Keynote Address

Professor Ken Wyatt AM, Director Aboriginal Health, Western Australia Department of Health

I want to commence by acknowledging the Elders who are present and those that have gone before that have imparted knowledge, wisdom and the skills that we carry with us into this generation and future generations. I also want to acknowledge people in this room whose contribution in the work that you do remains critical in the way that we impact on the lives of Indigenous communities in Australia. I have a 37 slide presentation but I am going to go though it fairly quickly because I want to leave it as more of an info source for which you can refer to later in terms of some of the points that I make reference to.

The context for Western Australia plays a significant role in the way that we consider the allocation of resources and the way in which we look at the proportion of Aboriginal people against mainstream Western Australian society. It’s particular in terms of resource allocation; areas of need verses the challenge of submission based approaches where strong organisations get good writers to put in bids and then attract the largest sums of money. That is a practice that exists right across Australia in any arena. If you are small then you tend not to have the skills mix.

The demographics for Western Australia; we take up one third of the nation and it is challenging. You look at a capital city with the proportion or the ratio of Aboriginal people to non-Indigenous Australians is in the lighter colour and then progressing outwards.

What’s interesting for Western Australia compared to all other jurisdictions including the territories which sometimes means that the communities aren’t in the process. That’s part of the challenge and it’s through the individuals and I know one that I want to acknowledge in my team is Rob Mullane; his passion, his commitment and his connection is the fact the he brings back intelligence along with the work of Jim Dodds and Matthew Lester. Because their contribution and Owen Ashby’s over a period of time has seen a commitment to environmental health programs.

On our program we can see that our focus is on key areas and I want to take us to a challenging thought halfway through this presentation that says that whilst we focus on those we sometimes develop a mind set. If I say to you “don’t think of an elephant” very few of you would think of anything else but an elephant. In environmental health, when we talk about environmental health we think of a set of paradigms within that so we stay locked into that and sometimes we don’t go outside the square and I think Xavier and Tarun yesterday made comment about the strategic gains that we have not achieved in terms of the level of resourcing required because there are different mind sets that are operating within the level and layers of government at the national, certainly at the state and then the local government role let alone the Aboriginal communities within the construct of the way they work.

Environmental health; what will be interesting is I wouldn’t mind at some point looking at our report in Western Australia; what we achieved in 2004 in terms of those benchmarks and see how far we have travelled since then to 2008, when the most recent survey was conducted – whether or not the report highlights the same issues or identifies other factors that come into play that means that we have not been able to reduce that number or alter. I find it fascinating that in a country like ours there are two communities I am aware of where the water that they drink is of a quality where it has uranium salts within their drinking water supply. We would not accept that in Bondi, Sydney, Perth or any other area. But our community chooses to live on country because country is important. What we don’t look at is the technology that changes the quality of water that the community receives.

Are we making a difference? Yesterday I heard a couple of our people making comment that maybe we haven’t had the gains we should have. We certainly haven’t had the level of resourcing in the way that we would like. Do we measure our success and failures? And when we have success why does it work and why can’t we translate it uniformly across the nation? What about giving community ownership? Sometimes we lead projects, initiatives and activities, but we never empower the people who it impacts on to take control and manage it themselves with the adequate resourcing and paradigms and framework that need to be there.

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Community engagement is challenging. Sustaining that engagement is even more challenging, and we have still not got that right. How do we then argue the resources using the data? The new directions are going to be very interesting. Yesterday there was reference to COAG. This is what the COAG bowl of spaghetti looked like. There were some key areas that were the priorities that the Commonwealth Government through the Rudd Government established for all states and territories to respond to. You can see across the top we end of with interesting names you have PORG, you had HORG, you had WGIR, you had NIRA, we had people involved with climate change but the grey boxes are the most challenging. Those are the heads of treasury who in their brief by COAG have been asked to look at the effectiveness of expenditure against all projects and programs in the future and to particularly focus of Indigenous initiatives. That’s being led by Ken Henry at the national level and Tim Mahoney from Western Australia is equally working very closely as the Under Treasurer for our state, with Ken Henry about saying if we are pouring money into Aboriginal affairs and into Aboriginal initiatives what are the outcomes? Why aren’t we seeing change after a decade? What do we hope to see as changes in the future?

