The Macquarie Dictionary defines ‘Indigenous’ as ‘originating in and character rising a particular region or country’. The term ‘Indigenous’ has been identified as problematic for some writers due to its general application to any country or land. This lack of specific acknowledgment of the Australian context diminishes their Aboriginality (New South Wales Health 2004). Therefore, where possible, this chapter uses the term ‘Aboriginal and Torres Strait Islander peoples’ to refer to the diversity of languages, cultural practices and spiritual beliefs of the first inhabitants of Australia. Aboriginal peoples from different parts of Australia have their own names for themselves, such as Koori, Yamaji, Nunga, Murri and Yolgnu. These names are specific to various regions and are only used when referring specifically to that region. Outside of Australia, the term ‘aboriginal’ is also used as a synonym for ‘indigenous’.

Aboriginal and Torres Strait Islander culture is said to be one of the oldest cultures in the world, dating back more than 40,000 years. There have been many debates regarding the number of Aboriginal and Torres Strait Islander peoples and the number of language groups prior to colonisation. The population estimate is dependent on the text source and varies from 300,000 to more than a million, with the number of language groups reported as between 200 and 250.

As tribal peoples, the tangata whenua or Indigenous peoples of New Zealand identify themselves by the names of their hapu (sub-tribe) and iwi (tribe). Renaming was an early process of colonisation and the adjective Maori, meaning ordinary or normal, was used as a noun to ‘reidentify’ them as one homogenous group (Smith1999). As it is now universally known, and for the purposes of this chapter, the term Maori is used to refer to the Indigenous peoples of New Zealand.

Maori, Aboriginal and Torres Strait Islander peoples belong to an international network of Indigenous communities who are unified in a collective struggle for their rights as first peoples. These rights are derived from their status as descendants of the original occupants of the lands and territories they now inhabit with others. Those others include the colonisers who have become the majority and migrant or ethnic minorities who came later. In the current fervour to promote ‘multiculturalism’, it is important to distinguish between Indigenous peoples and ethnic minorities (Maaka & Fleras 2005). Indigenous peoples occupy a unique political space and should not be ‘redefined’ as ethnic minorities in their own countries. The differences lie in the historical relationship that exists between the Indigenous peoples and the colonising power (the Crown), and their status does not depend on numbers in the population (Jackson, cited in Robson & Reid 2001).

In Australia, the declaration of European settlers in 1778 that Australia was an empty land, ‘terra nullius’, had far-reaching consequences that reside today in contemporary Australian society. In 1992, in the historic Mabo decision, the High Court of Australia overturned the ruling of terra nullius, and this paved the way for more appropriate recognition of Aboriginal sovereignty (Bessarah 2000). Aboriginal and Torres Strait Islander peoples traditionally had strong connections between family, culture and the land. The effects of non-Indigenous policies have weakened those links, which in turn has had a major impact on the health of many of these people (Mathews 1998, 2004).

Aboriginal and Torres Strait Islander peoples suffered under various state governments’ so-called ‘protectionist’ policies, such as the Aborigines Protection Act (1869, Victoria), Aborigines Act (1905, Western Australia), and the Aborigines Protection Act (1909, New South Wales). The protection (segregation) policy did not achieve its aims and was replaced by policies of assimilation (1950s–60s). The consequence of both the ‘protection’ and ‘assimilation’ policies was that many thousands of Aboriginal children were removed from their parents (Broome 2002). These children are known as the ‘Stolen Generation’ and a national inquiry into the separation of Aboriginal and Torres Strait Islander children is documented in the ‘Bringing them home’ report (Human Rights and Equal Opportunity Commission 1997).

The next policy shift was integration (1967–72), encouraging Aboriginal peoples to adopt European ways and abandon their culture (Human Rights and Equal Opportunity Commission 1997). The people of Australia voted in a referendum in 1967 to remove two discriminatory clauses in the 1901 constitution. This resulted in governments being prohibited from passing special laws relating to Aboriginal peoples. Aboriginal peoples were also to be recognised as Australian citizens and be included in the census.

By the time New Zealand was being colonised, Britain had started to acknowledge the harm being brought to Indigenous peoples in territories it had colonised. Unlike Australia, Maori were offered a treaty, and in 1840 the Treaty of Waitangi was signed by Maori and the British Crown. While it is seen as the ‘founding document’ of New Zealand, it remains the subject of ongoing political and public debate (Durie 1998, Orange 2004, Reid & Cram 2005, Walker 2004).

