On the ground

WHEN NOEL PEARSON launched The Quiet Revolution, the book of Marcia Langton's 2012 ABC Boyer Lectures, he had the audience in the palm of his hand for almost an hour. Pearson spoke quietly and clearly about pathways to being 'bourgeois', as he called himself. 'Why can't Australians be proud of us being middle class? Why can't non-Aboriginal folk in Australia support us in our quest to be part of an elite, to own our own homes and participate in the Australian economic and social fabric?' he asked.

It was a great talk that explored the creation of an Aboriginal and Torres Strait Islander middle class. Even if you heard the lectures, read the essays, the power of the words on the page put paid to the simplistic criticism that they were just a defence of the mining industry. This is a part of a much bigger project, a transformation, that for the first time means First Nations people are being trained and employed in all areas of the Australian workforce. And doing so in ways that retain and share their culture with others.

Both Noel Pearson and Marcia Langton are unapologetically part of the Aboriginal elite. Like WEB Du Bois in the US a century ago, their cool analysis and forthright advocacy discomforts those with a rusted frame for thinking about First Nations people, one which consigns them to intergenerational underachievement.

Du Bois believed that the top 10 per cent of any culture or population group is the vanguard that brings others along and around them. Born in 1868, three years after the end of the American Civil War, Du Bois was the first African-American to receive a doctorate from Harvard (and also later from Berlin) and one of America's first sociologists to use large social surveys to examine the circumstances of people living in disadvantaged urban areas. His idea of the 'talented tenth' was based on the notion that groups like the African-American population needed leaders with the very best education (his doctorate was in classics, philosophy and science) and this leadership would propel the success. He established the National Association for the Advancement of Colored Peoples in America, but left his homeland as a result of the McCarthy witch-hunts and died, at ninety-five, in Ghana, a few days before Martin Luther King Jr gave his 'I have a dream' speech. He was enormously influential in fighting for full civil rights in America, but earned the enmity of radicals who favoured more direct action.

Langton's essays are as bold, and potentially transformative, as Du Bois's writings were a century ago. As she writes: 'Indigenous participation in education systems and the economy are the main pathways out of the miserable conditions that produce ongoing disadvantage and reduce Aboriginal capacity to enjoy their rights as first Australians and citizens of one of the richest nations on earth.'

Well, they could be transformative if non-Aboriginal Australians really heard the messages on these issues. As she writes: 'The majority of Australians have remained ignorant of the reasons for the high levels of disadvantage that Indigenous people face, both because the reasons are complex, and because there is a wealth of misinformation as well as irrational belief about Aboriginal people in circulation.'

Langton is not party political, and believes that these issues should not be politically divisive and 'the truth is always much more complicated than the policy positions of governments, parties and campaign offices would have us believe.'


THIS RESONATES STRONGLY with me. After a lifetime researching Aboriginal child health and wellbeing, my ideas – about what we really need to do to address the continuing social, health, educational and opportunity gaps between First Nations people and ourselves – have changed. The insights I have gained from an outstanding group of First Nations researchers have shaped my personal and professional journey. I was their mentor, but they taught me.

In Launceston before an ABC Board meeting I 'passionately' (actually angrily) told Griffith REVIEW founding editor Julianne Schultz about my interpretations on the reasons why we have failed collectively, over many years, to implement effective services for Aboriginal and Torres Strait Islander people in all jurisdictions, across many services (from health to justice) and locations, urban as well as remote. She suggested that I write about it; I responded that 'it might be therapeutic'.

This is not just of academic interest, these are life and death issues, yet we seem to work around the edges of real change that could save lives, prevent disabilities and make whole life trajectories so much better.

What is my experience? What is my 'take' on these issues? What has been my pathway to a better understanding of the Aboriginal circumstance? A brief history of my encounters with Aboriginal issues might be helpful to set the scene.

I started late, graduating in medicine at University of Western Australia in 1970 before having any real contact or understanding of the First Nations people in my state. As a young doctor I joined the Aboriginal Advancement Council in East Perth and got to know many of the leading Noongars at that time, eventually attending Black Power meetings and being inspired by the Redfern mob (who set up the first Aboriginal Medical Service in Australia with Aboriginal control). It was transformative for me to be part of a team of doctors and others visiting every reserve, mission and camp from the Eastern Goldfields to Kulumburu and to observe the conditions and situations of many Aboriginal children and families.

