Oration-What ’ s needed to Close the Gap ?

The 2010 Chalmers Oration was delivered by Dr Tom Calma on 15 August 2010 at Flinders University in Adelaide, South Australia. Dr Calma's presentation concerned the groundbreaking roles that he and the Close the Gap Campaign have played in making a difference to the health of Indigenous Australians, especially those who live in rural and remote Australia.

Indigenous health and the Close the Gap Campaign will demonstrate that her expression of hope was justified.
There is no doubt that the situation of Indigenous health has improved in the past 10 years. Indigenous health equality is now firmly on the agenda with the establishment of a Federal Minister for Indigenous Health, and the National Indigenous Health Equality Council, thanks to the activities of the Close the Gap Campaign and many Aboriginal and Torres Strait Islander health activists, such as Dr O'Donoghue. She and those like her have, since the late 1960s, worked unceasingly for Indigenous people and it could be said that the Close the Gap Campaign stands on their shoulders.
It is vital to acknowledge this, and the fact that the earliest heroes of the Aboriginal cause have been calling for improvements to Indigenous health since the 1920s. This history and their legacy must never be forgotten. We cannot afford to be complacent for there is still much to be done.
Because of this, my own Oration entitled 'What's needed to Close the Gap?' must inevitably focus on current deficits. However my goal is to paint, as Dr O'Donoghue did 10 years ago, a picture of hope rather than despair.
If the name of the Close the Gap Campaign is unfamiliar it is because, like an iceberg, much of the Campaign's activity is beneath the public face. Due to the nature of our work, most lobbying efforts and representation at meetings are necessarily in Canberra or eastern-states focused. And because our efforts involve close work with government, confusion often arises because the Australian Government and the Council of Australian Governments' (COAG) Indigenous initiatives are branded 'Closing the Gap' 1 . There is a fine distinction here ('Close' vs 'Closing'), and although this is in part testament to the success of the Campaign, from the outset I must distinguish the Close the Gap Campaign's approach from the Australian governments' 'Closing the Gap' efforts. This is more than just a point of definition, for in that fine space of difference lies the answer to my question: 'What is needed to Close the Gap?' However, first let us establish the human rights foundation of the Campaign. The Close the Gap Campaign's goal is to close the health and life expectancy gap between Aboriginal and Torres Strait Islander and non-Indigenous Australians within a generation. This in itself is an answer to the question, because it contains the following features: • The adoption by Australian governments of a comprehensive national plan of action focusing on a wide range of health conditions and health determinants, that is properly resourced and has the goal of achieving health equality by 2030.
• The national plan will be developed and implemented in partnership with Aboriginal and Torres Strait Islander peoples and their representatives.
• The plan will define ambitious yet realistic benchmarks and targets.
•   This is a most important understanding, particularly for those who blame Indigenous peoples for their own poorer health, for instance for the rates of tobacco smoking. For while it is true that we are all ultimately responsible for the choices we make, it is equally true that for a variety of reasons Indigenous Australians have had fewer health choices than other Australians. The good news is that as the gap is 'manmade', its closing is also within our collective will and power.

Access to health services -or lack of it
Nowhere is the Indigenous lack of opportunity to be healthy seen more clearly than in relation to access to health services. In the 2004-2005 health survey 6 , for example, 21% of Indigenous Australians reported they had needed to go to a dentist in the last 12 months but had not gone, and 15% had needed to go to a doctor but had not gone. Reported reasons for not accessing health care included 'lack of availability of services', 'transport and distance to services', 'cost', and 'language and cultural barriers'. A higher proportion of Indigenous people in non-remote areas reported 'cost' as a reason for not seeking health care; while for those in remote areas, 'transport/distance' and 'the service not being available' were more commonly reported.
Another factor impacting on the use of health services is the relatively few Indigenous health professional available to deliver those services. As services such as Dr Noel Such an approach is characterised by: • Planning to achieve equality and equality of opportunity in relation to health in an ambitious but realistic manner.
• The use of targets and benchmarks in the plan.
• Indigenous Australians having the opportunity to participate as partners in planning, including planning for the implementation of the plan, and the delivery of services under that plan. However crucially, because non-discrimination is a fundamental element of human rights law, a state is obliged to ensure or provide equal opportunities to be healthy regardless of human differences, such as race and sex. And a state that does not provide equal opportunities to be healthy is legally required to institute a response referred to as 'progressive realisation' -that is, to ensure that equality of opportunity is achieved as soon as possible. The Close the Gap Campaign's approach is an example of progressive realisation in action.
Australia is also a signatory to the UN's 1965 International Other rights inform the Close the Gap approach. Selfdetermination, the right of Indigenous peoples, has many dimensions. However, within the broader context of the postcolonial nation state it is basically the right to self-governance.

Further Campaign developments in Indigenous health
In the 2 years since the Summit, great change has taken place in Aboriginal and Torres Strait Islander health, mainstream health and Indigenous affairs. In particular: •   We have all heard about 'dying' Indigenous languages, of our cultures being 'under stress', and the lack of leadership in some communities. These are not discrete issues but deeply related to health. Poor health and early and unnecessary death wreaks havoc among us, impacting on our emotional and social equilibrium. Poor physical health is one in a constellation of other related factors contributing to our disturbingly higher rates of mental health issues. Health status therefore significantly affects our capacity to be educated as children and young people. It affects our ability to later hold jobs and earn decent wages for the care of our children.
The drive for Indigenous health equality is a matter of great personal concern to Indigenous Australians. It's about our happiness as individuals and families; it's about our children, our parents and our grandparents, our communities, our languages and our cultures.
And for the nation, this state of affairs presents a profound challenge. It asks, 'What does it mean to be an Australian?' and 'What does this country stand for?'. For although we live in one of the wealthiest and healthiest nations on earth, we have tolerated profound inequality among ourselves that continues to this day. It is this persistent inequality that condemns our First Peoples to the life and health status of those living in the developing world.
While I have no doubt that things are improving, we were and still are a society deeply divided -a nation that has not yet faced up to its past, and one still in need of reconciliation. There is work to be done! This involves a national effort to reconcile us, to bring us together in expectation of what it is to live in this great nation: health and happiness, and respect and esteem from each other and the government we create together. In so doing, I believe it is essential to acknowledge the racial discrimination and neglect of the past. If we are to move forward together as one nation, the dark legacy of the past that dwells in today's poorer health of Indigenous Australians has to be acknowledged -and rectified.
Just as Prime Minister Rudd's acknowledgement of the ills of the past (Fig9) in his 'Apology to the Stolen Generations' is helping to generate a new era in Indigenous affairs, only by acknowledging the past can we move forward together to a future in which black and white Australians truly do stand together as brothers and sisters, enjoying an equally high standard of physical and mental health. This is the challenge ahead of us: to set in motion a planning process and a partnership to support, develop and implement 'What is needed to Close the Gap'.