Chapter 10 INDIGENOUS HEALTH

community control

Comprehensive Primary Health Care

cycle of poverty

This chapter begins by presenting a brief overview of traditional societies in Australia and New Zealand. It then turns to exploring colonisation in the two countries and its effects on Indigenous health. It reviews current levels of disease among the Indigenous populations of Australia and New Zealand and the effects of the cycle of poverty on Aboriginal and Māori people. It is argued that current Indigenous poor health status is the result of past and present colonisation. Factors which inhibit Indigenous self-determination in health, as well as Indigenous health care initiatives, such as community controlled health services, are reviewed in order to provide guidance for culturally safe health care provision.

LIVED EXPERIENCE

I found that the most productive times in terms of getting to know people in the community and them getting to know and trust me were our trips out bush. Sometimes I was invited to go out with a family over a long weekend or for longer during bush holiday. Out there I was dependent on the local people for everything — I was certainly the guest. It was during these times that friendships were forged and trust was deepened. After a bush trip I always found that my health care job became easier — negotiation and partnership fell into place. Yet my employer never saw this type of activity as legitimate work. We used to go out bush with the diabetics where we would all learn from each other, but this had to be done in our own time.

(Remote Area Nurse 2005, in Eckermann et al 2006: 151)

INTRODUCTION

Before exploring Indigenous health in Australia and New Zealand, it is necessary to identify who will be included in the discussions. In this chapter, the term Indigenous will include the Māori of New Zealand and the Aboriginal people of Australia. In the past, ‘Aboriginal’ has subsumed Torres Strait Islander people — much to their distress. Please note, Torres Strait Islanders are not the same as Aboriginal people. Their situation is unique in many respects and deserves separate discussion. While it is probably acceptable to discuss Māori as a group, even the term ‘Aboriginal’ does not necessarily sit easily with all of the descendants of the original owners of this continent. They have always used a range of terms to denote their in-group — for example, Murri, Murdi, Koori or Goori in SE Queensland and NSW/Victoria. Many people have also become much more specific of their identity since they have begun the slow and painful process of exerting their Native Title Claims. They proudly associate with their traditional language groups.

Today Aboriginal people form 2.4% of the total Australian population (ABS 2004). In New Zealand, Māori people constitute 14.2% of the total population (Statistics New Zealand 2003). Indigenous people in Australia, then, form a tiny minority compared to those in New Zealand.

THE INDIGENOUS PAST

Aboriginal people maintain that they have inhabited the continent since time immemorial. Archaeological evidence suggests that they have lived throughout the continent for at least 50 000 and up to 120 000 years (McGraw 1995). This length of occupation makes Aboriginal peoples the longest continuous civilisations in the world. Refer back to Chapter 9 where it was argued that Australia was a multicultural society long before the coming of Europeans because the continent was occupied by up to 500 different language groups. Refer back to the definitions of culture — language is an important indicator of culture. Consequently, there were many differences between the traditional custodians of Australia. However there was also a range of similarities. For example, all Aboriginal groups were hunters and gatherers who followed a seasonal pattern of migration across their well-defined territory (see Berndt & Berndt 1988). The nations/language groups were comprised of totemic groups, which lived in family groups and were governed by Elders. The Elders were most knowledgeable about the spiritual and physical worlds. The people’s behaviour was guided by the powers of spiritual forces, which came to them from the Dreaming (see Stanner 1979). The Dreaming represented their past, their present and their future and it was celebrated in ceremony, ritual and dance. These hunters and gatherers saw themselves as custodians of their country and while neighbours could fight, they never fought about land. Land alienation was unthinkable because the spirit of the land protected its custodians. ‘Strangers’ or visitors would be harmed unless they travelled the land with permission and knew the correct ritual to familiarise the spirits with their presence (Berndt & Berndt 1988; Elkin 1994). From all accounts (see McGraw 1995, Broome 2002), the people were healthy — their diet was rich in vegetables, grains and some protein, their hunting and gathering life style ensured that they had plenty of exercise. Indeed, when Cook first commented about the Aboriginal people he saw, he wrote that:

… in reality they are far more happier than we Europeans; being wholly unacquainted not only with the superfluous but the necessary Conveniences so much sought after in Europe, they are happy in not knowing the use of them. They live in a Tranquillity which is not disturbed by the Inequality of Condition …

(Cook in Beaglehole 1955: 399)

It would be wrong to present traditional Aboriginal societies as utopian — no doubt they were affected by natural disasters, suffered hunger and pain, illness and injustice. However, they were self-determining; they had order and security and had developed a satisfying pattern of life where food collecting would take no more than 35 hours a week (Hiatt 1970) and there was ample time for ceremony, song and dance.

