Inequality of Indigenous Health in Australia
Updated: Apr 30, 2020
Australians experience a relatively good level of health compared to people from most other nations. However, some sections of Australian society experience considerable levels of health inequality. Indigenous Australians have significantly shorter life expectancies than non-Indigenous Australians.
Academics such as Ron Hampton suggest that the poor state of Indigenous health is a result of present-day socio-economic issues and a multitude of historical factors. The racial discrimination that Indigenous Australians have suffered since colonisation is regarded by many to have been persistently detrimental to Indigenous health and wellbeing. These adverse effects can be seen when health is assessed from either a western biomedical view or through the more social and holistic concept of health which Indigenous Australians have developed over time. This article aims to explore how the role of race and racism, historical and contemporary issues and different perspectives on health has affected the health of
The racial discrimination that Indigenous Australians have suffered since colonisation is regarded by many to have been persistently detrimental to Indigenous health and wellbeing
Life expectancy is another indicator, often used to measure the health status of a population. Australia’s life expectancy rates have been described as “one of the highest in the world” by the Australian Institute of Health and Welfare with females living to an average age of 84.4 and males living to 80.3. In contrast to this, the life expectancy of an Indigenous Australian is estimated to be ten to seventeen years shorter than the national average. To put this in context, the only OECD nation that has a life expectancy lower than Indigenous Australians, is South Africa. For a modern and wealthy country such as Australia, it is concerning that such vast levels of inequality exist between different groups in society, especially if one considers the view that such inequalities health has not always existed.
Academics suggest that chronic disease rates within Indigenous communities would historically have been low due to several factors associated with the lifestyle that Indigenous peoples lived pre-colonisation. Indigenous Australians had a healthy lifestyle due in part to adequate nutrition, a physically active lifestyle and the geographical dispersion of small communities across a vast country.
life expectancy of an Indigenous Australian is estimated to be ten to seventeen years lower than the national average
When the British first began colonising Australia, middle-class Europeans likely suffered from poorer health than Indigenous communities due to the prevalence of diseases such as influenza, measles, tuberculosis, syphilis, and gonorrhoea. The colonisation of Australia is viewed as a turning point for Indigenous health. Infectious diseases introduced to Indigenous communities by the Europeans is understood to have killed vast numbers of the population. Some estimates suggest 75% of Indigenous communities were decimated within one generation by the scourge of introduced diseases which these traditional custodians of the land had no immunity.
Conflict and violence between Indigenous and colonial populations were significant up until the mid-1800s. This frontier period was characterised by a hostile environment in which massacres of Indigenous people was widespread across the continent. A small number of European settlers would also suffer during Frontier Wars as they were subjected to the guerrilla warfare tactics from the Indigenous peoples; however, the heavier toll was overwhelmingly thrust onto the Indigenous population. The introduction of the native police and the repeater rifle is thought to have effectively put an end to violent Indigenous resistance as they were literally outgunned.
Some scholars use the term ‘genocide’ to describe the massacres in the Frontier Wars, a term which may be controversial and uncomfortable for many Australians and a concept which has been denied by politicians such as former prime minister John Howard. In the context of contemporary issues, the term’ cultural genocide’ may be harder for historians or politicians to deny. ‘Cultural genocide’ as mentioned in the Journal of Genocide Research is described as a “deliberate destruction of a nation or ethnic group…by undermining its way of life”. An experience which Indigenous communities have long been subject to.
In 2007 the Howard government introduced The Northern Territory National Emergency Response Act which is commonly known as “The Intervention”. This act suspended the operation of the Racial Discrimination Act in several Indigenous communities and executed a range of draconian measures including the banning of alcohol consumption, withholding welfare benefits, abolishing cultural considerations from criminal proceedings and some instances compulsory land acquisition.
