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Aboriginal health: why is reconciliation necessary?

Lisa R Jackson and Jeanette E Ward

MJA 1999; 170: 437-440

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Introduction - Health and land - What is reconciliation? - A populist movement - Acknowledgements - References - Authors' details
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Many health professionals are deeply troubled by the persistent health inequities between Aboriginal and non-Aboriginal Australians. From a social and political perspective it is clear that, for there to be appreciable improvement in Aboriginal health, a process of reconciliation which acknowledges the past in the light of the present needs to be adopted across all sectors of society. We give some practical advice for promoting reconciliation.

Introduction Before the arrival of Europeans, the Aboriginal peoples of Australia were a strong and healthy race of hunters and gatherers whose active lifestyle promoted good health. Little evidence has been found of widespread illness or disease in Aboriginal people,1 making it unlikely that they suffered from obesity, hypertension, diabetes, renal failure, coronary heart disease, cancer, arthritis or other diseases endemic in Aboriginal people today.2

It is possible that, in 1770, when Cook charted the east coast of Australia, Aboriginal people were healthier than the average person in Britain or other parts of Europe.1 Further, Aboriginal people had a strong oral pharmacopoeia which was passed down from generation to generation.3 The early European colonists, without a means of replenishing their medical supplies, were taught by Aboriginals to use "medicinal plants growing in the new country".4

After at least 50 000 years of a strong and intact culture, the Aboriginal population was decimated by diseases introduced by Europeans, and those remaining were displaced from their lands and forced to change their lifestyle.1 Now, more than 200 years on, and despite attempts to improve Aboriginal health, the health of Aboriginal people is markedly worse than that of other Australians and of the indigenous peoples of New Zealand and the United States.5 While mortality rates for the total Australian population have been improving in recent decades, mortality rates for Indigenous women have not changed and the rates for Indigenous men have fallen only slightly.6 These data are from Western Australia, the Northern Territory and South Australia. Age-specific mortality rates in these three States in 1992-1994 were higher for all age groups of Indigenous people. The difference was most pronounced -- about five to seven times that of non-Indigenous Australians -- for those aged 25-54 years.7 Infant mortality, although decreasing among Aboriginal people over the past decade, also remains a problem, with rates reported in 1996 that are two to four times higher than the national average.7 Hospital separation statistics also indicate a greater burden of illness in Indigenous people: during 1992-93, there were 2.5 and 2.7 times more admissions for Indigenous men and women, respectively, than would be expected, based on all-Australian rates.6 Social disadvantage for many Aboriginal people is likely to contribute to their ill-health. At least 20 000 Aboriginal people still live in communities with permanently inadequate or contaminated water supplies.8 Almost a third (29%) of Aboriginal and Torres Strait Islander people older than 15 years who responded to a health survey were worried about having sufficient food.9


Health and land
Since the arrival of Europeans there has been very little formal recognition of the profound spiritual links of Aboriginal peoples to their land. The common law principle of Terra Nullius -- a territory belonging to no one -- was applied unilaterally. The British "took possession" of the land because they considered it to be unoccupied. Moreover, unlike the experience of Maori in Aotearoa (New Zealand) or the indigenous peoples in both the United States and Canada, there has never been a formal treaty between the Aboriginal people and the newcomers to Australia. It has been argued that the absence of a treaty with Aboriginal peoples is causally associated with their poor health and social disadvantage.5 Disempowerment has been accepted as a causative factor by the Royal Australasian College of Physicians in its Darwin Declaration (1997):
. . . that the health of Aboriginal and Torres Strait Islander Australians is disastrously poor compared with other Australians, and that the fundamental cause is disempowerment, due to various factors including continued dispossession from land, cultural dislocation, poverty, poor education and unemployment.10

To Aboriginal people, ill-health is more than physical illness; it is a manifestation of other factors, including spiritual and emotional alienation from land, family and culture. Aboriginal people have a spiritual link with the land which provides a sense of identity, and which lies at the centre of their spiritual beliefs.11 Land is the crux of Aboriginal health and well-being.

