Contemporary Issues facing Indigenous Australians

Institute of Governance Canada 4 November 2011

Dr Tom Calma National Coordinator Tackling Indigenous Smoking

and Founder, Close the Gap Campaign

CLOSETHEGAP

Outline of presentation

•  Theme: Contemporary Issues facing Indigenous Australians

Background to:

–  Indigenous Australia –  Issues affecting Indigenous peoples –  Social Justice Commissioner –  Close the Gap Campaign –  Tackling Indigenous Smoking –  Key Challenges and Initiatives

CLOSETHEGAP

National Coordinator, Tackling Indigenous Smoking 16 February 2010 to 31 July 2013

•  National Patron – Poche Centres for Indigenous Health Network

•  Patron, Rural Health Education Foundation •  Member, Close The Gap on Indigenous Health Equality Steering

Committee •  Member, National Congress of Australia’s First Peoples interim

Ethics Council •  Chair, Indigenous Suicide Prevention Advisory Group •  Member, National Indigenous Mental Health Advisory Group •  Deputy Chair, Cooperative Research Centre - Remote

Economic Participation (CRC REP) •  Ambassador, Constitution Reform to recognise First

Australians •  Co-Chair, Reconciliation Australia

Demographics

•  At 30 June 2006, the Indigenous estimated resident population of Australia was 517,200 or 2.5% of the total pop

•  Just over 50% are female •  Just over 50% under 30 years old •  194,000 Indigenous children aged 14 years (38 %,

compared with 19 % for the non-Indigenous pop) •  Fastest growing population group in Australia •  75% live in urban and regional environments •  Is likely to reach between 713,300 and 721,100 by

2021 - about the same as estimated population at the time of colonisation in 1788

Indigenous Language Map

250 languages at colonisation

100 languages still spoken

80 languages under threat

18 languages spoken by all age groups

within a community

Australia ¾ size of Canada

Most Indigenous people live on the Eastern sea-board

Indigenous and non-Indigenous age structures

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Life-expectancy Most Indigenous deaths occur in the middle adult ages

Source: Darren Benham analysis mortality data

Death Contributors

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Discussion paper Measuring progress in closing the gap

10December 2009

Chart 1

Sources: Australian Institute of Health and Welfare, 2006 Hill, Barker, Vos, 2007 Statistics New Zealand Health Canada Grim, 2005 United States Census Bureau United States Department of Health and Human Services N.B. Australian data using methodology applied prior to May 2009. In a report entitled ‘What makes First Nations communities successful’ Health Canada (Driscoll, Jackson, 2007) reports that health practitioners and First Nations community leaders believe the positive progress in Canada is the direct result of several actions: Multi-faceted focus across all sectors, ages, demographics and geographies,

linked to the drivers of life expectancy; Whole of community participation, including individuals, corporations, small

businesses, community organisations, schools and all levels of government; Progressive devolution of control of health and social services to the community

level from the mid-1980s, especially successful in Inuit communities; A participatory approach in which First Nations people were involved in defining

‘successful communities’, then engaging actors and institutions to realise this (see table below);

Development of a community well being (CWB) index, to guide and inform resource allocation, established by First Nations people together with the Federal Government;

Aboriginal and Torres Strait Islander Social Justice Commissioner

The campaign for health equality

OVERALL TARGET:

HEALTH STATUS EQUALITY WITHIN 25 YEARS

Targets and benchmarks as appropriate.

FOUNDATION TARGET:

EQUALITY OF OPPORTUNITY TO BE HEALTHY WITHIN 10 YEARS

Sub-target 1: Equality of access to primary health care within 10 years.

Sub-target 2: Equal standard of health infrastructure within 10 years

A human rights based approach

•  All policies and programs relating to indigenous peoples must be based on the principles of non-discrimination and equality, which recognize the cultural distinctiveness and diversity of indigenous peoples.

•  Indigenous peoples have the right to full and effective participation in decisions which directly or indirectly affect their lives.

•  Such participation shall be based on the principle of free, prior and informed consent.

A human rights based approach (cont)

•  Capacity building always needs to be considered and resources made available to facilitate meaningful participation by indigenous peoples as equal partners in planning, design, negotiation, implementation, monitoring and evaluation of policies that affect them.

•  Independent dispute resolution mechanisms should be put in place for the parties.

Principle of Progressive Realisation

•  Create a plan –  ‘ambitious yet realistic time frame’, –  set equality as a target, –  set a time frame;

•  Commit sufficient resources; and

•  Be accountable to the plan by setting benchmarks

Campaign Origins

•  2005 Social Justice Report to the Australian Parliament

•  CTG Campaign Steering Committee formed March 2006

•  CTG launched on 4 April 2007

What is the Close the Gap Campaign?

