international environmental health initiatives designed for developing country contexts provide some pointers to addressing the problems of unsanitary living environments and poor hygiene in remote Australian Indigenous communities.

ABORIGINAL AND TORRES STRAIT ISLANDER POLICIES

Extreme levels of disadvantage

Many Aboriginal people living in the Northern Territory (NT) experience extreme disadvantage. The key underlying causes for this disadvantage are social inequality and powerlessness, with these factors impacting negatively on their health and wellbeing (Devitt et al. 2001, House of Representatives Standing Committee on Family and Community Affairs 2000). The social inequality they experience is due to events of history and successive federal, state and territory government policies. Conflict and power are intrinsic elements in all policy decision making (Oliver 2006), but nowhere is this more apparent than in past and current policies that focus on Indigenous affairs. Many of these policies have been described by Aboriginal leaders as leading to a cycle of grief, anger and despair in the lives of Aboriginal people (Aboriginal Medical Services Alliance of the NT [AMSANT] 2000).

A historical perspective

The history of poor treatment of Aboriginal people by governments commenced with the declaration of terra nullius by the colonisers of Australia in 1788. This declaration reflected a perception by government of Aboriginal Australians being inferior and having no rights, and placed Aboriginal people at the mercy of the colonisers. Devitt et al. (2001 p 13) described how this unfolded in the NT:

Losing control of their lands resulted in the loss of their economic base; this was frequently accomplished in an ethos of gross personal violence, brutality and family dislocation. In the NT, it continued well into the lifetimes of contemporary Aboriginal people. Communities of hunters and gatherers became either a convenient workforce for the settlers within the economic system they hastened to establish or unwanted nuisances to be ignored, regulated, and moved on or, at times, exterminated.

It was not until 1967, in response to increasing political pressure that the Commonwealth government agreed to conduct a referendum to decide if discriminatory clauses concerning Aboriginal people should be removed from the Constitution. The overwhelming ‘yes’ vote of the referendum was interpreted as expressing a public desire that the Commonwealth should act decisively to resolve all problems concerning Aboriginal and Torres Strait Islander peoples’ rights. However, in the ensuing years, the political imperative for the Commonwealth Government to take action lost impetus and the situation stayed much the same (Long 2000).

In 1972, with a change in government, Aboriginal affairs again became a topical issue. Whitlam (1973), in a statement provided at a conference of Commonwealth and state ministers concerned with Aboriginal affairs wrote:

That my government intends therefore to assume full responsibility for policy and finance in respect of Aboriginal Affairs and will take any necessary legislative action to this end.

From this time, the Commonwealth (the Australian or federal government) has lead and coordinated policy initiatives concerning Indigenous affairs across the states and territories. In the same statement, the new government announced that its aim was:

This announcement marked the era of policy approaches that included the concepts ‘self-determination’ and ‘community control’. Still some states resisted giving Aboriginal communities control of their own affairs. Consequently, the Commonwealth introduced legislation to enable Aboriginal and Torres Strait Islander communities to incorporate so government initiatives could be progressed. Newly formed Indigenous community councils and housing associations were quick to accept responsibility for delivering housing and water and sanitation services in their communities (Long 2000). Few communities had the capacity to assume responsibility for these services.

Health, housing and environmental health policy

Policies to address the poor health and living conditions of Indigenous peoples have been described as confusing, disappointing, reactive, ad hoc, and with single strategies used to address the mix of social, cultural, political and economic factors that underlie problems (Coombs 1978, National Aboriginal and Torres Strait Islander Health Council [NATSIHC] 2003, Tatz 1974). Environmental health policy initiatives in remote communities have focused on providing technologies and infrastructure such as water, sanitation and housing. The newly constructed houses mostly consisted of three bedrooms, one bathroom and toilet, kitchen and living area. In the rush to construct new dwellings, issues of maintenance of health hardware and the need to adapt living practices for this new environment received only hasty consideration. Few people had insight into the potential problems that might arise (Long 2000). The rapid introduction of new technology, crowding, and problems caused by a failure to change behaviours to suit the new housing environment, lead to another layer of complexity when trying to prevent infection and improve child health. One observer reported that education was either not provided when household latrines were introduced into communities, or inappropriately provided (Tatz 1974). Little emphasis was placed on, and few resources were provided for, increasing community capacity and establishing effective administrative systems. The governance arrangements for Indigenous housing have been fragmented and unstable since Indigenous Community Controlled Housing Organisations (ICCHOs) were first established (Bailie & Wayte 2006).

Health policies have largely focused on the treatment or eradication of diseases by the use of vaccines and improved medical management. To date, there have been no comprehensive, long-term policies to try to address the problem of the poor growth and development of Aboriginal children. In health and other policy areas, prevention activities have received little attention, generally only mentioned as a secondary issue. Governments have tried to address some housing problems by funding community-based programs to teach families how best to use, care and maintain their new homes. However, the primary aim of many of these programs appears to be prolonging the lifespan of housing infrastructure rather than promoting safe hygiene practices and health improvement. In some communities, government-employed environmental health officers ‘hand over’ new houses to families.

Governments have predominantly employed short-term approaches to address the complex issues that underlie poor hygiene and living conditions in remote communities. This ‘short-termism’ appears to be a response to the political imperatives of new governments, new ministers and lobbyists. There has been little research concerning the causes of poor hygiene, housing and poor environmental health conditions in Australian Indigenous contexts. There has been no systematic approach to learning from the failures and successes of past policy and program initiatives. However, there is much to be gained from reflecting on the history of policy, the development of community infrastructure and epidemiological patterns of child health in addition to drawing on lessons learnt from the introduction of water and sanitation technology to communities in developing countries and other disadvantaged settings. In those communities, as in remote Aboriginal communities, providing water and sanitation technology has not automatically lead to the behaviour change associated with good hygiene. This problem is attributed to the failure to recognise that the technology introduced into disadvantaged communities needs to fit comfortably with the values, practices and beliefs of individuals and the communal group (Hubley 1993). Further, for technology to bring health benefits, appropriate hygiene behaviours need to be adopted and sustained by a large proportion of the community (Bateman & Smith 1991).

The National Environmental Health Strategy (Department of Health and Aged Care 1999) states that families, communities and governments need to protect their children from environmental contamination. In view of the poor living conditions and poor health experienced by Indigenous children living in remote communities, it would appear that a succession of federal and territory governments have chosen not to uphold generally well recognised public health standards in these communities. There are several possible reasons for this:

Hence, the situation remains today that poor living conditions and poor personal and domestic hygiene in remote Aboriginal communities is a major public health problem severely affecting the health and wellbeing of children in these communities (Coates et al. 2002, Currie 2002, Gracey 1998, White et al. 2001). In Box 22.1, by way of a case study, we describe the living conditions of young children in one remote NT community. There is a general consensus that preventing infection in the household and community is a health priority for Australian Indigenous children living in remote communities (Chang et al. 2002, Coates et al. 2002, Currie 2002, Gracey 1998, White et al. 2001). However, despite the rhetoric around the need to protect the health of these children it does not often translate into meaningful action (Department of Health and Aged Care 1999). Past government approaches to policy and program development to address Indigenous health and wellbeing is captured in this statement published in The National Aboriginal Health Strategy (NATSIHC 1989 p xi):

Aboriginal people often feel that the motivation for government action in Aboriginal health comes as a response to intermittent political pressure, rather than from a commitment to effective long-term solutions for future generations. The art of the ‘quick fix’ seems to be the norm. Expedient gestures for Aboriginal problems are made by government and any commitment lasts only until media attention has eased or until the next election.

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