This conference is taking place on the land of the Gadigal people. It's customary for speakers at occasions like this to acknowledge the traditional owners and then quickly move on to the business at hand.

But if it's OK with you, I'd like to begin with some history that has direct relevance to what we'll be discussing over the next couple of days.

Archeologists believe that for around ten thousand years the Gadigal people lived in this area. Of course, the Gadigal people themselves consider that they've lived here since the beginning of time.

The Gadigal and the other Sydney clans were among the first Aboriginal people in Australia to see the coming of Europeans to this continent.

They were also among the first to feel the impact of the invasion of their land.

There are still descendents of the original Gadigal people living not far from here, around Redfern. One of them, Allen Madden is the acting CEO of the Metropolitan Aboriginal Land Council.

You may know Allen from the thought provoking and entertaining welcomes to country that he frequently gives for events similar to this conference.

However, Allen and his family are among the very few people who can trace their ancestry back to the Sydney area before 1788.

This is because most of the Gadigal people were killed within a short time of the Europeans coming here.

As a matter of fact, within two years of the European arrival, more than half of Sydney's Aboriginal people were dead.

The Gadigal people lived closest to the new settlement. They were reduced from 50 in 1788 to only three in 1790.¹

So rapid and comprehensive was this decline that the bays of Sydney Harbour were awash with the bodies of Aboriginal people. One of the colonists, who later became Governor, John Hunter recalled seeing whole families lying dead in the caves and among the rock shelters.

After fifty years, the once more than 3000 Aboriginal people in the Sydney area, numbered just 300.

It's a common belief that most of these deaths were caused by massacres, that the majority of Aboriginal people killed during the invasion were shot or poisoned.

Certainly, there were many massacres around Australia as Aboriginal people actively resisted the invasion of their lands. From around the 1820's right up to the Coniston killings in the Northern Territory in 1928, historians estimate that more than 20 thousand Aboriginal people were murdered.²

However, the biggest killer of Aboriginal people during the invasion wasn't guns or poisoned flour. It was introduced diseases like smallpox, influenza, tuberculosis and venereal diseases.

For example, by the time the Europeans reached the Nepean River, 60 kilometres west of here, the smallpox had got there first and many of the local Aboriginal people were already dead or dying.

The pattern was repeated right around Australia.

Smallpox predated the arrival of Europeans to what would become Adelaide. Early missionaries observed local Aborigines singing a nguyapalti – or smallpox song that they had learnt from tribes further east in an attempt to ward off the disease.³

We know of four major smallpox epidemics that cut swathes across Aboriginal Australia. The last began in the Kimberley in the 1860's, spread to the Pilbara and Northern Territory and down the coast as far as Geraldton. One group – the Karangpuruu from Victoria River Downs station were reduced from 500 to just two men.⁴

According to archaeologist, Josephine Flood, smallpox was to Aboriginal Australia what the Black Death was to Europe in the Middle Ages.⁵

So, the biggest killer of the killing times wasn’t guns, but disease.

Of course, I don't need to remind most of the people attending this conference that two hundred and nineteen years after the European invasion began, the greatest threat to the oldest living culture in the world is still disease and other preventable forms of death.

Neither, do I need to remind you of the statistics, because most of you know far more about these than I do.

Many of you also know better than I ever could about what lies behind these statistics: a tragedy of immense human proportions, children who will never know their grandparents, communities robbed of their elders, parents too often burying their own sons and daughters. As a non-Indigenous Australian, I'm struck by the Aboriginal families I count as friends who often seem to be locked in a constant cycle of grieving as they attend an endless procession of funerals.⁶

This situation has been so bleak for so long that I suspect it leaves many people who don’t attend conferences like this one numb.

Professor Mick Dodson describes it as a kind of industrial deafness in this country when it comes to the suffering of the first Australians.

For me, this numbness, or deafness on the part of our community is even more disturbing than the statistics.

I know that it's not because Australians aren't compassionate when it comes to helping those in need.

Australians should be proud of our generosity to the victims of the Asian Tsunami. However, too many of our fellow citizens seem unaware that a crisis of Tsunami like proportions is ripping the hearts out of Indigenous communities across our own country as we speak.

It baffles me why as a nation we don’t show the same kind of commitment to Australia's gravest national crisis - the Indigenous health emergency.

As Indigenous Social Justice Commissioner, Tom Calma, has pointed out, it is simply not credible to suggest that a country as wealthy as ours can't fix a health crisis affecting less than three per cent of our citizens.⁷

As many of you would be aware, Indigenous health was the focus of much of Commissioner Calma's 2006 Social Justice Report.

