold our own, when the truth is quite different…
They think because of the prominent reporting of Indigenous issues that this somehow reflects the power of Indigenous participation. But this is not the truth.
They think that because of the large budgetary appropriations in the name of Indigenous affairs that this reflects a system that is working for Indigenous Australians. But this is not the truth. The truth is there is a massive industry around the appropriations and it is predominately non-Indigenous…
We have to solve this democratic problem. It is the problem of the 3 per cent mouse and the 97 per cent elephant.[vi]
Power in the policy world sits with others, not with Aboriginal and Torres Strait Islander Peoples. It resides outside of the domain of Aboriginal and Torres Strait Islander Peoples.
We must redress this power imbalance.
The state uses a range of instruments on us: legislation, policy, guidelines, contracts, funding agreements. I have seen these used to the utter detriment of our people. Take funding, for example. There are too many examples of the heavy transactional costs on services simply in doing their business to improve the lives of Aboriginal and Torres Strait Islander people. The Overburden Report: Contracting for Indigenous Health Services, published by the Lowitja Institute in 2011, analysed the complex contractual environment for the Aboriginal community-controlled health sector. It found that highly fragmented funding from multiple sources imposed a heavy burden of reporting and acquittal. In effect, the report concluded that the funding of the sector imposed barriers to care, impeded efficiency and diverted vital resources away from the ultimate goal of improving health outcomes for clients.[vii] Equivalent mainstream metropolitan health providers were not generally found to face the same onerous level of reporting requirements – hence the name of the study, the Overburden Project.
In 1995, responsibilities for health transferred – rightly – from the former Aboriginal and Torres Strait Islander Commission to the Commonwealth Department of Health. The reason for this was to locate the responsibility for our people’s health squarely with the agency responsible, the federal Department of Health. One question reverberates through the mind of Aboriginal and Torres Strait Islander Australia: Why is it that an Aboriginal or Torres Strait Islander person has never headed up the area of the department responsible for Aboriginal and Torres Strait Islander health? When we share this story with our colleagues in Aotearoa-New Zealand or Canada or the US, they are speechless in disbelief. We have had – and do have – many capable individuals with the skills to do the job. The cultural ceiling is firmly in place.
The absence of our people in the most senior roles is disastrous for policy development and implementation because, largely, our perspectives are not at the table. We are outsiders to the intimate internal discussions about our very own health and wellbeing. This results in policy-making that is distant from those who are most invested in ensuring that the instruments of state work for them. We need to understand how the differences between Indigenous worldviews and the dominant Eurocentric worldviews influence the development of policies and frameworks.
In a study published in 2016, Alister Thorpe, Kerry Arabena and others reviewed national, state and regional engagement policies and strategies around Aboriginal and Torres Strait Islander health and wellbeing, looking for best-practice examples dating from 2003, and for lessons learnt.
Few policies met all of the criteria for effective engagement, defined as a process that:
Provides Indigenous people with the opportunity to actively participate in decision-making from the earliest stage of defining the problem to be solved. Indigenous participation continues during the development of policies – and the programs and projects designed to implement them – and the evaluation of outcomes.[viii]
The review concluded that cultural diversity, Aboriginal and Torres Strait Islander worldviews, self-determination and human rights must be the basis of policy formation. It’s widely understood that Aboriginal and Torres Strait Islander participation in policy-making results in better decisions and outcomes; but I argue that we should drive the policy-making process. Partnership with and control by Aboriginal and Torres Strait Islander Peoples must replace the ubiquitous and tokenistic ‘consultation’.
FROM 1 JULY 2014, the Department of the Prime Minister and Cabinet was administering more than a hundred and fifty programs across a range of portfolios under five Indigenous Advancement Strategy funding streams. The 2014–15 Federal Budget reported a $534.4 million saving to the Indigenous Affairs portfolio through rationalisation of Indigenous programs intended to eliminate duplication and waste.[ix] This resulted in an enormous degree of uncertainty for Aboriginal and Torres Strait Islander people. At the community level, a number of organisations had to suspend effective programs and let employees go due to funding uncertainties. Many Aboriginal and Torres Strait Islander organisations, programs and individuals paid a very high price.
The Finance and Public Administration References Committee reviewed the tendering process for the Indigenous Advancement Strategy, noting that the price paid by the Indigenous communities for implementing the unreasonable timetable was too high. The committee recommended that future tendering processes should enhance the capacity of organisations to meet community needs; that selection criteria and funding guidelines should give weight to the contribution and effectiveness of Aboriginal and Torres Strait Islander organisations to provide for their community beyond the service they are directly contracted for; and that longer contracts should be awarded to ensure stability. The review reinforces the point that Aboriginal and Torres Strait Islander people have little cause to trust governments and the democratic parliamentary process. To build trust, the process must involve decision-making at the closest possible level to those affected by those decisions.
WHAT NEEDS TO be done? The answer to that question contains Aboriginal and Torres Strait Islander values, beliefs and knowledges, because our wellbeing is inherent in them.