As an agreement between two parties, the Treaty articulated a relationship between Maori and the Crown and, through good governance promised by the British, Maori would be protected from the detrimental effects of colonisation. The Treaty was written in Maori and English and, according to the Maori text, Maori would retain their lands and natural resources and the right to exercise authority over them (self-determination or tino rangatiratanga) (Durie 1998). Guarantees were also made to Maori in relation to equity and citizenship, ensuring they would have equal access to the benefits of a new society (Reid & Cram 2005).

Debate centres on questions of British intent and motivation for a Treaty and differing perceptions of whether Maori sovereignty was ceded or not. These questions are fuelled by inconsistencies between the Maori and English texts and disagreement about which text is the ‘right’ one. In reality, and regardless of which text is recognised, the promises in neither text have been fulfilled. Present-day inequalities between Maori and other New Zealanders in social, economic and health status do not reflect good governance or the equity and equal access to the benefits of society promised in the Treaty. Needless to say, nor did Maori retain their land and natural resources, let alone the right to exercise authority over them.

History shows that following the signing of the Treaty of Waitangi, the settler government was quickly established without the Treaty partner, and through mainly legislative process Maori were effectively dispossessed of their land and their sovereignty (Durie 1998, Orange 2004, Walker 2004). Like Australia, assimilation was a key agenda item and, well into the 1960s, policies including urbanisation and other acts of assimilation in New Zealand saw the loss of Maori language, culture, tribal unity and identity—all critical determinants in the health of Indigenous peoples.

The emergence of Indigenous peoples as a social movement has led to international acknowledgment of the historic and lingering impacts of colonisation on Indigenous communities throughout the world (Sissons 2005, Smith 1999). To appreciate the impact of land loss on the health of Indigenous peoples, it is necessary to understand their relationship with the natural environment. Apart from the universal value of land as an economic base and place to live, for Indigenous peoples the land is the foundation of social unity, cultural identity and the source of spiritual sustenance (Durie 1998, National Aboriginal Health Working Party 1989).

It should need no explanation therefore that when people are dispossessed of their cultural, spiritual, social and economic base, their cultural, spiritual, social and economic wellbeing will suffer—for generations. The present circumstances faced by Indigenous peoples are inextricably linked to the past.

Given the discussion of historical events and influences on contemporary Indigenous peoples and their health, and before examining more specific health issues, it is necessary to talk about racism. Racism refers to the belief that groups of people are based on genetic similarities rather than on social agreements between people. Racism, like sexism and classism, is about power. ‘It is the approach by which one dominant racial group has, and maintains power over another racial group and subordinates it’ (Smith 2004).

Most of us would declare ourselves ‘non-racist’ and would find it difficult to accept that racism continues to be a significant and widespread problem. However, although overt racism has become increasingly socially unacceptable, racism still exists. As Mellor et al. (2001) contend, subtle racism occurs in the context of everyday living, such as shopping, using public transport and eating in restaurants—and, importantly, accessing mainstream services, be it health, welfare, education or the justice system.

Understanding our own prejudices and taking responsibility for how these feelings can affect service delivery is one of the most significant things we can do to improve services for individuals and groups who are marginalised by the system. Most of us do not intend to be racist in our attitudes, but every time we assign a negative feeling towards someone based on their culture, language, behaviour or beliefs, this is racism. It usually happens because we have a different cultural viewpoint from the person to whom we are offering services. These different values and beliefs result in us making assumptions to predict behaviours in individuals or groups who are different from ourselves and can lead us to stereotype or generalise. A stereotype and a generalisation may appear similar, but they function very differently.

A ‘generalisation’ is a beginning point. It indicates common trends, but further information is needed to ascertain whether the statement is appropriate to a particular individual (Galanti 1991). A ‘stereotype’ is an endpoint. No attempt is made to learn whether the individual in question fits the statement (Galanti 1991). Stereotyping does not allow for individual differences within cultures and commonly victimizes groups by blaming their cultures for perceived and negatively valued practices. In Box 3.2, you will find a reflective exercise that encourages you to challenge the stereotypes.

A number of examples of institutional racism for Aboriginal and Torres Strait Islander peoples are provided below:

To counter overt and covert racism within the Australian health system, a number of principles have been prepared for the Cultural respect framework for Aboriginal and Torres Strait Islander health 2004–09 (Australian Health Ministers’ Advisory Council 2004 pp. 8–9). They include: