Aboriginal Children, History and Health

Beyond Social Determinants

John Boulton

• Publisher: Taylor & Francis
• Year: 2016
• Print ISBN: 9781138955240
• eBook ISBN: 9781317355304
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

This volume traces the complex reasons behind the disturbing discrepancy between the health and well-being of children in mainstream Australia and those in remote Indigenous communities. Invaluably informed by Boulton's close working knowledge of Aboriginal communities, the book addresses growth faltering as a crisis of Aboriginal parenting and a continued problem for the Australian nation. The high rate and root causes of ill-health amongst Aboriginal children are explored through a unique synthesis of historical, anthropological, biological and medical analyses. Through this fresh approach, which includes the insights of specialists from a range of disciplines, Aboriginal Children, History and Health provides a thoughtful and innovative framework for considering Indigenous health.

1 Introduction

John Boulton

DOI: 10.4324/9781315666501-1

In recent years, at the beginning of each Parliamentary sitting, the Prime Minister has presented a view of the health and socioeconomic indices for ‘closing the gap’ between mainstream and Aboriginal societies. It is usually an occasion for non-Aboriginal people to feel vicarious pride that their goodwill towards their fellow citizens has been translated into measurable benefit. These efforts at ‘closing the gap’ can be seen as a positive step on the long path dating back to the referendum of 1967 when non-Aboriginal Australians voted en masse for constitutional reform which they believed would improve the status of Aboriginal people (Attwood 2003).

Meanwhile, almost every week in the national media there are reports of events concerning catastrophic rates of disease, youth suicide and lack of engagement in school in remote Aboriginal communities. These stories run in parallel with uplifting ones about young Aboriginal men and women getting their first ever job in the mining industry or of young Aboriginal people from a regional town achieving an academic first for their family and community. The contrast in the state of social and emotional welfare of Aboriginal young people reflects the emergence in the past few decades of two separate demographic layers of Aboriginal society. Over 80 per cent of the approximately 650,000 people who identified as Aboriginal or Torres Strait Islander in the 2011 Census live an urban mainstream lifestyle on the east coast. The other layer, comprising approximately 75–80,000 Aboriginal people, or 20 per cent of the total, live in small towns and remote communities across the north of the nation and through the Central and Western Deserts. This divergence of health and wellbeing between the two demographics accounts for the paradox of an improvement in selected measures of health and wellbeing at a national level, yet the opposite in remote districts. It is the people who live in these latter areas who are subject to critical media scrutiny. The persistent reports of terrible living conditions in remote communities and of tragic events, particularly affecting children, have resulted in a hardening of public attitudes towards Aboriginal distress (Langton 2007, 145). However, little media attention is devoted to a nuanced analysis of the reasons for this situation or the failure of government spending to have an impact on improving health conditions in these remote areas. Much more rarely is media attention devoted to a nuanced analysis of the reasons for this situation or the failure of the vast amount of targeted government spending to have an impact on improving health conditions in these remote areas (Rothwell 2015a and b).

A society’s social capital is measured by its peoples’ health and education, as these provide the foundation for future personal and economic fulfillment. Hence the increasing discrepancy in the expectation for health between children living in remote Aboriginal Australia and children in mainstream urban society represents a profound failure of our nation state. This failure lies at the heart of our society. Descendants of the largely British colonisers have a moral responsibility towards First Australians. Aboriginal children suffered most on the colonial frontier because they were most vulnerable, and they continued to suffer rates of death and illness many times that of the British settlers during the nineteenth and twentieth centuries, the result of malnutrition, infectious disease and violence.

What the book is about

The focus of this book is on Aboriginal children who live in the remote communities scattered across northern and central Australia, and particularly on the Kimberley region of northwest Western Australia, and the reasons why their expectations for health, wellbeing and longevity have fallen further behind those of children in the urban mainstream society, both Aboriginal and non-Aboriginal. The national debate on the reasons for this alarming widening of the gap in expectations for health, education and fulfillment of human potential have become both politicised and extraordinarily complicated. A conflation of ideological positions from the Left, the Right and the environmentalists, as well as politically correct rhetoric, have acted as barriers to the conventional level of evaluation and cost-benefit analysis required of health strategies based on principles of health economics.

This book aims to be a guide to health professionals and others whose work takes them to remote Aboriginal Australia. It is also for anthropologists who may be familiar with this cultural landscape, but are perplexed as to why their friends’ and colleagues’ children and grandchildren suffer such a degree of ill-health. As well, we hope this book will be informative to the many good-hearted people who are genuinely concerned that Aboriginal children living in remote Australia suffer such a high risk of serious, preventable and life-shortening diseases, and why it is that the resources directed by State and Commonwealth governments have made such little impact (Commonwealth of Australia Department of Finance and Deregulation 2010, 11).

The intent is to provide a different perspective: namely, that in order to understand the origins of remote Aboriginal child ill-health it is necessary to analyse the historical influences within separate time frames. National discourse on health policy tends to focus on the immediate consequences of disadvantage which are characterised as the social determinants of ill-health (Carson et al. 2007). These include lack of education, unemployment, overcrowding and poverty as well as the psycho-emotional consequences of social exclusion from racism and structural inequity. However, the lack of efficacy of the present approach, as evidenced by the widening gap in health and wellbeing for children living in remote communities, shows that social determinants are far down the pathway of causality. In other words, these social determinants are themselves the result of far-distant historical factors. Our point is that it is necessary to step back and view the causal pathways to ill-health within a wider frame of reference.

