Speech by AMA President, Dr Bill Glasson to Rotary District 9630 Conference, Gold Coast: Indigenous Health - Our Shared Future

Good morning Rotarians.

I note the title of your Conference - "Our Youth - Our Future" - and I echo those sentiments wholeheartedly.

The AMA champions youth health issues. 

Providing the best possible environment for our kids to learn and grow is the best possible investment we can make.

The return on that investment will be better communities and a better Australia.

And, of course, we hope they'll look after us, as we get old.

An equally important investment we should be making is better health for Indigenous Australians.

And Rotary is doing great work in this area.  It's fantastic.

Not just in health, but more broadly in improving relations between Indigenous and non-Indigenous Australians.

Well done, all of you.

I have been advised that you have an Indigenous Australians Goodwill Committee, with members of that Committee here today.

We can only hope that your initiatives and your concerns can be replicated across Australian society.

We will be a happier, more confident country for it.

It is the Australian way to look after those who are doing it toughest.

And there can be little argument that, when it comes to health, Aboriginals and Torres Strait Islanders are doing it toughest.

In the 21^st century, with all the technology and gadgets and wealth that is about, we still see our Indigenous brothers and sisters dying too young.

I see it whenever I travel out west to treat patients in Aboriginal communities.

Short lives and poor quality of life.  It is our national shame.

Their life expectancy is 20 years less than ours.

That gap has been the same for the past decade.  No improvement.  None.

Infant mortality rates are three times greater than for the rest of the population.  The poor kids don't even make it into the world.

The sad reality is that the health of Indigenous Australians is worse than the health of people in many third world countries?

Here are some numbers to give you a better idea.

Nearly 90% of all Australians live to the age of 65.

Only 35% of Female Aboriginal and Torres Strait Islanders reach that age.

And just 22% of Indigenous men make it to the ripe old age of 65.

To give you an international perspective, I can inform you that more than 40% of Nigerians live to 65.

And 65% of Bangladeshis reach 65.

And over 70% of Thais make it.

Our Indigenous people are deprived of the pleasures of old age.

Worse, their young lose their role models too early.

Their parents and their elders get sick and die before their time.  Their communities mourn too often.

This is an intolerable situation.

Indigenous Australians are sentenced to chronic health problems from as early as 20 years of age.

And usually this leads to an early grave.

Why are Indigenous Australians admitted to hospital at twice the rate of non-Indigenous people?

Why do Indigenous Australians suffer much higher rates of renal disease, diabetes, injury and poisoning than other Australians?

This is one of the richest countries in the world with an enviable health system.

Good work has been done already, thanks to a handful of inspired and dedicated people.

And sometimes - just sometimes, mind you - there is enough money allocated for research and development.

What's missing still is sufficient on-the-ground medical workers, targeted health services and training resources and opportunities.

We need more indigenous doctors and nurses. That would be a start.

We need brave and inspirational leadership and appropriate funding to fix Indigenous Health.

The problem is that nobody really knows what is an 'appropriate level of funding'.

In the AMA's report card on Indigenous Health, we call for an additional $250 million every year - on top of existing funding.

This amount is based on research by Professor John Deeble a couple of years ago.

The $250 million would not be enough today, but it is till a useful benchmark - a useful starting point.

The reality is that the inherent inequity of the situation makes it impossible to put a dollar amount on what it will cost to fix the problem.

There is not enough.  There never will be enough.  But that should not stop us from trying.

Every life saved and every life enhanced makes it all worthwhile.

The AMA will continue to advocate for better Indigenous Health.  I urge others to join us.

I mentioned workforce briefly earlier.

We have a crippling shortage of trained health workers at all levels.

There are not enough Indigenous Health Workers, Indigenous doctors, and support staff such as planners, managers and accountants.

Some of these gaps can be and are filled by non-Indigenous people.

But the evidence from Canada, the USA and New Zealand shows the best way to improve the health of Indigenous populations is through the training and support of Indigenous individuals.

Indigenous health is not a discretionary expense.

Governments must find the funds to train the staff needed for a high quality primary health care system.

They must find the funds to set up and run services at the local level, no matter how small or remote the communities are.

Aboriginal and Torres Strait Islander people must also have access to mainstream health services, like the Pharmaceutical Benefits Scheme (PBS), the Medical Benefits Schedule (MBS) and public hospitals.

But access is often difficult...and always inequitable.

Indigenous people are forced to navigate an alien health structure that is too often counter-cultural.

Our systems have to be modified to make sure all Australians get access to the health care they need.