Professor Helen Milroy has developed a multidimensional model of health and wellbeing called The Dance of Life. Milroy was Australia’s first Aboriginal medical graduate – almost a century after Indigenous medical graduates in Canada (1866), the US (1889) and Aotearoa-New Zealand (1899)[x] – and first Aboriginal psychiatrist, and was a commissioner on the Royal Commission into Institutional Responses to Child Sexual Abuse. The Dance of Life is a series of paintings that represents the biological or physical dimension of life, the psychological or emotional dimension, the social dimension, the spiritual dimension and, most importantly, the cultural dimension. She locates education and training, policy, socio-political and international context as integral to the development of solutions. Milroy says:
We can only exist if firmly grounded and supported by our community and spirituality, whilst always reflecting back on culture in order to hold our heads up high to grow and reach forward to the experiences life has waiting for us.
The stories of our ancestors, the collective grief, as well as healing, begin from knowing where we have come from and where we are heading. From the Aboriginal perspective, carrying the past with you into the future is as it should be. We are nothing if not for those who have been before us and the children of the future will look back and reflect on us today…
When all of the dimensions are in balance within the universe, we can break free of our shackles and truly dance through life.[xi]
The ngangkari (traditional healers) of the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Lands put it this way:
As ngangkari we really look at people’s spiritual wellbeing – we look at how their spirit’s going. If people are becoming dispirited or really exhausted, tired, unable to do things – we can recognise that in Anangu [collective term for several Aboriginal groups in central Australia] and work alongside doctors to help them...
And so we tell you these things so you can understand something of our Law and our knowledge and of the work that we can do. We work as ngangkari in this way. This is our body of knowledge – it’s the important things that we do to help people feel well within themselves and stay well… Ngangkari have that role of finding a spiritual balance and wellbeing. [xii]
We know that our culture and long-held knowledges are protective of our health and wellbeing. Non-Indigenous people must understand that what will work, and therefore where the value lies, is in our culture being central to decision-making. This is expressed in policy that values Aboriginal and Torres Strait Islander knowledge; that places our leadership, institutions and solutions at the centre of policy-making; and that resets the power balance between those making the decisions and those for whom the policy is intended.
In their paper ‘Cultural wounds demand cultural medicines’, psychologists Michael Chandler and William Dunlop arrive at two key conclusions: that ill health suffered by Indigenous peoples is the culmination of ‘cultural wounds’ to whole communities and ways of life and that, while these wounds are experienced in individual ill health, the damage is collective and multiplicative, rather than simply personal and additive. These wounds must be addressed ‘not one individual sufferer at a time, but require instead being communally treated with “cultural medicines” prescribed and acted upon by whole cultural communities’.[xiii]
In order to prescribe and act upon the solutions that are needed to improve health and wellbeing outcomes, Aboriginal and Torres Strait Islander people – organisations, communities, individuals – must exercise agency, take control. And government at all levels must let go.
One of the first priorities must be to build on existing strengths to represent the interests of Australia’s First Peoples and negotiate on our terms. I mentioned earlier the development of the National Health Plan in partnership with the Aboriginal and Torres Strait Islander health leadership. The National Health Leadership Forum, an inter-organisational forum with a high resident level of expertise and representatives from Aboriginal and Torres Strait Islander health leadership across the country, has been established to engage with government and drive change.
Partnerships with organisations and collectives such as the Forum – not consultation as I referred to earlier – are required at all levels that allow for Aboriginal and Torres Strait Islanders to take the senior partnership role. Processes must be established through which Aboriginal and Torres Strait Islander Peoples can have a say in the matters that directly affect them.
As the Empowered Communities: Empowered People design document argues, governments must relinquish their role of ‘fixers’ and negotiate as enablers and facilitators.
This requires a radical shift not just in responsibilities, but in behaviours and attitudes of the key partners. Indigenous reform leaders are expected to step up and assume the lead role in driving challenging reforms in their regions and collaborating across opt-in organisations. Government partners, on the other hand, need to take a step back and participate in support of Indigenous leaders and their place-based development agendas. This does not mean that government takes a passive role. Government is an active partner. Its representatives come with valuable knowledge, experience and responsibilities that the other partners do not have. [xiv]
THERE HAVE BEEN demonstrable successes in Aboriginal and Torres Strait Islander health-service delivery. Aboriginal community-controlled health services are an important part of the Australian health system, and a critical resource for Aboriginal and Torres Strait Islander Peoples. The first, the Redfern Aboriginal Medical Service, was established in 1971, and there are now a hundred and fifty across the country. These services provide primary healthcare and are initiated and operated by the local Aboriginal community through a locally elected board. They deliver holistic, comprehensive and culturally appropriate healthcare to the communities that control them. They are a means of empowering communities through increased accessibility to health services, as well as through cultural continuity, community employment and participation in education
Another example of Aboriginal and Torres Strait Islander organisations delivering significant results for their people is the Institute for Urban Indigenous Health. The institute leads the planning, development and delivery of comprehensive primary healthcare services to the Indigenous population of South-East Queensland. Since its establishment in 2009, the institute’s network has expanded to eighteen multidisciplinary primary health clinics, with marked increases in the number of new patients, health checks and GP management plans.