In 1990, the National Aboriginal Health Strategy (NAHS) developed a widely accepted definition of health as perceived by Aboriginal peoples:

Health does not just mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community. This is a whole of life view and includes the cyclical concept of life-death-life.12

This definition of health places in context our history, the importance to Aboriginal people of their links with the land, and their disenfranchisement, sense of loss and present-day marginalised position within the Australian community. Accordingly, to understand Aboriginal ill-health, one must first acknowledge the impact of dispossession, theft, genocide, lost and stolen generations of families and the attempted decimation of the innumerable cultures of the people inhabiting Australia before 1770 (Box 1).

Furthermore, Aboriginal health is not just the domain of the healthcare system. By accepting the need for an approach that is multifaceted and covers all aspects of people's lives, including housing, education, employment and social justice, we can then understand that physical and symptomatic relief of disease will not in itself redress the burden of Aboriginal ill-health.


What is reconciliation?
There is no agreed definition of reconciliation. It is agreed, however, that reconciliation encompasses reparation, as recommended by the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families.14 In the report, Bringing them home, five components of reparation have been recommended. These have been taken from the van Boven Principles,15 drawn up by the United Nations Commission on Human Rights as guidelines for reparation of victims of gross violation of human rights:
  • Acknowledgement and apology

  • Guarantees against repetition

  • Measures of restitution

  • Measures of rehabilitation

  • Monetary compensation

Reconciliation always begins with acknowledgement or, more colloquially, "truth telling". Alexander Boraine, Vice Chair of the Truth and Reconciliation Commission of South Africa, has spoken of the capacity for forgiveness by those who suffered most under apartheid.16 In Australia, there is a need to acknowledge that the benefits now enjoyed by some have been at the expense of incalculable suffering to others. "Truth telling" is unresolved "sorry business" for our nation.

If contemporary Aboriginal health is accepted to be a manifestation of a population dying of despair, anger and disillusionment, then reconciliation is fundamental. It has been compellingly argued that "The diseases of anger and despair which wrack Aboriginal communities in Australia clearly have many of their roots in childhood."17 Acknowledgement of the causes of this anger and despair must occur as the first step in the process of reconciliation. Reconciliation is necessary but is not, in and of itself, sufficient to guarantee improved Aboriginal health.

Reconciliation becomes the foundation for health services development. The Australian Medical Association has stated that "The process of reconciliation would be incomplete without the provision of substantial additional resources for Indigenous health."18

As we await proper political processes to implement recommendations from the Muirhead Royal Commission into Aboriginal deaths in Custody19 and the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families,14 individuals and organisations can consider their own processes for reconciliation.


A populist movement
There are many ways reconciliation can be facilitated through a populist movement. The Council for Aboriginal Reconciliation has published eight key issues considered crucial to restoring Aboriginal community and culture.20 Box 2 proposes some practical strategies that health organisations and individuals can adopt as part of their commitment to reconciliation with the Aboriginal and Torres Strait Islander peoples of Australia. These processes can be built upon and adapted by healthcare providers according to their needs and expectations and those of their communities.

A people's movement of reconciliation is required to encourage and promote better health for Aboriginal Australians. To recognise the link between Aboriginals' burden of illness and their cultural destruction is the first step towards significant and lasting change.

Health professionals can consider a proactive partnership to promote reconciliation. Doing what we have always done to improve Aboriginal health will only give us the same health outcomes, and the statistics will continue to show the shameful morbidity and mortality rates of Australia's first peoples.

Although the Council of Aboriginal Reconciliation will be disbanded at the end of the year 2000, reconciliation itself will not cease. As many Aboriginal people are currently saying, now is a time for building bridges.

It will take an insightful and committed group of people to take on the challenge of restoring the justice which is long overdue. We hope that health professionals adopt reconciliation as a fundamental issue in their workplaces.


