COMMONWEALTH OF AUSTRALIA Official Committee Hansard HOUSE OF REPRESENTATIVES STANDING COMMITTEE ON FAMILY AND COMMUNITY AFFAIRS Reference: Indigenous health FRIDAY, 25 JUNE 1999 CANBERRA BY AUTHORITY OF THE HOUSE OF REPRESENTATIVES INTERNET The Proof and Official Hansard transcripts of Senate committee hearings, some House of Representatives committee hearings and some joint committee hearings are available on the Internet. Some House of Representatives committees and some joint committees make available only Official Hansard transcripts. The Internet address is: http://www.aph.gov.au/hansard To search the parliamentary database, go to: http://search.aph.gov.au HOUSE OF REPRESENTATIVES STANDING COMMITTEE ON FAMILY AND COMMUNITY AFFAIRS Friday, 25 June 1999 Members: Mr Wakelin (Chair), Mr Andrews, Mr Edwards, Ms Ellis, Mrs Elson, Ms Hall, Mrs De-Anne Kelly, Dr Nelson, Mr Quick, Mr Schultz and Mr Wakelin Supplementary members: Mr Jenkins and Mr Nugent Members in attendance: Mr Edwards, Ms Ellis, Mrs Elson, Ms Hall, Mr Jenkins, Dr Nelson, Mr Nugent, Mr Quick, Mr Schultz and Mr Wakelin Terms of reference for the inquiry: In view of the unacceptably high morbidity and mortality of Aboriginal and Torres Strait Islander people, the House of Representatives Standing Committee on Family and Community Affairs was requested, during the Thirty-Eighth Parliament, to conduct an inquiry into Indigenous Health. The Committee was unable to complete its work due to the dissolution of the House of Representatives on 30 August 1998. Consequently, the Committee has been asked by the Minister for Health and Aged Care to complete this inquiry in the Thirty-Ninth Parliament, reporting on the same terms of reference as follows: (a) ways to achieve effective Commonwealth coordination of the provision of health and related programs to Aboriginal and Torres Strait Islander communities, with particular emphasis on the regulation, planning and delivery of such services; (b) barriers to access to mainstream health services, to explore avenues to improve the capacity and quality of mainstream health service delivery to Aboriginal and Torres Strait Islander people and the development of linkages between Aboriginal and Torres Strait Islander and mainstream services; (c) the need for improved education of medical practitioners, specialists, nurses and health workers, with respect to the health status of Aboriginal and Torres Strait Islander people and its implica- tions for care; (d) the extent to which social and cultural factors and location, influence health, especially maternal and child health, diet, alcohol and tobacco consumption; (e) the extent to which Aboriginal and Torres Strait Islander health status is affected by educational and employment opportunities, access to transport services and proximity to other community supports, particularly in rural and remote communities; and (f) the extent to which past structures for delivery of health care services have contributed to the poor health status of Aboriginal and Torres Strait Islander people. Friday, 25 June 1999 REPS FCA 1 PARTICIPANTS AGIUS, Mr Timothy, Director, Aboriginal Health, New South Wales Health, BARCLAY, Mr Bill, Chief Executive, Tiwi Health Board BROWN, Dr Ngaire, Indigenous Health Adviser, Australian Medical Association BUCKSKIN, Mr Peter, Assistant Secretary, Indigenous Education, Department of Education, Training and Youth Affairs DEEBLE, Professor John DELANEY, Mr John, New South Wales Zone Commissioner and ATSIC Health Portfolio Commissioner, Aboriginal and Torres Strait Islander Commission EVANS, Ms Helen, First Assistant Secretary, Office for Aboriginal and Torres Strait Islander Health, Department of Health and Aged Care EVANS, Dr Lloyd, Medical Administrator, Royal Flying Doctor Service GREEN, Ms Krystina, Program Manager—Indigenous Issues, Australian Local Government Association HOUSTON, Mr Edward Shane, General Manager, Office of Aboriginal Health, Health Department of Western Australia HUNTER, Mr Arnold ‘Puggy’, Chairperson, National Aboriginal Community Controlled Health Council NANGALA, Mr Stanley, Director, Office of Aboriginal and Torres Strait Islander Health Unit, Queensland Health O’KEEFE, Ms Elissa, Member, Royal College of Nursing Australia PURUNTATAMERI, Mr Marius, Member, Tiwi Health Board ROE, Ms Yvette, Acting Chief Executive Officer, National Aboriginal Community Controlled Health Council SMITH, Mr Barry, Director, Community Branch, Department of Family and Community Services STRASSER, Dr Sarah, Director, Rural Training, Portfolio of Aboriginal and Torres Strait Island Health Education and Training, Royal Australian College of General Practitioners FAMILY AND COMMUNITY AFFAIRS FCA 2 REPS Friday, 25 June 1999 TAYLOR, Mr Peter, Assistant General Manager, Housing, Infrastructure, Health and Heritage, Aboriginal and Torres Strait Islander Commission TORZILLO, Professor Paul YEEND, Ms Julie, Acting Assistant Secretary, Reconciliation and Equity Branch, Office of Indigenous Policy, Department of the Prime Minister and Cabinet Committee met at 9.16 a.m. CHAIR—Welcome. I am Barry