Dr Rosalie Schultz
Submission to the Northern Territory Emergency Response (NTER) Review.
What is working?
1. Control of alcohol demand through income management for a limited number of people.
For decades prior to the NTER, some Aboriginal people have being seeking income management arrangements to assist personal budgeting. In the past, opposition from family members and complicated bureaucracy has impeded this. The compulsory income management supports people who would voluntarily seek income management.
However compulsion on Aboriginal people that does not apply to non-Aboriginal people is racist. Encouragement and facilitation of voluntary income management would support autonomy, and may be more effective in the long term in supporting self-determination.
2. Increased resources required for services to Aboriginal people have been urgent and well-recognized for decades.
This is not an emergency in the sense of needing a rapid response. Rather it is a condition that has developed over decades, which non-Aboriginal Australians should be ashamed of.
Increased resources can be most effectively used if introduced gradually, with widespread consultation among the people involved, researchers, policy-experts, and governments.
In particular, increased resources for policing, infrastructure and education are severely needed. The appalling health status of Aboriginal adults is a manifestation of appalling living conditions, over-crowding, lack of domestic and community infrastructure, low education, lack of employment and low income; compounded by racism and discrimination. Investing in health through investment in housing, policing, infrastructure provision and education will have long term improved outcomes in health and all these other areas.
What is not working?
1. Health service provision by people employed through the NTER
Responsibility for health services for Aboriginal people is not clear, and this leads to cost and blame shifting. Services are provided by governments, mainly Territory, private companies and Aboriginal controlled organizations, with variable levels of coordination and cooperation. The introduction of the NTER as an additional service provider has led to inefficiency in the use of limited health care providers and resources.
Child screening was already being widely implemented in NT, prior to the NTER. The takeover of this by poorly trained and well-paid NTER teams has led to loss of morale, loss of opportunity for experienced providers to continue their service, and confusion. The provision of follow-up for dental and ear conditions detected by the NTER team is welcome. Screening services already in place had documented these conditions in the past. The limited capacity of the health services to manage conditions detected on screening prior to the NTER was the limitation, not the ability to the service to screen. The high levels of ear and dental conditions found on screening are evidence of appalling living conditions that must be addressed for there to be any lasting impact of the NTER.
The ability of the NTER to recruit health care staff was through high rates of pay, short contracts and high levels of media attention. None of these are sustainable, and the increasing difficulties of the NTER to recruit and retain staff are not surprising. Health care workers interested in extremely short contracts (for example less than four weeks) require careful screening for their ability to provide adequate level of service after the necessarily brief orientation that can be provided during such a short contract. Work in Aboriginal health is a commitment, and inability to work in Aboriginal health for longer than four weeks is evidence that such commitment does not exist. Some of these people are deluded into the belief that their input can lead to significant change in Aboriginal well-being.
It is unlikely that NTER needs to establish any new services. Rather, it should enhance the resources in existing services. This would be preferred by Aboriginal people and the established workforce, including community controlled and government.
2. Generous employment conditions for NTER staff
Significant resources are being used for accommodation of visiting NTER staff, both hotel accommodation in major centres and new accommodation in remote communities. Every accommodation unit in a remote community that is occupied by an NTER staff member, is accommodation that is not open to a community resident. More frugal accommodation may be more in keeping with the resources available, and the setting. The underlying issue that led to the NTER is equity between Aboriginal and non-Aboriginal Australians. Therefore conspicuous inequity in conditions for staff and those they are employed to serve undermines the NTER.
Alternative measures that should be considered
Alternative measures to protect children through control of alcohol are required. A tax on alcohol by unit has been demonstrated to be effective in reducing alcohol consumption. Such a tax should apply to the entire NT community, removing any racist assumptions and controlling the dangerous levels of alcohol consumption in the non-Aboriginal NT community. Aspects of the NTER that are clearly designed to differentiate Aboriginal from non-Aboriginal people are offensive. These include allowances for where alcohol can be drunk, tourism and types of alcoholic beverage. Given the caused by alcohol that the entire NT community suffers, measures to control alcohol consumption are required for the entire community. These may reduce profits of alcohol outlets but will save lives and reduce health care costs.
In summary, the increased resources being released to promote the well-being of Aboriginal people through the NTER are welcome. However the best use of resources requires discussion and broad consideration with experts, experienced practitioners and local people. Child protection cannot be isolated from other areas of extremely Aboriginal disadvantage.
Dr Rosalie Schultz