As the prime minister stated just one month ago at his annual Closing the Gap address to parliament, we are simply not on track when it comes to equality in health.
Yes, there have been some improvements in terms of health care access, but the gap in life expectancy remains. It won’t be closed by the target date of 2031 and mortality rates in areas such as cancer are actually on the rise.
For Aboriginal and Torres Strait Islander people life expectancy remains between 10 and 17 years less than other Australians. It’s time for the government to take a serious look at why these differences still remain.
Good health isn’t simply determined by provision of or access to medical and allied health services. It is influenced by a range of factors impacting on human lives on a day-to-day basis including income, education, conditions of employment, power and social support – the social determinants of health.
While the social determinants of health take on a critical role in trying to close this gap, in Australia we continue to try and respond to the Indigenous health crisis by putting an “Indigenous spin” on western approaches. We must change this around. It has to be solutions that are developed, designed and supported by Aboriginal and Torres Strait Islander people themselves, for their own communities. If not we will not close the gap.
And we have to start by addressing the underlying issue of trauma.
Colonisation has caused enormous distress for our communities. The forcible removal of children from their families; the taking of land; the devaluing of Aboriginal and Torres Strait Islander cultures; subjecting our people to poor education and substandard housing on reserves; and the ongoing generational impact of this has created waves of trauma throughout our history.
The failure to understand and act on this trauma is missing from the effort to affect change in the social determinants of health for Aboriginal and Torres strait Islander people. Unresolved trauma impacts on the ability of our communities to participate in work, to parent, to feel socially and culturally connected and to participate fully in society.
Often, Aboriginal and Torres Strait Islander communities are retriggered in their trauma through ongoing social exclusion such as experiencing racism or feeling that their voices are not valued. This keeps people in a negative cycle of feeling bad and, as a result, experiencing ill health.
Trauma affects the way we think, act and behave. It is overwhelming and changes the way our brain and body works. For Aboriginal people that were taken from their families it has caused incredible suffering for individuals and communities in many different ways over many generations.
The survivors of this trauma have not always been given the chance to heal. You might see symptoms of this trauma play out as alcoholism, broken relationships, criminal offences, anger, family violence and suicide. Without healing, trauma stays with you and can affect your mental health, physical health and your relationships.
The social determinants of health need to be realigned in a cultural context of understanding the impact of trauma for Aboriginal and Torres Strait Islander people and how to overcome – to heal – from this. Focusing on changing just economic or education levels alone will not fix the profound challenges we face without also giving people the opportunity to improve their social and cultural connectedness and feel greater inclusion.
At the Healing Foundation we support people to better understand their trauma and work with communities to lead their own healing solutions. A big part of the work we are doing involves training and education. And we want to see trauma-informed workforces – particularly when it comes to health.
For Aboriginal and Torres Strait Islander people being culturally trauma-informed as a means to address the social determinants of health includes; connecting back to culture through belonging to cultural groups (increasing connection); practicing cultural activities that build strong spirit and identity including dance, song, art (mindfulness); building strong families and communities through healing (supporting healthy fulfilling relationships); and increasing communities understanding of trauma and safe spaces for addressing this (building on existing community strength).
It’s time for our nation to address the burden of trauma that has been passed down from generation to generation among our people.
This is a fundamental first step if we are going to tackle the problem of a large life expectancy gap properly and create real change for our Aunties, Uncles, our families – and most importantly our young ones.
Australia must act on this issue, and now. It simply cannot afford not to.
– Thursday 16 March 2017