Acknowledgements
We acknowledge the land on which we live and work as belonging originally to Aboriginal people. We thank the generosity of all those who sent us information, read our manuscript and gave us feedback. We also would like to thank the Indigenous Health Workers Network of the CSAHS for their support. This article was written while Lisa Jackson was completing the New South Wales Health Department Public Health Officer Training Program.

References
  1. Australian Institute of Health. First biennial report of the Australian Institute of Health. June 1988. Canberra: AGPS, 1988: 1-2.
  2. Cowlishaw G. Infanticide in Aboriginal Australia. 1978: In: The health of Aboriginal Australia. Reid J, Trompf P, editors. Sydney: Harcourt Brace Jovanovich, 1991: 3.
  3. Latz P. Bushfires and bushtucker. Alice Springs: IAD Press, 1995: 44-72.
  4. Cribb AB, Cribb JW. Wild medicine in Australia. Sydney: Fontana/Collins, 1981: 10.
  5. Ring IT, Firman D. Reducing indigenous mortality in Australia: lessons from other countries. Med J Aust 1998; 169: 528-531.
  6. Australian Bureau of Statistics/Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples. Canberra: ABS/AIHW, 1997: 87-89, 68. (Catalogue No. 4704.0.)
  7. Australian Institute of Health and Welfare. Australia's health 1998. Canberra: AIHW, 1998: 29, 32.
  8. Dodson M. Linking international standards with contemporary concerns of Aboriginal and Torres Strait Islander peoples. In: Pritchard S, editor. Indigenous peoples, the United Nations and Human Rights. Annandale, Sydney: Federation Press, 1998.
  9. Australian Bureau of Statistics. 1994 National Aboriginal and Torres Strait Islander Survey: Detailed findings. Canberra: AGPS, 1994: 10, 11, 13. (Catalogue No. 4190.0.)
  10. Royal Australasian College of Physicians. CommuniquŽ of the 1997 Cottrell Conference hosted by the Royal Australasian College of Physicians: Statement on the Delivery of Specialist Services to Remote and Rural Aboriginal and Torres Strait Islander Communities, 1997. http://www.racp.edu.au/open/cottrell.htm
  11. Woodward AE. Aboriginal Land Rights Commission Report. Canberra: AGPS, 1974.
  12. National Health and Medical Research Council. Promoting the health of Indigenous Australians. A review of infrastructure support for Aboriginal and Torres Strait Islander health advancement. Final report and recommendations. Canberra: NHMRC, 1996: part 2: 4.
  13. Independent Commission on International Humanitarian Issues. Proceedings of Conference, 1987: In: The health of Aboriginal Australia. Reid J, Trompf P, editors. Sydney: Harcourt Brace Jovanovich, 1991: xi.
  14. Human Rights and Equal Opportunity Commission. Bringing them home. Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families. Sydney: Sterling Press, 1997.
  15. Van Boven T. Revised set of basic principles and guidelines on the right to reparation for victims of gross violations of human rights and humanitarian law. United Nations Commission on Human Rights, 24 May 1996. (UN Doc: E/CN4/Sub2/1996/17.)
  16. McKendrick JH. Aboriginal reconciliation: a role for psychiatrists? Aust N Z J Psych 1997; 31: 617-621.
  17. Bartlett B, Legge D. Beyond the maze. Proposals for more effective administration of Aboriginal health programs. Canberra: National Centre for Epidemiology and Population Health, Australian National University, 1994. (NCEPH Working Paper Number 34.)
  18. Australian Medical Association. Australia Day Statement: Greater commitment to indigenous health would boost reconciliation. Media release. Canberra: AMA, 1999.
  19. Royal Commission into Aboriginal Deaths in Custody. Reports Vol 1-5. Canberra: AGPS, 1992.
  20. Council for Aboriginal Reconciliation. Eight key issues of reconciliation, the community consultative process. Sydney: Australians For Reconciliation, 1996-1967.
  21. Horton D, general editor. The encyclopaedia of Aboriginal Australia [CD-ROM]. Canberra: Aboriginal Studies Press, Australian Institue of Aboriginal and Torres Strait Islander Studies, 1994.
  22. Aboriginal and Torres Strait Islander Commission. As a matter of fact: answering the myths and misconceptions about Indigenous Australians. Canberra: Office of Public Affairs, 1998.
  23. Office of the Minister for Aboriginal and Torres Strait Islander Affairs. Rebutting the myths: some facts about Aboriginal and Torres Strait Islander affairs. Canberra: Office of the Minister for Aboriginal and Torres Strait Islander Affairs, Parliament House Canberra, 1997.
  24. Flood S. Essay for the Theosophical Society. Sydney, Public Defenders Office, 1997.