In the report, Commissioner Calma proposed that state and federal governments adopt two deadlines for ending Indigenous health inequality within a generation.⁸

ANTaR said at the time that we considered the deadlines proposed by Commissioner Calma – 10 years for achieving equal access to primary health care and health infrastructure and 25 years for achieving equality of health status and life expectation – were realistic and achievable.

We pointed out that it was shocking to think it would take a quarter of a century to lift the health of Aboriginal and Torres Strait Islander people to the level enjoyed by other Australians.

However, the situation has been so bad for so long that only a major, long term national effort of the kind proposed by Commissioner Calma will ensure success.

We agree that the lack of an agreed time frame has allowed the national scandal of Aboriginal health to fester for far too long.

As Commissioner Calma says in the report:

Perhaps the factor that is most striking, in its absence from the current framework, is the lack of a timeframe for achieving Aboriginal and Torres Strait Islander health equality… We should not be timid about setting a timeframe for when the solid commitments of government will be realized. The absence of such timeframes promotes a lack of accountability of governments. It sends a message that it is fine for things to simply drift along.⁹

Following the release of Commissioner Calma's report, a number of organisations came together to discuss how we might be able to campaign to convince governments to sign up to the deadlines. Led by Indigenous groups including the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Australian Indigenous Doctors' Association (AIDA), the group also includes largely non-Indigenous organisations like ANTaR, Oxfam and the Australian Medical Association.

It's this campaign that I'd like to talk to you about today.

Our aim is to have every federal, state and territory government in Australia make a measurable, properly resourced, bi-partisan commitment to closing the Indigenous life expectancy gap within a generation.

These commitments can’t be an empty promise. They must be accompanied by measurable action plans that are properly funded.

These plans will have to recognize that increasing Indigenous control and participation in the delivery of health services is crucial.

They will also need to take into the account social determinants of health such as housing, education and self determination.

We think that the 40th anniversary of the 1967 referendum is an appropriate time for a campaign of this nature.

There are strong parallels between the referendum campaign and our own. The 1967 campaign was supported in a bi-partisan manner at both the federal and state level. It demonstrated the success of a grass roots campaign of Indigenous and non-Indigenous people working together. Importantly, the Yes vote was a major step forward for Aboriginal people during the life of a Liberal Federal Government.

Of course, the campaign won't succeed unless we overcome the "industrial deafness" that Mick Dodson has spoken about. To do this we need to persuade more non-Indigenous Australians to care and to act. And we need to get them to pass this message on to our politicians.

Perhaps one of the reasons why more people don't act is that not enough of them, who don't get the opportunity to attend forums like this one, are aware of how Indigenous organisations right around the country are tackling and overcoming the poor health of their people.

Australians have been conditioned to think of Indigenous health in terms of despair rather than success. We suffer from the misconception that greater investment in Indigenous health won't achieve a satisfactory return.

In order to challenge this misconception, ANTaR has compiled a book of Success Stories in Indigenous Health, to be released next month.

With the support of the Rio Tinto and Mercy Foundations we've gathered stories from every mainland state and territory about how Indigenous community controlled health programs are improving, extending and saving lives.

Many of these programs I'm sure you'd be familiar with, but they remain largely unknown to the general community.

They include programs like these:

• One from my home town of Townsville in North Queensland, where the local Aboriginal and Islander Health Service developed a 'Mums and Babies' program to tackle the low birth weight of Aboriginal and Torres Strait Islander babies;
• The Mt Theo Outstation program that has reduced petrol sniffing in the Tanami Desert community of Yuendumu from 70 regular sniffers down to zero;
• Blackout Violence – started by Aboriginal women from Redfern, who with the support of the Metropolitan Aboriginal Land Council have used the sport of rugby league to stamp out family violence;
• The "Snake Condom" program that aims to reduce unplanned teenage pregnancies and sexually transmitted infections in Victoria;

The booklet also features programs to improve nutrition in Victoria and Western Australia; break the cycle of trauma caused by violence and abuse in New South Wales and Western Australia, improve the retention of Indigenous medical students in NSW, tackle substance abuse in the ACT, improve housing in NSW and a range of others.

We hope that the innovation, diversity and success of the programs featured will encourage our politicians to do more to end Australia's Indigenous health crisis. We also want the book to inspire the general community to demand more of our political leaders than they've shown in the past.

Our aim is to demonstrate to governments and the broader community that success in Indigenous health can be achieved if we're fair dinkum about working with Indigenous people and supporting programs such as these.

