Northern Territory Emergency Response - Public Health Implications Commentary
Public Health Implications of the Australian National Emergency Intervention to protect Indigenous children in the Northern Territory
Prepared by Joe Thomas
On 21 June 2007 Prime Minister, John Howard, and the Minister for Indigenous Affairs, Mal Brough announced ‘national emergency measures to protect Aboriginal children in the Northern Territory from abuse and give them a better, safer future’. Although the intervention is presented as a broad based social welfare initiative, it has a significant public health component. This paper briefly analyses the public health implications and the overall context of the intervention.
The Australian Federal government’s Emergency Response to protect Aboriginal children in the Northern Territory is a significant event in the chequered history of the relationship between the minority Indigenous Australians and the majority Anglo Saxon population. The Victorian Aboriginal Protection Act (1869) gave the colonial government control over where Indigenous people could live, where they could work, what kinds of jobs they could do, who they could associate with and who they could marry. Since this was enacted there have been several significant milestones (and a long list of massacres of Indigenous Australians as well) in the history of relationship between Indigenous Australians and the Australian government. Only in 1962 was the Australian Indigenous population given voting rights in Commonwealth elections and in 1992 the High Court of Australia rejected the argument of terra nullius as the legal basis of the occupations of indigenous land (the Mabo verdict).
One of the core contentions of this paper is that whilst outwardly it may appear that legal and other policy interventions among the Indigenous population are driven by values of democracy, equity and respect for pluralistic diversity, a closer scrutiny often reveals a lingering racism and a belief that Indigenous Australians are still a barbaric, sub-human lot. The overall philosophy of the Northern Territory emergency intervention does not differ much from the observations made in the 'Stolen Children' report: “Many children suffer abuse or neglect. The State or Territory has an obligation to ensure their well-being and protection. The nature of the official response, however, has varied over time according to prevailing philosophies and ideologies. In Western terms, welfare as a form of child saving has its origins in late 19th century middle-class concerns about the `dangerous' classes, single mothers and working-class families in industrialised regions of England.” (Commonwealth of Australia, 1997)
Aboriginality is historically characterised as morally deficient. A focus on child-saving facilitates blaming the family and viewing `the problem' as a product of `pathology' or `dysfunction' among members rather than a product of structural circumstances which are part of a wider historical and social context (Gilbert, Thomas, Dingwall et al 1983).
A long list of studies and commissioned reports have chronicled the plight of Indigenous Australians. (eg. The Bringing them Home Report, The Royal Commission into Aboriginal Deaths in Custody etc). However, the Wild and Anderson (2007) Board of Inquiry Report into the Protection of Aboriginal Children from Sexual Abuse, commissioned by the Northern Territory Government, attracted an unusually swift response from the Australian Federal Government. The Board of Inquiry’s task was to:
- examine the extent, nature and factors contributing to sexual abuse of Aboriginal children, with a particular focus on unreported incidents of such abuse;
- identify barriers and issues associated with the provision of effective responses to and protection against sexual abuse for Aboriginal children;
- consider practices, procedures and resources of NT Government agencies with direct responsibilities in this area (Family & Children Services and Police), and also consider how all tiers of government and non-government agencies might contribute to a more effective protection and response network; and
- consider how the NT Government could help support communities to effectively prevent and tackle child sexual abuse.
Various aspects of the implications of this response have been debated and analysed (Fran Baum, 2007, Jones PD. 2007, Ian T Ring and Mark Wenitong, 2007). However, there has been very limited analysis on the public health implications of this intervention. This brief review presents a summary of the details of the intervention, the context of intervention, the marginalisation of Indigenous Australians, and the public health implications of the intervention.
The Australian Government’s legislation package for the National Emergency in the Northern Territory was passed on 17 August 2007. The package comprises five Bills. It includes two appropriation Bills which provide for spending in excess of $580 million in 2007-08. The legislation package also includes:
- the Northern Territory National Emergency Response Bill 2007;
- the Social Security and Other Legislation Amendment (Welfare Payment Reform) Bill 2007; and
- the Families, Community Services and Indigenous Affairs and Other Legislation Amendment (Northern Territory National Emergency Response and Other Measures) Bill 2007.
The operational commander of the Northern Territory Emergency Response is an active soldier from the Australian Armed Forces, Major General Dave Chalmers.
Some of the proposed key measures include:
- Deployment of military and additional police to affected communities
- New restrictions on the sale of alcohol
- A ban on pornography
- Compulsory acquisition of townships currently held under the title provisions of the Native Title Act 1993 through five year leases
- Suspension of the permit system to enter the indigenous communities
- Quarantining of a proportion of welfare benefits to all recipients in the designated communities and of all benefits of those who neglect their children
- The abolition of the Community Development Employment Program (CDEP)
Context of intervention
A detailed analysis of the context of NTER is essential. This analysis covers the findings and recommendations of Wild and Anderson board of enquiry, the ethnographic context of Aboriginal communities in the Northern Territory, the political context (NT vs Federal) and the marginalisation of Indigenous Australians in general.
