ORIGINS OF PERSISTING POOR ABORIGINAL HEALTH An Historical Exploration of Poor Aboriginal Health and the Continuities of the Colonial Relationship as an Explanation of the Persistence of Poor Aboriginal Health Ben Bartlett Submitted as requirement of MPH by Research Supervisor: Prof Charles Kerr Department of Public Health & Community Medicine University of Sydney. August, 1998. Abstract The thesis examines the history of Central Australia and specifically the development of health services in the Northern Territory. The continuing colonial realtionships between Aboriginal and non-Aboriginal Australia are explored as a reason for the peristence of poor Aboriginal health status, including the cycle of vself destructive behaviours. It rovides an explanation of the importance of community agency to address community problems, and the potential of community controlled ABoriginal health services as vehicles for such community action. ACKNOWLEDGMENTS Many people have assisted in the development of my thinking about the issues around Aboriginal health presented in this thesis. Foremost have been the people I have worked with over the past 10 years in central Australia, especially at the Central Australian Aboriginal Congress. John Liddle, Betty Carter, Stephanie Bell, Lana Abbott, Helen Liddle, Doug Abbott, Dawn Ross, Lynette Stuart, Frank Ansell and Margie Liddle are some of those people. Other people who have challenged my assumptions and thinking have been Pat Anderson, Tracey Pratt, David Scrimgeour, Shane Houston, Jenny Baker, Barbara Flick, Stephanie Short, Pat O’Shane, Rosemary McGuckin, Dave Alexander, Jane Lloyd, Jeannie Devitt, Steve Skov, Paula Rix, Colin Tatz, Peter Baume and Chris George. I am especially grateful to Edward Tilton, David Legge, John Boffa, Deborah Durnan, Jo Harrison, Margie Collins, Bob Boughton, Carol Reid, Jock Collins, and Chris Elenor who, not only stimulated my thinking, but also critically read drafts and provided me with valuable feedback. Their inputs and criticisms were invaluable to my work. I particularly wish to thank Fran Coughlan who gave me access to her previous research (including some of her interviews) on the history of central Australia. This was a most valuable input and provided me with a sound basis from which to work. My supervisor, Charles Kerr provided me with sound advice and was always encouraging. Finally special thanks to Pip Duncan and Jesse Booth who provided me with personal support and encouragement through the whole process. 1 CHAPTER 1 - INTRODUCTION As an ‘activist’ practitioner I have not found it easy to find the time and focus to develop the intellectual frameworks in which to locate my experiences and passions. Such intellectual frameworks are based on experiences and such experiences are themselves limited and particular. They are limited by the length of time spent in such a situation. They are limited by the experiences of our own backgrounds. That is, we interpret particular experiences in the light of previous experiences that have helped shape our attitudes and ideologies. New experiences are interpreted in those lights. This is particularly the case when we consider our experiences working and living in different societies to our own. Whilst being in a different society, we also remain outside that particular community. That is, we retain our advantageous differences, including our ability to choose to leave. This is usually the case when health professionals work in populations characterised by socio-economic disadvantage. In this case, health professionals have a degree of wealth not shared by their client community. There is a class difference. As well, educational advantages of most health professionals compared with their client communities results in a knowledge/ information differential which further increases their relative power. With Aboriginal communities we are removed by another factor as well. We are of a different society. Aboriginal society and non-Aboriginal societies relate to each other in ways determined by the colonial relationship. However sympathetic we might be to the Aboriginal cause, we are also beneficiaries of the dispossession which is central to their present condition. It has been a privilege for me to work with people who have taken on the struggle to better the lot of their people. Aboriginal Health Workers on wages little better than the dole take on the difficult front line work that is Aboriginal health. People are sick. We know this from our statistics. But for members of this ‘high risk population’ it is their life. Many Aboriginal people do not know that their experience of ill health and death is any different from the non-Aboriginal population. Others do. But an appreciation of this difference is still in the realm of an intellectual abstraction. It does not mean anything compared to the 1. grief and pain of frequent funerals. For an Aboriginal health service it means that on regular occasions, key staff are involved in “sorry business1”. This means a minimum of half a day to attend the funeral. Depending on the closeness