In recent weeks both Noel Pearson and Health Minister Mark Butler have highlighted a condition known as rheumatic heart disease as the exemplar of why we need an Aboriginal and Torres Strait Islander Voice. Rheumatic heart disease is a major cause of suffering and early death in Australian First Nations people, yet for non-Indigenous Australians it is essentially a disease of yesteryear. Because it is almost exclusively a health problem for First Nations people, has its roots in social and economic disadvantage, and we fail to tackle it despite having the ability to do so, it is emblematic of Australia’s failure to “close the gap” in health outcomes.
I have dedicated my research career over the past 30 years to rheumatic heart disease. The story of that work in many ways mirrors the story of Closing the Gap – lots of passion, dedication and good ideas, but with almost no progress being made. First Nations people are developing, and dying from, rheumatic heart disease today at higher rates than ever, despite all our hard work as scientists, health care providers, and policymakers.
But a few years ago, something changed. I and my colleagues finally listened to what First Nations leaders had been telling us all along – that we could come up with all the great treatments, diagnostic tests and preventive therapies in the world, but no progress would be made until First Nations people themselves were empowered to lead and implement change, often using those tools we developed. In other words, we researchers and health care providers needed to cede control to First Nations organisations and communities, and become trusted partners and allies rather than to be just another in a long line of well-intentioned, top-down programmes destined to fail.
I am ashamed to say that this should have happened decades earlier. But at last we now have a national approach to rheumatic heart disease control that is led by Aboriginal Community-Controlled Health Organisations. Our research agenda is conducted in partnership with First Nations communities, and aims to provide the information and tools that those communities need to tackle this dreaded disease themselves. Don’t get me wrong - we have a long way to go, and lots more resources are needed, but I am more optimistic than ever that Australia can finally put behind it the shame of world record rates of rheumatic heart disease in our own country.
I have seen first-hand how important it is for Australia to listen to the voice of First Nations people. Aboriginal and Torres Strait Islander people should have control over the things that directly affect their lives – but The Voice is not even asking for that. It is simply asking for them to be able to have a say in those things. It is a humble proposition, and one that has been put forward by an unprecedented unity of First Nations leaders from around the country. Of course there are some First Nations people opposing it, but the vast majority are asking for us to say yes to The Voice.
The proposition for The Voice has been carefully and skillfully crafted. We are being asked to approve only the core principles – that it is enshrined in the Constitution and that Governments must listen to it, but that it is nothing more than advisory and has no ability to make decisions. As for working out the details if we vote yes - that task would fall, as it should, to our legislature. But whatever model is developed must abide by those principles being put to us on October 14. Australia has nothing to lose by voting Yes, but First Nations people have everything to gain. And if the lives of First Nations people improve, we all win.
The Voice in itself will not Close the Gap, but we can’t Close the Gap without it.
Paediatrician and Researcher