There is a commitment to whole of government approaches by COAG. People who have not read the papers around the COAG National partnership agreement will see reference to coordinated policy development, active engagement and consultation and in fact in some of the partnership agreements it is now a requirement that governments at all levels implement initiatives to draw in other key stakeholders and better coordinated and strategic use of funds. This is where there is an opportunity for this group in its leadership role, and Xavier in terms of the work that you do; it is to look at the opportunities and seeing where the points of connection are to argue for additional resources or more effect use of some of the resources that are going to be coming. The Prime Minister indicated that he was going to appoint a Coordinator General after presenting his report in Parliament he tabled it, he then went on to say that housing and infrastructure and remote communities needed a coordinated approach. So he announced the appointment or the creation of the Coordinator General to drive a number of key projects and recently Jenny Macklin MP announced the 15 communities across Australia which would be the priority focus of the Coordinator General. He or she will be responsible for major reforms in remote housing, infrastructure and employment in remote communities. Western Australia has 3 designated areas, the Territory has I think 6 and Queensland and then there is one other state. But the intent is that the learnings from his work will inform Commonwealth Government’s and COAG in the sense of what the other buy-ins for other communities as they start to roll out the Commonwealth funding. Now I would think that if we look at those last, because they will work closely to establish whole of government arrangements to support the achievement of the remote service delivery strategy. But they are also going to have appropriate levels of authority to cut through red tape. They are going to have access to all of the secretaries of Commonwealth departments. They are going to have unfettered access to the Minister to identify where blockages are occurring within the Commonwealth and state jurisdictions. In a discussion I was involved in two weeks ago there is a degree of nervousness about the appointment of this position and what are the states’ rights in respect to what this position will generate in the way of both Commonwealth and state coordinated approaches. And Xavier I think one of the challenges for both you and your colleague who chairs enHealth is to look at to the opportunity of meeting with the Coordinator General to look at where the points of connection are for the work that you are doing and driving because I think you will find that there are some very strong synergies around the visions that both committees have.

There are 21 partnership agreements under the new COAG arrangements. All the bilateral agreements that used to exist have all disappeared. But the key ones for all of us in this room is the national partnership on closing the gap in Indigenous health. That has a series of measures that go to the critical health issues that we argue for out of the environmental health context. And if we are improving health outcomes then these are some of the critical elements that we will have to consider and there are measures, key performance indicates and outcomes in each of the National Partnership Agreements (NPAs) Each of those measures now have to have an identified Indigenous element to them. So states and territories have got to report on the trending on Aboriginal people against those benchmarks including elective surgery and waiting lists.

So the paradigm of opportunity has shifted significantly. The National Partnership of Health Prevention is a very critical piece of the NPA jigsaw because it goes quite strongly to the front end of prevention and generates a debate on the focus of prevention. The other three are NIRA as we affectionately call it in its shortened term because we are good at acronyms, that has building blocks in it and the building blocks are about quality of life at the community level. It has a number of key planks that will also be in a sense underpin and relate to the work that you do in environmental health, it goes to community infrastructure. National partnership on remote service delivery is all about the infrastructure of a community and this is one where I see a very powerful connection in terms of driving some reform thinking in terms of environmental health and impacting on communities across Australia. If we don’t take that opportunity then we have set ourselves the mindset that we always want and we may have to bend and accept other people’s ideas and approaches and at the same time piggy-back ours onto it.

The National Partnership Agreement (NPA) on Indigenous economic participation is also another key opportunity CDEP is going as people in this room are very much aware; CDEP underpins some of the environmental health workers working in a community. We have to now look at whatever opportunities are being created though this agreement plus the budget announcements last night because that is critical in opportunity.

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There are three work force NPAs of which Indigenous people are a significant factor in each of those. We have been looking at pathways in education and cadetships that will take Aboriginal students in year 8 and year 9 into something like 20 health qualification pathways that will help to give them long term employment; environmental health is one of those that we’ve met.

Housing; there are four partnership agreements on housing. Again we have not unpackaged the opportunities in these but there are substantial funds. If you want to look at the detail of these go to the Council of Australian Governments website. COAG has now started to list the National Partnerships and the quantum of money that is committed over a four year period.

I just want to show you that if you take an agreement there are interconnections within those agreements that are not static and stand alone. In a talk I gave recently to a group of health people that if we take six of the NPAs there are strong points of connection in every one of those if we want to improve outcomes. That’s how we have to play with all the NPAs. No individual owns a single NPA. NPAs I believe are owned predominantly by the community and that’s why I make the comment that people education is important because if you can access information you make informed consent decisions. You can argue with some rigor around what you need within your community. All of the NPAs provide opportunities; it provides opportunities for public servants to think outside the square if they choose too. But equally for Australian society and the Aboriginal Community and Torres Strait Islander Community to get hold of these as well and ask them hard questions. This is in a sense for Indigenous Australia a once in a lifetime opportunity to change some of the status quo. But the other one that is underutilized and there are many people in this room that will not have used this report at all. The Australian Minister’s and Director General’s or CEO’s of health, the key leadership in Aboriginal health within the public sector including the NGO sector have agreed to the Aboriginal and Torres Strait Islander Heath Performance Framework. The framework really has a set of measures and is based on the National Aboriginal Health Strategy. The Productivity Commission now want to use some of our reporting out of that to inform their reporting under the overcoming Indigenous disadvantage reports which will take on a new name.

