Anecdote from Arnhem Land

 

A colleague happened to be in the same remote community as one of the NTERT “survey teams” last week and relates a story that doesn’t inspire a great deal of confidence.

A senior, very experienced, very respected AHW (recently on the Queens birthdays honours list) was at a meeting to discuss the planned interventions. Being a health worker, he raised the issue of the health checks and commented that they could only occur with parental permission. He was told that he should “talk to John Howard about that”, effectively ending his engagement with the process.

Later, my colleague overheard either NTERT or ICC staff talking about their meeting with the women who run a Child Safety program on the smell of an oily rag. Said colleague was shocked to hear the disparaging and dismissive comments towards the womens’ request (for an office and vehicle), given that this is supposed to be an area of primary concern.

This deeply flawed approach to community negotiation and involvement is made clear in the Social Justice Commissioners’ report, which I’ll look at next.

 

 

Mixed Feelings

The latest NTERT update notes;

still mixed feelings regarding the scrapping of permits;

Ungrateful brutes!

Here’s a clue on the nature of the “mixed feelings” from the operational head, Maj-Gen Chalmers,

Some communities have engaged in passionate discussions with the survey teams and that’s what we wanted.

Or, in other words, they hate the permit idea. But hey, Mal and John love the idea, so that makes it “mixed feelings”.

Remarkable Findings from the Taskforce

A stunning revelation from the NTERT Survey Teams,

Maj-Gen Chalmers said housing was one of the top issues facing the survey teams….

I can’t think of a more pointless endeavor; having ‘survey teams’ re-confirm one of the most well documented of remote Indigenous community issues.

The Federal Government has increased allocations for housing in the current financial year but it remains well below the known level of need. The overall national budget is around $500mil, while the known outstanding need in the NT alone is well over $1billion.

Maj-Gen Chalmers also says,

In the longer term there will be the need for additional houses and that will be addressed

Such insight. I wonder if he’s told Mr Brough?

The Fed Govt is currently engaged in a rather strange process of trying to encourage private ownership of houses and introduce commercial rents. Both may have a partial role to play, but until the massive hole in housing infrastructure spending is addressed, this is just re-arranging the deckchairs on the Titanic.

Let me give you an example.

Community K. in the northern NT, has a documented shortfall of 450 bedrooms. For this financial year it will get 4 new houses (16 bedrooms). With some inventive thinking could be stretched out to 10 new(ish) houses (40 bedrooms). This barely keeps pace with the population growth!

And the though that introducing commercial rents will help only shows how little the proponents of this idea actually know. In K., they currently charge rent at a per person rate, meaning that many houses bring in $400+ per week, which goes towards up-keep, municipal service and a few extras houses per year. If forced to charge commercial rates (let’s say equivalent to Darwin), the rental return per house would be reduced, affecting the ability to maintain existing and build new houses.

It’s crazy stuff, dreamt up in isolation from reality.

The Non-compulsory, Compulsory Health Checks

The promised health checks have begun. The first doctors went out to Hermannsberg last week, are more heading out to a few other central Australian communities today.

What will they be doing? Not much. Some of the intrepid doc’s at least have relevant experience, enough to know this,

It may not be physically possible to actually get them [kids] to come to the clinic and some of them will have had quite comprehensive medical checks before.

Any other notable issues from the experienced health professionals?

I think the main challenge is actually introducing ourselves to the community and getting a bit of trust in us in a very, very short time.

Such a pity that Major Gen. Brough didn’t bother to ask such experienced people before he announced this pointless aspect of the NTERT. Indigenous kids already get health checks. There is an early childhood health program that routinely checks 0-5 yr olds throughout the NT. Latest stats indicate that this picks up around 75% of the 0-5 population for specific growth assessments. Further health checks are provided though immunisation programs and on casual presentation at remote health centres. Even better, the health checks are conducted by mostly long-term staff such as Aboriginal Health Workers (AHW) who are well known to community members.

What is required is not medical tourists, but a commitment to long-term improvements in health infrastructure and personnel, especially GPs and AHWs. What really peeves me about this is the time, energy and resources being wasted (yes, wasted) on a futile, short-term intervention that will make no practical difference to the long-term health prospects of the involved communities.

Emergency V2.0

Now it’s WA’s turn.

The WA Government sent a letter to Mal Brough asking for a joint approach to child abuse issues in that state. Specifically, AFP resources to work with the WA Police.

