Improving Indigenous Health The Right Thing To Do

It is a great pleasure to be back here in the West.

It's an even greater pleasure to be asked to deliver the Michael Quinlan Oration on my pet subject - Indigenous Health.

I need not say more about the skills and the achievements and the humanity of Michael Quinlan…but I will anyway.

He is a great doctor, an inspiring teacher and a person who has given freely of his time and his knowledge over many years.

He personifies all that is good about medicine and being a doctor.

To borrow a term associated with another organisation, Michael Quinlan is 'the light on the hill'. A leader. A visionary. Someone to aspire to. Someone to look up to. Someone to show the way.

Michael Quinlan, I salute you.

You are the sort of catalyst I would like to see in every State and Territory and in every Indigenous community to improve the health of Aborigines and Torres Strait Islanders.

In my time as Queensland and Federal President of the AMA, I have been vocal about the state of Indigenous Health in Australia.

I have called it Third World.

I have called it a national disgrace.

I have called it Australia's shame. And it is.

Here we are in the 21^st century in what the Government calls 'the most affluent of times' and we have the first Australians lagging well behind in life's necessities.

Their health and access to health services is unforgivable.

Their housing is poor.

Their access to clean water and hygiene is limited.

Their sanitation in many cases is non-existent.

Their physical infrastructure - roads and guttering and the like - is primitive.

Their education is scratchy despite the very best efforts of their teachers.

All these social factors are linked. We need a holistic approach to deliver Indigenous Australians the basics of life - the quality of life - that the rest of us take for granted.

It is not an easy task. Never has been. Never will be. But we have to give it a go.

In recent months we have seen arguably the most extraordinary display of the spirit of giving by the Australian people since European settlement.

The Asian tsunami tapped a bottomless well of goodwill in the hearts of all of us.

So too did the Eyre Peninsula bushfires.

I want to see this spirit of giving now turned towards Indigenous health.

But it needs the leadership of the Federal Government.

I was deeply saddened that Indigenous health - and Indigenous issues generally - barely rated a mention in the last Federal election.

However, I have recently detected a spark of interest and concern from the very top.

On Australia Day, the Prime Minister said he wanted to do more for Indigenous Australians.

On the day after Australia Day I went to Parliament House in Canberra and asked the Prime Minister to give $400 million more every year for I haven't seen the cheque yet but I am sure he heard me and I am sure all the politicians from all the parties have heard me with this message every day since.

We may have to wait until Budget day in May to see if they heard me clearly…to see if they really care.

I regularly visit Indigenous communities and I'm sure quite a few of you here this evening have been out there, too…although they are not all rural or remote.

They are in the cities as well.

I told journalists recently that health standards in some communities are the worst they have ever been.

By the same token, in other communities health is the best it has ever been. But these communities are still the minority.

The statistics tell the true and chilling story.

For Indigenous Australians, life expectancy at birth is between 16 and 19 years less than for non-Indigenous Australians.

Standardised mortality ratios are more than three times the expected rate.

Death rates between 25-54 years of age are five to eight times that seen in non-Indigenous Australians.

The percentage of the Indigenous population expected to live to 65 is less than in many developing countries.

Chronic diseases are the leading causes of premature death in both Indigenous and non-Indigenous Australians.

These include diseases of the circulatory system - including hypertension, heart disease and stroke. There is also respiratory disease, chronic renal failure, diabetes and cancer.

Aborigines and Torres Strait Islanders have higher levels of chronic disease, which is also occurring much earlier in life.

Such chronic diseases, together with injuries, are also responsible for the increased rates of hospitalisation, which are approximately two-and-a-half times that seen in non-Indigenous Australians.

The Aboriginal population has mush poorer access to the range of health services that are on the doorstep of most Australians.

It's tougher for them to access the biggies like the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme.

But it is also harder for them to get to the Breast Screen Program.

Harder to get cervical screening.

Harder to get into the Commonwealth Hearing Services Program.

Harder to get renal transplants.

Harder to get into cardiac rehabilitation programs.

Harder to get immunisation.

Harder to get hospital emergency thrombolysis therapy.

Harder to be part of Practice Incentive Programs for asthma and diabetes, and elderly health assessments.

Everything is so much bloody harder for them.

While they are the people who are in most need of these programs and services, they can't get hold of them.

For Indigenous Australians, these programs are life and death.

They are the difference between quality of life - any quality of life - and a life cursed with sickness, pain and disability.

There are many reasons for this poor access but none of them is insurmountable - not if we have proper funding and unity of purpose.

There are geographic and social barriers.

There are institutional barriers.

There is poor policy development, public mistrust and lack of education.

And yes, there is racism.

And there is apathy - "It's not my problem. Let somebody else take care of it".

But it is our problem - all of us. We must take care of it.

The time has come to stop making excuses. It is time for compassion and action.

And I am not talking about handouts or welfare here. Nobody wants that - least of all the people in the communities.

They want and deserve the infrastructure to get started.

They want and deserve the leadership - at the national and State level, but more importantly at the local level.

They need some local heroes to drive projects and programs and ensure every dollar delivers a result.

They need local heroes to make sure there is cohesion in funding and purpose among the Government departments and agencies that set out to do good but often deliver only missed opportunities.

So the big fix for Indigenous health is a two-way street.

But it will involve a quantum leap in understanding from Governments and the wider community.

We cannot and should not look at Indigenous health problems and solutions in isolation.

We must consider income and social status.

We must consider social support networks.

We must consider education and literacy.

We must consider employment and working conditions.

We must consider social environments.

We must consider physical environments.

We must consider housing and nutrition.

We must consider personal health practices and coping skills.

