A voice for Indigenous people: A clear and welcome path to self-determination and reconciliation
This year, all Australians are being asked to consider an important question, and vote.1
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?
Not since 1967 has there been such an opportunity for Indigenous and non-Indigenous members of the community to come together to drive forward the process of reconciliation and self-determination for future generations.
A constitutionally enshrined Voice to Parliament is part of the invitation given to all Australians through the Uluru Statement from the Heart.2 It will advise the Australian Parliament and give Indigenous peoples a say on matters that affect them.
The referendum question, in of itself, is a relatively modest proposal to improve self-determination. A successful YES vote will lay the foundations for sustained change by providing a vehicle for real, practical and ongoing communication and partnership with wide ranging benefits across the landscapes of health, its social determinants and the Close the Gap targets.
The Voice to Parliament is not a new suggestion; it has been in process of development over many years, with multiple representative bodies and successive governments. The concept was formally proposed in the Australian context at the First Nations National Constitutional Convention held in May 2017, the delegates of which had been involved in regional dialogues. Globally many countries including Norway, Sweden, Finland, New Zealand, Columbia and the United States have established a First Nation Voice.
The Australian Reconciliation Barometer3 – a two-yearly survey on attitudes to reconciliation – shows consistent and strong support. The survey found that 86% of Aboriginal and Torres Strait Islander people and 80% of the general Australian community believe the creation of a national representative Indigenous body is important, while 87% of Aboriginal and Torres Strait Islander people and 79% of general community believe such a body should be protected under the constitution.
Australia's health system is funded, resourced and legislated through the government executive and Parliament; it is a reasonable expectation that these processes and decisions that affect Indigenous Australians are guided by Indigenous perspectives.
Unfortunately, this is not the lived experience of Aboriginal and Torres Strait Islander communities. There are long histories of adverse and disproportionate impacts resulting from laws and policies made without opportunities of representation.
Despite Australia boasting some of the best health outcomes in the world, including being in the top five for life expectancy,4 little progress has been made regarding the inequitable health outcomes of Aboriginal and Torres Strait Islander peoples.
Disparities in health outcomes and inequity in health faced by Aboriginal and Torres Strait Islander people are well known and extensively documented.5 Comparative population statistics show Indigenous child mortality is twice that of non-Indigenous children and the life expectancy gap remains at approximately 8 years, carry a burden of chronic disease 2.3 times higher than the general population, suffer from some of the highest rates of rheumatic heart disease (acknowledged as an endemic illness in the developing world).
Indigenous people also represent approximately 6.7% of ED presentations, close to double the proportion (3.5%) expected based on the Australian Census.6
Close the Gap, introduced in 2008 to address Indigenous people's inequalities, has struggled to make significant improvements in the majority of the targeted outcomes.
Despite the best of intentions; investments in new programs; and bi-partisan goodwill, Closing the Gap has never really been a partnership with Indigenous people.
We perpetuated an ingrained way of thinking, passed down over two centuries and more, and it was the belief that we knew better than our Indigenous peoples.
We don't.
We also thought we understood their problems better than they did. We don't. They live them.
We must see the gap we wish to close, not from our viewpoint, but from the viewpoint of indigenous Australians before we can hope to close it, and make a real difference. – Former Prime Minister Scott Morrison
The gap is not closing fast enough. I know many people are frustrated by the lack of progress… More of the same isn't good enough. We need to do things differently by working in partnership with communities to get better results. – Sen Linda Burney
The latest National Agreement was the first to be developed in real partnership with the coalition of Aboriginal and Torres Strait Islander Peak Organisations.
ACEM believes that when Aboriginal and Torres Strait Islander people are listened to and given agency on all issues, laws and policies that impact their communities, there are profound benefits to their health and well-being.
ACEM has a proud history in advocacy for, commitment to and driving Indigenous health initiatives.
In 2020, ACEM asked its own membership an important question on whether to amend our ACEM Constitution to include a health equity clause to strive for excellence and equity in emergency care for Aboriginal, Torres Strait Islander and Māori communities, passing with a resounding 93.73% vote for YES.
- ACEM's Strategic Plan 2022–2024 ‘Equity through Advocacy’;
- ACEM's Innovate Reconciliation Action Plan 2022–2024;
- ACEM Indigenous Health and Cultural Competency Program;
- ACEM Foundation pillar, supporting Aboriginal, Torres Strait Islander and Māori doctors undertaking emergency medicine training;
- Traumatology Talks: Black Wounds White Stitches;10
- Al Spilman Award for Culturally Safe Emergency Departments; and
- Joseph Epstein Scholarship.
We partner with organisations including the Australian Indigenous Doctors’ Association, Reconciliation Australia, the Leaders in Indigenous Medical Education Network and Close the Gap.
ACEM is proud to support the Voice to Parliament. The reason for this is inextricably linked to why we, as a profession, chose to direct the College to invest in Indigenous health.
The core values of ACEM are respect, integrity, collaboration and equity. The Voice speaks to these principles on a national scale. The only way that the Voice will not help us improve emergency care is if we refuse to listen.
ACEM believes the Voice will drive change and provide a clear and practical way forward for Aboriginal and Torres Strait Islander recognition and self-determination, as an essential step in our nation's growth, maturity and reconciliation journey.
We acknowledge and respect that for some Aboriginal and Torres Strait Islander people, and the general community, debates persist around the Voice, Treaty and their powers and processes.
Debate about the Voice is healthy, if it is respectful and based on facts.
Nevertheless, we respect the Uluru Statement from the Heart, and the Voice to Parliament, as a path forward based on significant community consultation, to disrupt the status quo that is serving so few.
Acknowledgements
I acknowledge the current and former members of ACEM's Indigenous Health Committee and associated working groups.
Competing interests
None declared.