After overseas training in public health, I returned to Australia to establish a research team in maternal and child health and use data to describe, advocate and influence. Some of our first studies were to define the gap in maternal and child health between Aboriginal and non-Aboriginal populations. This led to setting up research to measure the pathways to the poor outcomes we observed.

Even then, it was obvious that Marcia Langton's observation was correct – these pathways are complex. From my perspective, leading a research institute (not as a service provider), it was obvious that improving Aboriginal health needed to have truly connected thinking and policies; that improved health needed better living conditions, housing, education and employment, and the self-esteem that comes from being proud to be a First Nations Australian. This is just as important as – even a precondition to – not drinking, smoking or, being violent, and eating good food. This is what my Aboriginal friend and colleague Professor Dawn Bessarab describes as taking a 'bird's eye view', to expand the lens and way in which we view the complex issues impacting Aboriginal people from the micro to the macro. Another of our First Nations researchers, Dr Juli Coffin, whose special expertise is in encouraging healthy behaviours, is clear that interventions aimed at improving such behaviours will not work unless we appreciate the whole person, including their cultural strength, poverty, living conditions and family – actually just as we do with non-Aboriginal people.

The most important bit of my learning came not from data, but from increasing friendships and conversations with First Nations people in Perth, Kalgoorlie, Pilbara and Kimberley communities in Western Australia and with those in Galiwin'ku, in North Queensland, the Torres Strait and Cherbourg. Sandra Eades, the first Aboriginal medical graduate in Australia to achieve a PhD (another Du Bois for sure), and well-respected, nationally recognised elder Ted Wilkes responded to my request, 'what do you want the Institute to be for you?' by saying, 'we want it to be our mother'. Now, a mother gives her children all the knowledge, wisdom, capacity (and love) she can, so that her children can cope in a complex world.

At the Telethon Institute for Child Health Research we responded by making a commitment to employing and training as many First Nations researchers as we could, with the aim of giving the Aboriginal research agenda to them. Ted Wilkes put it simply: 'Who knows and cares most about Aboriginal health? We do. So give us the funding and the knowledge and partner with us to enable us to be responsible for our own health and well-being.' It was clear he understood the social determinants of health better than anyone, so we concentrated on changing the culture within the Institute to enable Aboriginal leadership to grow.

Sandra Eades joined the Institute as a PhD student in the mid-1990s, where she became one of the first First Nations people to secure a National Health and Medical Research Council (NHMRC) grant as leading chief investigator.

She employed an outstanding group of Aboriginal health workers as research assistants to conduct a longitudinal study of first-time Aboriginal mums and their babies in urban Perth. This group of researchers proved Ted Wilkes' approach. The study successfully enrolled the mothers and the Institute was able to follow their babies in ways that would not otherwise have been possible. It was a true partnership between those with different types of knowledge. Its success convinced the Institute that employing and training First Nations researchers and using their methods was essential for the success of the research agenda. All these health workers-turned-researchers had been trained by another pioneering First Nations Westen Australian health professional, Dr Joan Winch, who set up Marr Mooditj, the first Aboriginal health worker training program in Australia.


SANDRA EADES HAD a huge influence on the NHMRC with her roadmap for supporting Aboriginal health research. One brilliant idea from that and other public health strategic planning was Capacity Building Grants to redress this neglected area. In 2005, the Institute won the first such grant in Aboriginal health, with a team of ten Aboriginal investigators: Michael Wright, Ted Wilkes, Helen Milroy, Sandra Eades, Ngiare Brown, Juli Coffin, Dawn Bessarab, Jan Hammill, Cheryl Kickett-Tucker and Glenn Pearson. Over the five years of the grant most completed their PhDs and all have become leaders. A group of them, plus Pat Dudgeon and Rhonda Marriott, formed the group of eight chief investigators who subsequently secured NHMRC support for a Centre of Research Excellence in Aboriginal Health and Wellbeing: From Marginalised to Empowered.

I recall helping to write this grant only to have it totally rewritten by the Aboriginal chief investigators. They were committed to a different paradigm of research methodology than mine. They wanted to conduct their own research projects with full engagement with Aboriginal community groups, shifting the power for participation at every stage – from the planning through to data collection, interpretation and implementation. I had instead written a good NHMRC quantitative application hoping that once we got the grant we could incorporate these more qualitative approaches.

I warned that NHMRC was not ready for such a radical proposal. I was wrong. The whoops of joy when they succeeded raised the roof.


