Friday, 8 March 2013

Minorities: How they are created and how they are neglected

The world's oldest continent is a product of the Dreamtime when the ancients known as the First Peoples travelled across the great southern land of Bandaiyan, creating and naming as they went. The Dreaming, as it is known, is the origin of spiritual values and reverence for country (kuntri).      

There were many different Indigenous groups in Australia, perhaps 600 of them, each with its own individual culture, beliefs and language. These cultures overlapped and evolved over time.

The Rainbow Serpent   (known as Ngalyod by the Gunwinggu and Borlung by the Miali) is a major Ancestral being for Aboriginal people across Australia.  The Ancestral beings formed the song lines that cross the continent from north to south and east to west.
One version of the Dreaming story is:

The whole world was asleep. Everything was quiet, nothing moved, nothing grew. The animals slept under the earth. One day the rainbow snake woke up and crawled to the surface of the earth. She pushed everything aside that was in her way. She wandered through the whole country and when she was tired she coiled up and slept. So she left her tracks. After she had been everywhere she went back and called the frogs. When they came out their tubby stomachs were full of water. The rainbow snake tickled them and the frogs laughed. The water poured out of their mouths and filled the tracks of the rainbow snake. That's how rivers and lakes were created. Then grass and trees began to grow and the earth filled with life.

The respective relationships with the land of Indigenous and non-Indigenous Australians are epitomized in a line from a Paul Kelly song (those of you who can remember back as far as my first BLOG will remember him) in which the non-Indigenous line is ‘this land is mine’ and the Indigenous line is ‘this land is me’.

The complex and diverse Indigenous cultures of Australia are the oldest living cultural history in the world,  going back at least 50,000 years, perhaps 65,000 years (by comparison Ireland has been populated for just 9,000 years). At the time of first European contact, it is estimated that around 750,000 people lived in Australia.

You can imagine what the introduction of British colonists – and them being sailors and convicts - did to this ancient, rich, beautiful and fragile pattern!

 The ‘First Fleet’, comprising eleven ships, sailed into Botany Bay and Sydney bringing with them around 780 British convicts. This was on January 26, 1788, now celebrated as Australia Day, but labeled ‘Invasion Day’ by Indigenous colleagues with whom I have worked who see this landing as no cause for celebration. Two more convict fleets arrived shortly after. 

This settlement brought with it all manner of destruction for the Indigenous peoples not least of which was a wave of Old World epidemic diseases. Smallpox alone quickly killed more than 50% of the Aboriginal population, who lacked immunity. Then followed the appropriation of native land and water resources.  The combination of disease, loss of land, social and cultural disruption and violence reduced the Aboriginal population by an estimated 90% within 12 years of white settlement.

This story is replicated elsewhere in the world.
Mythology also told how the lands and lives of the Arctic Inuit were created and nurtured. The environment and animals of the Arctic and the adventures of the hunt created visions of spirits and fantastic creatures and the aurora borealis, or northern lights, might conjure images of family and friends visiting from the hereafter.  Alternatively the Lights might be invisible giants or the souls of animals.
The Inuit practiced a form of shamanism based on animist principles. They believed that all things had a form of spirit, including humans, and that to some extent these spirits could be influenced by supernatural entities that could be appeased when one required some animal or inanimate thing to act in a certain way. 

European arrival in Inuit lands shattered this delicate system of beliefs so closely in tune with nature and caused widespread death through new diseases introduced by whalers and explorers, and enormous social disruptions.

The imposition of western laws, in Canada for example through the RCMC, and a moral code decreed by missionaries wore down the culture and social fabric leaving the traditional supports in tatters.

European colonization of North America also had a devastating effect on the native populations through loss of land, disease, enforced laws which violated their culture and through the introduction of guns, alcohol and horses.  Suddenly the balance between man and nature, tribe and tribe was upset forever. Increased mobility alone meant more tribal trespass and the ease now of killing prey upset a symbiosis which had evolved over centuries.

European religions were introduced and conversion to them forced interfering with the traditional ancestral worship breaking down cultural understandings. Then, of course the Native Peoples’ lands were appropriated – and this appropriation resisted.

You can see the pattern here, and these are but a few examples of what has been repeated over thousands of years; our actions cause the emergence of minority groups who then inevitably become disadvantaged in numerous respects.

These ignominious beginnings have had a sustaining legacy.

As a group, Indigenous Australians have one of the lowest life expectancy rates in the nation. Today that life expectancy is on average 10 years less than for non-Indigenous Australians. A large part of this is due to chronic diseases such as cardiovascular disease, diabetes, cancer, chronic respiratory disease and chronic kidney disease. Many of these have common risk factors, including smoking, poor nutrition and lack of exercise. On returning from a visit to ‘outback’ Indigenous communities in the 1990s the then president of the College of Surgeons and I, as CEO, reported to a College Council meeting that whilst our developing countries outreach programme was leading to improvements in healthcare quality in those countries we had largely ignored an almost identical problem amongst  our own Indigenous peoples.   

Life expectancy figures for the Inuit population are complicated by the spread of Inuit peoples across a number of Arctic countries. However studies of life expectancy of Canadian Inuit peoples suggest it is 10 to 15 years less than for non-Inuit Canadians.

Native Americans’ life expectancy ranges from 66 to 81 depending on whether you happen to live in South Dakota or California (which itself raises questions) and, while averaging is fraught, if one averages, American Indians spend four years less on this planet than do other Americans.

Isolated and minority groups, whether indigenous minorities or ethnic minorities or economic minorities or social minorities are almost without exception worse off when it comes to quality of life and quality of health care. For instance, in the USA, the Agency for Healthcare Research and Quality (AHRQ) reports that:

·    African Americans received worse care than White Americans for about 40% of measures.
·    Asians received worse care than White Americans for about 20% of measures.
·    Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.
·    Poor people received worse care than high income people for about 80% of core measures.

In Ireland a particular unequal minority of concern are ‘the Travelling People’ (an lucht siúil or Pavee). Very little is known about the origin of the travellers. They may be descendants of people in Irish history who had been evicted from their lands; they may be descendants of travelling tradesmen, such as tinsmiths; or are they may be descendants of travelling bards.

 What is known is that there are concerns for this small minority of Irish (0.5% of the overall population). One is health. Life expectancy among the travellers is low and infant mortality high compared to the general population. A second is education. Because of their lifestyle, only half of the school-aged children are in school and many of the adults are illiterate. 
That minority groups are with us and always will be is inescapable; but that the quality of healthcare that many of these groups receive is poorer than the rest of the population should not be an inevitability.

ISQua has a clearly articulated set of objectives to enhance health care safety and quality in low and middle income countries. We believe this will have the effect of improving outcomes for the populations, including minorities, in those countries. ISQua’s overall mission will also lead to benefits for minorities as the effect of improvements filter through societies in general. ISQua has also made its intentions clear in focussing on minority groups in particular as one of its recent conference tracks directed to this theme attests. As we build our interest in this problem and search for possible solutions we would be assisted by your input and invite you to offer it.
The following sources where used in compiling this document.
Australian Museum Online:
Australian Government Culture and Recreation Portal:
Webster Online:
National Museum of Australia:
Publication No. AHRQ 11-0005-3-EF April 2011
Statistics Canada Health Reports

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