Authors' details Needs Assessment and Health Outcomes Unit, Central Sydney Area Health Service, Sydney, NSW.
Lisa R Jackson, RN, MPH, Aboriginal Public Health Officer.
Jeanette E Ward, PhD, FAFPHM, Director.

Reprints: Associate Professor J E Ward, Needs Assessment and Health Outcomes Unit, Central Sydney Area Health Service, Locked Bag 8, Newtown, NSW 2042.
Email: jwardATnah.rpa.cs.nsw.gov.au

©MJA 1999
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We appreciate your comments.

1: Land is the crux of Aboriginal health and well-being

Next to shooting Indigenous peoples, the surest way to kill us is to separate us from our part of the Earth. Once separated, we will either perish in body or our minds and spirits will be altered so that we end up mimicking foreign ways, adopt foreign languages, accept foreign thoughts and build a foreign prison around our Indigenous spirits, a prison which suffocates rather than nourishes as our traditional territories of the Earth do. Over time, we lose our identity and eventually die or are crippled as we are stuffed under the name of "assimilation" into another society.

A senior official of the World Council of Indigenous Peoples.13

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2: Practical strategies for promoting reconciliation between Aboriginal and Torres Straight Islander peoples and other Australians

1. Understanding country
Understanding the significance of land and sea to Aboriginal and Torres Strait Islander societies

  • Accept that for Aboriginals and Torres Strait Islanders, their cultural identity is bound up by ties to the land and sea.
  • Acknowledge that Aboriginal peoples inhabited Australia for at least 50 000 years before Europeans came.

2. Improving relationships
Building new relationships between Aboriginal and Torres Strait Islander peoples and all other Australians

  • Invite Aboriginal or Torres Strait Islander people to give talks to professional and community groups to which you belong.
  • Ensure that the people with whom you work do not have preconceived notions of Aboriginal people, in accordance with recommendation 9a of the Bringing them home report.14
  • Allow staff to attend cultural awareness sessions presented by Aboriginal and Torres Strait Islanders.
  • Join a local study circle and join the mailing list for the Council for Aboriginal Reconciliation.
  • Work with local Aboriginal people in your area towards a statement of commitment to reconciliation for your external communications (eg, a sentence on faxes and letterheads).
  • Find out if your local hospital has an Aboriginal Liaison Health Worker; if not, give your written support to the organisation to employ one.

3. Valuing cultures
Recognising the valuable contribution the cultures of Indigenous people make to the Australian heritage

  • Acknowledge the strength of Australia's Indigenous cultures and their importance to our national pride and our international image and trade.
  • Find out the name of the traditional owners of the land where you live and work.
  • Attend cultural events where the focus is on Aboriginal and/or Torres Strait Islander people and their lifestyles.
  • Obtain a copy of the Aboriginal Australia map, published by the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS).
  • Borrow or buy a copy of the Encyclopaedia of Aboriginal Australia.21
  • Read works by Aboriginal authors, such as Sally Morgan, Monty Prior, Ruby Langford Ginibi, Oodgeroo Noonuccal, Kevin Gilbert or James Miller.
  • Understand that Aboriginal people have had, and some continue to have, a strong traditional health practice.

