Opening remarks – National Indigenous Health Equality Summit
By Tom Calma, Aboriginal and Torres Strait Islander Social Justice Commissioner, Human Rights and Equal Opportunity Commission
Tuesday, 18 March 2008
Canberra
I would like to begin by acknowledging all of the Ngunnawal peoples - the traditional owners of the land where we are meeting over the coming days. I pay my respects to your elders and to the ancestors.
Thank you Aunty Agnes for your generous and warm welcome to country.
Distinguished guests, can I join Aunty Agnes in welcoming you to the National Indigenous Health Equality Summit. I welcome you on behalf of the Human Rights and Equal Opportunity Commission, as well as the Steering Committee of the Close the Gap campaign.
The next 3 days are the culmination of a long journey.
As I’ll explain shortly, the genesis of this Summit goes back to my 2005 report to Parliament. But of course the journey for Indigenous health equality goes back a lot longer than that.
An equal standard of health for Indigenous people was one of the calls at the National Day of Mourning held in Sydney in 1938. And it has been a call by the Indigenous health sector since its beginnings in Redfern in the late 60’s / early 70’s.
So as we begin what I believe is going to be a historic event, let us pay our respects to all of the elders, to all of the health workers and advocates – Indigenous and non-Indigenous – who have come before us on this journey.
To those who have paved the way, fought great battles, won some of them along
the way, never given up on those battles that they didn’t win and who have
set out a plan of what needs to happen.
We honour your
legacy.
To our pioneers – who founded Aboriginal medical services; who became nurses, doctors, other allied medical professionals and para-professionals, and only very recently, a surgeon; those who have become world class medical researchers and educators; and those who articulated guiding documents such as the National Aboriginal Health Strategy. We honour your legacy.
We take inspiration from your achievements. And we express our determination to build on your efforts to achieve our cherished goal of achieving Aboriginal and Torres Strait Islander health equality within a generation.
This Summit has its genesis in the findings of the Social Justice Report 2005 that was tabled in the federal Parliament in February 2006.
It is a report that I prepare annually on the impact of government action on the ability of Indigenous peoples’ to exercise and enjoy our human rights. Due to the vagaries of parliamentary tabling processes, my latest report will be tabled in Parliament tomorrow.
The 2005 report set forth a human rights based approach to achieving Aboriginal and Torres Strait Islander health equality within a generation.
It made three recommendations to this end.
The first recommendation was that the governments of Australia commit to achieving equality of health status and life expectation between Aboriginal and Torres Strait Islander and non-Indigenous people within 25 years.
The second recommendation set out a process for what would need to occur for
this commitment to be met. It called for:
- The governments of Australia to commit to achieving equality of access to primary health care and health infrastructure within 10 years for Aboriginal and Torres Strait Islander peoples;
- The establishment of benchmarks and targets for achieving equality of health status and life expectation - negotiated with the full participation of Aboriginal and Torres Strait Islander peoples, and committed to by all Australian governments;
- Resources to be made available for Aboriginal and Torres Strait Islander health, through mainstream and Indigenous specific services, so that funding matches need in communities and is adequate to achieve the benchmarks, targets and goals set out above; and
- A whole of government approach to be adopted to Indigenous health,
including by building the goal and aims of the National Strategic Framework for
Aboriginal and Torres Strait Islander Health into the operation of Indigenous
Coordination Centres regionally across Australia.
The final recommendation then recommended that the Australian
Health Minister’s Conference agree to a National Commitment to achieve
Aboriginal and Torres Strait Islander Health Equality and that bi-partisan
support for this commitment be sought in federal Parliament and in all state and
territory parliaments.
That was two years ago.
Since the release of the Report I have been working with a growing coalition of organisations who have committed to working in partnership to see these recommendations implemented.
The full list of organisations who have participated in this campaign is listed in your Summit information pack. It is an extraordinarily committed group of organisations and individuals, across a vast array of different sectors of the community.
