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C. Strakosch (2004)
Institutional racism in Australian healthcare: a plea for decencyMedical Journal of Australia, 181
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The truth according to the TRC. In: Amadiume I, Abdullahi A, editors. The Politics of Memory: Truth, Healing and Social Justice
The truth according to the TRC
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The Past, the Present, the Future of Aboriginal Health Policy [disser tation
Henry (2004)
Institutional racism in Australian healthcare: a plea for decencyMed J Aust, 180
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The Past, the Present, the Future of Aboriginal Health Policy
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A Histor y of Inequality in South Africa
J. Boyce (2005)
The Fabrication of Aboriginal History
J. Lynch, G. Smith, S. Harper, M. Hillemeier, N. Ross, G. Kaplan, M. Wolfson (2004)
Is income inequality a determinant of population health? Part 1. A systematic review.The Milbank quarterly, 82 1
Gavin Mooney Social and Public Health Economics Research Group (SPHERe), Curtin University of Technology, Western Australia Abstract Objective: To draw historical parallels between inequalities in South Afr ica and Australia and their implications for public health, and especially Aboriginal health, in ublic health research suggests that inequalities matter in population health.1 A history of inequalities in Australia would make for important reading for an Australian public health audience. We are thus required to pay attention when a country like South Africa yields up such a histor y of inequality as is provided by Terreblanche. 2 The public health lessons herein, howev er, stem not only from inequalities per se. Terreblanche makes clear that history also matters, as does what happens to the distribution of political power and its use. For an Australian audience there are lessons here, particularly with respect to Aboriginal health. Terreb lancheâs work is one of great scholarship â a history stretching over 350 years. That represents more than simply a lengthy period. It covers a South Africa with ver y different political regimes and social structures: the colonial period to 1910; the segregation and apartheid years to 1994; and the post-apartheid years to 2002. Despite the differences, these eras are all linked by inequalities, perhaps most signif icantly including the post-apar theid years. Remarkably, inequalities ha ve in fact increased since 1994 when the African National Congress (ANC) came to power. On recent history, Ter reblanche2 suggests that the investigation by the Truth and Reconciliation Commission (TRC) âshould not have been restricted to only 34 years â especially in a country in which human rights of blacks have been g rossly violated for almost 350 yearsâ. Second, he argues that the TRC covered only violations by individuals. It did not examine the structural issues in the society that g ave rise to segregation and apartheid. In 1652, Dutch mariners established a post in Cape Town. Initially, as Ter reblanche2 records, acting in accordance with instr uctions from The Netherlands, they did ânothing to disturb [Indigenous peopleâs] cultural integ rity and socioeconomic stabilityâ. But then the policy was broken and âa little war of plunderâ broke out. In the wake of that, van Riebeeck, the Dutch commander, claimed: âWe have won this countr y in a just manner through a defensive war, and it is our intention to keep it.â This was the start of the colonisation of South Africa âof land deprivation that continued for 250 years ⦠and culminated in the Land Act of 1913 which set aside only 8 per cent of South Africaâs total land area as ânative reser vesâ.â Yes, parallels with Australia, b ut where 8% would have been better than nothing. The more recent history of South Africa shows that to overcome inequalities it is not enough for the disadvantaged to gain formal political power. The ways in which that power is used and to whose ends are crucial. As Terreblanche2 identif ies, South Africa is no longer, as it was briefly after 1994, attempting to pursue greater equality. It has succumbed to the âattractionsâ of neo liberalism. In 1993 there was what Ter reblanche calls âthe pre-election elite compromiseâ. This was an agreement reached between the ANC and the cor porate sector. It makes intriguing reading and explains so much of what has the latter. Methods: To use the wor k of Terreblanche in South Africa and Houston in Australia to demonstrate the relevance of past inequalities to some of todayâs health problems. Results: Economic structural issues remain crucial to the development of and the future health of these two countries. There are more grounds for hope for a more equal society in South Africa than there are in Australia. Conclusions: South Afr ica has made some attempt to face its past while Australia has not. Attempts to kill off Aboriginal culture continue. Aboriginal health will only improve when white Australia is prepared to face its âblackâ past and move beyond the racism and indifference that surround Aboriginal affairs. The neo liberalism of both countries serves their disadvantaged populations ill. (Aust N Z J Public Health 2004; 28: 559-60) Correspondence to: Professor Gavin Mooney, Social and Public Health Economics Research Group (SPHERe), Curtin University of Technology GPO Box U1987, Per th, Western Australia 6845. , Fax: (08) 9266 2608; e-mail: g.mooney@cur tin.edu.au Submitted: August 2004 Accepted: September 2004 2004 VOL. 28 NO . 