4. Sharing history
Understanding that the history of Australia began long before the arrival of Captain Cook in 1770

  • Read general textbooks about Aboriginal history: A secret country, Unfinished business, Six Australian battlefields, The world of the First Australians or Invasion to embassy.
  • Read the summary of the Muirhead Royal Commission into Aboriginal Deaths in Custody19 and Bringing them home14 (the Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families).
  • Read information documents on contemporary Aboriginal issues such as As a matter of fact22 or Rebutting the myths.23
  • Encourage Aboriginal and Torres Strait Islanders to share their knowledge and perspective of history.
  • Ensure schools attended by your children have Aboriginal and Torres Strait Islander resources in their classrooms and libraries.
  • Watch videos that tell the story, including Women of the sun, Lousy little sixpence and Around the kitchen table (to name just a few), or see movies made by Aboriginal people such as Radiance.

5. Addressing disadvantage
Acknowledging that Indigenous people are the most disadvantaged group in Australian society

  • Acknowledge that inequities in such basic areas as education, health, housing and the justice system are very real to Aboriginal people.
  • Having learned from reading, watching and listening, speak up when others voice myths, errors and prejudices about Aboriginal and Torres Strait Islander peoples.
  • Do not allow people speaking untruths to ever believe that your silence means agreement.
  • Support your children when they make friends with Aboriginal and Torres Strait Islander children.
  • Favour businesses that support reconciliation.
  • Encourage affirmative action in your workplace.

6. Custodial levels
Drawing attention to the fact that Aboriginal and Torres Strait Islander people continue to be arrested and imprisoned at a rate far above that of the wider community

  • Find out what has been done in your State or Territory to implement the recommendations of the Muirhead Royal Commission into Aboriginal Deaths in Custody.19
  • Support efforts by the healthcare sector to implement the recommendations of this report specific to health.

7. Destiny
Supporting empowerment of Indigenous peoples -- giving them greater control over their own destiny and a right to self-determination

  • Join a study circle or attend local community consultations to discuss ideas and initiatives for self-determination in the spirit of partnership.
  • Phone your local Members to let them know of your support and that of your organisations. Ask what specific actions they have taken during their term in office.
  • Invite Indigenous people to participate and ensure their voices are heard in the formulation and implementation of policy decisions.

8. Formal document(s) of reconciliation
Determining whether reconciliation would be helped by a formal document(s) of reconciliation.

  • Support recognition of the unique position of Aboriginal and Torres Strait Islander peoples as the Indigenous peoples of Australia.
  • Put into policy in your organisation a process of reconciliation with an outcome date.
  • Once the formal documents of reconciliation are available, adapt them for your practice and ensure they enter as policy into your organisation.

9. Native Title
Recognising the implications of the Native Title debate

  • Realise that matters such as the current Native Title legislation have significant implications in areas (other than land usage), such as health and social justice.
The Public Defender, Sean Flood, in a talk given at the Theosophical Society (Sydney) in November 1997, explained this clearly:
The Nation's soul is at risk. Extinguishment of Native Title is extinguishment of Indigenous culture and ultimately the cause of sickness and death of Indigenous peoples.24
  • Learn more about Native Title.
  • Acknowledge a component of restitution, as documented in the Bringing them home14 report, which allows Native Title holders the authority under traditional law to define the content and scope of that title.

10. Stolen generations
Acknowledging the injustice and the trauma of forcibly removing Indigenous children from their families and communities, as has been done since the earliest days of European colonisation in Australia

  • Recognise and acknowledge the consequences of the past and seek ways to make amends.
  • Participate in Sorry Day, National Aboriginal Day Organising Committee (NADOC) and National Reconciliation Week activities.
  • Speak out against prejudiced views.
  • Support programs that help Aboriginal and Torres Strait Islander individuals and families overcome the trauma they are still suffering.
  • Listen to Aboriginal and Torres Strait Islander people talking about what has happened and ask what you can do.

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