Skip to 0 minutes and 14 secondsThe reason why we advocate for cultural capability in nursing and midwifery students, when they're working with Aboriginal and Torres Strait Islander peoples, is because we hear so many times, I treat everyone the same. And in actual fact, when we talk about equity and equality, we actually can't give everyone the same thing, because people have started in a different place. And in the case of Aboriginal and Torres Strait Islander Australians, we have had whole legislations that have stopped people from going to school. Hence, we have low education attainment. I, myself am the first one from my family to actually get a university degree.

Skip to 0 minutes and 52 secondsAnd here we are, well, at the time it was the '90s, I think, when I gained my first degree. But-- so we're behind the eight ball. So it's kind of like if you've ever seen the image of a fence. And if people are on different steps to see over the fence, we have to give people what they actually need to be able to achieve equity in Australia. If you use the same inputs and treat everyone as if they're the same, you will of course guarantee an inequality of outcomes because everybody has different needs. If you have an inequality of inputs because different people's needs are being met, you're more likely to guarantee an equality of outcomes.

Skip to 1 minute and 31 secondsAnd that is the difference between equality and equity or sameness and fairness or equality and social justice. So currently when we use the term Aboriginal and Torres Strait Islander health in Australia, what we really mean is fitting Aboriginal and Torres Strait Islander people into a western, biomedical health system as if that system is normal, and as if nothing has to change about that system. We're taking an epidemiological approach that Aboriginal health is simply another cohort. It's just another cohort. And you just try and get that cohort to get the best services from this normal, equal health system that's set up for everybody. But therein lies the reproduction of inequity. Doing that we're actually reproducing inequity.

Skip to 2 minutes and 21 secondsWhereas really if we're talking about Aboriginal and Torres Strait Islander health we have to take a paradigmatic approach, where we're saying that Aboriginal health is not just a cohort, it's actually about what Aboriginal health and Aboriginal people can teach the rest of medicine and health about good health care and delivery. We didn't survive here for 60,000 years because we knew nothing about medicine or nothing about health or nothing about the land. We have our own particular science and way of delivering health care that must have some value. But the system is currently not set up to value Aboriginal and Torres Strait Islander knowledges. And it's certainly not set up to deliver it.

Equity and equality aren’t the same

Trying to solve inequality assumes we all have the same opportunities and experiences. The reality is that Australia’s First Peoples continued experiences with racism makes this untrue. Only when we begin to address inequity can the playing field be truly levelled (Decuir & Dixson, 2004, p. 29).

Let’s explore further.

Equality

Equality relates to ‘sameness’. It promotes fairness and justice by working to provide everyone with the same thing. The problem is, equality can only work if everyone starts from the same place.

Equity

Equity relates to fairness. It is about making sure people get access to the same opportunities. Sometimes our differences and our history creates barriers to participation. This means we must first ensure equity before we can enjoy equality.

Image visually represents the difference between equality and equity Interaction Institute for Social Change Artist: Angus Maguire www.interactioninstitute.org www.madewithangus.com

Inequities and inequalities in health

The health and wellbeing of Australia’s First Peoples continues to be influenced by colonial policies and practices. While advances in medicine have improved the health of Australians over recent decades, the health of Australia’s First Peoples hasn’t improved at the same rate.

The World Health Organisation (2016) defines health inequalities as the ‘difference in health status or in the distribution of health determinants between different population groups’. It recognises that some determinants of health are ‘unnecessary and avoidable, as well as unjust and unfair’, resulting in health inequalities and inequities (WHO, 2016).

This concept of ‘unfairness’ is central to understanding ‘inequity’. When it comes to socially disadvantaged groups, such as Australia’s First Peoples, racism and discrimination hinders access to opportunities to pursue health (Taylor & Guerin, 2014). And that’s not OK.

Inequity has a long history for First Peoples

The inequalities and inequities we continue to see in the health status of First Peoples is representative of the bigger picture relating to their lack of human rights in Australia. The fight for equality, equity and cultural recognition continues to be overlooked.

For example, did you know that Australia’s First Peoples are not recognised in Australia’s constitution? Did you know that Australia is the only Commonwealth nation that doesn’t have a treaty with its Indigenous people? If you’re not sure what a treaty is, in this context, it’s an agreement between Indigenous peoples and governments.

The Australian Constitution

When the Australian Constitution was being drafted, Aboriginal and Torres Strait Islander peoples were excluded from the discussions concerning the creation of a new nation to be situated on their ancestral lands and territories. The Australian Constitution also expressly discriminated against Aboriginal and Torres Strait Islander peoples. The Australian Constitution did not – and still does not – make adequate provision for Australia’s first peoples…it has failed to protect Aboriginal and Torres Strait Islander rights as the first peoples of this country (Australian Human Rights Commission, ND).

It’s a human rights issue

Watch the UN Declaration on the rights of Indigenous peoples. It’s an informative video highlighting the significant steps forward in recognising Australia’s First Peoples’ rights, but also the setbacks in the past three decades. First Peoples have the right to culture and identity.

This is an additional video, hosted on YouTube.

One of the best ways Aboriginal and Torres Strait Islander people can help bring about positive change is by using the language of rights when talking about the issues in their communities. Using the Declaration reminds all levels of government of what these rights are.

Since 2016, the Victorian Government has been working with Aboriginal Victorians towards Australia’s first treaty. The Uluru Statement from the Heart is the most current issue in Indigenous affairs, calling for the establishment of a First Nations Voice in the Australian Constitution and a Makarrata Commission.

Listen to the audio link to hear Professor Gregory Phillips talk about the Constitution of Australia and his thoughts on the recent proposal of a treaty for Australia’s First Peoples.

Listen to Professor Gregory Phillips

Your task

Did you already know that First Peoples continue to remain unrecognised in the constitution? How comfortable are you with this, from a human rights perspective? Share your thoughts and comments with the group.

References

Australian Human Rights Commission (ND). Constitutional Reform: Fact Sheet - Recognising Aboriginal and Torres Strait Islander People in the constitution.

Decuir, J.T. & Dixson, A.D. (2004). So when it comes out, they aren’t that surprised that it is there: Using critical race theory as a tool of analysis of race and racism in education. Educational Researcher, 33(5), 26-31.

Taylor, K. & Guerin, P. (2014). Health Care and Indigenous Australians. South Yarra, Australia: Macmillan Education Australia

World Health Organisation (WHO). (2016). Health Inequality and Inequity.

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This video is from the free online course:

Safer Healthcare for Australia's First Peoples

Griffith University