The intervention was implemented under the pretext that it would address the high rates of child sex abuse reported in the Little Children are Sacred report. This report found that sexual abuse of children in the Northern Territory was happening due to breakdowns of Indigenous culture and society, resulting from poor health and housing, substance abuse, unemployment, and dispossession of people from their lands. This intervention policy which was revoked in 2012, has been broadly criticised by organisations such as the United Nations who declared that the policy; openly discriminated against Indigenous communities, infringed on human rights and further stigmatised Indigenous communities.
the term ‘cultural genocide’ may be harder for historians or politicians to deny
Policies like The Intervention and others such as the Protection Policy and Assimilation Policy are likely to have adverse effects on Indigenous health both physically and psychologically. Policies that take away the land, families, resources and spiritual connection to their homeland have, in many instances, result in a demoralised and emotionally scarred Indigenous people. It is hard not to see policies like these as racist and discriminatory. Indigenous Australians have dealt with racism on individual and institutional levels since colonisation. Early policies such as The Protection policy may have been justified at the time by utilising pseudo-scientific thinking such as the theory of Social Darwinism, which used Charles Darwin’s theory of evolution to misdescribe social inequalities. These views helped to rationalise the belief that Indigenous Australians were an inferior race to the non-Indigenous.
Institutional racism by successive governments towards the Indigenous population can be traced back to the very beginnings of Australian colonisation. When Captain Cook first discovered Australia, he claimed that the land was ‘uninhabited’ and declared that the country was ‘Terra nullius’ implying the country is an empty continent, unoccupied and free for the taking. This shows a disregard for the legitimacy of Indigenous peoples at that time. Institutional racism continued when politicians were developing the constitution. The constitution of Australia excluded Indigenous Australians from participating in the nation. It explicitly stated that Aboriginal ‘natives’ should not be counted as people of the commonwealth or state. These sections of the constitution were removed after a referendum in 1967 when Indigenous Australians would finally be regarded as Australian citizens.
There are many examples of racism that Indigenous Australians suffered. Other examples include the segregation of Indigenous children within the educational system and the financial exploitation of Indigenous workers. The racist policies put in place by the government institutions are likely to have justified individual racism on a personal level which has been experienced regularly by Indigenous peoples. Experts accept that the experience of racism has a detrimental effect on the mortality and morbidity rates of victims.
The notion of ‘good health’ is understood as a social construction. The definition of health by western cultures is often different from the understanding of health and being that Indigenous Australians have developed.
Most western healthcare systems are based on the biomedical model of health, which recognises illness as a malfunctioning of the body’s biological mechanisms. Cartesian dualism is a component of the biomedical model which theorises that the mind and body are separate entities. Therefore, the biomedical model has traditionally not taken psychological aspects of illness into account when considering an individual’s health.
Indigenous communities have a greater social understanding of health and wellbeing, with a focus on the broad social living and working conditions that affect health. Although not disregarding physical health, this social model considers mental health, emotional wellbeing, cultural, social and environmental factors impact overall health and wellbeing levels.
The importance of Indigenous people’s connection to land forms an important focus for their identities. Connections to country which have been maintained for many generations, provide an essential sense of belonging to the traditional landowners. The dispossession of traditional lands from Indigenous Australians has been a traumatic experience.
Indigenous understandings of health and wellbeing are different from non-Indigenous in regards to kinship, language, childbirth practices and medical remedies such as those practised by the Ngangkari. The biomedical approach to health enforced on Indigenous peoples is at odds with their traditional view of health. It may not be the most effective way of tackling Indigenous health problems. Hampton and Toombs write that “a holistic approach to health and wellbeing is the first step to improving indigenous health in Australia” and a focus on physical, mental and social wellbeing are all essential if the gap between Indigenous and non-Indigenous Australians is to reduce.
Many factors have affected Indigenous health since Australia was colonised. Racism and violence, the denial and destruction of culture all seem to have had a detrimental effect on the health and wellbeing of Australia’s first peoples, resulting in high rates of health inequities. If Australia acknowledges and learns from the past, health equality may gradually improve. If the country ignores its history, social stratification and health inequality will continue to broaden.