Polynesian people settled in New Zealand between 250 and 1150 CE (Belich 1996). Known as Māori, the people were organised into hierarchical, land-owning clans, sub-tribes and tribes. Māori were agriculturalists and fishers as well as hunters. They tended to live in village style communities. Their society was divided into three groups — hereditary chiefs (rangatira) who had the authority to rule, commoners, members of the clan who traced descent to the founding ancestor, and slaves, who were either born into captivity or captured in war (Te Ara — The Encyclopedia of New Zealand 2007). Unlike Aboriginal people, then, Māori were a very hierarchical society, which practised warfare to acquire land as well as slaves. Sheppard (2005) believes that Māori life in traditional times was a struggle — food was scarce, there was much warfare, life expectancy was between 25 and 30 years, pneumonia and other respiratory diseases were common. Nevertheless, ‘In 1769 James Cook concluded that Māori were a healthy race, remarking on the great number of elderly men …’ (Sheppard 2005).

Both Aboriginal and Māori societies had a strong spiritual association with the land and the world around them. Aboriginal people have described the land as their mother — for Māori ‘the relationship of families and sub-tribes with land and other resources was integral with Māori creation beliefs, the deeds of ancestors, and other events told in tradition’ (Sheppard 2005). Further, Aboriginal and Māori people believed in the power of the spiritual world to heal and to harm. Traditional healers were revered and feared in Australia and New Zealand because of their specialised spiritual powers. This is not to say that the people were unaware of the natural causes for illness (see Reid 1982), rather, the expectation was that transgressions against the spiritual world would also be punished by ill health. Consequently traditional healers had to have knowledge of both physical and spiritual healing. Turn to Box 10.1 for an example of traditional healing practices.

Box 10.1 Traditional healing

Professor Elkin (1977) referred to the traditional healers as Aboriginal men of high degree.

The healers are kindred to Amerindian ‘men of power’ and shamans. These healers are specially chosen and trained to remove the influence of sorcery and evil spirits and to restore the wellbeing of the soul or spirit. Their role is extremely important because most serious illness is thought to be brought about by loss of a vital substance from the body (soul loss), introduction of a foreign and harmful substance into the body (spirit intrusion or possession), or violation of taboos and sorcery (singing). The traditional healers usually gain the power to heal through inheritance or through special spiritual experiences. They possess a spirit called mapanpa which is associated with healing power.

(Devanesen 2000: 3)

COLONISATION

Australia and New Zealand were both colonised by Britain at the hight of its colonial power. In 1788, when the first Europeans settled in Australia, it was classed as terra nullius, nobody’s land according to European law, because the colonisers could not see any evidence of the kinds of social organisations (e.g. settlements, government, land use) with which they were familiar. The invaders’ perception of civilisation and settlement/occupancy were guided by political philosophers of the time, such as Locke, who argued that land ownership was dependent on working the land. Land in their own countries which was not cultivated was classed as empty, common land, which could be taken by those who would cultivate it — consequently, other lands, annexed through colonisation, could be held by the Crown to be sold or leased to those who wanted to cultivate it later (Miller 1985). As a result Australia was ‘discovered’, annexed and settled — Aboriginal people were not even accorded the status of ‘conquered people’ (Gumbert 1984); the British government did not feel obliged to negotiate a treaty, and, when Cook ‘claimed’ Australia, the whole of the continent became Crown Land. Reflect on Box 10.2 and explore the ‘mindset’ which underpinned this kind of thinking.

Box 10.2 ‘Mindset’ — reflection

After reading about the basis on which Australia was declared nobody’s land — consider what that tells you about Europeans’ perceptions and evaluations of different cultures.

They had no understanding yet felt that they had a right to evaluate, to measure, other cultures against their own. This habit, established in the 18th and 19th centuries, persists — we continue to evaluate others in terms of our own reference frame. It is a common, yet fairly destructive, habit and shows little understanding about the intricacies and complexities of the term ‘culture’.

The ‘settlement’ process was a little different in New Zealand. Here traders and whalers visited for decades before Britain decided to become formally involved in the government of the islands (Ministry for Culture and Heritage 2007). War raged between the Māori tribes, who had been introduced to firearms in the Musket Wars of the 1820s and 1830s. Adventurers from Britain and Australia stayed, first in small, then ever increasing, numbers. The colonial government of Australia and Britain were conscious that these elements were often lawless and attempting to organise illegal land acquisitions. Some of the Māori chiefs had petitioned the Crown for independence within the empire (Ministry for Culture and Heritage 2007). Consequently there were Indigenous forces within New Zealand, which welcomed the influence of the British. In 1840, the Treaty of Waitangi was signed.

