The Zone

Adam Steinberg on indigenous health


''Hospital medicine is just a Band-Aid solution to all the problems we're facing with the health of indigenous Australians. Hospital is just really the last resort for a lot of these problems and something that became bleedingly obvious to me is the fact that we need a more community-based approach to indigenous health problems.

''How do you start to worry about health when you do not have education opportunities and why would you bother about education opportunities when there are no employment opportunities? And why is employment important when no one you know has a job?''

Steinberg believes the solutions must ultimately come from within indigenous communities, but that models elsewhere in the world provide guidance, particularly on health.

Steinberg recently became the first Australian to win the Ralph I. Goldman Fellowship in International Jewish Service, a coveted international study opportunity he is going to use to further his examination of community development throughout the world.

He is here in The Zone today to discuss how the gap between the health outcomes for indigenous Australians and the rest of the community might be narrowed.


He believes ''radical new systems'' are required, and that the key to progress is collaboration between indigenes and medical professionals, with Aborigines owning the responsibility of championing change in their own communities.

The full transcript of our discussion and a short video by Steinberg are at zone. He will be online on Monday for an hour from midday to respond to questions.

He stresses that, as a white man from Melbourne, he does not have the solutions. But he does, as a specialist in community medicine, have some informed ideas.

What is clear is there is a profound problem, the starkest encapsulation of which is that the life expectancy of indigenous people is about two decades less than that of the rest of the population. Money has not improved the situation.

''For every dollar the Australian government spends on non-indigenous health, it spends $1.47 on indigenous health,'' Steinberg says. ''There is no doubt there have been resources devoted to this problem, but why is there not progress?''

Steinberg talks of a ''meaningful space'' where change comes from discussion between medical professionals and indigenous people.

Australia has been going backwards, while the gap between the life expectancy of indigenes in New Zealand, Canada and the US and that of the rest of those populations has fallen significantly.

Steinberg has worked in Ethiopia, Israel and Ghana. He is now in Manila as part of a team from the world's biggest Jewish humanitarian organisation, the Joint Distribution Committee, helping in the aftermath of the recent devastating typhoon.

He says our failure to do better in one of the world's richest nations surprises people elsewhere.

''When I was in Ethiopia the American doctor who had been based in Addis Ababa gave a presentation where he showed various developing world health problems afflicting Ethiopian children.

''He would put a slide up and ask the audience what the ailment was and each time he was shocked that I could recognise the condition. He couldn't believe that Australia, a well-resourced, developed country could still have medical conditions you could find in Ethiopia and the developing world.''

Indigenous Australians suffer higher rates of almost all illnesses and disease. Rates of sexually transmitted diseases in the Northern Territory are the world's highest. It is estimated that as many as three times the number of indigenous babies die in their first year as do non-indigenous infants.

About two in three indigenes die before the age of 65. Chronic illnesses, particularly cardiac disease, are the biggest killers. Deaths from diabetes are seven times more common for indigenes than for the rest of the population. Aboriginal people are twice as likely to die from a respiratory disease.

While in Darwin, Steinberg discovered that indigenous people languish in the hospital system. Upon arrival he was assigned an elderly woman who had been in hospital for three months and was not recovering.

''I said to my team, 'You know what, let's take this lady outside. These are people who spend most of their time in the outdoors, so let's take her outside and just have a conversation with her'.

''And, really, what happened because of that single act was it opened up a whole dialogue about her, her community setting and the issues they were facing.''

He says that simple act created a ''meaningful space'' that fostered trust and understanding. His patient recovered and Steinberg applied the idea to other patients. ''It really changed the way she interacted with the system and the problems. Imagine if we could do that on a national scale.''

He hopes his encouragement of other young doctors to go outside the hospital and listen to individual patients will engender ever-greater collaboration and understanding, and perhaps even lead to ideas about creating community clinics and ways to deliver medical treatment away from hospitals.

Steinberg is a first-generation Australian whose grandparents survived the Holocaust. As a doctor, he feels a sense of duty to the sick and unprotected.

But his desire to find solutions to the health woes of indigenous Australians is deepened by parallels he sees between their plight and the historical suffering of Jewish people.

''Your history needs to inform your values and therefore your actions and if you look at the Jewish narrative, from the Passover story in Egypt to

the Holocaust in Eastern Europe, there is a strong message there about looking out for the other.''

He argues that by the time indigenous people, particularly those in remote Australia, get to hospital it is

all but too late. This is why he sees hope in community medicine, where the focus is on prevention rather than cure.

He believes empowering women has great potential, and draws on the experience of radical Indian social entrepreneur Bunker Roy, who has transformed communities through the world by training grandmothers to install solar power systems.

''When you change the life of a woman you change the life of her family and then her community. In Ethiopia, the [Joint Distribution Committee] really focuses on micro-finance, scholarship and vocational training of women in all different settings of the country.

''That target group can really start to change the dynamic and the fabric of a community. That extends to Ghana, where it is a huge focus of the development work. The lesson from the Israeli model is things like different notions of what communal living is.''

He sees it as ironic that so many of the diseases and illnesses suffered by indigenous Australians are caused or exacerbated by food and alcohol introduced by white people.

A simple community-based way to offset some of the dietary problems would be, he says, to help women establish kitchen gardens. Here again, he underscores the idea that such solutions can be suggested by outsiders like him, but must be owned by indigenous people.

Harking again to the Jewish parallel, he says the kibbutz model in Israel is helpful.

''The kibbutz is a part of a society where all your basic needs are really looked after by the community, but to be part of that community you have got to contribute in some way.

''And just imagine that if, instead of using all the Centrelink payments and land-rights payments to just give credit to people's cards, we invested into the community in that way and really gave people a sense that if you do this for one person somebody else is going to do something for you and we can really look after each other in that way.''

After Manila, Steinberg is planning to use his fellowship to work in community medicine in the Russian city of St Petersburg. He is humble enough to know that, after decades of largely futile efforts by policy and medical experts there, he is unlikely to be able to solve the problems.

But he is determined enough to at least try to make some progress by surveying what is happening in similar situations around the world.

A new vision is obviously needed, and sometimes a fresh, young pair of eyes can bring focus and perspective to seemingly intractable problems.


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