The campaign has to date progressed without any financial support from Australian governments – it has been self-funded by the collaboration between approximately 40 organisations across the Indigenous health, NGO, reconciliation and general health sector more broadly.
At this point, can I ask you to join me in acknowledging the efforts of these organisations in the work they have done and in the convening of this Summit. I don’t think in any of our wildest dreams that we could have imagined that the work we have done could have opened up the opportunities that now lay before us.
Almost twelve months ago we formally launched the Close the Gap campaign on the back of that report. Our friends Ian Thorpe and Catherine Freeman formally did the launching at the Olympic Stadium – and we will be joined by them again on Thursday in Parliament House when we begin the journey to the next stage of this process.
One of our primary aims at the time was to obtain the commitment of all Australian governments – through COAG – and of the Australian government in particular due to its significant responsibilities for primary health care – to commit to closing the gap on Indigenous life expectancy within a generation. And it was to obtain this commitment on a basis of partnership and shared ambition with a wide range of sectors of the community.
As you will be aware, the Councils of Australian Governments did exactly that on 20 December 2007. In their Communiqué they state:
COAG agreed the 17 year gap in life expectancy between Indigenous and non-Indigenous Australians must be closed.
COAG today agreed to a partnership between all levels of government to work
with Indigenous communities to achieve the target of closing the gap on
Indigenous disadvantage. COAG committed to:
- Closing the life expectancy gap within a generation;
- Halving the mortality gap for children under five within a decade; and
- Halving the gap in reading, writing and numeracy within a
decade.
The Australian government has also contributed a significant amount to the cost of convening this Summit, and has expressed a desire to enter into a new partnership to achieve Indigenous health equality. As will be particularly apparent today, there is a significant representation of senior government bureaucrats from the Australian government, from the COAG working groups process, and from different state and territory governments in attendance and participating in the deliberations of this Summit.
And we hope to confirm this new partnership and determination when we are joined by the Minister for Health and Ageing, and the Minister for Families, Housing, Community Services and Indigenous Affairs, along with members of the Opposition in the Great Hall of Parliament House on Thursday for the final session of the Summit.
So we have now achieved our first goal – recommendation 1 of the Social Justice Report 2005.
Through this Summit, we aim to make significant progress towards achieving the second recommendation of the report – in particular through the establishment of benchmarks and targets for achieving equality of health status and life expectation.
Before I talk about how the Summit will proceed, I want to pause to reflect on some of the key features of the findings and recommendations of the Social Justice Report 2005 that have been fundamental to this campaign so far.
This process is fundamentally about human rights. It articulates a human rights based approach to Indigenous health.
It may surprise some people, but this is one of the most cutting edge developments in the international sphere. The right to health has been acknowledged for 60+ years, dating back to the Constitution of the World Health Organisation, the Universal Declaration of Human Rights and in the International Covenant on Economic, Social and Cultural Rights.
But health programming has only now begun to ‘catch up’, and to talk seriously about what a rights based approach to health means.
Because of this – a rights based approach offers a relatively new perspective on the factors necessary to address health inequalities and ensure to all people the right to the enjoyment of the highest attainable standard of health.
Your information pack contains a letter sent to each delegate at this Summit by the United Nations Special Rapporteur on the Right to the Highest Attainable Standard of Health. I encourage you to read the letter.
It notes the interest in the outcomes of this Summit from the United Nations. And it emphasises that the Social Justice Report 2005 and the Close the Gap campaign that emerged from it, is international best practice for implementing the right to health.
So we shouldn’t under-estimate the significance of what has been achieved to date through this process, or what we are trying to achieve in these three days.