THE NEW PARADIGM excites me: I am persuaded by its potential to improve Aboriginal services in health and other areas. This group of elite First Nations researchers scoured the world in true scholarly, Du Bois-like fashion and come up with a transformational approach to Aboriginal wellbeing. It is based on respect and participation.

If we can influence the huge, mostly white Aboriginal services bureaucracy to change the way it delivers services (rather than the what) the gap will rapidly close. Learning this lesson has been painfully slow in this country.

There are two major changes in this approach -– the first is to truly engage with the people who are the intended recipients of the services that are needed. This demands familiarity with a well-developed, internationally accepted set of methods known as 'community participation action research'. There are well-established ways to do this, which have been used with the 'Untouchables' (Dalits) in India and the First Nations in Nunavut (Canada). As a result, service delivery has been revolutionised.

It is not rocket science, but grounded in a self-evident truth: most of us only use the services we trust, that we feel we have some control over and that benefit our families and ourselves.

Aboriginal people in this country have little experience of exercising such a fundamental power over the services deemed appropriate for them. For many decades these services have been shaped by distant experts who thought they knew best.

Engaging Aboriginal people in the development of programs and methods results in them getting exactly the services they need, in their environments and for their unique circumstances. It also provides jobs, an additional advantage to them, which adds to the efficacy of the services. Aboriginal people will travel across the metropolitan area to attend an Aboriginal-controlled service. This means that while the overarching principles of services can be developed centrally by government agencies – for example, early childhood learning is good for children to be ready for school, or complete vaccination prevents childhood infections, or sugary foods and drinks should be avoided to prevent Type 2 diabetes – the way that these services are implemented should be done in collaboration with those who will be affected, the people themselves. Otherwise they simply do not work.


IT SEEMS OBVIOUS, but it is a lesson we have been slow to learn.

Understanding this is crucial. It explains why we have spent so much money on Aboriginal services that have failed. They have not failed because Aboriginal people are hopeless, drunk and useless, but because the services were not appropriate. It does not take long for trust to be destroyed and the one-size-fits-all delivered by policy bureaucrats from capital cities to be discredited. Such services rarely employ Aboriginal people at any level (despite unprecedented numbers graduating from tertiary institutions), and yet those non-Aboriginal employees continually make decisions about the welfare and wellbeing of First Nations people.

There are some clear examples of this from the direct experience of the Institute. In the late 1990s, two outstanding Noongars, Dean Collard and Barbara Henry, established the Indigenous Family Program in Perth. It provided services to the most disadvantaged and needy urban Aboriginal families, those who were users of multiple welfare including housing, family support, disability, child protection and justice. The holistic program run by Noongars for Noongars who understood their circumstances was evaluated by a team from Curtin University who found that it was one of the most cost-effective programs yet developed and delivered in the state for Aboriginal people. The funding ran out, and the program was absorbed ('mainstreamed') by government and it stopped being effective. In 1992, the Institute helped a passionate group of Aboriginal women set up a maternal and child health and wellbeing service called Ngunytju Tjitji Pirni in the Eastern Goldfields. It is still going strong with partnerships with all Aboriginal and mainstream services. Most of the staff and all the board directors are Aboriginal. It brokers relationships between 'clients' and the services these families need to improve their health and wellbeing – not just health but across the board. It has built trust and improved outcomes. It is great to visit and see the pride with which these young (and not so young) women perform their work. They have now incorporated, have their own purpose-built facility and outreach to local communities. The Foetal Alcohol Syndrome Strategy developed by Fitzroy Crossing women June Oscar, Maureen and Emily Carter and Olive Knight is outstanding, an excellent example of local people coming up with local solutions. Another example, the Broome Aboriginal Medical Service is the best in town. Almost half its patients are not Aboriginal.


IT IS SALUTARY to note that the majority of Aboriginal and Torres Strait Islander people do not live in remote communities: in Australia just over half a million identify as First Nations people; most live in New South Wales (148,000) closely followed by Queensland (146,000), then Western Australia (78,000) and the Northern Territory (66,000). Only a quarter live in remote or very remote communities; most live in urban areas or close to regional centres.

The implications of thinking about these numbers are significant, and challenging to the generally received wisdom in this country. It means that services aimed at health and wellbeing fail the majority of Aboriginal people, who live close to them in cities or rural towns and, most shockingly, even though Australia is a wealthy country we are unable to provide services to such a relatively small number of people.

The gap in terms of life expectancy, and other measures of achievement, is not just the difference between those living in the most poorly serviced remote communities and those in the rich cities – it is a gap that can be found within cities and regional towns. The reasons are many, but at core there is a simple explanation: all too often services are delivered to, not developed in consultation with, First Nations people.