We must also consider the other factors and realities of life that affect Indigenous Health.

Things like:

• Income and Social Status
• Social Support Networks
• Education and Literacy
• Employment/Working Conditions
• Social Environments
• Physical Environments - including housing, water, sanitation, nutrition
• Personal Health Practices and Coping Skills
• Healthy Child Development
• Biology and Genetic Endowment
• Health Services
• Gender

All of these have relevance to the present day health reality of Aboriginal and Torres Strait Islanders.

If any of you visit Indigenous communities on a regular basis - as I do - you will know that most of these factors are lacking to say the least.

Things like heating and cooling, clean water, hot water, sanitation, garbage collection - things you and I take for granted - simply do not exist.

And we must never underestimate the links between poor education and poor health.

There is a lot of learning to be done when it comes to personal health and hygiene, but the lessons are hard to learn when you cannot read or write.

All of you have the possibility to improve the situation in one or more of these areas.

I'd like to now quickly look at how some people are attacking the issues of Indigenous Health.

One person working hard in this area is the Aboriginal leader, Noel Pearson.  I'm sure you have all heard of Noel.

In 2002, he called for a People Action Network.

His motto is, "Ask not what your people can do for you, but what you can do for your people."

He said there is a need to develop social and cultural capital within the communities.

He asked the question: how can social trust, unity, mutual help, support, praise and    encouragement - positivity - be rebuilt in communities where the levels of disunity, disputation, jealousy, suspicion and victimhood are so high?

He broke down his themes:

•  People.  We need to focus on people, not just organisational structures.
• We need to get the relationships between community and families/individuals right - there is a dysfunctional relationship at the current time: community is supressing families/individuals' initiative and responsibility, whilst individuals/families are at odds with community.
• How can individuals and families contribute to the common good, instead of seeing the common good as something that must be raided for resources and used for a power base.
• How can we rebuild voluntary contributions to the common good and break the mindsets and habits of welfarism - where we ask what our community can do for us, instead of asking what we can do for our community?
• He called for Action.  Not just talk.  Get things happening.  Don't wait for other people or the government to do it.
• Network. - he asked how can we have free associations of community members - instead of hierarchical, organisational structures?
• How can we engage everybody in playing a part in contributing to the building of social and cultural capital of the community?

Noel Pearson's People Action Network idea has its supporters and detractors.  But at least it is out there.

Another school of thought is the idea of "social entrepreneurs".

You may have heard of entrepreneurs, but maybe not social entrepreneurs. 

A School of Social Entrepreneurs was opened in the UK in 1997.

A social entrepreneur is someone who builds the social and cultural capital in a community - which sounds very much like what Noel Pearson is calling for.

A social entrepreneur is someone who works in an entrepreneurial manner, but for public or social benefit, rather than to make money.

While entrepreneurs in the business sector identify untapped commercial markets, and gather together the resources to break into those markets for profit, social entrepreneurs use the same skills to different effect.

For social entrepreneurs, the untapped markets are people or communities.

Social and business entrepreneurs have a lot in common.

They 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.

The problem is there are not enough of them.

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.

But social entrepreneurs are born, not made.  We can't produce them or teach them.  They just appear from time to time.

There are individuals with social entrepreneurial talent out there.  We need to identify them and nurture them and let them find their way.

They need mentors.  Fellow social entrepreneurs with experience.

And they need a network willing to support the practical development of skills.

I hope the concept is clear to you despite the lack of detail.

As I said, the key is about identifying possible social entrepreneurs.

Just recently I was reading about a group who says its main objective is service - service in the community, in the workplace and throughout the world.

Their motto is Service Above Self.

Another of their objectives is the advancement of international understanding, goodwill, and peace through a world fellowship of business and professional persons united in the ideal of service.

This same group of people - and they are not doctors - set out to rid the world of polio by 2005.

These people are not afraid to set goals.

These people do not avoid the tough jobs.

That group of people is Rotary International - all of you in the room today.

Yes, I'm standing out front of a room full of social entrepreneurs.

The tools, the resources, the funding, the programs, the doctors and the nurses are out there somewhere.

The ideas - from Noel Pearson to Governments to Indigenous leaders and health professionals are out there, too.

Rotary is doing its bit.  Service is your mission.  We must replicate your commitment and energy and get it to work in improving the state of Indigenous Health in Australia.

Australia leads the world in many things.

But we lag well behind when dealing with Indigenous Health.

We can make a difference.

We can improve lives.

We can improve life expectancy.

Better still, we can save lives.

Thank you.