Overall, the human rights based approach to health has the following components. It:
- emphasises the accountability of governments for socio-economic outcomes among different sectors of civil society by treating these outcomes as a matter of legal obligation, to be assessed against the norms established through the human rights system;
- establishes fundamental principles to guide policy development – such as that Indigenous peoples are not discriminated against and are provided with equality of opportunity, including through recognising their distinct cultural status;
- highlights that governments have immediate responsibilities to guarantee that the right to health will be exercised without discrimination of any kind, and to take deliberate, concrete and targeted steps towards the full realisation of the right to health;
- recognises as legitimate, and as non-discriminatory, the establishment of specific programs for particular groups (such as based on race) which are taken with the purpose of addressing inequality;
- establishes that the obligation of government is to respect, protect and fulfil the right to health, which requires a combination of responses ranging from refraining from committing harmful acts, introducing measures to prevent others from committing such acts, and taking positive steps to realise the right to health;
- emphasises process for achieving improvements in these outcomes, with the free, active and meaningful participation of Indigenous peoples being critical;
- establishes criteria against which to assess health policy and program interventions to ensure that services are appropriate, accessible, available and of sufficient quality, and that they also do not fall below a core minimum or essential level of rights;
- requires governments, working in partnership with Indigenous peoples, to demonstrate that they are approaching these issues in a targeted manner, and are accountable for the achievement of defined goals within a defined timeframe; and
- requires the taking of an holistic perspective that recognises the
inter-connections between different rights and the importance of addressing the
social determinants of health.
Crucially, it also places the burden on government of justifying that it has made every effort to use all available resources at its disposal in order to satisfy, as a matter of priority, the right to health.
A rights based approach to health has also begun to be operationalised internationally and throughout the United Nations through the Common Understanding of a Human-Rights Based Approach to Development Cooperation. The Common Understanding emphasises, that:
- People are key actors in their own development, rather than passive recipients of commodities and services;
- Participation is both a means and a goal; and
- Strategies should be empowering, not disempowering, and encourage active
engagement of all stakeholders.
This is a very challenging framework.
It forces us to consider some fundamental questions and re-assess how we have gone about addressing Indigenous health in the past.
It is a disciplined system. It requires a strong evidence base and a strong participatory focus – not just in setting up programs or in deciding on targets, but at all levels of health programming, planning, delivery and monitoring.
And it fundamentally requires an honesty and integrity to health service delivery that we have never had in this country for Indigenous peoples. That is an integrity that ensures that programs are capable of meeting the needs that they are set up to achieve.
The National Aboriginal Health Strategy was never funded to achieve this. So far, the National Strategic Framework suffers from the same problem.
The time for lofty commitments and rhetoric is gone. What this rights based approach does is ensures accountability so that commitments are matched to timelines for action and achievement.
No more drifting along hoping for the best!
Part 4 of your Summit pack contains the draft targets that have been developed through this process as the basis of the work over the next two days. I’ll discuss their role in a few moments, but you will note the strong elements of a human rights based approach coming through them. If you look to the draft outline at the beginning of those targets – on page 34 - we note that:
- there is a need for integrated targets, across the health sector, focusing on primary health care, supporting infrastructure needs and addressing the social determinants of health;
- we will only achieve the COAG goals of closing the gap by ensuring integration between these targets – cherry picking particular illnesses or programs will not work;
- there needs to be a focus on targeting programs to the level of need – the goal of equality of access to services is based on this understanding;
- the establishment of targets is a first step in a continuing process based on genuine partnership; and
- fundamentally, that there will need to be a fresh approach to these issues
– as we say, ‘a little bit more of the same will not close the
gap’.
So how will the Summit proceed?
The program is included at page 4 of your Summit pack.
Today is intended to share information and start the discussion on the pathway to achieving health equality.
Through the Steering Committee for the Close the Gap process we have established three working groups to progress targets for consideration at this Summit. Today you will hear presentations from the Chairs of the three working groups. These are in relation to health targets; primary health care; and health infrastructure.
Tomorrow those working groups will meet with delegates to consider the draft targets that are included in your Summit kit and to refine them.