More than three decades after Helen Milroy graduated, there are some two hundred Aboriginal and Torres Strait Islander doctors, and some three hundred and ten enrolled medical students across Australia – more than double since 2006.[xv]
While workforce gaps remain, the growing number of Aboriginal and Torres Strait Islander health professionals – in nursing, allied health, medicine and Aboriginal and Torres Strait Islander health – is game changing. But the power of our people, our health professionals, our health services, our national organisations is yet to be fully realised.
Aboriginal and Torres Strait Islander health leadership is highly organised and effective. This has been built up over decades, and has its genesis in community control. Our connection to our communities and our capacity for collective action is our strength. Our obligations go far beyond a point-in-time funding agreement with government. Our obligations run far and deep – to our ancestors and to our futures. This requires Aboriginal and Torres Strait Islander Peoples to be the architects of our destinies. It requires others to partner with us.
Real transformative change will only occur when we understand Aboriginal and Torres Strait Islander health as a construct that values Aboriginal and Torres Strait Islander knowledges; places Aboriginal and Torres Strait Islander leadership, institutions and solutions at the centre of policy-making; and resets the power balance between those making the decisions and those for whom the policy is intended.
I would like to finish where I started: at Gulkula, and with Dr Yunupingu’s welcome to Garma:
A song cycle tells a person’s life: it relates to the past, to the present and to the future. And as Yolngu we balance our lives through the song cycles that are laid out on the ceremony grounds, the universities of our people, where we hone and perfect our knowledge…
I…remind you that Yolngu are very different to other Australians, although we are proudly Australian. We have our own law and way of life and with it the ownership of our land and everything in it. And it is because of this that we do not always fit in with everything you might believe in and we do not always agree with your thinking. Sometimes we disagree very strongly with non-Yolngu ways and ideas. But we try to balance our worlds and make a future that is rewarding for everyone.[xvi]
[i] Sharp, J 2015, Does the NT Youth Justice deliver justice for vulnerable young offenders or their Victims?, <http://www.clant.org.au/images/images/the-bali-conference/2015/Sharp_ppt.pdf>.
[ii] Stanner, WEH 1968, ‘The Boyer Lectures - The Great Australian Silence’, Australian Broadcasting Commission, Sydney.
[iii] Ferdinand, A, Paradies, Y & Kelaher, M 2013, Mental Health Impacts of Racial Discrimination in Victorian Aboriginal Communities, Summary Report, The Lowitja Institute, viewed 18 April 2018, via Lowitja.
[iv] Department of Health 2013, National Aboriginal And Torres Strait Islander Health Plan 2013–2023, Australian Government Publishing Services, Canberra, p. 7.
[v] Soutphommasane’s Address to Congress 2014, audio recording, Lowitja, Melbourne.
[vi] Pearson, N 2014, ‘A Rightful Place – Race, recognition and a more complete Commonwealth’, Quarterly Essay, Issue 55, Melbourne.
[vii] Dwyer, J, O’Donnell, K, Lavoie, J, Marlina, U & Sullivan, P 2011, The Overburden Report: Contracting for Indigenous Health Serviced, 2nd edn, The Lowitja Institute, Melbourne.
[viii] Thorpe, A, Arabena, K, Sullivan, P, Silburn, K & Rowley, K 2016, Engaging First Peoples: A review of government engagement methods for developing health policy, The Lowitja Institute, Melbourne.
[ix] Australian Government 2015, Budget 2014–15: Budget Measures Budget Paper No. 2: Expenses Measures, Australian Government Publishing Services, Canberra.
[x] Anderson, IPS 2008, ‘The Knowledge Economy and Aboriginal Health Development’, Onemda VicHealth Koori Health Unit, The University of Melbourne, Melbourne.
[xi] The Royal Australian and New Zealand College of Psychiatrists (n.d.), The Dance, <https://www.ranzcp.org/Publications/Indigenous-mental-health/Aboriginal-Torres-Strait-Islander-mental-health/The-Dance-of-Life.aspx>.
[xii] Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council Aboriginal Corporation (NPYWCAC) 2013, Traditional Healers of Central Australia: Ngangkari, Magabala Books Aboriginal Corporation, Broome, pp. 192-245.
[xiii]Chandler, MJ & Dunlop, WL 2015, ‘Cultural Wounds Demand Cultural Medicines’, in M Greenwood, C Redding & S de Leeuw (eds), Determinants of Indigenous peoples’ health in Canada, Canada Scholars’ Press, Toronto, pp. 78–89.
[xiv] Wunan Foundation 2015, Empowered communities: empowered people, via Wunan Foundation, p. 41
[xv] Australian Indigenous Doctors’ Association 2014, ‘Twice as many Indigenous doctors’, AIDA, viewed 18 April 2018, <https://www.aida.org.au/news/media-releases/twice-as-many-indigenous-doctors/>.
[xvi] Yunupingu, G 2016, ‘Chairman’s Welcome’, Garma 2016, Yothu Yindi Foundation, <http://resources.emedia.com.s3.amazonaws.com/garma/2016_Garma_Program_Booklet_WEB_DPS7_reduced.pdf>.