Although the NTER was triggered by the report of Wild and Anderson, several earlier inquiries, commissions and studies have contributed to a greater understanding of the overall situation of the Indigenous population. The tone of the Wild and Anderson report was set by the common words or concepts that emerged in the course of the consultations. They were: Dialogue, Empowerment, Ownership, Awareness, Healing, Reconciliation, Strong family, Culture and Law (Wild and Anderson, 2007). The report is particularly, emphatic about the need for genuine consultation: “In the first recommendation, we have specifically referred to the critical importance of governments committing to genuine consultation with Aboriginal people in designing initiatives for Aboriginal communities, whether these be in remote, regional or urban settings”.
The report also further noted “ There is nothing new or extraordinary in the allegations of sexual abuse of Aboriginal children in the Northern Territory. What is new, perhaps, is the publicity given to them and the raising of awareness of the wider community of the issue. Sexual abuse of children is not restricted to those of Aboriginal descent, nor committed only by those of Aboriginal descent, nor to just the Northern Territory. The phenomenon knows no racial, age or gender borders. It is a national and international problem”. It has been reported that 85% of notifications for suspected child abuse occur in non-Indigenous children in Australia (AIHW, 2006).
The Indigenous population is 30% of NT’s overall population. 38% of the Territory’s Aboriginal population comprises children under15 yrs (ABS 2006). The Indigenous population is settled in 641 discrete communities, 9 towns (1,000 – 2,000+), 50 communities (200-999) and 570 communities with less than 200 people. 72% of the NT Aboriginal population lives on Aboriginal lands outside urban centres (DHCS, NTG nd).
According to some of the researchers, overall, Aboriginal death rates may have worsened over the last thirty years or so (Bartlett & Legge, 1994). With regards to life expectancy at birth the Indigenous population lag 20 years behind the non-Indigenous population. The difference in life expectancy between the Indigenous and non-Indigenous population in the Northern Territory (1996-2000) is 18.1 to 20.0. (Zhao and Dempsey 2006).
Life expectancy at birth for Aboriginal and Torres Strait Islander Australians was estimated to be 59.4 years for males and 64.8 years for females, compared with 76.6 years for non-Indigenous males and 82.0 years for non-Indigenous females for the period 1998-2000. (ABS, AIHW 2005). In comparison, the life expectancy of the Indigenous population in Australia is much closer to neighbouring East Timor. A country of just over a million people, depending heavily on Australian aid, East Timor is one of the world's poorest nations, ranking below Congo and Sudan in its indicators of human development with a life expectancy of 56 years for women and 54 years for men (AusAID 2007).
Whilst the general Australian population enjoy universal literacy, almost 10% of Aboriginal people have never attended school (Jenne Roberts, 2001)
Public health implications
Nancy E. Kass (2001) provided an ethics framework for public health interventions. Based on this framework, some of the key questions that need to be examined to understand the public health implications of the NTER are:
- What are the overall public health goals of the NTER?
- How effective is the NTER in achieving public health goals?
- What are the potential burdens of the program?
- How can the burdens be minimised; and what are some possible alternative approaches?
- Is the NTER program implemented fairly?
Public health goals of the intervention
The overall goal of the NTER is presented as a set of “broad ranging measures to protect children, stabilise communities, normalise services and infrastructure and provide longer term support to build better communities” (FaCSIA 2007). One of the key objectives is child health checks by the child health check teams. However, it appears that NTER is not providing clear public health goals in terms of public health improvement, that is, in terms of reduction of morbidity or mortality. It is likely that a reduction in morbidity and mortality need not and could not be the goal of NTER. However, individual public health programs should not be undertaken that are not part of a larger package of programs whose combined goal is the reduction of morbidity and mortality.
It appears that the assumptions behind the NTER are not based on any sound public health or health promotion principles. Health promotion is the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health. The NTER does not enable Aboriginal people and communities to gain more control over their own health and the determinants of their health.
How effective is the NTER in achieving public health goals?
It appears that due to lack of clarity in the goals of NTER, its effectiveness in achieving public health goals is compromised at the outset.
Any genuine effort to address child abuse in communities needs to take into account of the environmental factors which facilitate wide spread child abuse. ‘Health promotion is about working with people not on them, it starts and ends with the local community, it is directed to the underlying as well as immediate causes of health, balances concern with the individual and the environment, emphasizes the positive dimensions of health and concerns and should involve all sectors of society and the environment’ (Nancy E. Kass. 2001)
The assumptions behind the intervention do not lead us to believe the programs will achieve its public health goals. In particular, there is a lack of clear justification on the linkages between the prevention of child abuse and the need to deploy military, the compulsory acquisition of townships currently held under the title provisions of the Native Title and the suspension of the permit system to enter Indigenous communities.
Potential burdens of the program
Even though the widely perceived social welfare goals of NTER may be desirable, considering the history of relationship between the Indigenous population and the settlers, NTER provides ample opportunities to exacerbate the situation. NTER presents a great risk to the privacy and confidentiality of the Indigenous communities. The media portrayals of Indigenous communities as the hub of child molesters are a clear violation of right to privacy and confidentiality. It is collective stigmatization. There should not be a collective punishment to the community for the potential crimes of few.