We must consider healthy child development and biology.

We must consider existing health services.

And we must consider the impact that gender and culture have on health and well-being.

All these factors are different to what you and I experience in the comfort of middle class suburbia.

They are alien concepts to most Australians, especially today when we are told that everybody is prosperous…or should be.

Improving Indigenous health is not mission impossible.

We need only look to the successes with Indigenous populations in Canada, the USA and New Zealand.

However, all is not gloom on the home front.

There are many success stories from which we can learn, including here in Western Australia.

And I have learnt that from the source.

After my call on the PM to give me a cheque for $400 million, my comments on the worst aspects of Indigenous health were widely reported.

They even made the airwaves in Geraldton.

Before long one of the AMA advisers in Canberra received a phone call.

On the other end of the line was one of the community leaders from Geraldton who said quite passionately - "Tell that Dr Glasson that it's not all crook, we're doing a pretty good job over here."

And he is right. They are.

And so are Noel Pearson and his team up in Cape York. In all States and Territories, there are good news stories.

But there are still more bad ones than good - and therein lies the challenge.

The Government response, while small, has been in the right direction.

There have been moves to what is being termed 'mainstreaming' of services - although mainstreaming has many different meanings in different settings.

The AMA supports Government aims to increase coordination of all government services in communities.

They will do this by focusing on co-location of different staff responsible for different services provided and funded at both the Federal and State level.

This will help reduce waste and duplication, but this approach needs to go even further.

Mainstreaming of services does not have to mean that the mainstream is the service provider - it is merely the funder.

Mainstreaming itself will not be the solution.

Health has been "mainstreamed" for some time and yet, as I mentioned earlier, the overall health of Indigenous Australians has not picked up. It has more likely slipped.

Aborigines still do not have the same access to quality affordable health services as the rest of the population.

More community control is needed.

The AMA is concerned that what is being implemented is not a partnership of equals.

This concern has been justified as we learn more about the first Shared Responsibility Agreements.

They appear one-sided. It's all about 'you do this, and we'll give you this'. No local control. Little respect. No understanding or acceptance of local priorities or circumstances.

For instance, I heard an interesting response to the Government's 'no school, no pool' approach.

A leading Indigenous figure said shouldn't it be 'no pool, no school'. Get the hygiene fixed first.

It's an interesting and valid viewpoint and, whether you agree with it or not, it is pragmatic.

Often the most practical solutions are simplest and work best.

How about this as a checklist for somebody going into a community to assess health and hygiene levels.

1. How long does it take for a patient to get to see a GP, a specialist, or allied health provider?

2. What services are available at the nearest basic medical service?

3. What is the quality of housing and how many people per bedroom in the community?

• How many people share a toilet or shower?
• What sewage and garbage collection services are there?
• Is there fresh water?
• Is there a school?
• How many kids per teacher?

And that's just a start, but will provide a picture of where there are pluses and minuses.

To respond to the broad range of needs, the Federal and State Governments must pool funds across all agencies and cooperate on funding and service delivery at the local level.

Reporting and accounting and auditing procedures must be simplified and standardised.

Pooling will not be easy as there is nothing so mournful as a government agency and its funding being separated.

Once the hurdle of pooling funds is cleared, communities will have more freedom to fulfil their Shared Responsibility Agreement.

And this would involve setting a community budget.

The Government must do the right thing by ensuring that Shared Responsibility Agreement funding is allocated on individual community need and not historical levels of funding. We know that history has failed in most instances.

Health and well-being is complex in all societies, but especially so in our Indigenous communities.

It involves not only care of the body but also care of the mind and the spirit.

It involves the offering of hope and opportunity.

At its core is the survival and flourishing of Aboriginal culture within modern Australia.

And as I said earlier we need leadership at the local level, preferably from a local.

I have called these people social entrepreneurs. They are doers. They work for public and social benefit, not to make money.

One such doer is Noel Pearson.

I'm sure you have all heard of the fantastic work he is doing up in Cape York in Queensland.

Noel's motto is, "Ask not what your people can do for you, but what you can do for your people."

Noel's strategy is to develop social and cultural capital within the communities.

While not everybody agrees with his philosophy and his methods, he is getting positive results.

Noel and his colleagues are social entrepreneurs and we need more of them - a lot more of them.

We'll need many hands to implement the programs and initiate the services that can be funded by the extra $400 million a year that the Government will pledge to Indigenous Health in the May Budget.

Social entrepreneurs build something out of nothing.

They are ambitious to achieve.

They marshal resources - sometimes from the unlikeliest places - to meet their needs.

They are constantly creative.

And they are not afraid to make mistakes.

Social entrepreneurs never say "it can't be done".

If you look at the successful projects, health and non-health, in Indigenous communities over the years and decades, the work and deeds of certain individuals shine through.

It's probably true to say there have been, and still are, social entrepreneurs hard at work in the communities and they are delivering great services and improved health.

When people try to copy successful programs and transplant them to other communities, they often fail. Why?

I think it's because the human catalyst - the social entrepreneur - has not been replicated.

So, along with the better funding and the better services, we need a production line of social entrepreneurs - hardworking and dedicated leaders who survive on social capital.

I reckon Michael Quinlan would work wonders out there in Indigenous communities if we let him loose.

But I am sure he has taught a few and they are out there waiting for the call.

Australia leads the world in many things.

But we lag well behind when dealing with Indigenous Health.

We can make a difference. We must make a difference.

We can improve lives.

We can improve life expectancy.

Better still, we can save lives.

All we need is a unity of purpose, the spirit of goodwill and compassion, and a $400 million cheque from John Howard every year starting in May.

It's the right thing to do.

Thank you.