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Mooney Point of View happened in South Africa since. The agreement includes the following: âT redress social backlogs, South Africaâs economic policy must o be driven by the objective of durable [economic] growth in which all can share equitably⦠There is widespread understanding that increases in the government deficit would jeopardise the economic future of the country [and that] given the importance of maintaining a competitive tax structure, [f iscal policy] will emphasise expenditure containment rather than raising taxes ⦠Trade and industrial liberalisation will be an important part of the restructuring of the economy. â strate gy that, if Aboriginal Peoples became less obviouslyAboriginal and ever whiter by breeding, adopting white values, living according to white behavioural rules, and identifying with the aspirations of white Australia, then conflict would be eliminated. The âAboriginal problemâ would go away. Australian history shows that the attacks by the colonial and by later Australian regimes caused enormous suffering, including the destruction and erosion of culture, identity and life of a significant number of Aboriginal Peoples. â Houston brings out tellingly that an understanding of the past is crucial to future policy. For example, he indicates: â⦠in the specific context of a resource allocation formula across different regions or communities how the analysis of the past can affect future policy. In developing this approach, what was crucial was to allow for the preferences of Aboriginal Peoples to describe the good to be pur sued. This reflects the past in terms of how Aboriginal Peoplesâ culture and identity and in turn preferences are formed by our history. Especially relevant are our preferences for health and our construct of health. It is these that determine the nature of the good that we seek from health care resources. â That spells neo liberalism. Ter reblanche makes a compelling case that the corporate sector forced the TRC, once established, to narrow the terms of reference with which it was originally set up. The TRC did have a wide mandate with an explicit intention to report on the âbroad patterns underlying gross violations of human rightsâ and âthe identity of persons, authorities, institutions and organisations involved in such violationsâ. Yet in the event, as Mamdani3 points out, it was restricted to perpetrators who are âa small group, as are those victimised by per petrators. In contrast beneficiaries [of the system of apar theid] are a large group, and victims defined in relation to benef iciaries are the vast majority in society.â The TRC ignored structural issues that allowed the gross violations of human rights to occur in the f irst place. W have had no formal apartheid in Australia and no TRC. Our e âblackâ history goes back only to 1788; our Aboriginal histor y much longer. We have had no Australian history written on our inequalities. Yet there are clear parallels as well as some disturbing differences. Just as Ter reblanche argues that in South Africa we cannot understand the 30-odd years leading up to 1994 without looking further back, so attempts to foreshorten or even ignore history in Australia are unwarranted and unhelpful. The âhistory warsâ4,5 fascinatingly have been fought between white fellas on the one side and white fellas on the other. They have argued numbers of Aboriginal people killed. Are mine bigger than yours? Does it really matter whose numbers are right? What was attempted was to kill not so much some number of Aboriginal people â be it X or 2X or 1.74X â but Aboriginal culture. That is the issue that these white fellasâ histor y wars have either conveniently forgotten or focused on minimally. In so doing, they have literally âlost the plotâ â which was to destroy Aboriginal culture. That attempt, to kill off Aboriginal culture, remains today. It is, symptomatically, poverty, dr ugs, grog, sniffing. It is, causally, a racist effort to destroy a culture, a destruction that started 216 years ago and continues today. The history from an Aboriginal perspective has now been recorded by Houston. 6 In reading his account of Australian histor y alongside Terreblanche, it becomes immediately clear that we need to hear much more from that perspective. For example, Houston writes: âIdentity and culture require nurturing. To secure sustainability and growth, both physical and spiritual, they require those who belong to any specif ic culture to be able to believe and trust in their worldview. The continued assault of colonial Australia on Aboriginal identity and culture was born of the progressively transpar ent It is the attempt to destroy culture that is so critical in Aboriginal ill-health in Australia. Truly to comprehend Aboriginal health today, we need to understand history, not just Aboriginal histor y per se b ut the inequalities in Australian history and especially as perceived by Aboriginal people. It is noteworthy that whatever the evils of apartheid in South Africa, an attempt to destroy black culture was not one. To understand the public health issues facing South Africa today, Ter reblanche is essential reading. For an Australian public health audience, there are also important lessons, especially for Aboriginal health. Ideally, however, w e need an Aboriginal Ter reblanche. Houston6 has made a start. The South African public sector pre 1994 was âshaped to serve the whitesâ. As Ter reblanche 2 emphasises: âThe task of restructuring the public sector and redirecting public spending towards serving the needs of blacks ⦠is an enormously difficult one.â In the meantime âthe quality of life of the poorer 50 per cent of the population has deteriorated considerablyâ. Yet as a regular visitor to South Africa, I cannot but smell the hope in the air there for a more equal society. What is worrying, as we survey the desolation that is Australian Aboriginal health, is that our public sector and our public health services remain today too f irmly âshaped to serve the whitesâ. Henry and others7 tell us how institutional racism remains rife in Australian health care. The ANC gover nment has made some mistakes but at least the y can genuinely claim national pover ty as an excuse for inaction. Australians can only claim indifference. With respect to Aboriginal health there is little smell of hope in the Australian air.
Australian and New Zealand Journal of Public Health – Wiley
Published: Dec 1, 2004
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