In typical Brough style, he has announced another emergency, and has offered to send in the troops!

Mal Brough is the personification of the old adage; when you have a hammer in your hand every problem looks like a nail.

It’s Mals’ way or the highway.

Brough is now criticizing the lack of Police in WA, but just a few weeks ago, he was very critical of WA for not sending those same WA Police to the NT.

How The Hell Did We Get Here? 4

This review, “Comparing Australian with Canadian and New Zealand Primary Care Health Systems in Relation to Indigenous Populations: Literature Review and Analysis” provides a good overview of the differences and similarities between the approaches to Indigenous health in Australia, NZ and Canada. As far as similarities go there are many; a significant differential in heath status is the norm and funding shortfalls for health service provision relative to need are widely reported.

Yet, the life expectancy differential in Australia (17 yrs) is twice that of NZ and Canada. So it doesn’t appear that it is just under-spending on health that is the issue.

The review notes several relevant findings on this point,

A key cause of Indigenous Australians’ poor health status compared with Indigenous populations in Canada and New Zealand may be cultural—namely, the rejection of the colonists’ health system, with an increasing rather than declining lack of trust in it.

And,

Emotional and cultural barriers are two of five main risk factors identified for Indigenous ill-health in Australia, resulting in high rates of mental health problems and an inability or unwillingness to access primary health care services.

A highly significant difference between Australia and the other is the issue
of formal recognition of ‘First Peoples’,

Treaties have contributed to the improved health status of Indigenous populations in Canada and New Zealand, according to Ring and Firman (1998): “Treaties, no matter how loosely worded, have appeared to play a significant and useful role in the development of health services, and in social and economic issues”. In Australia, the lack of distinctive legal recognition of Indigenous people’s autonomy and culture may compound the effects of being a small demographic minority in a large continent in contributing to the poor health, welfare and more general socio-economic outcomes of Indigenous Australians.

So, how do such esoteric matters contribute to poor health outcomes?

A leading epidemiologist, Michael Marmot, has been researching this exact question. Traditional risk factors for poor health, such as high blood pressure, lack of exercise etc., can only account for part of the disease burden that is observed in any given population, even when income and education levels are considered. This unexplained portion, Marmot has attributed to “control factors”, that is, the degree of autonomy and freedom from external controls, that we experience in our lives. The higher one’s position in the social realm, the greater control one has. While the mechanism of action is unknown, he argues that it may be a two part action. One that relates to the worth we are given in society that either boosts or undermines our own sense of worth, and hence our level of motivation to make healthy lifestyle choices. The second may be that having lower levels of control is more stressful and certain stress hormones may have a negative impact on immune functioning, predisposing to illness.

Perhaps one of the most powerful acts of ‘practical reconciliation’ might be one that the proponents of this practical approach would deride as ‘merely symbolic’- a treaty with Aboriginal Australians recognising their ‘First Peoples’ status.

Dazed and Confused in the NT.

Major Gen. Brough has been touring several Central Australian communities this week. Santa Teresa was on the itinerary, and the issue of alcohol came up. Santa Teresa is a dry community (like most remote Indigenous communities), meaning that it is illegal to possess or drink alcohol in the community itself. The practice is for drinkers to access their alcohol elsewhere and then drink on the town boundary, before rolling on home.

Let’s just revisit the initial announcement on this topic,

Firstly in relation to alcohol the intention is to introduce widespread alcohol restrictions on Northern Territory Aboriginal land for six months. We’ll ban the sale, the possession, the transportation, the consumption and (introduce the) broader monitoring of takeaway sales across the Northern Territory.

I thought that this meant a proposal to reduce the availability of alcohol across Aboriginal lands in the NT.

Yet, after Mal’s adventures in Central Australia yesterday, he said this ,

We are looking at having canteens where there is an amount of alcohol…. where [there are] no takeaways, where people don’t go home and get drunk.

Despite the call for alcohol restrictions, the idea of “wet canteens” is to make alcohol more widely available on Aboriginal lands. This shows two things, one good and one not. On the good side, that Mal is talking to people and isn’t blindly sticking to the original plan. On the other hand, it just demonstrates again the vast distance between the June 22nd announcements and reality, and the confusion within the Government on how to achieve its’ stated aims.

