According to the Australian Institute of Health and Welfare, external causes of death account for the single biggest difference in causes of death between First Nations Australians and non-indigenous Australians.
The World Health Organisation defines external causes of death as: a death due to accidents and violence including environmental events, circumstances and conditions as the cause of injury, poisoning, and other adverse effects.
External Causes of death according to the Australian Institute of Health and Welfare represents 6.1 percent of deaths in the non-indigenous community and 15.2 percent in the First Nations Australian community. This difference of about 150 percent is the single biggest cause in the gap in life expectancy between the two
demographics.
As a child I grew up in a community and witnessed first-hand how this statistic converts into real life. My family, like the rest of the community members, adhered to the cultural protocols concerned with the mourning of the passing of a loved one, referred to as ‘Sorry Business’. Engaging in a Vow of Silence is a term used to describe the protocol of woman of a deceased family member not speaking for extended period and only using Warlpiri sign language to communicate.
Coming of age, I recall one afternoon when I realised that the Vow of Silence was not being practiced as often, albeit the frequencies of death warranted it. Reflecting on this observation I soon realised this was due to the phenomenal number of deaths resulting in the impractical situation of woman continuously and unabated entering into Vow of Silence upon vow of silence, resulting in the situation woman never speaking again.
Like ancient Vikings, my Warlpiri culture is an oral culture and relies upon the singing of poems and stories to educate future generations on history, laws and cultural systems. Woman unable to communicate due to Vows of Silence would have the consequence of eroding cultural knowledge.
What initially was a passing observation was to have a profound impact on me for decades to come. But there were few, if any experts with whom this observation resonated. The alarming fact was that whatever is the cause of this issue is not cultural or community in origin, because no culture on earth inherently creates a situation that erodes the indispensable protocols of mourning the passing of a loved one.
According to ACOSS, on average 30% of First Nations Australians live in poverty, in some communities, up to 51% live in extreme poverty. This is compared to just 13 percent for non-indigenous population. This is what External Causes of Death on the scale experienced by First Nations Australians is describing: suicides, life threatening behaviour and addictions. This of course does not include, hospitalisation caused by attempted suicides, or hospitalisation caused by life threatening behaviour and addictions. Essentially, if poverty were to be reduced to the same scale as non-indigenous Australians, Close the Gap life expectancy targets would be superseded. Admissions to hospitals would be reduced and other positive flow on effects this would cause as experienced by the broader non-indigenous community.
My journey of discovery into this phenomenon resulted in being confronted with a consistent recurring stream of commonality of absence of discussion into a deeper understanding of poverty. Such is the established link between poverty and health outcomes that any attempt to engage in deeper discussion was dismissed almost every time in the first minute. As though nothing is needed to be added to the existing knowledge or understanding of poverty.
When dusting myself of from yet another roll of the eyes in reaction to me linking poverty with health outcomes. As though I had communicated to someone, did you know when you jump in water you get wet? I would find the strangest places of solace to keep me going and reiterate my observation an in-depth deep discussion on poverty and how it operates in First Nations Australian communities is shallow or almost non-existent.
For example, my solace would come in the form of philanthropic organisations such as the Smith Family, who to their immense credit relatively recently made the salient observation that the children of parents who came to them for assistance were now parents bringing their children; Therefore, alleviating poverty, fixing poverty necessities a deep dive to unpack poverty. Not, simply acknowledging it exists, provide assistance and by magic, it disappears.
Like many of the 51 percent of community members living in extreme poverty, I have family who live in extreme poverty. Houses in remote communities have been built. But the prerequisite discussion into poverty was omitted from the planning.
A combination of climate change, housing design requiring air conditioning to inhabit buildings, resulting in power bills of such magnitude, resulting in disconnection of power, resulting in unpowered fridges, resulting in unusable medicines, resulting in admission to public hospital in a regional centre 100km away impacting on stress on health system, burnout medical staff and sour relationships between the first nations community and non-indigenous community, who in those regional centres see the impact of extreme poverty in other social indicators apart from health.
A deeper discussion of poverty as a social determinate of health is more than recognising one jumping in water will make you wet; For one: Are you jumping into the Atlantic Ocean in winter with no life vest? Jumping into shark infested waters? Or into a shallow pond headfirst? I know from research in Canada that programs or initiatives designed for First Nations Canadians work as well or better for non-indigenous Canadians.
Us Warlpiri do not have a word for poverty; we import a foreign word to describe the circumstances and issues created by poverty; ‘Humbug’. I discovered on my journey when explaining poverty, I needed to develop communication tools such as the Knowledge Transfer and Acquisition process, EEK (Exposure equals Experience which equals Knowledge) and that Continuity of Attendance and Healing are required to heal poverty, but that Continuity of Healing is punctuated by poverty and therefore conventional approaches need to factor in continuity of attendance and healing as part of the planning process.
Simply replicating initiatives without a deep dive into the mechanic of poverty when implementing such initiatives does not produce the outcome and dismissing the issue as a culture issue in origin is as demonstrated be the erosion of the Vow of Silence protocol is not the cause. Simply put, the gap in the Close the Gap initiatives is as the Smith Family discovered is the gap in the knowledge in how the poverty cycle works and how the poverty cycle operates in a First Nations Australian community context.
However, I also learnt it is one thing to have worked through unpacking, explaining and identifying potential solutions to poverty but another to be heard. Ignaz Semmelweis experience as you can appreciated strongly resonated with me.
Therefore, to my profound amazement I was introduced to someone, who not only spent nights in remote community houses inflicted with extreme poverty, had spent decades being exposed to the issues and circumstances ‘Humbug’ is referencing, and whose time in community is such that he intrinsically understands the issues experienced in communities are not normal for First Nations Australians. My initial reaction was and still is, I can’t believe such a godsend is an atheist!
However, as uncertain I was on whether I was going to get the proverbial water makes you wet roll of the eyes. I instead received a courteous professional time of day to consider my observations. Living life like Ignaz, I cannot begin to explain how I felt when my ideas were being assessed, measured and examined from a person with combined lived and professionalism reviewed my thoughts. The work with Purple House being one example of the incredibly respectful and enduring work Dr Quilty has engaged in with the First Nations community. The solace provided through the simple professional courtesy filled my cup.
Walya Productions belief is with better understanding comes better communication and with better communication comes better relationships and with better relationships better outcomes. The objective of the Walya Productions Social Equity and Health course is to provide practitioners support and assistance in completing their, CDP, and Cultural Safety requirements.
This will assist you with better understanding and communication when developing a patient doctor relationship, which in turn will assist with care outcomes and better prepare you when engaging and raising awareness with other staff and professionals who grapple with the issues confronting the First Nations community in a manner which is sensitive and informed.
It is Walya Productions belief, understanding the issues First Nations Australians are dealing with that contemporary Australian community have unfortunately inherited will assist with better relationships, informed discussion, advocacy and policy formulation for the benefit of health, education and community outcomes for future generations of Australians to come.