The second part of this new paradigm is the importance of culture in developing and delivering effective services. Culture includes access to country, even for those living away from it and those whose links were torn apart by forced removals from family and land. I have been taught and told about this by urban, semi-urban, rural and remote people. Their relationship to land and landscape is visceral. Just look at Aboriginal paintings from all the different parts of Australia and how the art so beautifully represents culture and country. It is truly unique and different to non-Aboriginal feelings and connections to and about land.

The consequences of forced removal of so many at such a young age has exacerbated intergenerational trauma. The legacy of this almost completely explains the current high rates of violence within communities, child maltreatment, substance abuse and the high mental health and chronic disease rates. Rather than demanding First Nations people 'just get on with their lives and take responsibility for their own futures because the past is behind us', we need to think about the healing needed to restore self-esteem and enable progress. Incorporating this into Aboriginal services needs the best of Aboriginal minds and professionals guiding the process.

One reason for my anger and frustration about all this is that over the past four decades, the Royal Commission into Aboriginal Deaths in Custody, Bringing them Home, the Western Australian Coroner's report in response to the twenty-one youth suicides in the Kimberley region and other investigations have all come up with similar recommendations. Hardly any have been implemented. The most important set of recommendations relates to ways of aiding healing to address the trauma that comes from these past practices. Failure to implement these recommendations means that far too many people have died or had their lives adversely affected. In light of this neglect, it is amazing that Aboriginal people in Australia have done as well as they have, that a small middle class has formed and is growing.


WITH THE LEADERSHIP of a group of Aboriginal leaders including Ted Wilkes and Ken Wyatt, who is now in the Federal Parliament, the Institute in 2001 conducted the most intensive and extensive Aboriginal child health survey in Australia. The Western Australian Aboriginal Child Health Survey interviewed one in five of all Aboriginal children, their parents, carers and teachers, across the state. A large proportion of the researchers were Aboriginal. For the first time in Western Australia, the extent and the impact of the Stolen Generation on the current generation of children and young people was quantified. The proportion of children with family members who were forcibly removed from land or family ranged from a low of 40 per cent to highs of around 60 per cent. This means about half of the young people in the state had direct personal experience of forced removal. The impact of this in terms of breach of trust, family formation, future parenting and economic capacity is enormous. The negative outcomes were significantly higher amongst those with a family history of removal, and included mental health problems, substance abuse, poor school performance and gambling.

Each of the four volumes – health, social and emotional wellbeing, education, families – of this large and important survey concluded with a chapter on the lessons for policy and practice. They are worth re-visiting. The messages coming from so many groups is that culture has the power to heal, give self-esteem, prevent juvenile suicide and incarceration. These findings cannot be dismissed – they need to be respected and taken seriously.

Michael Chandler's data from British Columbia in Canada showed that First Nations communities with strong culture – language, treaty negotiations, strong councils, etc – had the lowest youth suicide rates in the country, while those with weak cultural practices had the highest suicide rates in the world. A strong culture is the key to self-esteem and that will save lives and help make them worth living.

The main lesson that I have learnt from this experience is how best to work with Aboriginal people. I now understand that working in true and equal collaboration is the only way to effectively ensure Aboriginal advancement in a society that has marginalised them for centuries.


THE WORD 'EMPOWER' is over-used, but it is what this is all about. I have enjoyed learning about Aboriginal Australia and treasure these friendships that have formed as a result. Along the way my perspectives on life, health, culture, stories and land have also changed. If we really want to close the gap, to ensure that Aboriginal and Torres Strait Islander people progress to participate socially, economically and civilly in Australian society, then those in control of budgetary and policy decisions affecting First Nations people will have to change their frame of reference, as mine has changed.

Most politicians and bureaucrats are not racist, most want better outcomes. But unless they change to appreciate that we need to work differently and to give First Nations people the power and capacity to change their own lives, then the gap will not close and it will seem that we are a racist country.

Money alone, from mining company royalties or compensation, cannot buy cultural strength, self-esteem or better health. So it is not sufficient to hand over the money and walk away, leaving Aboriginal organisations and groups ill-equipped to be accountable, or to provide all the input required to be effective. It means, as Ted Wilkes said to me all those years ago, 'We need you to partner with us, to enable us to succeed.'

And how exhilarated we will be to walk hand in hand with the likes of Marcia Langton and Noel Pearson and to say we have walked this path together and we have achieved a better society.

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