Māori had clear expectations of how the benefits would occur. There would be a sharing of authority, and this would enhance chiefly mana. The country would be protected from acquisition by other foreign powers. A kawana (governor) would control Europeans, especially those buying land, who were causing difficulties in some areas. The Treaty would bring settlement and more markets for Māori services that were essential to settlement, and Māori could obtain more goods and take advantage of benefits brought by Europeans. Some chiefs saw that change was inevitable. The clock could not be turned back to the period before 1840, so the treaty was seen as a way into the future.

(Ministry for Culture and Heritage 2007)

The treaty certainly ceded sovereignty to Queen Victoria who was supposed to guarantee the Māori chiefs ‘their land, forests, fisheries and other treasures so long as they wished to retain them (giving the Crown exclusive rights to their purchase); and granting the Māori people royal protection and the rights of British subjects’ (Sheppard 2005).

Despite the fact that the Treaty of Waitangi was annulled in 1877, because it had not been legalised by an Act of Parliament, it has been officially acknowledged as the document which underpinned the nation of New Zealand (Durie 1998; Ramsden 2002). Māori, then, were accorded the status of a sovereign people at the time of colonisation, perhaps because they lived in structures with which Europeans were familiar (i.e. they were organised into groups such as clans and tribes, were ruled by chiefs and pursued agriculture). Further, they fought bloody battles against the British after the signing of the Treaty of Waitangi because of unacceptable land alienation between 1840 and 1876.

The process of colonisation in Australia was unique because the continent was annexed as belonging to nobody. Further, while Aboriginal people were actively segregated from non-Aboriginal society into reserves and missions, the policy in New Zealand was to amalgamate Māori (Ministry for Culture and Heritage 2007). In many other respects, however, colonisation had the same effect.

In both countries the first 100 years of colonisation were marked by enormous loss of Indigenous life. In Australia, Lancaster Jones (1970) estimated that between 1788 and 1947 the Indigenous population dropped between 50 and 90% (depending on the geographic region) from an estimated 300 000 at the time of colonisation. If Mulvaney’s (2002) claim, that 750 000 Indigenous people occupied the continent in 1788, is correct, the loss of Indigenous life was horrific, and indicative of the many groups of traditional owners who were literally wiped out. Similarly in New Zealand, the Māori population declined by at least a third in less than a century (Durie 1998) — some believe that it declined by 50% between 1840 and 1892 alone (Te Ara — the Encyclopedia of New Zealand 2007).

Loss of Indigenous life has been attributed to warfare and introduced diseases, as well as loss of land, loss of economic independence, loss of human rights, discrimination and racism (see the work of Evans et al 1988; Reynolds 1989; Durie 1998; Lippmann 1999; or Moses 2004). The interaction of these forces is presented in Figure 10.1 below.

Figure 10.1 The cumulative effects of colonisation

(reproduced with permission from Eckermann et al 2006: 19)

THE AFTERMATH OF COLONISATION

Warfare marked the struggle for land and independence between Aboriginal and non-Aboriginal people and Māori and Pakeha. In New Zealand it was recognised as war — in Australia it was called ‘resistance’, partly because of the way in which the country was annexed, and partly because the nature of guerrilla warfare was not yet understood by the British (see Broome 2002, Eckermann et al 2006).

Under the government policy of Protection, Aboriginal people were institutionalised in segregated reserves and missions where their lives were fully regimented and controlled. The practice has been identified as institutional racism; that is, racism enshrined in laws which were only applied to one sector of the Australian population and continued for 100 years in some states and territories; for example, Queensland (see Reynolds 1987, 1989, 2003; Evans et al 1988; Eckermann et al 2006). Such institutionalisation seriously affected Aboriginal people’s physical, social, economic, spiritual and political welfare (see Broome 2002, Lippmann 1999). They were unable to travel, marry, bring up their children, work where they pleased, earn the same wages as non-Aboriginal workers, go to school at all or attend school beyond sixth grade, or receive pensions, unemployment benefits or child support payments. Indigenous Health statistics in Australia and New Zealand reflected government neglect and the people’s despair and hopelessness following the massive culture shock of colonisation. Reflect on colonisation as culture shock in Box 10.3.

Box 10.3 Colonisation as culture shock — reflection

Review Figure 9.2 in Chapter 9. Consider the culture shock stressors — communication, attitudes and beliefs, mechanical differences, compliance, isolation and customs.