You should not feel constrained about having input into these groups. And don’t feel you must wait until the workshop tomorrow. The purpose of this being a residential Summit is to enable interaction to occur throughout the process. So please begin the discussions with our Summit Chairs and other working group members so as to maximise the time available tomorrow.
Today we will also have a number of panels from government representatives. This will include sessions with representatives from DOHA – both the mainstream and Indigenous specific areas of the department; FAHCSIA; Prime Minister and Cabinet; Treasury; the COAG Health and Ageing Working Group; as well as the Productivity Commission, Australian Institute of Health and Welfare; and the Northern Territory Government.
Tonight we will also have a session with the Indigenous Dentist’s
Association of Australia on oral health targets
Tomorrow will be largely
devoted to developing targets and benchmarks. Parallel to the three workshops
on health targets; primary health care; and health infrastructure, will be two
other workshops on mental health, social and emotional wellbeing; and social
determinants.
We will also have a workshop in plenary on establishing a new partnership and
government accountability for achieving health equality.
In the afternoon
our Working Groups will write up their discussions for distribution among the
Summit participants. While they do so, we will hear a range of presentations
selected by the Steering Committee. These include on Reconciliation Action
Plans – which form a basis for organisations to set up accountability
mechanisms to demonstrate their own commitments to closing the gap; and one by
Oxfam Australia on campaigning to further the close the gap targets post the
Summit.
There are also two presentations on issues that are of great significance – one on cardio-vascular disease and the other on issues relating to Indigenous people with disabilities: an area that is extremely prevalent but almost entirely overlooked in all health and other frameworks.
We will then conclude the day with facilitated discussion about outcome documents for this Summit. These include a Declaration that will be the centrepiece of Thursday’s events in the Great Hall in Parliament that lays the foundations for a new partnership between the Australian government, the Indigenous health leadership, the health sector, community organisations and Australian people.
So let me remind us what we are here to achieve.
We aim to set out a vision – a vision of what health equality looks like and how we achieve it. and
We aim to confirm partnerships – partnerships with government; across governments; through COAG; among the Indigenous and non-Indigenous health sectors; and the broader community.
We aim to set forth a framework for joint planning and implementation – where we work with new partners to jointly set targets and deliver specific strategies. One sector can not accomplish the immensity of this objective alone.
And we aim to establish joint monitoring processes – where partners must jointly monitor their performance so it is not a blame game. Each sector will require a commitment to action and be prepared to support each other in meeting each sector’s responsibilities and in learning from mistakes.
Let me conclude by returning to the words that I used when we launched the Close the Gap campaign in March last year. I stated:
Governments cannot guarantee that their citizens will be healthy – that involves individual choice and freedom. But they can guarantee that every opportunity has been provided to facilitate this outcome.
(At present, we do not have) a level playing field - an Indigenous child born today does not have the same life chance as a non-Indigenous child.
The call that we make today is for governments, working with Indigenous people, with non-government organisations and the broader Australian community, to shake off this lethargy.
Let’s stop being disappointed at our lack of achievement on Indigenous health and dare to dream about a positive future for all Australians.
To do so is not a pipedream. For we know that overcoming Indigenous inequality in health status is achievable.
There are examples of rapid gains in health status being made with focused, deliberate steps being taken. Steps that are backed with resources and driven by timelines. This is the lesson from countries like Canada, New Zealand and the USA. And it is the lesson from various trials conducted within Australia.
There is also a litany of government reports and research which show us the path. Governments, working in partnership with Indigenous peoples, have identified the solutions and have committed to implementing them.
We are beyond hearing about general commitments without timeframes. We need bipartisan support to make overcoming this difficult challenge a national priority. All governments need to work together collegiately, in partnership with Indigenous communities and with all sectors of Australian society.
Our primary message is not to simply scream ‘crisis’. Our message, and our goal, is to champion hope and to focus on solutions. This crisis is not insurmountable. We can triumph.
I look forward to working with you, to challenging you and to be inspired by you over the coming days.
Thank you.