Even where “canteens” (known as ‘Clubs’ in the NT) do exist, the problem of alcohol abuse does not go away. In fact, where there are Clubs, there tends to be a strong feeling, especially amongst the women within those communities, that they should be shut down. The Clubs were introduced to as an idea to encourage controlled drinking. However, it was always a partial response. Treatment services for addiction are a necessary adjunct to make this a realistic strategy, and they have never existed . To this point, Mal Brough hasn’t addressed that issue, strengthening the view that he is a well-meaning and enthusiastic proponent of a flawed approach.

In For The Short Haul

Some of Mal Broughs’ positions have been difficult to understand. Contradictory even. I won’t speculate on motivations because it’s pointless, but it useful to understand the philosophical underpinnings of a particular approach. The emphasis on short term measures has been perplexing, as most of the problems are chronic. The Minister has rejected or ignored several long-term proposals. There was the letter from the NT Governments Chief Minister, Claire Martin, last June suggesting a combined Federal/Territory approach with “intensive intervention” in the areas of “alcohol abuse, overcrowded housing, law and order, governance and welfare reform“. John Howard thought that this was not good enough for such an “urgent problem” so he did nothing for another 1 year and 7 days, just to prove the point.

Then there was Mal Brough’s 2nd dismissal of Claire Martin on their first meeting after the June 22nd press conference. Martin again suggested the intensive long-term approach. Brough dismissed this as “having an agenda“,

(Her) agenda was not to work out how we are going to save the children right now.

And he went on to say,

We reiterated that the commonwealth Government is here for the long haul…

Which is rather strange given the approach to funding a Child Protection service in the NT. It was funded for its first 6 months and applied to the relevant Commonwealth department for on-going funding, but was rejected. Brough was critical of the NT for only providing 6 months funding,

First and foremost, we actually want to see the Territory Government also pick up the ball here and not pay go-away money to people for six months.

A six-month commitment is just “go-away money“? Does that apply to bringing in Federal Police for 6 months?

Mal Brough is actually a big fan of the 6 month plan, despite his criticims of the NT Government. Apparantly it’s part of his philosophy (if you can call it that). Thanks to Andrew Bartlett for the link to this article . Now I find Broughs approach is quite understandable,

They’re complex issues, but I don’t think they have complex answers.

All that is required is to marshal your forces then surge towards the objective and soon enough it will be ‘mission accomplished’. A military approach to chronic social problems is not going to work. Let’s hope Mal starts doing some listening.

How The Hell Did We Get Here? 3

There has been some reaction to criticism of the ‘Emergency Taskforce’ that views it as ‘willing failure’ of the measures. This is a rather cynical response that ignores the fact that much of the criticism existed prior to this latest ill-conceived adventure.

The Governments own appointee to the position of Aboriginal and Torres Strait Islander Social Justice Commissioner, Tom Calma, has been a consistent critic. He issued this statement, rather prophetically, just one week before the Mal&John Press Conference of June 22,

“Current federal Government policy treats Indigenous people as ‘problems to be solved’ rather than as active partners in creating a positive life vision for our communities,” Mr Calma said.
“The irony is that this fosters a passive system of policy development and service delivery, while at the same time the government is criticising Indigenous peoples for being passive recipients of government services.”

Direct hit. The ensuing debate couldn’t have shown him to be any more correct in his assessment.

The press release was titled “Government approach to Indigenous affairs seriously flawed“. It marked the release of the annual Social Justice Report which I’ll review it in some depth soon, to see just how far off track the NT Emergency Response Taskforce actually is.

Exemplary Planning

A major emphasis has been placed on the issue of quarantining welfare payments for Aboriginal people in remote communities, to ensure that money is appropriately spent. Mal Brough fist raised the idea in April last year . You might think that this means the Federal Government has been busy investigating the idea and working out practical details for what would be a very complicated and potentially counterproductive move. Of course, you’d be wrong. Brough’s idea, reinvigorated by the “Little Children are Sacred” report has become official policy, endorsed by the Cabinet on Tuesday. Details were to be announced yesterday, but that has now been delayed. No doubt because they are still trying to figure out a way around the significant practical problems of actually doing it. Larvatus Prodeo has a good discussion on the topic. It follows that in the 14 months since the Minister raised it as an issue, his department has done no work on researching the proposal in terms of likely benefits, practical problems, and implementation.

Or perhaps they did and told him it wasn’t a rational policy response to the problem?