To the Editor: Russell and colleagues recently wrote an open letter to the new Minister for Health.1 In response, we call for the Minister to champion the cause of Indigenous health.
Russell et al raise a number of pressing issues directly relevant to the health portfolio.1 However, of all the challenges that face you, perhaps the greatest is reversing the neglect and extreme health disadvantage experienced by Australia’s Indigenous people.2 Although the task is daunting, and detractors may argue that there are no evidence-based solutions, 150 years of collective experience from across the globe provides compelling support for real investment in the spheres of water, sanitation, housing, education, employment and primary health care to reverse health disadvantage. Tragically, while these basic necessities are taken for granted by most Australians, they remain a dream for many Aboriginal and Torres Strait Islander peoples.
The greatest public health gains during the previous two centuries resulted from ensuring that communities had sustained access to clean water, adequate sanitation and appropriate housing.3 It is astonishing that these basic rights should remain on the unresolved agenda of a highly developed country. To our shame, these basic direct health determinants are not yet guaranteed for Aboriginal and Torres Strait Islander Australians.4
Relative poverty, absolute poverty and social exclusion all have a major impact on health.5 In Australia, relative poverty denies many Indigenous communities access to housing, education, transport and other societal benefits. It would be naïve to argue that this inequitable distribution of Australian resources has not been a major determinant of the poorer health of Indigenous Australians.6 The recent Auditor-General’s report on whole-of-government Indigenous service delivery arrangements clearly indicates that current approaches are inadequate and fall short on service delivery.7
There is therefore a critical need for decisive direct investment in basic infrastructure and its maintenance in Indigenous communities, along with comprehensive primary health care. This must extend to equipping and developing individuals and communities through a major investment in education and creation of employment opportunities that engages the community and is developed in true and equal partnership with respected Indigenous leaders and communities
You may argue that many of these health determinants fall beyond your direct sphere of accountability. You may choose to point to the small-scale success stories, particularly in Indigenous primary health care. However, as Minister for Health and Ageing, you will continually be confronted by the direct evidence of the deleterious results of these health determinants on the life expectancy and health of Indigenous Australians.8
The time is ripe for a bold national leader to champion this cause in the corridors of power. We encourage you to become that advocate among your Cabinet colleagues. The challenge is yours. Will you have the courage and moral fortitude to make your mark on Australian history?
- 1. Russell LM, Leeder SR, Armstrong BK, et al. The first 100 days: an open letter to the new Minister for Health [editorial]. Med J Aust 2007; 187: 608-609. <MJA full text>
- 2. Wenitong M, Mokak R, Councillor H, et al. Rising to the health challenge for Aboriginal and Torres Strait Islander peoples: what will it take [editorial]? Med J Aust 2007; 186: 491-492. <MJA full text>
- 3. Hamlin C, Sheard S. Revolutions in public health: 1848, and 1998? BMJ 1998: 317: 587-591.
- 4. Aboriginal and Torres Strait Islander Social Justice Commissioner. Social justice report 2005. Sydney: Human Rights and Equal Opportunity Commission, 2005. http://www.hreoc.gov.au/social_justice/sj_report/ sjreport05/index.html (accessed Dec 2007).
- 5. Wilkinson R, Marmot M, eds. Social determinants of health: the solid facts. 2nd ed. Copenhagen: World Health Organization. http://www.euro.who.int/document/e81384.pdf (accessed Dec 2007).
- 6. Newman L, Baum F, Harris E. Federal, state and territory government responses to health inequities and the social determinants of health in Australia. Health Promot J Aust 2006: 17: 217-225.
- 7. Australian National Audit Office. Whole of government Indigenous service delivery arrangements. Report no. 10 2007–08: performance audit. Canberra: Commonwealth of Australia, 2007. http://www.anao.gov.au/uploads/documents/2007-08_Audit_Report_101.pdf (accessed Dec 2007).
- 8. Aboriginal health: a decade-old election promise [editorial]. Lancet 2007; 370: 910.
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