Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Hansard source

This nation's effort to close the gap is probably one of the truly important pursuits that unite both sides of this chamber—and of course chambers all around this great country, with state jurisdictions doing great work as well. I want to make an observation about where Closing the Gap is heading. We have heard a lot about the extra investment in Closing the Gap, but there is still not enough of a focus on outcomes. My great concern is that the prime ministerial reports that happen every year—and I hope they will continue to—clutch at small glimmers of hope but that, in a context where hospital investment has nearly trebled and where we now have billion-dollar investments, in places like Alice Springs, Palm Island, the Kimberley, the gulf and the APY we are yet to see the community transformations that particularly see young children given a start early in life. If there is one area where I think everyone would agree, it would be that. Every Australian citizen would believe that a child deserves the best possible start in life. There is no cultural disagreement on that; it is a social norm that transcends our boundaries and goes right around the world.

What we know at the moment is that children are still not going to school in adequate numbers, and there is basically a division about whether this is a responsibility of education or the police. We still have an issue where alcohol is not yet agreed upon between major jurisdictions, let alone communities. My strongest recommendation would be that, fundamentally, alcohol is something that can only be available in any community around the world if it stacks up on social impact. The social impact is quite simple: do kids go to school, are youth getting training and do people have jobs?

If alcohol reaches a point where it prevents that, then it does not cross any bar for social acceptability.

We have an expectation of the community that there is roughly two-thirds workforce participation for healthy adults who are not caregivers. That is a number that every community aspires to. No community anywhere in the world survives if it does not achieve a certain level of workforce participation; it is economic engagement 101. We can talk about delivering services to people, kicking the door in and going in and changing their lives, but as zealous as we get about these programs ultimately there is only so much you can do with services. Ultimately you have to create the opportunities and an environment where people can have a go.

It is very interesting that this year Australia's Aboriginal population will reach 600,000, and 100,000 of those live in what I would call remote and very remote locations. Half a million Aboriginal Australians now live in cities and regional towns, so we are seeing a complete shift in the demographics. With that goes political power, because half a million Aboriginal Australians will be demanding better services where they live—and I do not blame them. But the answer is, if we are going to close the gap, no gap will close without closing the remote gap. Let us not forget that.

There are multilayered and many poorly coordinated services in urban areas. We can work on that one. That is a doable challenge and a problem I want to have. But the problem I do not want to have is no services. The problem I do not want to have is no doctor in a community. The problem I do not want to have is not being able to get good teachers to schools in remote areas. Let us be clear: this is a uniquely Australian challenge. Canada, potentially, has the same challenge but not to the same degree. Australia is the second-most sparsely populated continent in the world, and we have the second-best health system. So we will always have a fantastic challenge: a massive challenge and huge expectations on our workforce to go out and do the tough jobs where most of us would never even conceive of living, let alone working. But we have a health system that will push our professionals to deliver those top-class services. That is the challenge for Australian lawmakers: fine.

But in the end what we need to remember is that we must not pat ourselves on the back, because in the age standardised death rates Aboriginal Australians fall slightly from 2,000 per 100,000 to 1,500 per 100,000—if they are mainly being driven by self identification of mostly healthy urban-living Australians who are identifying as Aboriginal at very high levels. There has been a 45 per cent increase in self identification since 2001. It is not all birth rate; it is self identification. So we need to examine true birth rates and acknowledge that the population in most remote and very remote areas is virtually stagnant. If you look at the one per cent growth in remote Queensland, the two per cent growth in remote Northern Territory, the fall in remote Western Australia and the fall in population in remote South Australia, it is roughly a 100,000-person problem that we have, but a massive challenge that I fear we are not addressing with the current close the gap agenda because we are simply taking national figures.

Perhaps it is a time to look specifically at the remote gap. Perhaps it is time to stop saying we are simply delivering better services in urban areas and, by simple weight of numbers, achieving a closing of the gap. Michael Marmot has done impressive work about early intervention with children. We have the adverse childhood experiences study from California. Everything tells us that the key window of opportunity is between the ages of 18 months and five years. I commend the government for doing their five-year-old health check and for including a biosocial component to it, but the reality is that five years of age is too late. The reality is we have already missed the boat at five years of age. So the question to everyone of us here and at both state and federal levels is: what are we doing for young kids from the age of 18 months?

