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Proponents of the upcoming referendum on the Voice to Parliament say it will help to Close the Gap in Indigenous health outcomes, and one academic interviewed for this article said she understood why some Australians have questions about the referendum.
First Nations health and wellbeing is front of mind as Australia draws nearer to the 2023 referendum regarding the Aboriginal and Torres Strait Islander Voice to Parliament (the Voice).
For this article, InSight+ looked at what the Minister for Indigenous Australians is saying about the Voice.
We also spoke to prominent Australian health practitioners and academics to get their thoughts on the referendum, what it means, how it relates to First Nations health and wellbeing, and what they think about the vote.
Minister Linda Burney addresses the nation on the Voice
Minister for Indigenous Australians, the Hon Linda Burney, identified health as the first issue she would ask a Voice to Parliament to address in her National Press Club address this month, if the vote to alter the Constitution were successful.
“In 2023, it’s time for Australia to recognise Indigenous Australians,” Minister Burney said.
She went on to address questions regarding why she believes a Voice to Parliament is needed.
“The simple answer is because the gap isn’t closing fast enough,” said Minister Burney.
“For too long, governments have made policies for Indigenous Australians, not with Indigenous Australians. We need the Voice to change that.”
The concept of “Nothing about us without us”, includes the idea that Aboriginal and Torres Strait Islander health initiatives are more successful when Aboriginal and Torres Strait Islander people are involved in and responsible for them.
Minister Burney referred to new data showing that just four out of 19 targets for Closing the Gap are on track.
“We can and we must do better,” said Minister Burney.
“I honestly believe the Voice can help,” said Minister Burney. “[It] will be mechanism for government and Parliament to listen.
“It will be like a resource of local knowledge and solutions that can help us make better policies.”
During NAIDOC (National Aborigines and Islanders Day Observance Committee) Week, Minister Burney presented Dr Kelvin Kong, an otolaryngology, head and neck surgeon at John Hunter Hospital, with the 2023 NAIDOC Person of the Year Award.
Dr Kong has called for improvements in the health of young Indigenous Australians to stop them “falling through the cracks”.
Calling for structural change: the Uluru Statement from the Heart
The call for a 2023 referendum on the Voice to Parliament originated with the 2017 Uluru Statement from the Heart.
Representatives from more than 250 Aboriginal and Torres Strait Islander groups gathered to sign the document, inviting Australians to take action to create a better future for First Nations peoples.
The Statement called for two main actions: recognising Indigenous people in the Constitution with a Voice to Parliament, and Makarrata (or treaty).
The Voice (whose design principles are outlined here) would be a permanent body, outside of politics, advising the Australian Parliament and its executive on legislation and policy of significance to Aboriginal and Torres Strait Islander peoples.
This year, the government passed a bill triggering a referendum on the Voice to Parliament.
The referendum is expected to occur in October, on a date to be announced.
Proponents of the Voice suggest that a more permanent advisory influence at this level will improve the health and wellbeing of Indigenous Australians, enabling Australia to Close the Gap in the health of Indigenous and non-Indigenous peoples.
Dr Ngaree Blow on the Voice and Aboriginal community control
Dr Ngaree Blow is a Quandamooka, Goreng-Goreng and Yorta-Yorta woman completing her advanced training as a public health physician.
She works as the Director of the Wurru Wurru Health Unit at the University of Melbourne and was a lead medical officer for the coronavirus disease 2019 (COVID-19) outbreak response in 2020–21 with the Victorian Department of Health.
Dr Blow hopes that the referendum outcome is a “Yes” vote, but says that the success of a Voice in improving Indigenous health and wellbeing depends on many factors.
“If there is a yes to the vote – which I do hope there is because I think a ‘No’ is more detrimental to our communities – we then have to think about how much this Voice has say over what happens,” said Dr Blow.
Dr Blow said that, in her experience as a lead medical officer during the COVID-19 pandemic response, the success of Aboriginal community controlled programs suggested that a Voice to Parliament could help more than just Indigenous communities in its holistic approach to health and wellbeing.
“Aboriginal community controlled institutions were knocking on the door of government well before government were thinking about them,” said Dr Blow.