Wakelin, Chairman of the House of Representatives Standing Committee on Family and Community Affairs. Thank you very much for attending, particularly those who have travelled so far. Many of you have travelled a significant distance. It is part of the task of this committee, and I am sure that many of you who represent national organisations do a lot of travelling in your various responsibilities. The issue of indigenous health has been a challenge for successive governments and communities for a very long time. I was looking through the ANAO report this morning, and it reminded me that the Commonwealth has had some linkage since about 1911. It has, indeed, a long history. The challenges are as acute as ever, but I think we can look forward optimistically, because I have no doubt that there is a determination and a will from right across the community to progress this issue. Everybody has been invited here today for their particular skills and the particular contributions they can make, and there are more people who will come in. I am looking forward to it. It will be a reasonably open, free-flowing affair, I hope, so that we can have discussion across the table. We have our keynote speakers and then we will open it up for discussion after that. The members of parliament are here as part of the committee. We are here to listen. We are here to ask questions in the discussion period. We will not be participating in that sense because that is not our role today. Our role is to draw from you your skills, your professionalism, your knowledge of the sorts of things that we need to do as a parliament to move the issues forward. A word to those from the states: I understand from the work of Professor John Deeble that about 80 per cent of the finances spent on Aboriginal health are within the state province. Obviously, the states are key players, and we really look to the partnership and within the framework agreements to progress that. I now call the first speaker, Professor Paul Torzillo, who I understand has some linkage with my part of the world, in Nganampa health. Paul, would you assist us by opening the proceedings on the issue of remote health services. Prof. TORZILLO—Good morning. I work with Nganampa Health Council in the Pitjantjatjara homelands. It takes about an hour and 25 minutes to have an appropriate discussion about the housing for health work, so I cannot do that this morning. I will spend five minutes on it and give you a couple of bottom lines from that work, much of which is now in published and public literature, and then I will spend my second five minutes on health service delivery. Overhead transparencies were then shown— FAMILY AND COMMUNITY AFFAIRS Friday, 25 June 1999 REPS FCA 3 Prof. TORZILLO—In the early eighties, we were faced with the issue that most of the experienced people here will know a lot about, which is that everyone had always said that the living environment was one of the main reasons why Aboriginal people were sick. So we decided then to take a detailed look at this: if the living environment was causing illness, how was it doing that, what were the key drivers and what could be done about it? Starting with the Pitjantjatjara homelands, we conducted a review—the UPK report, which means a strategy for wellbeing. So we defined then what were the things that people needed to do to keep themselves well if they were living in the bush, and they were the same things that anyone around the table would have to do. We prioritised those things in the fashion you see on the slide. We then proceeded to look at the living and housing environment in detail and tried to determine what was the health hardware, which is an expression that Fred Hollows used—what were the things you needed to be able to do those things. If you are a mother living in the Pitjantjatjara homelands or anywhere else, what do you need to have to be able to wash your kid once a day and wash their hands and face frequently? Why couldn’t that happen, and what would you need to make it happen? We did a detailed study of what was happening on the lands; we then went on to make some recommendations about design, implementation, construction and supervision. A couple of key issues that came out of that work were that maintenance was a major driving force in the poor living environment. It was not funded, it was not planned and it was not being done. It was clear to us that maintenance programs, properly funded, properly planned and properly conducted, could maintain health hardware, maintain the things you need to have a healthy lifestyle, and if it was not there, then the provision of housing actually generally provided a health hazard because housing broke down. Water did not get in; waste did not get out. The second generic issue for people interested in policy is the idea about a critical mass phenomenon; that is, if you are in an environment where things are good enough that you can wash your kid twice a week, and you improved things so you could wash your kid three times a week, you would probably have no impact on the health status of children.