The book is intended for a general audience. It's not an academic text so I’d be reluctant to over analyse the contents. But there are some factors that many of the programs seem to have in common.

The first is that the majority could be described as "bottom up" rather than "top down". Most of them originated at the local level, driven by priorities decided by individual Indigenous communities. Some employed methodologies pioneered elsewhere, but these were adapted so that they have local relevance. Most of the programs depend on the knowledge, authority and support of community elders for their success. All of them are positive examples of Indigenous community control. They show that improved health outcomes are less likely to come from miracle cures or imposed new treatment regimes than by the ability of Indigenous people to determine their own futures and be accountable for decisions impacting on their own communities.

Of course, focusing on success alone, while it may give us all a warm inner glow, is unlikely to be enough to achieve the change we would like to see.

Indeed, it could be counterproductive. It could encourage a mistaken perception that all is OK in Indigenous health, that Governments are doing enough and things should be allowed to just drift along. That we can afford to coast and take our feet off the pedal.

Unless a vision of success is accompanied by a greater sense of urgency and compelling examples of the consequences of not acting, Governments will be let off the hook. The deadlines proposed by Commissioner Calma will not be agreed to, much less met and ten years from now there'll be the same discussions occurring at conferences very similar to this one.

For this reason, ANTaR applied for and recently received confirmation of funding from a charitable foundation to gather film footage from up to seven different communities that will show the human consequences of Australia's Indigenous health crisis. We hope this footage will help convey the human tragedy behind the statistics.

We're concerned to collect this footage sensitively, by observing all of the appropriate protocols so that it supports, rather than exploits the communities featured. Our aim is for it to complement the Success Stories booklet. The booklet shows what can be achieved if we support Indigenous health initiatives. The film will show the consequences of not acting.

If we are to get people to act, we need to let them know that the campaign is supported by organizations and individuals they have confidence in.

Late last year ANTaR was pleased to be one of the organisations signing an open letter published as a full page ad in the Australian calling on all governments to commit to Commissioner Calma's deadlines.

The letter pointed out that while there are already national commitments and policies in place to address Indigenous health inequality – what is missing are appropriately funded programs that target the most vulnerable.

Among the almost 40 organisations signing the letter were the Human Rights and Equal Opportunity Commission, Oxfam, NACCHO, AIDA, the Australian Council of Social Service, Caritas, UNICEF, the Australian Red Cross, the Cooperative Research Centre for Aboriginal Health, the Fred Hollows Foundation, the Royal Australian Colleges of General Practitioners and Physicians and the Telethon Institute for Child Health Research.

We've now received replies from the Federal Health Minister, the Federal Opposition and most of the states.

While he was still Opposition Leader, Kim Beazley committed to reversing Australia's third world Indigenous health statistics within two terms of office.

In their letter, Labor said that the new Opposition Leader, Kevin Rudd stands by the commitment made by his predecessor.

In his reply, Health Minister, Tony Abbott said that "the idea of establishing targets is potentially useful," and indicated that his department would be setting up a working group to explore the use of targets.

Unsurprisingly, neither the Government, Opposition or states have committed to the funding increases that most experts consider are essential to overcoming the Indigenous health crisis.

Although, we know that money is not the answer alone, particularly when it's not accompanied by doing things better, this lack of a funding commitment is one of the key barriers to closing the life expectancy gap.

In this, I'm reminded of the words of Julie Tongs' and my former boss, Robert Tickner who said that:

While it is undeniably important that indigenous people play their part in improving health through personal responsibility and community driven programs to tackle such issues as bad diet and substance abuse, they cannot make the necessary changes alone. Without the strategic intervention of the national government, driven if necessary by a campaign of public opinion, no lasting change will be possible.

It seems to me that those words still apply, six years after Robert wrote them in his book, Taking a Stand.

For his part, the Federal Health Minister correctly points out that his Government has increased funding on Indigenous health since 1996.

However, his preference is for a gradual increase in funding, rather than the more significant investment called for by the Australian Medical Association, Access Economics, Professor Ian Ring, NACCHO and others.

According to Minister Abbott, funding should only proceed within the capacity of the sector to grow, especially in rural and remote areas.

While this may sound reasonable on the surface it doesn't ring true to many of the people running the programs featured in ANTaR's Indigenous Health Success Stories booklet. Too many of these programs have been prevented from expanding – not because of lack of capacity, but lack of funding.

It also doesn't ring true to my own experience working within government as a ministerial adviser.

