By Chris Martin
Released last week, the federal government's review of its five-year National Aboriginal Health Strategy has added more detail to the picture emerging from various state studies of a permanent and deepening Aboriginal health crisis.
Alarmed by the report's findings, which place Aborigines worse off than many Third World peoples in their access to and use of health facilities and services, the government's immediate response has been to seek a scapegoat.
Federal health minister Carmen Lawrence has led a charge to take back control of Aboriginal health administration from the Aboriginal and Torres Strait Islander Commission (ATSIC), while Brian Howe and others have sought to defend ATSIC's role.
Greens (WA) Senator Christabel Chamarette argues that no lasting improvement to Aboriginal health is likely until real community control of health administration is in place.
On Commonwealth control of Aboriginal health care, Chamarette points out: "... this move must include major increases in funding as well as cooperation between the Commonwealth, the states and the community. This must be a partnership committed to the importance of local Aboriginal community control and participation."
In the Australian of February 9, NSW Magistrate and former head of the state Department of Aboriginal Affairs, Pat O'Shane argued that simply throwing more money at the problem is inadequate: "Millions of dollars have been expended on Aboriginal health affairs. A good deal has been wasted for various reasons including: an excess of bureaucratic requirements, yet the lack of real accountability procedures, an excess of personnel, yet a lack of proper training ... a proliferation of programs, yet a lack of co-ordinated, integrated plans."
O'Shane called for the National Aboriginal Health Strategy to adopt specific goals, for example: "eliminate trachoma within five years; 95 per cent child immunisation within three years; elimination of tuberculosis within ten years; provision of sanitary facilities in all Aboriginal communities within twelve months; sex education programs in all schools' curricula within two years; 85 per cent reduction in sexually transmitted diseases within five years and so on.
"Such programs need to be integrated with housing programs, tree planting programs, implementation of innovative water technologies, literacy programs (especially for women) and the like ... The one major factor militating against achieving such goals is the lack of political will within government and bureaucratic ranks."
In the Australian of February 13, Noel Pearson of the Cape York Land Council agreed with O'Shane on the lack of community control, citing the situation in Cape York where most services are located in Cairns and Townsville, well away from the Aboriginal community centres.
He went on to stress the need for coordinated planning, saying, "Improved Aboriginal health outcomes require a holistic approach which addresses primary care needs, improves housing and other infrastructure, works towards the restoration of land and repairing the spirit, gets on top of the alcohol problem and gets the community development going".
Pearson argues that ATSIC is the first step on the road to autonomy, self-determination and self management, while agreeing that it can succeed only if it wins the support of local Aboriginal organisations working directly with the community.