Indigenous Law Bulletin
by Gavin Mooney
Government institutions in Australia are racist in their interaction with Indigenous people. This ‘institutional racism’ is contextualized by a recent history in which Australian society has shown itself to lack compassion. For example, the Howard Government’s refusal to officially apologise to Indigenous people, their demonisation of asylum seekers, and the increasingly inequitable distribution of wealth in this country. This lack of compassion has extended to the allocation of resources within the health care system. Indigenous health has disappeared from the political agendas of both main parties.
There is a mistaken belief that we have an equitable health care system. For example, there is a perception that Medicare is universal and fair, but the reality is that it is neither. A study looking at the use of Medicare by Aboriginal and non-Aboriginal people over a three year period in the mid-1990s showed that Aboriginal Medicare users born in the 1940s received just over $1000 of benefits while non-Aboriginal people got nearly $1800. We know that Aboriginal people are on average much sicker when they enter hospital. Yet the level of benefits for Aboriginal people hospitalised was only 67 percent of that for non-Aboriginal people hospitalised. The Aboriginal people were getting nursing care while non-Aboriginal people were getting high cost medical interventions.
On average, Australians use Medicare funded primary health care to the extent of just over $530 per year. The rich people of Double Bay in Sydney use over $900 per annum of such services. In the Kutjungka Region in the Kimberley, which is one of the most remote areas of Western Australia (‘WA’), the Aboriginal people are amongst the sickest in Australia. Yet they use less than $80 in Medicare primary health care funds per year. The inequities in health care for Aboriginal people have been investigated, and brought to the attention of politicians and the public in various reports. In the last 20 years there have been more than 20 reports into aspects of Aboriginal health. The problem is that so little action is taken to address these inequities.
In 2001, the level of funding for Derbarl Yerrigan Aboriginal Medical Service (‘Derbarl Yerrigan’) in Perth was about 10 percent ($800 000) below their level of expenditure. They were accused of ‘overspending’. Management consultants were sent in to look at their financial management.
At that time the level of spending by similar services on people in general in Perth was $760 per person. There is a strong argument that healthcare spending on Aboriginal people should be five times greater than for non-Indigenous people. This would account for the greater needs of Aboriginal people, the need for culturally secure services (ie services for which differences in culture result in no greater barriers for access), and the fact that some surveys suggest that there is a desire within the populace to discriminate positively in favour of the health of Aboriginal people. Multiplying the $760 figure by five would allow $3800 per Aboriginal client at Derbarl Yerrigan. However, the level of expenditure at Derbarl Yerrigan was only $830, which was slightly higher than the non-Indigenous figure of $760 but well short of $3800.
I presented these figures of underfunding to the Board of Derbarl Yerrigan and some senior state and commonwealth bureaucrats at a meeting. During the meeting, one of the senior bureaucrats whispered softly to me, ‘the problem is that will let them off the hook’. This argument was not only invalid but also racist. It implied that we (whites) were against them (blacks).
Derbarl Yerrigan was forced to close one of its successful branches in the Midland area on the outskirts of Perth. At about the same time, the Perth teaching hospitals were overspending by $100 million, which was about 12 percent of their budget and about 120 times the overspending at Derbarl Yerrigan. The teaching hospitals were bailed out. The cost of that bail out was almost certainly borne in part by the Aboriginal health budget of the Health Department.
This story provides at least five examples of institutional racism. First, the very serious underfunding of this Aboriginal Medical Service (‘AMS’). Second, the negative attitude of the state and federal health departments to financial management by Aboriginal staff. Third, the ‘them’ versus ‘us’ mentality of a senior bureaucrat. Fourth, the difference in concern regarding value for money in the teaching hospitals and the AMS. Finally, the greater priority of spending on teaching hospitals than for the AMS.
The example of the Indigenous Family Program (‘IFP’) is also revealing in terms of institutional racism. This Noongar community run organization is based on Aboriginal values. It connects Noongar families in severe crisis with the various government agencies that can deal with their problems. These families’ problems cannot be fixed easily. They are identified by the Aboriginal community as being the most severely dysfunctional families.
For example, before the involvement of the IFP one extended family of 12 people had dealings with 40 different agencies in the span of 12 months, with 222 meetings occurring between the family and these agencies. However, at the end of that time the family was no better off. After the IFP commenced aiding the family they did much better on all sorts of indicators. The IFP achieved substantial reductions in human misery for the families it worked with. Furthermore, an economic evaluation of the program showed that there was a saving of at least $1.50 for the state coffers for every $1 spent by the state.
Despite producing a remarkable turn around for many families very efficiently, the Government was unable to find a way of adequately funding this program. The Premier was elected to power on a platform of social justice. When he was challenged with the figures showing that the program was good value for money, he described his government’s failure to provide adequate support for this program as ‘an anomaly’.
A bigger problem was the bureaucrats. The program met its budget and various financial statements were found to be acceptable by the relevant government departments. Yet after that they placed all sorts of barriers to receiving funding. Ironically, most of the problems came from the Department of Indigenous Affairs, where most of the staff are not Aboriginal.
Together with another senior (white) researcher I was invited to attend a meeting with the leading Aboriginal figures at IFP. We discussed how the IFP might persuade the government to agree to funding. The other senior researcher tried three times to argue for a largely white based board to sit above IFP and ‘assist’ it. This was an attempt to take over the IFP and disempower it. This would have destroyed the whole basis of the IFP because it is founded on Noongar cultural values.
At a recent consultation on Aboriginal health research run by the National Health & Medical Research Council in Perth, an Aboriginal academic named Barbara Henry, raised a fundamental issue about Aboriginal life: How white do you have to become to get ahead? This question is faced by Aboriginal people employed in Government bureaucracy. Many are employed because of their special skills and insights into Aboriginal culture and life, but they are often and actively discouraged from bringing too much Aboriginality into the workplace.
This is another example of institutional racism. It is not enough to get Aboriginal people into the bureaucracy. When they are obliged to act in a non-Aboriginal manner towards Aboriginal people by representing non-Aboriginal values and views they are tarred with the same brush as non-Aboriginal people. This leaves them open to accusations from their community of being a sell out, or worse a coconut ie brown on the outside and white in the middle.
We need a more compassionate society. This is an idea echoed by Amartya Sen when writing about helping the poor and disadvantaged. He emphasises the ‘overwhelming role for intelligent and equitable social policies’ and ‘an appropriate social commitment’. To move to a more compassionate society and in turn a more equitable public sector will require strong political leadership. As Martha Nussbaum argues, ‘we want leaders whose hearts and imaginations acknowledge the humanity in human beings.’ Without a more compassionate society there are severe limits to progress towards equity for Aboriginal people in Australia.
There is a strong case for informing the community about the priority that needs to be given to Aboriginal health. At a WA Medical Council meeting in 2001, a randomly selected group of Perth citizens expressed strong preferences for positive discrimination on Aboriginal health.
Building a more compassionate society will take leadership. We need leadership not just in Canberra and our state governments, but in our universities and our public services generally. All of these institutions must address institutional racism before Aboriginal people can achieve equity in Australia.
Gavin Mooney is a Professor of Health Economics at Curtin University.
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 Above n 5.
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 Above n 4
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