-  A movement that is growing -  Lead by Indigenous people -  Embraced by the Australian

population -  Bi-partisan political

agreements signed or pledged at federal level and in all mainland states and territories

-  Supported by over 80 non-Indigenous health peak bodies and affiliates and human rights advocacy groups and organisations

-  Non government funded campaign

Steering Committee members Indigenous Leadership • Mick Gooda, Co-chair, Aboriginal and Torres Strait Islander Social Justice Commissioner, Australian Human Rights Commission • Jodie Braun, Co-chair, and also Co-chair National Congress • Australian Indigenous Doctors’ Association • Australian Indigenous Psychologists’ Association • Congress of Aboriginal and Torres Strait Islander Nurses • Indigenous Allied Health Australia Inc. • Indigenous Dentists’ Association of Australia • National Aboriginal Community Controlled Health Organisation • National Aboriginal and Torres Strait Islander Health Workers’ Assoc. • National Indigenous Drug and Alcohol Committee • National Aboriginal and Torres Strait Islander Health Workers’ Association • National Coordinator, Tackling Indigenous Smoking

Steering Committee members cont.

Building partnerships •  Oxfam Australia •  Australian General Practice Network •  Aboriginal Health and Medical Research Council •  Australian Human Rights Commission (Secretariat) •  Australian Medical Association •  Australians for Native Title and Reconciliation •  Australian Peak Nursing and Midwifery Forum •  Bullana - the Poche Centre for Indigenous Health •  The Fred Hollows Foundation •  Heart Foundation Australia •  Menzies School of Health Research •  Palliative Care Australia •  Royal Australasian College of Physicians •  Royal Australian College of General Practitioners •  Professor Ian Ring, Wollongong University (expert adviser)

The truth is, a business as usual approach towards Indigenous Australians is not working. Most old approaches are not working. We need a new beginning — a new beginning which contains real measures of policy success or policy failure; a new beginning, a new partnership, on closing the gap with sufficient flexibility not to insist on a one-size-fits-all approach for each of the hundreds of remote and regional Indigenous communities across the country but instead allowing flexible, tailored, local approaches to achieve commonly-agreed national objectives that lie at the core of our proposed new partnership; a new beginning that draws intelligently on the experiences of new policy settings across the nation. Prime Minister Kevin Rudd, Apology to Australia’s Indigenous Peoples, 13 Feb 2008[i]

Statement of Intent

•  Prime Minister •  Minister of Health and

Minister of Indigenous Affairs

•  Opposition Leader •  Every major

Indigenous and non Indigenous peak health and human rights body

•  First and only bipartisan agreement

20 March 2008

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Statement of Intent “……commits the Government of Australia, Indigenous Australians, supported by non-Indigenous Australians and non-Indigenous health organisations to work together to

achieve equality in health status and life expectancy between Indigenous and non-Indigenous Australians by

the year 2030.”

•  To developing a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequalities in health services, in order to achieve equality … by 2030

•  To ensure the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs.

People Movement National Close The Gap Day – 25 March – 840 events

NRL Round, Indigenous All Stars and Cup

Community Involvement

RAPs

Reconciliation Australia is dedicated to closing the

unacceptable life expectancy gap between Indigenous and

non-Indigenous children. One of our key strategies in

achieving that ambition is to support and encourage

organisations to sign up to their own tailored

Reconciliation Action Plan (RAP).

Philanthropy

Greg Poche - Health care philanthropy. Poche Centre for

skin care research and treatment in Sydney

(Melanoma Institute) and Poche Centres for Indigenous Health in Sydney and Adelaide

Council of Australian Governments December 2007

All Australian Governments have agreed to close the inequality gap in Indigenous health outcomes in a generation

Council of Australian Governments 29 November 2008 All Australian Governments have agreed to a $1.6 billion investment in Indigenous health over four years –  $805.5 million Commonwealth commitment –  $771.5 million State and Territory contribution

In excess of $ 8 billion of new money pledged for Indigenous affairs since November 2008

Closing the Gap funding

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1. Principles to underpin a national effort

2. A partnership 3. A health equality plan

OID Report 2011

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OID Report 2011

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•  Social Justice Report 2005 •  March 2006 – CTG Coalition formed •  July 2006 – RAP scheme launched •  April 2007 – National Launch of CTG •  December 2007 – COAG commitment •  May 2008 – SOI signing •  November 2008 – COAG $1.6 billion ($8 bil pledged) •  February – NRL All Stars match •  March – Opening of Parliament – PM’s Report •  24 or 25 March – National CTG Day •  August – NRL CTG Round •  All state and territory governments signing SOI •  2011 – Development of a comprehensive national

plan announced by Ministers on 3 November. 39

CLOSETHEGAP STORY

UN  Declara*on  on  the  Rights  of  Indigenous  Peoples  

Articles 24.2 and 23, United Nations Declaration on the Rights of Indigenous Peoples state: •  Indigenous individuals have an equal right

to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.

•  Indigenous peoples have the right to determine and develop priorities and strategies for exercising their right to development. In particular, indigenous peoples have the right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own institutions.

Breaking News – 3 November 2011 Thursday 3 November 2011 NEW NATIONAL ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH PLAN

The Minister for Health, Nicola Roxon and Minister for Indigenous Health, Warren Snowdon, today announced the development of a new health plan for Aboriginal and Torres Strait Islander Australians.

The National Aboriginal and Torres Strait Islander Health Plan will be established by the Australian Government working in partnership with Aboriginal and Torres Strait Islander peoples and organisations, and state and territory governments will be invited to be participate.

"The plan is an important step in providing a road map for action across Australia," Ms Roxon said.

“It is important this plan is thorough and inclusive, covering not only health but also factors which impact on health, such as education, housing, employment and early childhood development,” Mr Snowdon said.

Hallmarks of the CTG Campaign

Chronic Disease Funding

•  $805.5 million will be committed over four years, and will focus on three priority areas: - $161 million to tackle chronic disease risk

factors. - $474 million to improve chronic disease

management and follow up. - $171 million over four years for workforce

expansion, training and support.

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•  National Coordinator, Tackling Indigenous Smoking •  Tobacco Action Workers and Healthy Lifestyle

workforce of 340 over 4 years •  Community educators and facilitators not clinicians •  Targeted social marketing messaging •  Prevention, reduction and cessation •  Training existing workforce 45

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Key elements of the TIS initiative:

• Equitable distribution and access;

• Changing norms;

• Engaging community leaders, health workers and parents who can really make a difference, particularly in influencing young people and children;

• Flexibility and support for innovation; and

• Tailoring a range of mechanisms to meet the needs of local communities. 48

Host Organisation Responsibilities – all Aboriginal Medical Services

•  data collection •  development and implementation of

appropriate smoke free work place policies and support staff who wish to cease smoking

•  consideration of potential interactions with other Closing the Gap measures and to utilise established or common resources & infrastructure

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Deadly Dan – The Smoke Free Man (CEITC)

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Beyond the Big Smoke - KAMSC

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JCU – Top End Project

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Localised messaging for a remote environment

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54 http://www.iuih.org.au/

Locally developed health messages for an urban environment

Major policies in Indigenous affairs > Referendum (1967)

•  CDEP (1977) > AEDP (mid 80’s), •  ATSIC (1990 – 2005) •  Native Title (1993) > Australia Colonised (1788) •  New Arrangements in Indigenous Affairs (2005)

(2005) •  NTER & Welfare Reform (2007)

(2007) •  UN Declaration on the Rights of Indigenous Peoples (2007) •  National Apology (2008) •  National Congress of Australia’s First Peoples (2010)

•  Constitutional change to recognise First Australians (2013)

Constitution Reform to recognise Indigenous Australians

•  To pass a referendum, a double majority must be achieved: that is, a majority of those voting throughout the country must vote in favour, as well as separate majorities in each of a majority of states. This means that the majority of people in 4 of 6 states must also vote in favour of the proposed Bill.

•  Since 1906 only 8 of 44 referendums have been carried, including the 1967 referendum - 90.77% of the nation came together in support of Indigenous rights.

•  Aboriginal and Torres Strait Islander peoples are ‘the oldest continuing cultures in human history’ yet the nation’s founding document, the Constitution, does not mention Australia’s Indigenous peoples.

•  It was only in 1992 with the Mabo Judgment that the Doctrine of 'Terra Nullius', meaning a 'Land that belongs to no-one', was overruled.

National Representative Body

•  Recommended in SJR •  SJC presents Govt with

options paper that identifies key considerations

•  National workshops and consultations

•  Steering Committee formed and Chaired by SJC

•  Report presented to Govt •  Govt adopts report •  Interim Board appointed

April 2010 •  Elected Board 8 July 2011

•  The Congress was incorporated as a Company Limited by Guarantee in April 2010. As a company the Congress is owned and controlled by its membership and independent of Government.

•  Two full time Co-Chairs and six part time directors

•  120 members of Congress

A National Board of Directors led by elected male and female Co-Chairs and six Directors who are responsible for the Chambers of the annual Congress meeting

The Board is supported by an Ethics Council – a special body of experts who provide independent advice on standards and guidelines.

Congress staff, headed by the Chief Executive Officer, assist with operations, policy advice, membership, promotion and education.

www.reconciliation.org.au/igawards/pages/about-the-awards.php

Indigenous Governance Awards

Overcoming Indigenous

Disadvantage Report 2011

Productivity Commission

website

Questions?

Further information can be found at:

www.health.gov.au/tackling-chronic-disease

www.aihw.gov.au/

www.pc.gov.au/gsp/reports/indigenous

www.ceitc.org.au/ 63