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Submission Number
Doctors Reform Society
Submission date
Main Submission Automated Transcript

The Doctors Reform Society of
PO Box 591
Ermington NSW 1700
ph (02) 9613 8305
fax (02) 9613 8305

Thursday, 29 April 2021

Prepared by Dr Ben Bartlett on behalf of the Doctors Reform Society

Thank you for the opportunity to comment on the Interim Co-­‐Design Report led by Professors
Marcia Langton and Tom Calma, on the Aboriginal and Torres Strait Islander Nation Voice

The Doctors Reform Society has been involved in health policy development for over forty years,
This work has included advocacy for Aboriginal health and an emphasis on addressing all causes
of poor health outcomes for all people irrespective of income, socioeconomic status, race, culture,
and geographical location..

We note that the main focus of this co-­‐design task was to develop proposals for an Indigenous voice
to government. As such, the report clearly outlines a range of options and models to enable First
Nations peoples to advise all levels of government on significant matters that affect their
wellbeing and how these can be addressed.

The actual design of the Voice is best determined by Indigenous people themselves as they are
best placed to develop processes that best represent the diversity of Indigenous communities.

Our submission focuses on the importance of this process in closing the gap in health disparities
between Indigenous and non-Indigenous Australians.

Whilst Aboriginal community-controlled health services have made an enormous contribution to
improving Aboriginal health and in alleviating the suffering of individuals and families with health
issues, the foundations of good health go far beyond the scope of clinical service, both curative and
preventative. Research into the social determinants of health has identified a long list of critical
factors that determine the health of populations – culture, housing, water and waste disposal,
education (including adult literacy), employment, etc.

Underlying these well-documented determinants, international research has identified what has
been termed the ‘Control Factor’ in determining health outcomes. The classic ‘Whitehall Studies”
led by Professor Michael Marmott in the United Kingdom demonstrated that, after taking account
all known risk factors for a range of causes of death, there remained a significant influence only
explained by where individuals sat in the British Civil Service hierarchy. In other words, this was
about degree of control people have over their lives. Over ten years ago, Marmott applied his
findings to the situation of Indignous Australians, arguing for “the importance of creating the
conditions that enable people to take control of their lives.” 1

In recent years, there has been increasing awareness of transgenerational trauma prevalent in
Aboriginal communities.

While some have cast Constitutional recognition of Indigenous peoples as merely symbolic, we

1 Michael Marmot, Social determinants and the health of Indigenous Australians MJA 2011; 194 (10): 512-513.
point out that such acknowledgement has an impact on people’s identity, and confidence. This,
coupled with a structural means of influencing policy and programs in their communities and a
truth telling process will go a long way in overcoming intergenerational trauma which underlies
much of the ill health of people.

We note that over the past 40 years or so various Aboriginal consultative bodies have been
established by government, only to be shut down by government when it has suited them. The
latest example is ATSIC.

For many years programs have been established to address various aspects of community life,
only to be defunded after a few years regardless of their effectiveness.

The Uluru Statement from the Heart provides an historic opportunity to provide Indigenous
Australians with the opportunity to provide guidance and leadership to the Parliament about what
is needed and how interventions can be delivered. There are real challenges in this as Aboriginal
Australia is not an homogenous population but is vastly diverse. Thus, one size does not fit all, and
to be effective local communities must have the opportunity to determine appropriate strategies
and deliveries. Governments at all levels have failed to navigate these realities.

Thus, it is crucial that The Voice be enshrined in the Constitution so that governments are obliged
to implement the structures necessary for The Voice.

Based on the above we propose that:

1. Following a decision about the most suitable, representative model for an Indigenous
Voice and before it is legislated, the government honour its election commitment to hold
a Referendum on the constitutional enshrinement of an Indigenous Voice.

2. The Referendum design and information campaign be by bi-­‐partisan committee led by
First Nations representatives, ensuring that the Australian people have access to clear
and comprehensive information about the Indigenous Voice.

3. Enabling legislation for the Voice must be passed after a referendum has been held in
the next term of Parliament

4. The membership model for the National Voice must ensure previously unheard
Aboriginal & Torres Strait Islander people have the same chance of being selected as
established leadership figures