Here are some of the measures, there is a measure in there; 2.01 access to functional housing. Now all of these measures are set up to say why is the measure important? The second part we wanted to know was what are the findings from around the world, what are the findings from within Australia , build that into the measures into the report so that people reading it could determine trends from around the world. The third part that was important was what are the implications; what are the implications if do something and what are the implications if we sit on our hands and do nothing. So the health performance framework sets out three components in their measures that really lays open the opportunity to use it. When I co-chaired the COAG Health and Ageing Indigenous Working Groups we used this framework to argue for the $1.5b that we acquired through the COAG process. We underpinned our argument with measure and evidence. It was through that process that we won over ministers Macklin and Roxon in the early stages. In fact we were not anticipating our ambitious claim ever being met. But when they came back and said that we accept your argument for $1.5b over 4 years for Aboriginal health then what that did was reassure us that the Health Performance Framework was a good instrument to use in the negotiations. The other thing we did was we transcended all our jurisdictions, including the Commonwealth, part of what I appealed to was to transcend who you belonged to. Talk about 27 leaders who could make a difference for the health of Aboriginal people and on that basis the team working in a way that was very different to the mindset that often prevails in the way committees lobby manage and ensure they have a slice of the action. I work with a group of professionals and my co-Chairs here from Queensland also acknowledges that we took a different approach and by doing that we went outside the square, we gained the amount that far exceeded our expectations.

You can see that it covers those very critical areas that you deal with on a regular basis. Overcrowding in housing and transport, two others that are in that framework of measures. Transport we often don’t give attention to but it is critical in terms of people accessing services resources and points outside their community. Access to functional housing is a typical burden. If you are the principal person who provides the income the care and protection and you are a senior matriarch as well, then you accept and anticipate that overcrowded housing will prevail; it’s just common logical sense in the kinship structures we have. Single parent families by age group 2.12. Access to traditional lands 2.17. Outside the normal thinking of the scope of health but they are now embedded as measures that we report on.

Social and economic factors are very strongly embedded in tier two because there were three tiers. Health Stats, Social and Economic, and then Health System Performance which had never been in there before because we want the health systems to be measured. Education participation the literacy, numeracy impacts on the work that we do in environmental health. Employment status including CDP participation 2.07, income 2.08, community and safety and prime and there are three of them and transport 216. So can change be sustained through a new approach to achieve environmental health reform? I believe it can because certainly I want to take a tangent that is slightly different. One of the measures I argued for along with my colleague; he and I caused a great deal of debate in the technical advisory group because people said how do you measure community functioning and report on it? You will never get director generals or ministers for health wanting to have information about community functioning included in a health performance report. How can a community function and take on environmental health programs and health programs and not be responsive to the individual human rights of any Australian in this country. It doesn’t matter whether the community is a family of two to communities of 500 plus there is still a need to make sure that people access the range of services and this was challenging it took us 18 months to get agreement and consensus on this measure across the national. We had two sets of consultants working on this one and the debates were very rigorous and if any of you have worked with Shane Houston you would know the way in which he sits there, waits until somebody puts their point of view and then he dismantles their argument in a very gentle way. And part of that was very testing for both sets of consultants because they had to go back and re-think. So we can see that we challenge the traditional approach in order to bring debate. But health providers’ planners and health and social policy interests require more than say the level of sickness in a community if they are to work with a communities and families to achieve health equality in life. I see environmental health clearly set in the middle of that statement because it’s not just about fixing sickness it’s about fixing communities in which people live.

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The infrastructure had been identified as one element affecting community functioning but there are other factors that are equally important in community functioning. Hospitals was a factor as well. Some of the environmental health illnesses if they are not addressed tend to be left until they become worse because hospitals are not just five blocks or two suburbs away, they are significant distances. The slide that you were shown yesterday morning showing the relationship of communities and access to hospitals was a clear marker of some of the challenges and these are just some that I will let you ponder on.

