Session 9: Approaches to Indigenous Health – a debate

What is the role of public health practitioners in improving Indigenous health? Are we:   Agents of ongoing colonisation who make Indigenous people into White people?   Encouraging welfare dependency and stagnation?   Increasing our privilege by making careers from Indigenous people?   Fighting against racism and oppression and for social justice?

In this debate each group will be arguing for one of four positions First round: each group has up to 8 min to argue for their position Second round: each group has up to 4 min to rebut or co-opt other groups’ arguments

‘Public health’ is a Western neo-colonial project. Indigenous people have distinctive, non-Western conceptions of health, and therefore do not benefit from Western public health. Indigenous people should not be subjected to the intrusion and surveillance of public health measures. Indigenous people who are involved in such programs are adopting the position of the coloniser and can only further marginalise the Indigenous community, making health worse rather than better.’ Position 1

Position 2 ‘Public health is effective by way of the scientific method and should not be concerned with specifically social or political processes. The best way to help Indigenous people to is to continue making scientific and technical advances which benefit everyone in society. Indigenous health is improving at the same rate as non-indigenous health. Focusing on the ‘gap’ is irrational and leads to pouring resources that could be used for important research into duplicating services and ineffective cultural awareness programs.’

Position 3 ‘Although colonisation may be the historical cause of Indigenous ill-health, the real problem today is that public health efforts are hampered by the belief among non- indigenous left-liberals (who make up the vast majority of the public health workforce) that Indigenous people are passive victims of colonisation. Both Indigenous and non- indigenous people need to substantially lift their expectations of indigenous people who are endangering themselves and others through their risky behaviour. No more passive welfare that rewards bad behaviour. No more excuses. Indigenous people need to stand up and take responsibility, and innovative government policy must be developed to reward people who do so.’

Position 4 ‘It is clear that the intensely colonial nature of public health has been of detrimental to Indigenous people. However, in Indigenous hands, it can be different. All public health efforts should be directed and controlled by Indigenous people. Programs should build capacity and empower Indigenous people and communities such that any non-Indigenous people working in Indigenous health will become redundant as soon as possible.’

DEBATE

Consider the similarities and differences between the debate positions in relation to:   Whether non-Indigenous people should or should not act on Indigenous people   The notion of Indigenous people as the same as or as different to non-Indigenous people   Structure vs. agency in the context of responsibility for health

These debate positions ‘solve’ the conundrum of Indigenous public health by:   In debate position 1 by asserting that Indigenous people are so different that they do not require non-Indigenous (public health) intervention   In debate position 2 by assuming that Indigenous people are the same health-seeking citizens as other Australians and should be treated accordingly

  In debate position 3 by requiring Indigenous people to be health-seeking citizens and rewarding those who are   In debate position 4 by requiring public health to respect Indigenous people as different by privileging Indigenous agency over the right/obligation to be healthy   Debate positions 1-2 result in no intervention aimed at Indigenous people while positions 3-4 advocate for action