There is limited or no acknowledgement of the cultural and linguistic diversity of the Indigenous population. The Indigenous population in Northern Territory is not a homogenous cultural group. The emphasis of NTER is to treat the Indigenous population as a homogenous entity. This may further enhance existing ethnic divisions and animosity.
Assigning the military to implement social welfare policies is a practice often reserved for the autocratic regimes of a bygone era. Very few developed countries send their military to implement domestic social welfare programs and there is ample evidence to indicate that a ‘police state’ approach to child abuse does not improve the lot for children who grow up being abused” (Jones. P. D., 2007)
There is ample evidence to suggest that the paternalistic overtone of the NTER is likely to produce adverse outcomes. There is no effort to acknowledge or strengthen community resolve to deal with domestic violence and child abuse in the communities. Historically, legislations directed to Indigenous populations are coercive and they pose further risks to liberty and self-governance of Indigenous population. NTER is no exception.
Minimising the burden and possible alternative approaches
It appears that there is no comprehensive assessment, discussion or consensus on the possible burden of NTER. The health professionals associated with the intervention are ethically obliged to assess the burden and to determine whether the program could be modified in ways that minimise the burdens. It is not too late to re-state a clear public health objective for the intervention.
Is the NTER program implemented fairly?
Perhaps distributive justice is one of the lost opportunities of the intervention. The deprivation of the Indigenous population is not a Northern Territory social phenomenon alone. It is in fact a national emergency. Perhaps, a national Indigenous emergency response would have been more appropriate
Further social harms result from reinforcing the social stereotypes that are created or perpetuated through NTER, such as the stereotype that only Indigenous people in the Northern Territory are perpetrators of child abuse
NTER had an opportunity to correct existing injustices, especially given the strong link between poor living conditions and poor health outcomes. Public health professionals have a responsibility to advocate for better housing, better jobs, meaningful education and Indigenous self-determination since such advocacy might be the best route to improving Indigenous peoples’ health.
Balancing the benefits and burdens of NTER
The NTER policy is based on multiple considerations in addition to public health objectives. However, one of the strong components of NTER policy is its public health objectives. The public health community has a responsibility both to advocate for programs that improve health and to remove from policy debate programs that are unethical, whether because of insufficient data, clearly discriminatory procedures, or unjustified limitations on personal liberties.
One of the solutions to the potential disagreements on the benefits and burden of NTER is by establishing a system of fair procedures. Procedural justice requires a society to engage in a democratic process to determine which public health functions it wants its government to maintain, recognizing that some infringements of liberty and other burdens are unavoidable. There should be open discussion of what a society gains from good public health and why such benefits often cannot be obtained through less communal or more liberty-preserving methods.
We live in a pluralistic society where each individual and community is respected and valued equally. The right to decide and to assess the benefits and burden of any public health programs on any community is one of the values of pluralist society. Ultimately, different communities have a right to comment on public policies, based on their own balancing of benefits and burdens. The state has a responsibility to present a fair process, or at least a pluralistic process, in steering local public health policy.
Additional resources for addressing the underlying disadvantage of the Indigenous population are always welcome. However, it appears that the overall impetus of NTER is short-term political gain. There is little evidence to indicate that much thinking has been made to address the long-term goals of addressing the disempowerment of the Indigenous population in NT and in Australia in general. NTER should explicitly address the fundamental causes of disease and requirements for better health come. The program should in no way compromise or disrespect the rights of individuals in the community. An emergency label of a public policy initiative should not be an excuse to avoid the fundamental right of the community members to offer inputs.
The NTER should be an opportunity for the public health staff, health workers and health activists to advocate for the empowerment of Indigenous community members. It appears that the NTER failed to use the available evidence and information needed to implement effective policies and programs that protect and promote the health of the Indigenous population in NT and in general. From a public health perspective the NTER should incorporate alternative approaches that anticipate and respect diverse values, beliefs, and cultures in the community and enhance the physical and social environment.
Piecemeal approaches are unlikely to contribute to the long term health and well being of Indigenous Australians. Prolonged oppression and marginalisation of Indigenous people has contributed to the severe depletion of self-respect and cultural pride. Individual autonomy, self esteem, and health are linked together (Michael Marmot, 2003). A reconciliatory environment which respects the cultural uniqueness of Indigenous Australians and the richness it could contribute to the Australian knowledge and cultural realm is essential for promoting the health and well being of Indigenous Australians. Perhaps Australia signing the United Nations Declaration on the Rights of Indigenous Peoples would be a first step towards a national reconciliation with the Indigenous Australians (UN, 2007). The Declaration on the Rights of Indigenous Peoples was adopted by a recorded vote of 143 in favour and Australia was one of the four countries voted against. Australia has the know-how, skills and the resources to address the health and well being of Indigenous Australians. What is lacking is an unpardonable political will.
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