At the recent graduation of health science students in Sydney, Father Frank Brennan SJ AO spoke of the challenges in closing the gap on Aboriginal disadvantage. The following is an excerpt from his address.
Thank you for the honour of being the last lecturer to whom the 2011 graduands from the Faculty of Health Sciences have to listen – and without the need for any marking or assessment.
Yesterday I stopped over in Townsville to visit an Aboriginal friend who is doing life in the Townsville jail. Though Aborigines are a single digit, small percentage of our population, they are the overwhelming majority in the Townsville Women’s Prison. My friend was trained in the health sciences. I asked her what I should say to you today. She said, "Look with two eyes. Look beyond. Look for things which are unspoken. They are the things that matter. When your spirit is broken you cannot communicate your pain. That’s why my people are sick."
Those of you graduating in the health science know the challenges confronting us in closing the gap on Aboriginal disadvantage. The current gap in Aboriginal life expectancy is estimated at 11.5 years for males and 9.7 years for females. Non-Indigenous life expectancy is expected to rise over coming years. So Indigenous male life expectancy will probably have to increase by almost 21 years by 2031 to close the gap. This is a challenge for all Australians, especially those of you who are to be health professionals. Approximately 70 per cent of the gap in health outcomes is due to chronic diseases, which tend to have common lifestyle-related risk factors such as smoking, poor nutrition, obesity and low levels of physical activity.
There are five key influences on our health: genetics, social circumstances, lifestyle, accidents, and access to healthcare. Often we focus only on the access to healthcare. There is not much we can do to alter our genetics. With better occupational health and safety at work, good design standards, and improved public infrastructure, we can reduce the risk of accident. The World Health Organization (WHO) and Sir Michael Marmot in the UK have done a power of work finding that social determinants have a big impact on health outcomes. If you are from a poor, dysfunctional family with little education and low job prospects, your health outcomes most probably will be much worse than those of the person from a well-off, functional family with good education and fine job prospects. The Rudd Government started concerted work on addressing the social determinants of health for Indigenous Australians with the annual Closing the Gap report. Is it not time for a similar approach to address the health needs of marginalised groups in the community generally?
The Commonwealth has undertaken fresh initiatives to improve the lifestyle of Australians most likely to have poor health outcomes – especially smokers, heavy drinkers, the unexercised and the obese. But there is only so much government can achieve in attempting to modify people’s behaviour without also improving their prospects in education, housing, work, income and social connectedness. Policies that target behavioural change in a vacuum just do not work. There is little point in telling the unemployed, homeless person with minimal education and few social contacts: "Don’t smoke and don’t go to McDonald’s. It’s not good for you."
The Gillard Government maintains a commitment to social inclusion. Sir Michael Marmot found in the UK that health inequalities result from social inequalities. He has put forward the idea of proportionate universalism. He says, "Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage."
It is not a matter of just providing more resources which improve the lot of all persons – much like the rising tide raises all boats. At the same time as we lift the bar, we want to decrease the steep gradient between those with the best and those with the worst outcomes, whether the indicators are income, education, housing, employment or social connectedness.
We need to break down the silo mentality. As health professionals, you need to be aware of the inequalities confronting your patients, being committed to greater equity in their local regions so that the scarce health dollar might deliver better real health outcomes for all, especially those whose health is most at risk.