IF PROGRESS, albeit slow progress, is being made in Aboriginal health, as the federal Health Minister, Tony Abbott claims, it owes more to panic decisions made 35 years ago than to anything that has happened under the Howard or Hawke or Keating governments. That does not, however, stop the politicking.
Abbott cited as a demonstration of the progress a dry demographic report on Northern Territory Aborigines which suggested that their life expectancy had increased by about 10 years over the past 40 years, even if it is still nearly 20 years shorter than the average life expectancy for other Australians.
He rushed out the report so as to reduce the impact of an Oxfam report, prepared for the National Aboriginal Community Health Organisation, pointing to how Australian indigenous health lagged well behind the health of Maoris in New Zealand, Inuit in Canada, and Indians in the United States.
With a contentedness befitting a minister who often gives The Australian a day's start on news and gets uncritical commentary to match he said contentedly on Lateline on Monday that "I think that [The Australian] had every intention of running with the bad news [the Oxfam report] but I think, to their credit, they decided that the newsier news was not that we had more bad news but that for once we had a bit of good news in the area".
Actually the two reports go together to suggest that real improvement in Aboriginal health is far off, and that government has no policies or programs likely to make a significant difference.
So what was the good news? Between 1967 and 1988 average Aboriginal life expectancy in the Northern Territory increased by about six years four for men, nine for women. White life expectancy increased by the same amount, leaving Aborigines much the same behind.
By far the biggest component of this (about four years) was in reducing the number of babies who died in their first year of life. There was a slight increase in the survivorship of children aged one to 14 (adding a year to the average life expectancy) and to elderly Aborigines, adding about half a year, but the life expectancy of most adults did not otherwise much change. By contrast, the increases in life expectancy during this period were fairly uniform over the overall population.
Over the next 20 years, 1988-2007, some further progress was made, if without the spectacular improvements in the prospects of a baby. Child mortality has continued to fall (worth about a year to the average life expectancy), there has been almost no improvement in life expectancy between the ages of 15 and 44, but those who reached that age had steady improvements (amounting to an expectancy of three years or more). Life expectancy increased in the general population, so the gap did not diminish.
In the late 1960s, Aboriginal infant mortality (death in the first year of life) was a national disgrace, particularly in the NT, where, in places, it ran up to a quarter of all babies born dying. In the early 1970s, an incoming Whitlam government threw dollars at the problem and told senior health bureaucrats that "heads would roll" if they did not drastically reduce mortality.
They did, but not, initially at least, by much changing Aboriginal infant morbidity. Children were as sick as ever. But measures were taken to grab every desperately sick child, remove it to hospital, by air ambulance as often as not, to pump it full of drugs and food and bring it back from the brink of death. A few weeks later it would be returned to its parents, and, as often as not, soon became sick again, again to be evacuated and "saved". In 1977, the average Aboriginal baby in one Central Australian Aboriginal community I then knew well had spent 16 weeks, in an average four episodes, in hospital in its first year of life.
The scourge of infectious disease, particularly among children, and the attack this caused on immune systems, consumed the health care facilities available, but those at the front line knew that better health services could make only a marginal difference, at best stopping the very sick from dying. Real improvement could come only from the physical wherewithal by which people could be healthy: better housing and, particularly, reduced crowding; better water supplies, improved sanitation; electricity so that people could wash themselves, their clothes and their bedding; employment, and the educational facilities that could make people employable.
The increased investment in such things has always fallen woefully short of the bare minimum necessary to make much difference.
Better services matter, too. Aborigines, the most disadvantaged people in Australia, were also visibly the most sick. But they used fewer services than anyone else. This was in part because so many lived in remote areas where there were simply no facilities. But it was also a reflection of the cultural chasm between a public and private health system which worked reasonably well for a wider population (who were only occasionally sick), but was not adapted for a community which was often sick.
That's why there was so much pressure and such a need for community-based services, and for close Aboriginal participation in the organisation and planning of services for Aborigines. Government has made a good deal about how much money is spent in this field.
But even with this "special" money, which has sometimes come with the false suggestion that Aborigines get something other Australians do not get, public spending on Aboriginal health is still significantly lower, per capita, than on non-Aborigines. Even non-Aborigines in remote rural Australia. A typical non-Aboriginal family at, say, remote Roxby Downs in South Australia, costs the state twice as much for health (while being basically well) than a typical (equivalently sized) Aboriginal family at Ernabella in the same state. And that's quite apart from the vast difference in the quality of their living arrangements.
Adulthood is when our young Aboriginal men and women, particularly men, are now dying too early, whether from lifestyle diseases such as diabetes and hypertension, or from fighting, road trauma and drug and substance abuse. Make it to 45 and one's life outlook improves, if still falling well short of national norms.
Spending by the Federal Government on Aboriginal health is 50 times, per capita, public health spending in say China, or Burma, or Chad, even if the outcomes are worse.
There was a time when Canada, the US and New Zealand were studying what we were doing and copying us. Not any more. In those countries the gap, while still there, is closing. In Australia, it is not. Nor is there any sign that it can, or by much, at any rate. Not with present policies.
As of now, there are about eight million fewer years of life that an identifiable sector of the Australian population enjoys than if they were non-Aboriginal. With the Aboriginal birth rate still significantly higher than the non-Aboriginal Australian norm, I predict that this will be at least 12 million fewer years by the time Tony Abbott leaves politics, assuming he has a normal political life span. What a legacy for a health minister
No comments:
Post a Comment