When we talk about Aboriginal health, we often talk as if the problem is "Being Aboriginal" - but in reality, "Being Aboriginal" is a marker for having experienced racism, discrimination, colonisation and genocide.
Pat Anderson The Australian 27 July 2013
in July, the federal government launched its new National Aboriginal and Torres Strait Islander Health Plan.
As with all such plans, much depends on how it is implemented. With the details of how it is to be turned into meaningful action yet to be worked out, many Aboriginal and Torres Strait Islander people, communities and organisations and others will be reserving their judgment.
Nevertheless, there is one area in which this plan breaks new ground, and that is its identification of racism as a key driver of ill-health.
This may be surprising to many Australians. The common perception seems to be that racism directed towards Aboriginal and Torres Strait Islander people is regrettable, but that such incidents are isolated, trivial and essentially harmless.
Such views were commonly expressed, for example, following the racial abuse of Sydney Swans footballer Adam Goodes earlier this year.
However, the new health plan has got it right on this point, and it is worth looking in more detail at how and why.
So how common are racist behaviours, including speech, directed at Aboriginal and Torres Strait Islander people?
A key study in Victoria in 2010-11, funded by the Lowitja Institute, documented very high levels of racism experienced by Aboriginal Victorians.
It found that of the 755 Aboriginal Victorians surveyed, almost all (97 per cent) reported experiencing racism in the previous year. This included a range of behaviours from being called racist names, teased or hearing jokes or comments that stereotyped Aboriginal people (92 per cent); being sworn at, verbally abused or subjected to offensive gestures because of their race (84 per cent); being spat at, hit or threatened because of their race (67 per cent); to having their property vandalised because of race (54 per cent).
Significantly, more than 70 per cent of those surveyed experienced eight or more such incidents in the previous 12 months.
Other studies have found high levels of exposure to racist behaviours and language.
Such statistics describe the reality of the lived experience of Aboriginal and Torres Strait Islander people. Most Australians would no doubt agree this level of racist abuse and violence is unwarranted and objectionable. It infringes upon our rights - not just our rights as indigenous people but also our legal rights as Australian citizens.
But is it actually harmful? Is it a health issue? Studies in Australia echo findings from around the world that show the experience of racism is significantly related to poor physical and mental health.
There are several ways in which racism has a negative effect on Aboriginal and Torres Strait Islander people's health.
First, on an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.
Second, Aboriginal and Torres Strait Islander people may be reluctant to seek much-needed health, housing, welfare or other services from providers they perceive to be unwelcoming or who they feel may hold negative stereotypes about them.
Last, there is a growing body of evidence that the health system itself does not provide the same level of care to indigenous people as to other Australians. This systemic racism is not necessarily the result of individual ill-will by health practitioners, but a reflection of inappropriate assumptions made about the health or behaviour of people belonging to a particular group.
What the research tells us, then, is that racism is not rare and it is not harmless: it is a deeply embedded pattern of events and behaviours that significantly contribute to the ill-health suffered by all Aboriginal and Torres Strait Islander Australians.
Tackling these issues is not easy. The first step is for governments to understand racism does have an impact on our health and to take action accordingly. Tackling racism provides governments with an opportunity to make better progress on their commitments to Close the Gap, as the campaign is known, in Aboriginal and Torres Strait Islander health. The new plan has begun this process, but it needs to be backed up with evidence-based action.
Second, as a nation we need to open up the debate about racism and its effects.
The recognition of Aboriginal and Torres Strait Islander peoples in the Constitution is important for many reasons, not least because it could lead to improved stewardship and governance for Aboriginal and Torres Strait Islander health (as explored in a recent Lowitja Institute paper, "Legally Invisible").
However, the process around constitutional recognition provides us with an opportunity to have this difficult but necessary conversation about racism and the relationship between Australia's First Peoples and those who have arrived in this country more recently. Needless to say, this conversation needs to be conducted respectfully, in a way that is based on the evidence and on respect for the diverse experiences of all Australians.
Last, we need to educate all Australians, especially young people, that discriminatory remarks, however casual or apparently light-hearted or off-the-cuff, have implications for other people's health.
Whatever approaches we adopt, they must be based on the recognition that people cannot thrive if they are not connected.
Aboriginal and Torres Strait Islander people need to be connected with their own families, communities and cultures. We must also feel connected to the rest of society. Racism cuts that connection.
At the same time, racism cuts off all Australians from the unique insights and experiences that we, the nation's First Peoples, have to offer.
Seen this way, recognising and tackling racism is about creating a healthier, happier and better nation in which all can thrive.
Pat Anderson is chairwoman of the Lowitja Institute, Australia's National Institute for Aboriginal and Torres Strait Islander Health Research.
... Lets not forget that racism is a wider public health problem
Dr Tim Senior Crikey 9 August 2013
... There is a clear effect of the experience of racism on health. Some examples, quoted by Dr Angela Durey, who has researched the health effects of racism:
On an individual level, I know people who hate going to hospital because of their experiences, who won't go to the police if they have trouble because of their experience of racism from police officers. Many people will have their own stories.
When we talk about Aboriginal health, we often talk as if the problem is "Being Aboriginal" but in reality, "Being Aboriginal" is a marker for having experienced racism, discrimination and colonisation.
Experiencing racism is a cause of so many of the health problems we keep describing, including lifestyle risks factors.
It's also not enough to say that people can avoid experiencing racism by not visiting the website. This assumes that those contributing to the website and those visiting "just for a laugh" do not exist outside Facebook, that at work,or with friends, none of these attitudes come into play.
It assumes that an Aboriginal person can read that someone contributing to this website works for Consumer Affairs Victoria, Centrelink, an insurance company, a catering company, and believe that they will be treated fairly when they get there.
Those contributing to this group and reading it are reinforced in their beliefs that it is OK to talk like this, that it's all just a bit of a laugh. But in the same way that drink driving harms other people, racism harms other people. It's not OK, and that needs to be made clear.
What is the way forward? A first step has been taken - Facebook seems to have taken some action. But we need to remain vigilant, as others will pop up.
We should compare providing these pages to making someone work in a smoke filled room or lending the drunk driver your car keys.
Tweet your displeasure, post your disagreement to Facebook. We could all leave Facebook if the site if they persist in being slow to remove unhealthy racist material and quick to remove healthy breast feeding material.
We should follow with interest the investigations by ACMA and the Human Rights Commission.
We can challenge racism wherever you see it - All Together Now campaign well on this, and you can support them here.
And finally, as Durey says, we need to turn the lens on ourselves - "white privilege is an invisible package of unearned assets" that we seldom examine, or as John Scalzi imaginatively puts it "The lowest difficulty setting there is."
This is not about white guilt or self flagellation. This is recognising that we are stood at the top of a cliff, not at the end of a level playing field.
How are we constructing our health services? What is the experience of Aboriginal people using them? ...
To do this, however, we need to listen more closely to the Aboriginal voices out there. For they are telling us about their experiences if we care to listen.
Declaration: Tim Senior has represented the RACGP at the Close the Gap Steering Committee and works for the Tharawal Aboriginal Corporation. Though the organisations he works for would not disagree with these statements, although they may not express it in these terms. These are personal opinions and not the official position of any organisations I work for.
Previous Croakey articles by Tim Senior