of the relationship it might mean a week or more. And in the midst of this there are people who accept the responsibility of this struggle. I have been privy to the community’s grief, and their struggle for a better life. I have seen politicians, bureaucrats, health professionals, health promoters, researchers come and interact with Congress leadership. I have not always been a passive observer. The majority of these visitors have been extremely well meaning. But most have also come with the parameters of their inquiry, or ideas for solutions quite firmly set. Few have managed to appreciate that they are at the frontier, or what this means. Henry Reynolds has written extensively about this. His research has been premised on an understanding of two societies clashing in almost all respects – economically, politically, philosophically, spiritually and militarily. Thus there are two stories. Neither side of this frontier knows the whole story. If you are non-Aboriginal the stories you will have grown up with will be of the pioneering ‘father’s’ conquest of a harsh land, of unprovoked attacks by ‘savages’, of the inevitability of the extinction of blacks, and the humanitarian concern to ‘smooth the dying pillow’. Of the pioneering women who helped ‘make’ this country despite it being a man’s world. And now we can enjoy the benefits of the hard work of our predecessors. If Aboriginal, the stories are more likely to be about enjoying the wealth of the land, until the white-man came. The stories are likely to be of heroic resistance against the odds. Stories about removal from country, massacres, forced settlements, gaol, taking the children away. Grief. Children are likely to have been warned not to trust the white man. Some of the stories now are about strategies for post-war reconstruction, and about reconciliation with the conquerors to facilitate this. 1 ‘Sorry business’ is the colloquial term used in Aboriginal communities to mean all the things involved in a When I first went to Alice Springs in 1984, I was bewildered at the lack of anger expressed at this history of blatant injustices. I later came to appreciate that the anger is directed inwardly. Inwardly to family, and increasingly to self. The oppressed do not express their anger to the oppressors. So a major issue, in writing this thesis, is how do I write in a way that is useful, and understandable whilst not betraying the privileged relationship, and not stripping it of the emotion and passion which ultimately must drive the required changes. Some degree of emotional response to the human catastrophe that is poor Aboriginal health status is appropriate. Grief … Anger. An understanding of the situation requires there to be an appreciation of the emotions involved. This is not Eritrea where self-determination means defeating the oppressor, and establishing the organisational expression of self- determination, that is a sovereign government. Aboriginal people forever will be a minority in their own country. They will be dependent, to a significant extent on the attitudes of non-Aboriginal Australians. They will be shaped by these attitudes, and what responses government make. The availability of funding will also shape what happens, and most of this will be determined outside the Aboriginal politic. I see no escape from this. For Aboriginal Australia it will always be a matter of degree – the degree to which a government will consult; the degree to which Governments will support community initiative; the degree that liberal parameters will be drawn. Some Aboriginal leaders (eg Michael Mansel) have been quite explicit about the need to have a ‘government to government’ relationship, and indeed have formed a Provisional Aboriginal Government. The idea of some notion of Aboriginal government has also been pursued in different ways in Northern Australia2. Inuit models have been explored and debated3. But the current political mood does not encourage such long-term political solutions. Many commentators emphasise the pre-colonial relationships between Aboriginal groups, and the lack of any singular Aboriginal identity to discredit any Aboriginal political movement or even Aboriginal organisations. death – the funeral, custom, and grief. 2 Fletcher, C ‘Aboriginal Non Democracy; A Case for Aboriginal Self-Government and Responsive Administration.’ ANU, North Australia Research Unit, Darwin, Discussion Paper No 23, October, 1994. 3 Jull, P ‘The Constitutional Culture of Nationhood, Northern Territories and Indigenous Peoples.’ ANU, North Australia Research Unit, Darwin, Discussion Paper No 6, May, 1992. The environment in which I have worked has involved relationships with people. There have been too many funerals, too much heartache; and yet this is what drives some people to spend their lives in a struggle to improve things. It is in this context that I have become aware of the colonial relationship as a major barrier to improving Aboriginal health status. The lack of appreciation of this dynamic by most health professionals results in their inability to negotiate a way forward.