Mutual obligation and Indigenous health: thinking through incentives and obligations

To the Editor: As I have said elsewhere, “The last thing the majority wants is that the tyranny of the majority be applied to it. It is much easier to apply the tyranny of the majority to a minority. In a properly functioning democratic society minorities are not subjected to, but are protected against, the tyranny of the majority. Is the tyranny of the majority being applied through the medium of the Howard government onto the Aboriginal communities of Australia in this matter of ‘shared responsibility agreements’?”1

I note with interest recent articles by Collard and colleagues2 and by Kowal,3 debating “shared responsibility agreements”. The expressions “shared responsibility agreement”3 and “mutual obligation” are variations of the expression “social contract”. The concept of “social contract” underlies the concept of democracy originating in the writings of Thomas Hobbes, John Locke and Jean-Jacques Rousseau. Present-day political scientists discuss social-contract theory in their writings about democracy, and may mention “mutual obligation” or “shared responsibility”. While it is commonplace for aspects of the social contract to apply to subgroups in the population, it is discriminatory to make arrangements that apply only to a particular racial or ethnic group.

Even though the agreements are declared to be voluntary, it is likely that Aboriginal communities are under pressure to do as they are told to achieve social contracts with the Australian Government. If Indigenous people must comply with certain conditions before they can achieve social contracts, how might similar conditions be applied to the rest of the Australian population? The “ticking time bombs” of Australian public health are smoking and obesity. If non-Indigenous Australians refuse to stop smoking and refuse to eat less and take more exercise, should access to public hospitals and pharmaceutical benefits be denied them? Should they be denied petrol to force them to walk and to use public transport? Obviously not. These services are not subject to social-contract agreements as thiswould be a clear violation of Australian law.

Australian members of parliament in particular, and Australians in general, for the sake of themselves, their families and of Australian health care costs, would benefit from negotiating “shared responsibility agreements” with themselves to stop smoking and to lose weight. In current circumstances, “shared responsibility agreements” with Aboriginal communities represent inequality of sharing the responsibility for health.