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Mackean, Tamara; Watson, Marshall --- "Human Rights Special - Indigenous Sovereignty and Indigenous Health" [2004] IndigLawB 75; (2004) 6(7) Indigenous Law Bulletin 19


Indigenous Sovereignty and Indigenous Health

by Dr Tamara Mackean and Dr Marshall Watson

The relationship Indigenous peoples have with their land is very different to that of non-Indigenous peoples. For Indigenous peoples the land is living, breathing, family. Not an inanimate substance; it is to be nurtured not exploited; it is to be respected as a mother, a giver of life and not disregarded and sucked dry of its gifts. Most importantly, Indigenous peoples are irrevocably connected to their country in a spiritual, emotional, cultural and physical manner and, as such, care for the land within these dimensions. This multi-dimensional nature is bound in Indigenous lore and law, kinship structures, history and philosophy.

The first Europeans who arrived in this country were looking for new lands to acquire. Their relationship with land was one of productivity and power and they had no understanding of the land as a multilayered spiritual entity. They proclaimed this place as ‘terra nullius’, a place of no people, and set in motion catastrophic events that nearly destroyed the oldest living culture in the world.

What does this mean for us today? We need to understand that our history of denying Indigenous people their sovereign rights has been directly responsible for the appalling health status currently experienced. As a society we have been poorly informed about the links between these issues. Every single Australian needs to be fully cognisant of our complete, unedited history if we are to move forward as a nation; if we are to embrace reconciliation.

We need to go back to the dawn of time; the Dreaming; tjukurpa. The Ancestral Beings created the earth, land, water, animals and plants. They gave the knowledge of creation and of the purpose of the objects of creation to the first people, our ancestors. This oral knowledge was passed down generation by generation as stories, songs and dances. The first people lived a life bound by law and lore in which strict relationships were adhered to; management of the land was paramount; men’s and women’s business was separate and punishment severe. Their way of life was one of significant activity with a diet high in protein from native animals and containing complex carbohydrates like seeds and grains. From all accounts Aboriginal and Torres Strait Islander peoples were of good health and causes of death were primarily through injury.[1]

Let us cast our eyes to the other side of the world, to Europe. A vastly different way of life in which poverty, overcrowding and occupational hazards played a huge role in poor health and early death. There were many infections, such as tuberculosis and syphilis, infant deaths and unsafe work practices. Christianity was the prevailing religion and the knowledge of creation was contained in written form.

These two vastly different cultures came together in a violent and destructive way. The settling of Australia was based on the notion that Aboriginal and Torres Strait Islander peoples had no form of government or land management. They were seen as inferior beings and expected to die out. The scientific community hypothesised that they were the ‘missing link’ in Darwinian evolutionary theories and should be studied before they became extinct. Akin to flora and fauna, Aboriginal and Torres Strait Islander peoples were the subject of sanctioned massacres and the ravages of introduced disease. This early period of contact existed in a state of lawlessness and a philosophy of survival of the fittest. From the perspective of the Indigenous peoples, the invasion and rape of their land was reflected in the battle deaths of their men and the rape of their women.[2]

Eventually, the colonising body decided to round up the remaining Indigenous peoples and place them, for their own protection, in camps and institutions. Salt water people were moved to the desert, northern people to the south, rivalling tribes were placed together and the Indigenous way of life was restricted and deemed improper. Aboriginal and Torres Strait Islander peoples were forbidden their normal diet of fresh Indigenous meats and plants; instead they were dependent on rations of flour, sugar, tea, lard and tinned meat. Within these institutions, tribal languages, traditional ceremonies and practices were banned and punishable by beatings and hard labour. Where there had been law and order and a delicate balance between humans, animals and plants, there was now disarray, confusion and inequity.[3]

The people became sick.