“During that response, I advocated for our team to also [focus on] refugee and migrant communities, because they were having the same issues that we were: having fewer security blankets around employment and being able to access [COVID-19] education when you couldn’t leave your home.
“Even though this Voice to Parliament is meant for First Nations, having that voice enshrined in the Constitution could have huge impacts and benefits … that could benefit all people,” she said.
To improve holistic health for Indigenous people, the Voice would need to come alongside treaty and truth-telling about Australian history and colonisation, Dr Blow said.
“All three things have to happen in order for there to be self-determination.”
AIDA announces its support for the Voice
Dr Blow refers to the Australian Indigenous Doctors’ Association (AIDA) this month announcing its support for the Voice to Parliament (here).
AIDA stated that the wellbeing of Aboriginal and Torres Strait Islander peoples should no longer be discriminated against and politicised.
“The position that AIDA holds is based on our vision to rectify the continued health disparity that disproportionally affects Aboriginal and Torres Strait Islanders and this unique opportunity to influence policy, which may not present itself again in our lifetimes,” it said.
Despite support for the Voice, questions remain
Dr Kelly Menzel, the Associate Dean Education at Gnibi College, Southern Cross University, has written about her reaction to the Voice, and also spoke with InSight+.
She is a Ngadjuri woman from South Australia with ancestral connections to the Bundjalung Nation in northern New South Wales and south-east Queensland.
Dr Menzel said she wondered whether a “Yes” vote could be treated as a panacea for the work of reconciliation, saying that the work is the job of all Australians, not merely First Nations people.
“I absolutely believe and agree that Aboriginal people’s voices should be privileged,” said Dr Menzel.
“I took a transcript of Linda Burney’s speech at the Press Club to know more. I understand the concepts, and I’m still not 100% clear.
“I understood and agree with the rhetoric that Aboriginal people should be taking care of Aboriginal business. We are the first peoples of this continent and, as such, should be recognised.
“But I still have these unanswered questions. And if I do as an Aboriginal person, non-Indigenous people must have so many questions,” Dr Menzel said.
How will the referendum work?
On referendum day, Australians over the age of 18 years will be asked to vote. The question asked will be:
“A proposed law: to alter the Constitution to recognise the First Peoples of Australia by establishing an Aboriginal and Torres Strait Islander Voice. Do you approve this proposed alteration?”
For a referendum to pass, the vote must achieve a double majority (a national majority; ie, more than half of voters from all states and territories) as well as a majority of votes from at least four of the six states (votes from the Australian Capital Territory and the Northern Territory will count only toward the national majority).
The Australian Electoral Commission (AEC) will issue a pamphlet before the referendum including 2000-word summaries of both the “Yes” and the “No” campaigns.
The AEC has said that, although it is not responsible for fact-checking the summaries, it is considering partnering with third-party organisations that would.
It has also created a “disinformation register” about the referendum process on its website.
This is one of several articles on the Voice that InSight+ intends to publish before the referendum.
If you would like to submit an editorial for consideration, send a Word version to mjainsight-editor@ampco.com.au.
Regrettably, the article presented is biased in that it really only presents the Australian Labor government’s perspective. Was the opposition spokesperson on Aboriginal Affairs or Warren Mundine given an opportunity to present the alternative No case so there is a balanced discussion? There also appears to be no comments from those health workers supporting the No case. One wonders if this is another “group think” promotion for the yes case without due consideration for pros and cons of the case?