In what ways did traditional Aboriginal societies clash with the colonists — did they speak the same language (communication), follow a similar kind of life (mechanical difference), maintain similar religions, gender roles, authority structures, family organisation or perceptions of beauty (attitudes and beliefs, compliance and customs), and — in relation to isolation — did Aboriginal groups experience shock when they were excluded from the land?

A growing number of writers (see Tatz 1999; Moses 2004) have maintained that this period of Australian colonial history was characterised by genocide. Thus Kociumbas (2004: 98–9) commented:

What is unique about Australia is not its violence, but its apparent legality and above all its modernity. It was modern technology that made possible the pace and effectiveness of killing, and modern law that provided the judicial niceties that condoned it. Thus it enabled minimal state involvement via visible military action, and gave carte blanche to changing groups of helpers claiming expertise in managing surviving populations where extreme surveillance did not preclude starvation, the absence of medical services, and utter neglect.

Consider Box 10.4 — this is an account of settlement life in the early 1970s — not 100 years but just one generation ago. Consider the level of surveillance which characterised Aboriginal people’s lives on that settlement. Note that until the 1960s many public facilities, such as hospitals, segregated Aboriginal patients in ‘Aboriginal Only’ wards in most states and territories (see Dowd’s 1985 account of hospitals on the east coast of NSW).

Box 10.4 An account of settlement life in the 1970s

When I lived on an Aboriginal settlement in Queensland in the early 1970s, people got up with the siren, went to work, had lunch and stopped work with the siren. At 10pm the generator was turned off and we were all expected to go to bed so that we’d be fresh for the next day’s work. To enter the settlement I had to have permission from the Director of Aboriginal Affairs and I had to report to the non-Aboriginal manager on my arrival. I had to report every time I intended to leave the settlement and report when I returned. This rule also applied to Aboriginal people who lived on the settlement or who wished to visit relatives. If a visitor was considered a ‘trouble-maker’ by the administration, permission was refused.

Everyone on the settlement worked — even if they swept the streets — there was no unemployment benefit or supporting parent benefit. Those ‘unmarried’ mothers who did not have a job would be expected to work in the dormitories, cooking or sewing, and would be paid with pocket money and food. The only pensions available were old age pensions. The settlement had attracted attention because of high infant mortality rates. The Department of Health consequently insisted that all babies be brought to the settlement clinic on a regular basis for blood and parasite, weight and height checks. If mothers did not comply, they could be fined or jailed in the settlement jail. Films or dances could only be held if the manager gave permission, gambling and drinking were prohibited. There was a boy’s and a girl’s dormitory for children who had been removed from their families in other parts of Queensland and who were thought to be at risk — until the 1940s all children were routinely removed from their families at age 3 and reared in the dormitories to protect them from potentially bad influences. Except for the main street, where houses were relatively good, and where all of the non-Aboriginal staff lived, houses on the settlement were virtual shacks — most did not have glass in the windows — shutters kept out the cold — the walls were not lined and few had hot water systems.

Think about this — if I was regimented in this fashion, how much more oppressive would this have been for people who called the settlement their home.

(Eckermann A-K 1971–1972, personal experience)

Settlements, fringe settlements on the outskirts of towns and reserves marked Aboriginal people’s living conditions until the 1950s, when government policy changed from protection to assimilation and more moved into towns and cities. Because of the history of neglect and exclusion, many Aboriginal people were undereducated. Even without the barriers of racism and discrimination, many did not have the necessary education for skilled work. Consequently, Aboriginal people were among the most vulnerable in the Australian economy. Similarly, Māori people were also vulnerable, having suffered large land losses after 1840. By 1896 only 11 million acres, out of a possible 66.5 million acres, remained in Māori hands. By 1920, this was reduced to 4.7 million acres (Sheppard 2005 online). This land loss had drastic effects on the Māori economy and the ability of the Māori people to remain self-determinant.

Self-determination for Aboriginal people became Australian government policy in 1972; it changed to self-management in 1975, and it has retained that label over the past 30 years. The literature provides an extensive analysis of Australian government policies (see Lippmann 1999; Broome 2002; Eckermann et al 2006). For a brief summary consider Box 10.5. Think — why has it been necessary to develop ‘Aboriginal only’ policies? What effects have these policies had on Aboriginal people — have they supported or frustrated self-determination?

Box 10.5 Aboriginal people — government policies

Government policies towards Aboriginal people may be divided into eight periods:

1. European Settlement 1788–1880s — Aborigines regarded as lowest rung in social hierarchy.

2. Segregation 1890s–1950s — strong missionary influence — ‘civilising the savages’.

3. Assimilation 1950s–1960s — push for education to full citizenship.