A geological perspective provides a metaphor: in the cross-section of a cliff face, tens of thousands of years are seen as a thin layer of coloured clay; the centuries of British settlement are similarly only a thin layer within the eons of Aboriginal life on the country. This metaphor is visually portrayed by the Walmajarri artist Hanson Pye, from Mulan community beside Paruku-Lake Gregory in the Tanami desert, in his painting ‘Parnkupirti Layers’. He paints the layers from the Waljiri ‘where my ancestors been sitting just here, making tools, spearheads, camping, they been singing corroboree’ through to the ‘top part of the painting [which] is from the Kuwari (present day). But they still the same’ (Pye 2013, 27).

The tragedy of children’s health in the Fourth World concerns us all, whether for a Walmajarri child living beside the desert lake of Paruku or an Inuit child living beside the frozen Arctic Sea.

Western health models recognise the strong association between social determinants and ill-health, but are limited in their analysis of the epidemiological and historical factors relevant in Australia. For example, they do not consider the effects of intergenerational maladaptive responses to psychic stress from violence. There is emerging evidence that such intergenerational patterns are in part mediated through epigenetic factors, particularly in relation to response to stress (Tremblay and Hamet 2008). The situation is similar for malnutrition, such that the high prevalence of central adiposity and consequent risk of early-onset diabetes and cardiovascular disease can be understood as the manifestation of a nutritional ghetto which has a direct effect on the human capital of its inhabitants (Wells 2007, 267). The recognition of such key influences on the behavioural patterns that mediate morbidity are, paradoxically, obscured by the very power of the conventional epidemiological approach. This means that many of the behavioural patterns in Aboriginal communities that are clearly deleterious to health will not necessarily be recognised as relevant factors because Western models will tend to overlook them. For example, how do you measure the effect of behaviour that arises from fear of sorcery, or the risk of overwhelming infection from the barriers to hygiene caused by overcrowding, let alone genetically mediated factors in a particularly susceptible population which lead to high morbidity? Although this is obvious to any observer, there is little ability in current Western models to take into account such problematic factors.

Figure 1.1 Baby at Yirrkala, Arnhem Land, 1948. Mountford-Sheard Collection. PRG1218/34/325. Printed with permission of the State Library of South Australia

Middleton emphasised that an ecological perspective is essential to understanding the causality of Aboriginal child ill-health. She based her view on the findings of an intensive study of the socio-cultural and environmental factors related to the high levels of morbidity and mortality in the community of Yuendumu during 1969–71. Quoting Moodie (1973, 43), she observed: ‘it is never the disease which is the ultimate health problem, but the environmental and behavioural circumstances which allow the disease to flourish’ (Middleton 1976,129). For this reason the public health physician McMichael argued for a far wider view of causality because ‘modern epidemiology’s search for specific proximate causes has deflected us from social-contextual models of disease causation . . . Hence, the recent calls for . . . recognizing that population history, culture and social structure determine the level and internal distribution of disease risk’ (McMichael 1999, 890).

Another way of understanding health and disease is through an analysis of the extent to which human behaviour is now constrained, and has thus been changed, by the nation state in regard to the fundamental prerequisites of parenting. The human prerequisites for parenting are for sufficient allo-mothers (‘other mothers’ such as grandmothers and aunties) to sustain cooperative parenting; the knowledge and skill to supply the baby with a sufficient food energy intake to enable a timely transition to the Childhood Phase of growth without risk of growth faltering from malnutrition (Hochberg and Albertsson-Wikland 2008, 2); and an environment without stress from the threat of violence to the mother and her kin. This line of thinking takes us back to the deep origins of becoming a human and the emergence of childhood as a unique phase of development of modern man from our hominin antecedent H. erectus, upwards of 1.5 million years before the present (Hawkes and Coxworth 2013). If these prerequisites to fulfill the intensive nurturing requirements of the immature human baby are disrupted, as they have been in the case of the Aboriginal population as a result of colonisation, then the child’s health and survival is at risk.

Dancing with strangers

Whichever way we look at Aboriginal child health and its deep origins, and at the wellbeing of Aboriginal people within the history of Australia since 1788, we are confronted by a profound moral dilemma: given the inevitability of colonisation of the Australian continent during the period of European imperial expansion, how could the two societies have lived in peace for mutual benefit? The tracks of possibility and history split on 10 December 1790, the day Governor Arthur Phillip’s gamekeeper John McEntire (McIntyre) was speared by Pemulwuy, the Bediagal leader. Governor Phillip sent out expeditions reluctantly led by Watkin Tench to exact violent retribution (Langton 2008, 25). This event provides a concrete point in time on which to focus our imagination and to speculate on how things might have progressed differently. This point in time has been examined by some of Australia’s most imaginative and distinguished writers, including Kim Scott in That Dead Man Dance that fictionalises the story of the early days of the British garrison at Port George, now Albany, when friendships were forged between British and Nyoongar people (K. Scott 2010); also in Inga Clendinnen’s Dancing with Strangers (2003). Clendinnen’s title illuminates what might have been by referencing the afternoon on which British sailors danced a hornpipe on the beach for the entertainment of local Aboriginal families. These writers suggest that an alternative, more peaceful, future was possible in Australia’s distant past, but violence intervened. The reluctance on the part of most people to consider alternative futures, or make hypothetical imaginative journeys back in time, reflects the level of denial within mainstream society. This denial lies unresolved at the core of the nation, and although it is tangential to the main thrust of this book, it needs to be kept in mind within the national discourse on reconciliation.

The Aboriginal child in history

In pre-contact Aboriginal society, babies ...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of plates
• List of illustrations
• Notes on contributors
• Foreword by Colin Tatz
• Preface
• Acknowledgements
• 1 Introduction—John Boulton
• PART I The child in the human story
• PART II The child in political history
• PART III Political, ecological and social disruptions to the prerequisites of parenting
• PART IV Disorders of child growth and development: a metric of structural violence
• PART V Conclusion
• Glossary
• Index