In reply to Max (July 18, 2023, at 2:57 pm) let me say that the past paternalistic attitudes of governments towards Indigenous peoples have to come to a stop. Giving Aboriginal and Torres Strait Islander communities a say in the matters that affect their communities will mean better policies that get better outcomes. The VOICE will provide more clarity about objectives and in identifying manageable priorities. Too often, public servants have lacked cultural competence, and have failed to develop respectful relationships with Indigenous partners. Many government officers lack the skills and experience in whole-of-government and inter-governmental approaches, save alone the concept of ‘place-based’ initiatives (see, for instance, the Birthing on Country Centre of Excellence at Waminda, an Aboriginal Community Controlled Health Service in Nowra, NSW, which supports cultural safety during pregnancy, birth and the postnatal period). Frequent changes in government personnel exacerbate the skills deficits and disrupted relationships with community partners. It is true that some, if not many, Indigenous community leaders lack skills in community governance, engagement, and capacity building. Likewise, the same can be said about government bureaucrats tasked with providing solutions to Indigenous health and social wellbeing problems that they do not fully comprehend. The VOICE will ensure that these skills deficits will be addressed and will call for a greater focus on ‘shared responsibility’, effective coordination and decision-making mechanisms, and less reliance on ‘quick wins’. As regards the often-read comments of the past ‘throwing of heaps of money at Aboriginal problems with little to show’, surely this is an argument that points to the inability, or the not wanting to do so, of governments to evaluate policies and programs for Indigenous peoples. Of course, the evaluation process must involve both sides. If the VOICE is to work then it is opportune that evaluation be taken on board by both sides.
I suggest that Max investigate the Diabetes Management and Care Program that was developed by a not-for-profit, Aboriginal-run organization, Unity of First People of Australia, to address the special needs and problems of ‘lifestyle’ diseases among Aboriginal people in remote Western Australia. Having commenced in 2002, only after several months of the program’s operation, positive changes in knowledge about food, nutrition, exercise, and disease and altered attitudes and behaviours related to dietary and exercise patterns came about. There were also improvements in weight control and in pathology test results relevant to the risk of subsequent development of diabetes and cardiovascular disease. These results have come about because of the input of Aboriginal persons on the ground not by government bureaucrats in Perth or in Canberra. The program explained and raised community awareness, in locally and culturally appropriate ways, why so many Aboriginal people become overweight or obese and develop diabetes, cardiovascular disease, and chronic renal disease and their complications. This was done by using patient, empathetic, community-based carers who understand Aboriginal people well and who were trusted by them. This program goes back to 2002. Since then, what have governments learned about the abilities that Indigenous people have to solve and for that matter, want to solve, health issues that affect them? With the VOICE to Parliament, we will see more of these initiatives because Aboriginal and Torres Strait Islander people will be given the opportunity to indicate to government policy- and decision-makers what will work best for First Nations people. The VOICE will be a two-way process and aid in better collaboration between Indigenous peoples and both the holders of the government purse strings and government policymakers.
Yes agree with Max , much of the advocacy around the voice presupposes that it will discover solutions to the many intractable generational problems that hundreds of millions of dollars, decades of sincere endeavour and a vast network of indigenous advisory bodies have been unable to do.
How it will do this and why it will succeed when all else before it has failed and why it needs to be enshrined in the Constitution to do so has not been satisfactorily explained.
The question in the referendum must be revised and the two distinct propositions asked. The result will be a resounding endorsement of constitutional recognition with the fate of the voice much less certain. Conflating the quite separate and distinct issues of indigenous constitutional recognition and the constitutionally enshrined voice seems more like an exercise in wedge politics. Linking the two as is currently the case dooms both.
This is not the time for zero sum games.
An exhaustive and creditable summary of the problems and limitations of past programs, Stephen P. Young (July 17, 2023 at 10:13 pm), with the last three lines articulating a disarmingly simple solution: the Voice.
Unfortunately (and out of character with the rest of the Comment) without any evidence as to why this – rather than all the other attempts – will be successful.
State governments control hospital and ambulance services, the Voice is Federal. It could not advise the Queensland Government to allow a Tweed Heads man to access cancer treatment at Southport University Hospital.
The current wording of the Referendum does not require the Voice to have any input into health services, it may choose to concentrate its efforts on treaty, sovereignty, and reparation legislation, as its first priority.
The PM needs to remove the voice from the referendum and legislate it now.
If it demonstrates itself as an effective initiative that warrants preservation inpertuity then it can be referred to the Australian people for endorsement via referendum in the future.
This is the way to banish the spectre of ATSIC.
The referendum question on indigenous recognition in the preamble should proceed ASAP – prior settlement by aboriginal people, preceding Europeans by tens of thousands of years, is simply a fact and cannot be refuted.
The requirements of accuracy and justice necessitate its inclusion in the Constitution urgently.