I, as a former doctor, say it is not easy to diagnose vulnerable kids at 18 months, but you can certainly diagnose vulnerable families at 18 months. You can identify the families living in poverty, with closely spaced children and a caregiver who either has a mental health record or who has a criminal record and has spent time in jail. This is the incredibly challenging cohort we need to identify very early and be unapologetic about delivering great services to them. But at the moment we do not. It is all white noise of health service provision, mostly fee-for-service. You see someone, they go out the door and basically if things fall over it is the next practitioner's problem. There is no continuity. Aboriginal medical services do a fantastic job, but too often they have a state health facility down the road seeing the other half of the population or the half that get really sick and have to be evacuated.

It is time in smaller regional communities to have some cooperation between state and Aboriginal community controlled services. Of course communities love having an AMS, but there is no point if you have half the data held at the Queensland health facility and no collaboration. Maybe we need to get these systems working together. It is something that Medicare Locals cannot do alone. A Medicare Local covering a large expanse of some of these areas is simply too far removed to make a great difference.

The last thing we want in our health system, as good as it is, is another level of bureaucracy trying to talk to other providers. What we need are more people on the ground and an unshackling of local clinicians to tailor services for their community. That all sounds very glib, but, in reality, if we cannot get those opaque state community health services talking to the work that is being done in primary health care that is funded by the federal government, we will just keep having more blame shifting, more gaps and more people suffering those consequences. I strongly urge both sides of this chamber: if we are serious about closing the gap, let's do the following.

Let's agree on earlier benchmarks to measure progress. It is okay to congratulate ourselves on a fall in age standardised death rates, but they have been falling at the same rate since 1998, so the current do-nothing scenario is the current rate of fall. If you look at infant mortality or death rate targets for Close the Gap, we were going to hit them anyway with the existing slopes we were achieving before we started the CTG agenda. We need closer measurements and more frequent measures of success.

Secondly, we need more of a focus on outcomes, not outputs and certainly not inputs. We need to be measuring just how many people quit the fags. There is no point measuring how many public health promotions we roll out or community barbecues we put in or people on the ground delivering services—that is fine; that is a bureaucratic output. I need to know how many people quit smoking. This is vital information for us to know whether we are investing money in the right way, and it is a huge amount of money in Indigenous smoking.

Thirdly, we need to perhaps look at a new Close the Gap agenda item—a new target. I know that there is a target on employment, but there is no target for economic engagement and there is a very, very subtle but important difference. It is not enough to soak up Aboriginal Australians, particularly in remote areas, into jobs that are simply created in community that have no fundamental market basis or foundation behind them. We need to be engaging Aboriginal families in the real economy.

Everyone around the world is comfortable with the idea that, at some stage in your life, you leave your community for training and to get a job. We move. Aboriginal Australians are no different: they did it, too, for generations until we created the welfare trap. So I urge both sides of this chamber: if we are going to direct incentives, we should direct them to people who do the things we want—who go out and seek training or have a go at a job. Provide all the culturally safe services that underpin that, but let's support people who have a go. It is no longer good enough to put people through certificate II training in stockman work when none of them get a job and you train another 15 for a cert. II in stockman work. If we are not going to place these youth and give them the support to move together in cultural groups and work outside of their immediate country, we are not actually solving any problem at all.

Marcia Langton said it so well. She said we have a once in a generation opportunity called the mining boom. Before it slips through our fingers so ephemerally, we need to grasp something from it for Aboriginal Australia. If we are going to transform the wealth under the sands that are fundamentally Aboriginal ground, let's absolutely work in a forward way with mining companies to see what low-skill jobs can be taken up by Indigenous Australians—planning ahead. If there is one operation that plans ahead it is mining. They can tell you their mining time lines for years in advance. With, of course, the potential fluctuation of prices, they can tell you what their operational plans are. Let's help Indigenous Australians who are living in those regions—No. 1. Let's set goals not to pick a few happy faces out of a community and pat ourselves on the back because they are wearing high-visibility jackets; let's actually say that every person who lives in that community was given a chance at a job with that mining firm or that aquaculture operation or something in their region. And, if it is a big community, those youth will have to go further—we accept that. But government's job is to facilitate that, because there is no reason why the kids who leave school at the age of 13 cannot go into training. They are a relatively small cohort, but at the moment we just let RTOs swing through on fortnightly flights, stay there for half a day and sign people up to do training that ends in nothing. We have to have a denominator based approach that leaves no-one behind.

