A united stand from medical professionals and organisations will send a powerful message
May 2007 is the 40th anniversary of the 1967 Referendum, when an overwhelming majority of the Australian population voted to end discrimination against Aboriginal and Torres Strait Islander peoples.1 While some gains have been made since 1967,2 inequalities in health status between Aboriginal and non-Aboriginal Australians remain.
In the Medical Journal of Australia alone, medical and health professionals have contributed to over 150 articles about Aboriginal and Torres Strait Islander health in the past 6 years. All levels of government have set out frameworks, strategies and recommendations to improve the health of Indigenous Australians, and have celebrated their commitments.3 Aboriginal and Torres Strait Islander leaders and representative organisations have supported exemplary health programs and shared these success stories in the hope of having their capacity enhanced to better provide for their community’s health needs.4-6 The research has been done,7 so why are governments not acting on their own recommendations?
Since the release of the Aboriginal and Torres Strait Islander Social Justice Report 2005,8 leading Indigenous and non-Indigenous medical and health organisations and human rights groups have been asking this question. This momentum led to an open letter published in The Australian newspaper in December 2006,9 and the beginning of a campaign calling on all Australian governments and the public to “commit to a plan of action to achieve health equality for Indigenous peoples within twenty-five years.” The letter was signed by 37 key health and human rights agencies, and more agencies are signing up to the campaign daily.
The purpose of the open letter (reproduced in the Box) is to campaign for a national commitment to achieving health equality for Aboriginal and Torres Strait Islanders by tackling areas where there is insufficient action, and where evidence indicates that action will deliver substantial gains. This approach is laid out in the Social Justice Report 2005.8 The open letter:
sets a target of achieving health equality within a generation (25 years), thereby challenging incremental policy approaches that have avoided benchmarks, timeframes, comprehensive measures and accountability;
directs attention to the evidence-based priority areas;
is led by strong, united Aboriginal and Torres Strait Islander health organisations and an Indigenous workforce providing cultural and professional leadership, challenging views that Indigenous Australians are not taking responsibility; and
is supported by a significant and increasing number of powerful Australian health and human rights groups.
The open letter states that “Indigenous Australians continue to needlessly suffer and die early, not from a lack of solutions or government commitments, but from a lack of political will and action.” How can the Australian medical community assist?
First, they must ask themselves if they are prepared to remain complicit in the real lack of will and action shown by Australian governments at all levels. Australia’s shameful record in incremental (and hence ineffectual) actions to redress health disparities between Aboriginal and non-Aboriginal Australians reflects particularly poorly on medical and health professionals. Is it acceptable that international governments have made significant advances in the health of their indigenous peoples while ours lags behind?10,11 Are we happy to keep writing the reports and advocating for resources only to have those efforts fail? (For every dollar spent per person on health goods and services for non-Indigenous people in the 2001–02 financial year, only 18 cents more per person was spent on Indigenous peoples, despite their health status being three times poorer.12) The interest of this Journal’s readership on this matter, and our professional organisations’ policies indicates we are not.
Second, as distinguished and respected people in prominent positions in society, medical and health professionals must not underestimate their ability, and indeed their responsibility, to advocate for health equity. If the missing ingredient is a lack of political will, perhaps the medical profession can shift that will and public opinion. Unity on this matter as a profession and an organised course of action sends a powerful message that we are both willing and able to make the health of Aboriginal and Torres Strait Islander peoples a top health priority. Many important public health and humanitarian gains have been made through targeted campaigning. A good example is the recent mental health campaign, led by “beyondblue”, which resulted in an announcement of $1.8 billion in new funds in the 2006 budget.13
As leading advocates for the health of Aboriginal and Torres Strait Islander peoples, we are humbled and honoured to be working with many committed and skilled colleagues — both Indigenous and non-Indigenous. We know many of these colleagues share our frustrations at the funding shortfalls preventing the delivery of adequate health care to Aboriginal and Torres Strait Islander peoples.7
We now appeal to the Australian medical community to support us. Here we present the open letter again to coincide with the 1967 Referendum celebrations, inviting you to come on board. Speak or write to your federal and local politicians. To be a party to the open letter and the Indigenous health campaign, send your support, your signatures and your logo to sjreportAThumanrights.gov.au.
Open letter calling for equity in Indigenous health
Signed by: National Aboriginal Community Controlled Health Organisation, Human Rights and Equal Opportunity Commission, Congress of Aboriginal & Torres Strait Islander Nurses, Aboriginal Medical Services Alliance Northern Territory, Australian Indigenous Doctors’ Association, and 32 other health and human rights agencies. Full list and further information available at: http://www.humanrights.gov.au/social_justice/health/health_OpenLetter.html
- 1. Reconciliation Australia website: www.reconciliation.org.au (accessed Apr 2007).
- 2. Condon JR, Barnes T, Cunningham J, Smith L. Improvements in Indigenous mortality in the Northern Territory over four decades. Aust N Z J Public Health 2004; 28: 445-451.
- 3. National Aboriginal and Torres Strait Islander Health Council for the Australian Health Ministers’ Conference. National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003–2013). Framework for action by Governments. Canberra: Australian Government Department of Health and Ageing, 2004.
- 4. National Aboriginal Community Controlled Health Organisation. Aboriginal peoples making the health system equitable. Canberra: NACCHO, 2006.
- 5. A national profile of Australian Government funded Aboriginal and Torres Strait Islander Primary Health Care Services. Service activity reporting: 2003–04 key results. Results of a joint Office for Aboriginal and Torres Strait Islander Health (OATSIH) and National Aboriginal Community Controlled Health Organisation (NACCHO) initiative. Canberra: Australian Government Department of Health and Ageing, 2006.
- 6. Panaretto KS, Lee HM, Mitchell MR, et al. Impact of a collaborative shared antenatal care program for urban Indigenous women: a prospective cohort study. Med J Aust 2005; 182: 514-519. <MJA full text>
- 7. Dwyer J, Silburn K, Wilson G. National strategies for improving Indigenous health and health care. Aboriginal and Torres Strait Islander primary health care review: consultant report No. 1. Canberra: Commonwealth of Australia, 2004. http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-oatsih-pubs-reviewphc.htm/$FILE/1national.pdf (accessed Apr 2007).
- 8. Calma T. Aboriginal and Torres Strait Islander Social Justice Commissioner social justice report 2005. Chapter 2. Sydney: Human Rights and Equal Opportunity Commission, 2005. http://www.hreoc.gov.au/social_justice/sjreport05/index.html (accessed Apr 2007).
- 9. Open letter: A call for health equality for Aboriginal and Torres Strait Islander peoples. The Australian 2006; 11 Dec: 6.
- 10. Ring IT, Firman D. Reducing Indigenous mortality in Australia: lessons from overseas. Med J Aust 1998; 169: 528-533.
- 11. Bramley D, Hebert P, Jackson R, Chassin M. Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States. N Z Med J 2004; 117: U1215.
- 12. Australian Institute of Health and Welfare. Australia’s health 2006. Canberra: AIHW. 2006. (AIHW Cat. No. AUS 73.) http://www.aihw.gov.au/publications/index.cfm/title/10321 (accessed Apr 2007).
- 13. Howard J, Prime Minister of Australia. Better mental health services for Australia [media release]. http://www.pm.gov.au/media/Release/2006/media_Release1858.cfm (accessed Apr 2007).