Time continued and the White Australia policy was enacted on a frightening scale. From within the institutions, the rations depots, the missions, the station camps, the places Aboriginal and Torres Strait Islander peoples had become dependent on for food and safety, children were taken. From their mothers’ arms, from their hiding places, from what remained of their way of life, the children were taken. This caused fractures in the very essence of peoples’ being that would echo throughout generations.[4]

Indigenous peoples in Australia now suffer third world-health in a first-world country. The infant mortality rate is two and a half times that of the rest of the population, the standardised mortality ratio for all causes of death is three times, and the life expectancy is on average twenty years less. Chronic diseases such as cardiovascular disease, obesity, diabetes and renal disease, from a legacy of processed foods and dwindling activity levels, are major sources of this increased morbidity and mortality. Another major source is lack of infrastructure and resources, particularly in remote areas.[5]

Lack of access to health services is also a major contributing factor. This issue needs to be considered not only in terms of geography but also culture and history. Health professionals played an active role in the removal of children, hospitals were places where people died without their family and country, and mainstream services involved extensive institutional and individual racism.[6]

The greatest achievements in addressing Aboriginal health have been based on elements of sovereignty. Aboriginal Community Controlled Health Organisations (‘ACCHO’) are an excellent example. They are administered by an Aboriginal board that has been selected by the community the organisation services. They have developed means of dealing with individual and community health issues that are accepted by Aboriginal peoples. This can be considered to be self-determination, a fundamental, sovereign Indigenous right.[7]

Mainstream services have also made advances, albeit more recently. Health programs that utilise community development and empowerment principles have also been accepted by Aboriginal and Torres Strait Islander communities.[8] Incorporating traditional values into all health services is essential. Improved outcomes, such as in neonatal birth-weight, have occurred where care of pregnant Aboriginal women has been undertaken by trained, local, female, Aboriginal health workers.[9]

It is difficult for a health system that has been built on non-Indigenous values to respect and respond to Indigenous health needs, but it is possible. A necessary part of this process is the training of culturally aware non-Indigenous health workers. This is reflected in the recent development of the Committee of Deans of Australian Medical Schools’ Indigenous Health Curriculum Framework. This framework offers a set of guidelines for medical schools to incorporate Indigenous health into medical education and has been accepted by the Australian Medical Council as a benchmark for accrediting medical schools.[10]

Today we face one of the biggest health challenges of our time – a multifaceted, multigenerational and fundamental human rights challenge. Of utmost importance is the need for the Australian community to acknowledge its first peoples, and acknowledge the sovereignty that has never been ceded by Aboriginal and Torres Strait Islander peoples.

I am descended from the matriarchal line of the Walyen tribe, I acknowledge those who came before me and I acknowledge the spirit of this place we call Australia – Tamara.

I am a Noongar man and I acknowledge my Ancestors and Elders and the Spirit of the land – Marshall.

Dr Tamara Mackean is a lecturer in Aboriginal and Torres Strait Islander Health at the Flinders School of Medicine, a Member of the Aboriginal Health Research Ethics Committee (SA) and the Australian Indigenous Doctors’ Association Executive Committee (Regional Director for South and Central Australia).

Dr Marshall Watson sits on the Flinders University Indigenous Health Professional Education Advisory Committee and is involved in both clinical and cultural teaching activities for the Graduate Entry Medical Program.


[1] National Aboriginal and Torres Strait Islander Health Council (‘NATSIHC’), National Strategic Framework for Aboriginal and Torres Strait Islander Health, (2003).

[2] Mattingly & Hampton, Survival in Our Own Land: Aboriginal Experiences in South Australia, (1987).

[3] NATSIHC, above n1.

[4] Human Rights and Equal Opportunity Commission, Bringing them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, (1997).

[5] Australian Institute of Health and Welfare and the Australian Bureau of Statistics, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander People, (2003).

[6] NATSIHC, above n1.

[7] National Aboriginal Community Controlled Health Organisation (‘NACCHO’) Website <www.naccho.org.au> at 28 November 2004.

[8] Fran Baum, The New Public Health, (2nd ed, 2003).

[9] E Tursan D'Espaignet, M Measey , M Carnegie, D Mackerras, ‘Monitoring the “Strong Women, Strong Babies, Strong Culture Program”: The first eight years’, 39 Journal of Paediatrics and Child Health, (2003), 668-672.

[10] Committee of Deans of Australian Medical Schools, Indigenous Health Curriculum Framework, (2004).


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