When Treasurers and Cabinet Expenditure Review Committees knock back Indigenous programs that Departmental officers have worked long and hard on to develop, it's usually not because of a lack of capacity but a lack of political will.

For a recent example close to home, you only need to look at the New South Wales Government's failure to find any new funding for its response to Breaking the Silence, a 300 page report on child abuse in Aboriginal communities, commissioned by Attorney General, Bob Debus.

Written by a task force headed by Aboriginal leader, Marcia Ella-Duncan, Breaking the Silence found that child abuse in Aboriginal communities had reached "epidemic proportions," with child sexual assault up to four times the rate of the general population. According to Ms Ella-Duncan, the report paints a "stark picture of intergenerational abuse and social disadvantage."

Task force members showed enormous courage to speak out on such a painful subject. After a meeting with Premier Morris Iemma they were left with the impression that the Government had listened to them and was persuaded that preventing Indigenous children being abused was a top priority.

They believed the government was morally outraged enough to commit the resources needed to seriously tackle the problem. They were wrong.

Announced over the Christmas break, the Government's response to Breaking the Silence is a five year plan containing 88 sensible recommendations, but not a skerrick of additional funding to assist their implementation.

The Sydney Morning Herald reported that three Ministers including Attorney General Debus argued for between $20 and $40 million per year to fund the package. However, they were blocked by Treasurer Costa, who at around the same time found $25 million to compensate the operators of the Lane Cove Tunnel for delaying potentially unpopular road closures until after the state election.

The Government announced its response at a time when the taskforce Chair was away and difficult to contact.

This may have been clever politics, but the Government's refusal to adequately fund the package will undoubtedly cost some Aboriginal children their lives and destroy many more others over the coming years.

According to one senior bureaucrat who contacted the Indigenous newspaper, Koori Mail, agencies are already stretched beyond capacity and will be unlikely to achieve the necessary changes with no additional resources.

A former senior bureaucrat herself, Ms Ella-Duncan agrees. She said the failure to allocate proper resources would just place more pressure on already ill-equipped departments, despite the undoubted good intentions of many within the government.

So the decision by the state's Treasurer had nothing to do with a lack of capacity but that was its result. The sad truth is that no other group of children in New South Wales would have been treated in this way. The package wasn't properly funded because these are Aboriginal children at risk and it was calculated that not enough voters would care.

That's also the reason why state and federal politicians don't properly fund other programs that would save Aboriginal lives. They simply don't think that enough people care. Together with an increasing number of other organisations and individuals – both Indigenous and non-Indigenous, ANTaR is working to prove them wrong.

Firstly, we're trying to counter the myth that Governments are currently devoting sufficient spending to Aboriginal health by presenting the following facts:

This year the Federal Government will spend approximately $390 million on Indigenous-specific health programs. This is around 0.9 percent of the total Health and Ageing portfolio budget of $39.4 billion. Given that Indigenous people also draw on the mainstream health budget, it's estimated that for every health dollar spent on non-Indigenous people, the government spends around $1.17 on Indigenous people.¹⁰

That would be a reasonable figure if Aboriginal health was only seventeen percent worse than the health of everyone else.

But Aboriginal people are 300 percent sicker on average than everyone else. As a result, this figure is woefully inadequate.

We're also reminding people of how the Australian Medical Association's estimate of the required additional spend of $460 million per year compares to the tax cuts announced by the Treasurer in last year's budget.¹¹

According to the AMA's figure, $1.84 billion is required over the next four years to overcome the Indigenous health shortfall. That's a fraction of the $37 billion in tax cuts to be handed out during this time.

Of course, funding is only one component and it's not just governments that bear responsibility. You've probably heard of Reconciliation Australia's initiative encouraging organisations of all shapes and sizes to develop Reconciliation Action Plans to demonstrate how they will contribute to closing the life expectancy gap. ANTaR thinks this is a fantastic initiative and we support it 100 percent. However, our particular contribution to the campaign is in the area of advocacy and that's why I'm focusing primarily on the area of government responsibility.

Once we've convinced people of the merits of the case, we need to provide them with a vehicle to help them act.

ANTaR is doing this with a variation on our Sea of Hands concept.

For people who may not know about ANTaR, we're a national network of mainly non-Indigenous organisations and individuals working in support of justice for Aboriginal and Torres Strait Islander people.

We were formed in 1997 and are probably best known for the Sea of Hands. The Sea of Hands has been signed by more than 300 thousand people and displayed in every major city and many regional locations. You may have attended Sea of Hands events at places like Bondi and Manly Beaches, Hyde Park and outside Parliament House, Canberra.