We don’t always in our thinking other than those that live in areas, think about communities being cut off because of rains. You hear of a flood, I was talking to one of my ex-colleagues from NSW and who still remains a colleague, about the rain they have been having in their area. When I was talking to Rob I said I had watched the impact of the floods and we assume that when a flood happens in a couple of days the roads are clear and in some of these places the roads are not clear for a couple of weeks because they are gravel or they are dirt and you can’t afford to drive on them with vehicles because you will damage the roads. Housing conditions, access to clean water, sewerage, it is all embedded in community functioning. It is a significant measure that we have not considered in the context of some of the strategic thinking we have to do. It covers educational services, communication, transport, community services, connectedness to family land and history, culture.

I won’t dwell on this. I believe that often in our communities we play draughts. We take one step at a time and sometimes you hear a mob will say oh we got so far down the road and we have this, this and this but the government changed its funding priorities and policies and so we don’t have money. A classic of that for those that are old enough will know the Miller Review looked at traineeships and training in Aboriginal communities and when the Miller Review was finished Dawkins who was Treasurer at the time decided that he would abolish all traineeship for Aboriginal communities. The Hawk Government then transferred $60 million to create the Torres Strait Islander Regional Authority. What they didn’t do was appropriate the additional $60 million out of the Commonwealth Budget; they abolished programs which meant that a lot of strategies put into place to skill young people and environmental health in WA was one of the pathways we used that particular source of funding under Andrew Penman to start training some of the people. That disappeared and so in a sense some gains we had made stopped. I believe that as leaders we have really got to draw the charts and the maps and look at the strategic directions that we take in acquiring the services I have had the opportunity, no actually a privilege of working in two Jurisdictions; NSW as a Director of Aboriginal Health and WA, and WA in two agencies; health and education- the two biggest. What I have seen is a trend of leadership occurring but not being sustained. That leadership taking a thought; running with it but not mapping it and charting the direction; that we need to take community projects and initiatives. Strategically we have probably for the first time in the COAG strategic group in Indigenous Health working group process mapped the pathway then charted the course and strategically achieved the changes that are needed we need to do the same in environmental health. The small amounts that keep coming for environmental health are often impacted on by efficiency dividends by Commonwealth and state government agencies when they have to review budget cutbacks. It is a soft area; it is easy to cut. So in a sense we need to take a leadership role.

The red tie I’m wearing I wore deliberately because it’s part of a strategy we had in education. I went to a meeting and I said when I was asked to give a keynote and I said “What happens if we look at the apparent retention rates of Aboriginal kids, we look at their progression from year 1 to year 12 we would see the following” and I identified the following, but I said “Just imagine if every principal in a government and non-government school took two Aboriginal kids out of every year level group and mentored and sponsored them through to their year 12 with a TER or whatever it is in each jurisdiction. And if there were 2000 schools you would have 4000 Aboriginal kids graduating. The Australian Principles’ Association or APADC as it was then took up that challenge and took on the slogan of ‘Dare to Lead’ and they negotiated with every principal and they have signed up principals now to start closing the gap in educational attainment. In health we don’t do that. In health we don’t even sit second to native title or land arguments. We don’t sit in relation to education and yet health and education have an incredible intrinsic link; you need both to improve. So in a sense for environmental health which is part a sub component of the big health picture. When it comes up against elective surgery lists, waiting lists we sit well and truly down the continuum. So the challenge then becomes how do we better position ourselves because one day when I go to community I want to see their view. I want to see a view where our people have quality housing, quality infrastructure. Have the framework that you would expect to see in a major community.

One of the things and one that I want to acknowledge is the jewels in the crown back in the early 1990’s; that instead of having a small number of environmental health workers we would have had environmental health workers in at least 120 of the Aboriginal communities that needed them. But we are not there. I would have expected us to have influenced the Commonwealth Government around community infrastructure and environmental health under-pinning some of the NPAs but it is about resolving what parliamentarians and task forces have seen and what I hope that in any of those NPAs that have been rolled out that we see the reforms that are needed. So it would be good if all of us took the leadership role, both collectively and individually that the network of maintained links is developed and made stronger. The website link that was launched yesterday is the beginning step. But collectively we can chart the pathways; we can map the directions. The only thing that we have now got to do and it’s people like myself and Tarun, Xavier and yourselves have got to be strategic in influencing other people. Because if we don’t in 10 years time or 5 years time I wonder if we will be looking at a report from today and saying these are the five key points out of that report we still have 83% of communities without sufficient water supply. We still have communities without sufficient rubbish disposal arrangements. We have a percentage of communities whose sewerage systems are still problematic and we still continue to allow the three tiers of government to in a sense pass the buck to each other because that is what happens in the environmental housing arena.

I thank you for the opportunity of being with you. I enjoyed yesterday’s sessions and I must apologise that I have to return to Perth at lunch time. I would have liked to have joined you at dinner tonight to have listened and engaged in some of the conversations but to all of you thank you for the work that you are doing.