If you are a primary caregiver, there is no reason why you cannot turn up with your own child to the childcare centre, support your own child and possibly be inspired yourself to do some further education. If you are incapacitated, of course, that is fine. If you are a big brother that is actually looking after two or three young blokes that are going off the rails, that is fine, too—there is room for that. But for everyone else, let's give them a shot. At the moment, we are not doing it. We hear about Noel Pearson's good work; we hear about Twiggy Forrest.

There are efforts in Alice Springs but they have massive challenges because Alice Springs is fundamentally the bottom of the waterfall, isn't it? It is where everyone ends up when they cannot live in the community or do not want to live in the hub and spoke. Then you have Alice Springs, which is basically the catch-all. I would put to this chamber: if we have a once-in-a-generation challenge, it is to look after the children that end up in those Alice Springs town camps. Again, do not pick out two or three kids and pat ourselves on the back. I am saying that, if you receive a payment from the state, the expectation of receiving a parenting payment is: be a parent, come along and be part of a childcare centre that engages you.

Ms Hall interjecting—

Yes, I was there last year. Let's engage those children and actually give them the abecedarian model, if that is what the evidence shows us. We know one thing: engage these children roughly 24 hours a week—you do not need a PhD, you do not need a master's degree to do it—engage these children in bilateral, purposeful efforts to start them on the road to literacy and numeracy. Let us overlay a cultural component to it. For goodness sake, put some traditional language into that approach. But there is no excuse to give up and there is no excuse to simply say that the parents could not muster the effort to get those children along to a centre.

If you get a state payment, part of it is taking your kids along and giving them a start in life. That is a basic, fundamental positive social norm. It exists in Cape York. For anyone who has not visited the Aurukun school, I challenge you: go and see young Aboriginal Australians there who will look you in the eye at the age of eight years of age and say, 'I want to be a fireman. I'm going to be a rescue worker. I will be an ambulance worker.' Anyone who says we have lost a generation, I challenge you to go and see what is happening in Aurukun with direct instruction, because at 3 pm those children will still be in class and they will be asking to stay another half hour because they want to achieve their own objectives. The teachers says, 'These kids don't want to finish school until they finish their work.'

We can keep Aboriginal children at school after lunch. This old dogma that no-one in remote communities will stay in school after lunch is a fallacy that belongs in the last century. These kids are like everyone else—they want a shot. When you sit down with an Aboriginal child and sit there with their parents and that young boy or girl reads to their parents, there are tears in the eyes of those parents. I do not care what their background is. That is what the state can offer: a chance at a new future and a different future.

Those kids in Aurukun are going to change it. There is 75 per cent school attendance. We still have issues around the other 25. We have in other parts of Queensland—in Mornington Island, Doomadgee and others—tried extra IT as an inducement, but ultimately our challenge is the afternoon rollcall. Can we engage kids after the breakfast club in the morning where the roll is ticked off? That is a challenge, of course, for school providers in remote areas and to young teachers often straight out of graduation with very little experience. I say to them: you do the toughest job of all, but thank you for doing it. When you go there you are probably taking on one of the great educational challenges. I congratulate you for incorporating traditional culture and language where you can in that syllabus.

Too often we have swung from the extremes—from expunging Indigenous culture from educational curricula to trying to teach nothing but Indigenous language until grade 5. Both extremes were foolish. We can come back and find that middle ground. We can do that and close the gap. We can achieve that in education, we can achieve it and seeing young Indigenous Australians going to university. We will see improvements in infant mortality. We are slowly seeing improvements in death rates. This is a gap that Australia can close. (Time expired)

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