We're currently creating a virtual Sea of Hands on our website that will allow you to upload a hand with your details on the site and simultaneously send an email to your local politicians asking them to commit to Commissioner Calma's deadlines.

You'll also be able to send an email via the site to your friends and colleagues inviting them to participate. You'll be able to track the progress of the campaign on our website. As more people join the campaign the Sea of Hands will increase in size and density. You'll be able to scroll over the site and see your own hand and those of thousands of others. We hope that hundreds of thousands of people will sign up to the virtual Sea of Hands to show politicians that we do care and expect action on Indigenous health.

We hope to have this up on our site by early April. But already on the site you can sign a pledge and download a hard copy to distribute.

As possibly the only speaker at this conference who couldn't be described as an Indigenous health expert, I'm acutely aware that advocacy should be only one component of our efforts to close the life expectancy gap between Indigenous and non-Indigenous Australians.

Advocacy is no substitute for the vital, hard and sustained work in research, community health as well as policy development and delivery that many of you conduct every day.

But equally, those efforts will continue to be compromised unless they're backed by an equally sustained effort to harness public support and change the behavior of those in power so that their priorities for action match their rhetoric.

I began with some history and I'd like to conclude with some other, more recent history. It's recent enough for people like Julie Tongs and Ken Wyatt to remember it, I'm sure.

Around 14 years ago, the then Minister for Health, Graham Richardson went on national television and said that he would solve Australia's Indigenous health crisis. He said that $1.3 billion was needed in new funding and he would deliver it. However, shortly after that he retired from parliament and those promises were never delivered.

A couple of years later, another politician, the Minister for Aboriginal and Torres Strait Islander Affairs, Robert Tickner took a proposal to Cabinet that would have seen $500 million devoted to fixing the basic infrastructure so essential to improving Indigenous health.

However, in the dieing days of the Keating Government, just after a particularly disastrous bi-election and with a general election looming, the proposal was defeated and Indigenous communities never saw that money.

What was a shattering defeat for Robert was an even greater loss for those Indigenous people whose lives were cut short by the Government's unwillingness to act.

More than a decade later, I wonder what, if any, progress has been made, despite all the hard work, commitment and intelligence of so many people.

This is not in any way meant as a criticism of anyone in this room, nor of the thousands of decent people who've dedicated their lives to Indigenous health and who've achieved some remarkable successes.

But it is a comment on the nation's priorities, or more correctly the lack of them.

I also wonder what conferences like this one will be discussing 10 and 25 years from now.

Will they reflect on how we finally achieved equal access to primary health care and health infrastructure and how a generation after Tom Calma made his call we closed the life expectancy gap?

Or will they focus on the same question that will be posed at this conference after lunch, whether we're doing enough given the lack of improvement in key areas?

While we're under no illusion about the size of the task ahead, ANTaR is determined to persuade as many people as we can to support the campaign and get governments to commit to those deadlines and resource them with a vision and anticipation of success.

However, as a small, largely non-Indigenous organization we won't be able to come close to doing this alone.

We aren't Indigenous health experts and our advocacy will fail unless it's informed by the expertise of people like yourselves.

We're also largely a non-Indigenous organization. So we can only proceed if the campaign proceeds according to Indigenous priorities and allows space for Indigenous leadership.

So I hope that you'll take an interest in our work as well as the work of our campaign partners like the Human Rights and Equal Opportunity Commission, NACCHO, AIDA, Oxfam, the AMA and others.

I hope that you'll advise us on areas you think we should focus on and tell us if you think we're on the wrong track.

And most of all, I hope you'll support the campaign and encourage others from your organisations to do the same.

If that happens, together we might be able to say we’ve succeeded in a task that ever since the invasion of the Gadigal lands 219 years ago as a nation we've always failed in – achieving equality of life expectancy between Indigenous and non-Indigenous Australians.

Then we could really say that Indigenous health is everybody's business.

Footnotes

¹ Josephine Flood, The Original Australians, Allen & Unwin, 2005, p 38.

² Flood, p 105.

³ Flood, p 107.

⁴ Flood p 128.

⁵ Flood p 128.

⁶ Jeff McMullen makes a similar point. I'm indebted to Jeff for much of the material (PDF) in this presentation.

⁷ Social Justice Report, p 12.

⁸ Social Justice Report, p 10.

⁹ Social Justice Report, p 67.

¹⁰ Australian Government, Portfolio Budget Statements 2005-06, Health and Ageing, p 115.

¹¹ Australian Medical Association, Aboriginal and Torres Strait Islander Health Service Funding (PDF).