The fresh lick of paint on the toilet blocks can’t cover up what’s wrong with Ninga Mia. An Aboriginal shantytown in the shadow of one of the world’s biggest gold mines, living conditions here are probably as grim as they get in Australia. A third of houses lack bathrooms and toilets, and even those that have these basic facilities are overcrowded and often insanitary.
”This is the richest square mile in Australia and our people are living here in substandard conditions,” says Maria Meredith, the manager of Ninga Mia’s Aboriginal corporation. Behind her the Kalgoorlie Super Pit looms over the town in a towering escarpment, while machinery from the mine’s lime kilns clanks constantly in the background.
The pit is big enough to swallow up the City of London, and the 26 tons of gold mined from it every year are worth £182-million on world markets.
”Our people, they’re the ones that showed them the gold in the first place, but what sort of contribution goes back into the community?” Meredith asks. The facts of Aboriginal health in Australia are a pressing and constant concern.
Whereas Australia as a whole ranks between Sweden and Iceland as ninth in the world for life expectancy, indigenous Australians come between the Cambodians and Sudanese at 178th.
Those born Aboriginal can expect to die 20 years younger than their non-indigenous compatriots. Aboriginal infant mortality runs at nearly four times the rate of the general population, putting it on a par with Russia and Sri Lanka, despite a nationwide record that is better than Britain’s.
If you are indigenous, you are seven times more likely to catch meningitis, 10 times more likely to catch tuberculosis, 40 times more likely to catch syphilis, and 67 times more likely to catch gonorrhea. If you are an Aboriginal child, you are twice as likely to be born with a low birthweight and five times more likely to have a mother younger than 17.
If you also live in a remote outback community, the odds are evens that you will have scabies and two to one that you will have other running sores. Remote Aboriginal communities record the highest rates of roundworm infection in the world, and one 1997 study found hookworms in 93% of children in one community.
In the offices of Bega, Kalgoorlie’s Aboriginal-controlled health centre, the chief executive, Greg Stubbs, shakes his head at the clinic’s registration figures. Health services normally see a pick-up in attendance as patients hit their late 50s and start encountering more problems, but Bega has a dramatic drop-off. Just a 12th of their 7 000 clients are over 55.
”They’re not turning up because they’re dying,” he said. ”It’s only just over 60 years ago that Aboriginal people round here have come into this civilisation, and our people just haven’t been able to cope with the huge changes.
”They don’t go hunting for bush tucker any more, they go to the shops and buy western food. They don’t get the exercise they should.”
Six hours’ drive east of Perth in the heart of Western Australia’s prosperous goldfields, Kalgoorlie is where the two sides of Australia’s health divide come face to face.
Money flowing from the mines and from heritage tourism makes its white population richer than the national average, but Aborigines live in a different world.
Ninga Mia, a community on the town’s outskirts, where 150 people live in often squalid conditions, does not even appear on the maps handed out by the tourist office.
Services at the settlement have slowly improved over the years. When it was set up in 1983, its dwellings were corrugated-iron sheds without power or water, and until 12 months ago 49-year-old Beth Nelson was still living in a fibreboard shelter with no toilet or bathroom.
Les Calyun and his wife Marianne, both 30, are moving out of their dilapidated house, having spent six months living there with their three children. ”It’s pretty poor,” he said.”We haven’t got a front door. I got some board and put it up. There’s a toilet but it’s not working though, gets blocked all the time. The window went out so I had to stick that bit of plastic over it there.”
Poor housing exacerbates other problems. Dusty and unhygienic surroundings mean that deaths from respiratory problems are four times more common among indigenous Australians; deaths from heart disease and strokes are three times more common. Diabetes, fuelled by the change in diet and lifestyle, causes death 10 times more frequently, and in some communities affects more than half of all people.
Neil Thomson, professor of public health at Edith Cowan University in Perth, said poverty, racism and dispossession were at the heart of the problem. ”It’s almost a classic example of the impact of social factors on health. If you were dispossessed and marginalised in this way, how would you cope?”
The same factors intensify the problems of violence endemic in most Aboriginal communities. Aborigines are 45 times more likely to become victims of domestic violence and 40% more likely to commit suicide. Add in the effects of car accidents and fights, and violent deaths are three times more common.
Even the most well-appointed buildings in Ninga Mia are overcrowded. A house the size of a large bedsit typically provides a home for seven or more people, often accompanied by a regular stream of distant relatives from more remote communities.
The sheer scale of the problem often seems to confound public health experts. Treating Aboriginal poor health can be like picking up the pieces of a shattered society: less about handing out the right pills than it is about healing the chaos that has resulted from colonialism and dispossession.
Resentment
Health workers admit that some of the biggest challenges simply involve educating people about health. Aware of the resentment caused by generations of white paternalism, they see practical as well as ethical problems in trying to tell people how to live their lives.
At the same time, they know that the lifestyles of Aborigines in rural Australia are often making them ill, and that people don’t realise their health is poor because they have never known it to be good.
Working on a painting in the back of a stripped-out old van in Ninga Mia, 61-year-old Dinni Smith fights off a hacking cough to insist that he has never been sick.
The tragedy of Aboriginal ill health is that its causes are well understood and could be prevented without the need for dramatic technological breakthroughs.
”Talking about the health system is a misnomer in this case,” said Neil Thomson. ”The problem is the failure of the health system to take responsibility and advocate broader change, as well as just delivering services.”
Many white people in Kalgoorlie resent Bega’s attractive new clinic as a sign of government largesse to Aborigines, but in truth health spending a head on indigenous Australians is only 20% higher than overall, coming to just over A$3 065 (£1 200) for each person.
Given the extraordinary difficulties surrounding Aboriginal healthcare, even conservative estimates calculate that the A$1,245-billion annual budget needs to be boosted a further 20%. A 2001 report by the government’s official spending equity body went further, and said it should be doubled.
Kalgoorlie may seem a long way from the Canberra bureaucracy where such decisions are made, but it is far from a forgotten backwater.
Australia’s health minister, Tony Abbott, flew into town on Tuesday for a pre-election meet and greet with local movers and shakers, and the treasurer, Peter Costello, also popped in last week. Neither found time to visit Ninga Mia. – Guardian Unlimited Â