In my opinion, one reason for the coming of the Uluru Statement from the Heart arose out of years of frustration that the Coalition of Peaks, a group of the peak or leading Aboriginal bodies that are involved in the provisioning of health and social well-being services to Aboriginal people (e.g. NACCHO or the National Aboriginal Community Controlled Health Organisation).and other bodies (such as the Australian Indigenous Doctors Association in concert with the Australian Medical Association) were experiencing with the Commonwealth Government over its handling of the original Closing the Gap Campaign which was set up to run from 2008/2009 to 2030. Officially known as the National Indigenous Reform Agreement, the Closing the Gap Campaign by about 2015 had shown itself to be, shall we say, unproductive. There were 7 targets (6 originally with 1 added later) which included, as we all know, closing the gap in life expectancy (LE) between Indigenous and non-Indigenous Australians by 2030. This frustration was also expressed by certain elements within the Council of Australian Governments (COAG). Originally set up by the Rudd Labor Government, responsibility for the Closing the Gap Campaign was to pass over into the hands of the Liberal-National Coalition Party who, arguably, did not meet its side of the bargain. and this, when it had an authorized responsibility to do so under the terms of the National Indigenous Reform Agreement. (Many such National Agreements, and for that matter National Partnership Agreements were set up by the Commonwealth, particularly during the terms of the Fraser and Howard Governments. The use of the word ‘Partnership’ was always a subject or issue over which there was continuing disagreement between Government policymakers and those Aboriginals for whom such National Partnership Agreements were intended.) As early as 2010 and 2011 but particularly more so In 2015, 2016, and 2017, calls were made by the Coalition of Peaks and others to have the Closing the Gap Campaign revamped. Aboriginal people wanted to have a say in how policies and programs could be set up and better managed to meet their specific needs. Keep in mind, however, that given the heterogeneity of Indigenous communities what works in one community may not or will not work in another. Why the Commonwealth’s initiatives have failed and will continue to fail is due to the fact that they are designed within the mindset of ‘White’ bureaucrats who have little knowledge of the ‘Indigenous perspective’ (i.e. the Indigenous people’s way of relating to social turmoil, to the concept of ‘sickness’, et cetera). Indeed, the ideas surrounding palliative care and birthing as perceived by First Nations people are different from that of non-Indigenous Australians or the Western ‘bio-medical model’. Thus, for many programs designed to Close the Gap, it is essential that Aboriginal people partake in the decision-making and that government bureaucrats respect and protect the culture of Australia’s Indigenous peoples.
The Liberal-National Coalition Party would not listen to lead Indigenous Organisations, this despite Prime Minister Scott Morrison’s claims in his own annual Prime Minister’s Closing the Gap Reports that collaboration between the Commonwealth and lead Indigenous organisations was vital to the success of the Close the Gap Campaign. Even so, the Closing the Gap Campaign was eventually revamped with the new edition of the program having commenced in 2019. Known as the Closing the Gap Refresh, this new campaign’s official title is the National Partnership Agreement on Closing the Gap 2019-2029. Canada went through the same process of a ‘Refresh’ with many of its health and well-being programs designed for its three major groups of Indigenous peoples, namely the Inuit, the Metis, and the Indians. All three groups are recognized in the Canadian Constitution, although the Indians per se are considered Canada’s ‘true’ First Nation people. The Closing the Gap Refresh (back to Australia) has some 19 targets! Not one of them at this time is fully on track to reach its targeted objective(s). Progress is being made on some targets but not fast enough. For instance, the target to get Indigenous adolescents into tertiary or technical education, as I understand. is making inroads slowly. If better and faster progress is needed, it is needed now. If ever there was a time for the Australian Government to work and collaborate better with Indigenous peoples, it is now. Only through the establishment of a ‘VOICE to Parliament’ will better and faster progress be made in closing the gaps in the disparities of health, socio-economic status, and emotional well-being between First Nations people and non-Indigenous Australians.
I am afraid a Yes vote will end up like ATSIC……not much to show for lots of money spent. I’ve worked remotely and it will require more than money to fix the predicament afflicting hunter gatherer people living remotely
There’s solid evidence that health outcomes are better when First Nations communities control their own services. And that Indigenous knowledge can enhance health care for all Australians, as described here. Surely Australia is ready to move away from its parentalistic, condescending approach.