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The inequality of Indigenous health

June 20, 2017

Australian’s have a good health status compared to other nations.
Evidence suggests that considerable levels of health inequality are experienced by different sections of Australian society . Indigenous Australians experience significantly poorer 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 negative 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 effected the health of Indigenous Australians.
 

Life expectancy is one indicator that is 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, life expectancy of an Indigenous Australian is estimated to be ten to seventeen years lower 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 nation 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 have not always existed.
Academics suggest that chronic disease rates within Indigenous communities would historically have been low due to several factors associated with the hunter-gatherer lifestyle that Indigenous peoples lived pre-colonisation. Indigenous Australians are believed to have had a healthy lifestyle due in part to good nutrition, a physically active lifestyle and the geographical dispersion of small communities were across a vast country.
At the same period middle-class Europeans would likely have suffered from poorer morbidity rates than Indigenous communities due to the prevalence of diseases such as influenza, measles, tuberculosis, syphilis, and gonorrhoea.
The colonisation of Australia can be viewed as a turning point for Indigenous health.
Diseases introduced to Indigenous communities by the Europeans is understood to have killed vast numbers of the population. Some estimates suggest that 75% of the Indigenous population are thought to have been decimated within a generation by the scourge of introduced diseases which the Indigenous people would not have had any immunity to.

 

Conflict and violence between Indigenous and colonial populations was significant up until the mid-1800’s. This frontier period was characterised by an hostile environment in which massacres of Indigenous people have been reported. In this period European settlers would also have suffered as they were subjected to the guerrilla warfare tactics from the Indigenous peoples. Overwhelmingly though the heaviest toll was taken by the Indigenous population. The introduction of the native police and the repeater rifle is thought to have essentially put an end to the 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 outright 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". The implementation of this act suspended the operation of the Racial Discrimination Act  in some remote Indigenous communities and executed a range of measures which included banning 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 criticised broadly by organisations such as the United Nations who declared that the policy; openly discriminated against Indigenous communities, infringed on human rights and further stigmatized Indigenous communities).
Policies like this and historical policies such as the Protection policy and Assimilation policy are likely to have negative effects on Aboriginal health both physically and psychologically. Policies which take away the land, families, resources and spiritual connection to their homeland could be expected to result in a demoralised and mentally 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 incorrectly explain social inequalities which helped to rationalise the view 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 to the legitimacy of Indigenous peoples at that time.
Institutional racism continued when politicians were developing the constitution. The constitution of Australia essentially 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 were removed from the constitution after a referendum in 1967 at which time Indigenous Australians were finally regarded as 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 exploitation of Indigenous workers who were considered to be incapable of being responsible for their own finances. The racist systems 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. It is accepted that the experience of racism has a detrimental effect on the mortality and morbidity rates of the victim.

The notion of 'good health' is understood as a social construction. The definition of health by western countries is often different from the understanding of health and being that Indigenous Australians have developed.
Western healthcare systems are usually 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 does not take psychological aspects of illness into account when considering an individual’s health.

Indigenous communities have a more social understanding of health and wellbeing, with a focus on the broad social living and working conditions that effect health. Although not disregarding physical health, this social model considers mental health, emotional wellbeing, cultural, social and environmental factors effect overall health and wellbeing levels.
The importance of Indigenous people’s connection to land forms an important focus for their personal identities. These links to country which have been maintained for many generations, provide an essential sense of belonging to the traditional land owners. The dispossession of traditional lands from Indigenous Australians has been a traumatic experience.

Indigenous health and wellbeing is different to non-Indigenous in regards to kinship, language, childbirth practices and medical remedies such as those practiced by the Ngangkari.
The biomedical approach to health which was enforced onto Indigenous peoples is at odds with their traditional view of health and 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 an social wellbeing are all important if the gap between indigenous and non-indigenous Australians is to reduce.

There are many factors that have affected Indigenous health since Australia was colonised. Racism and violence, the denial and destruction of indigenous Indigenous 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 inequality. If