Illness Is a Weapon: Indigenous Identity and Enduring Afflictions

7. Closing the Gap

ChApteR 7 Closing the Gap I sn’t anyone doing anything to help?” I am often asked this question when discussing the pervasive ill health of Lajamanu. I invariably reply that improving Indigenous health is a national priority in Australia. As a result, a great deal of money is dedicated to increasing health education , upgrading facilities, and ensuring the provision of care. Over half of the Northern Territory’s health budget is spent on Aboriginal people, who comprise approximately one third of the population (Northern Territory Department of Health 2004, 35). In 2008, the Commonwealth government committed to providing A$21.5 million boost to remote area health services in the Northern Territory (Macklin 2008, 17). After quoting these figures, the next questions I usually receive are, “Where does all the money go?” and “Why doesn’t it make a difference?” To come to grips with the continuing reality of Aboriginal ill health, it is important to explore past and present government health policies and the assumptions that underlie them. The gap—a phrase used to characterize divergent health outcomes between Aboriginal and non-Aboriginal Australians—has become a wellknown and often invoked slogan. In presenting the rates of Aboriginal ill health across the nation, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples reviews “the burden of disease gap,” the “mortality gap,” and the “disability gap” (Pink and Allbon 2008, 148, 159). Like most other publications examining illness, it notes, “Wherever possible, data are provided . . . on the differences between Indigenous and non-Indigenous Australians” (Pink and Allbon 2008, xxi). The report repeatedly draws attention to the “stark contrast” between Aboriginal and non-Aboriginal data (Pink and Allbon 2008, 156). Statistics are marshaled to illustrate the disparity in health: The mortality rate for Indigenous people is almost three times that of non-Indigenous people, while Indigenous Australians were 1.3 times more likely to suffer from heart diseases and circulatory problems than non-Indigenous Australians, 3.4 times more likely to contract diabetes, and 10 times more likely to 149 have kidney disease (Pink and Allbon 2008, 151, 104). Statistics such as these have motivated a number of initiatives designed to improve Aboriginal health. One of the first attempts at a new approach to Aboriginal health, the National Aboriginal Health Strategy (1989), aimed to ensure that Aboriginal people would have the same level of access to health services and facilities as their non-Aboriginal counterparts by 2001 (Thomson and English 1992, 23). To achieve this goal the strategy advocated a primary health care approach employing intersectoral cooperation to facilitate improvements in housing, education, and health care delivery (National Aboriginal Health Strategy Working Party 1989). Cross-cultural awareness—possessing an understanding of Aboriginal culture, lifestyle, and sensibilities—was a primary feature of this method. Although “the task of the state is to equalize the outcomes for Indigenous and nonIndigenous : to make the lines on the graph converge,” this has come to include a recognition and preservation of cultural difference (Kowal 2010, 190). Unfortunately, the National Aboriginal Health Strategy did not precipitate a noticeable change in health outcomes and a review committee found little evidence of successful implementation (National Aboriginal Health Strategy Evaluation Committee 1994, 2).1 Despite a lack of results , recent health policies continue to echo the strategy’s goals. Almost twenty years later, the importance of environmental health, health promotion , primary health care, and culturally appropriate services continued to be stressed in policy documents.2 To complete the picture of Aboriginal health that I have sketched thus far and provide an explanation for why health has not improved despite numerous initiatives, the goals of policy must be examined beside the social , cultural, economic, political, and experiential contexts of Aboriginal communities. As a comprehensive exploration of Indigenous health policy could easily fill an entire volume, I will confine my analysis to four themes that can found throughout many initiatives across the globe: improving environmental health and infrastructure; developing education programs for Indigenous people; endorsing a holistic approach to health care; and educating non-Indigenous health professionals in a crosscultural approach. These goals are derived from similar assumptions: While improvements in infrastructure and facilities are needed, these changes are not considered sufficient to substantially reduce rates of illness . Aboriginal people must also modify their behaviors. Consequently, 150 IllNess Is A WeApoN health programs stress the importance of improving hygiene, nutrition, and compliance. For many of...