The Politics of Suffering: Indigenous Australia and the End of the Liberal Consensus
by Peter Sutton | Melbourne University Press | $34.99
AN INTERVIEW with Peter Sutton published in the Age in July began with the tag line, “Driven into action by loss, the linguist and anthropologist wants to shake the very foundations of Indigenous policy,” and concluded:
Asked what would he do if he woke up one day and found himself advising Kevin Rudd, he says: “I am not a policymaker; policy is not my special bag. I am somebody who has lived a lot with people and lost a good many friends.
“I have been driven into action by grief more than anything else. Stimulating discussion and getting people to think the unthinkable, that is the goal I have set myself.”
This self-reflection encapsulates the passion, energy and intellect that inform The Politics of Suffering, which draws together a number of essays and presentations into a provocative and unsettling critique.
Sutton’s criticism is driven by an objection not to political action, as such, but to “the way political ideology and political censorship have led to poor policy evolution and to the dissemination of disinformation in Australian Indigenous affairs...” His overriding concern is with “the corrosive effect of ideological politics, or even merely white post-imperial guilt politics, on our ability to respond realistically and truthfully to the enduring crisis states so many Indigenous individuals continue to suffer.”
Sutton does not seek to document the evolution of Indigenous policy or the policy process over the past four decades. Rather, this is a critique of the liberal political values in Indigenous affairs. His approach is framed by the assumption that these political values have dominated the development of policy in Indigenous affairs, and that bad policy has been the consequence of an ideological excess that has contributed to a decline in Indigenous social and health outcomes.
To begin with, it’s worth considering whether the dominance of liberal political values in Indigenous affairs is as clearcut as Sutton is suggesting. In her study of political discourse in Aboriginal and Torres Strait Islander health, Rosemary Aldrich documented four discursive themes running through the period 1972–2001: the competence and capacity of Indigenous Australians to ‘‘manage’’; matters of control and responsibility in relation to health; the construction of Indigenous Australians as “other”; and the characterisation of the Indigenous health problem. Her analysis reveals that the different discursive frames generally reflect the predisposition of the commentator. Conservatives, for example, emphasised the importance of the behaviours and choices of individuals (with solutions requiring behavioural change). Social democrats, on the other hand, characterised the problems as structural (with solutions requiring government-driven system change). Aldrich documents the shifting influence of these distinct views and how they reflect broader movements in the political terrain.
These ideological shifts within Commonwealth policy are further complicated by the impact of Australian federalism on policy. The period since the 1967 referendum has seen a growing dominance of the Commonwealth government in Indigenous policy. But state and territory jurisdictions still exert considerable influence through their role in the administration and delivery of services. An alignment in the political ideology across all jurisdictions is uncommon – and even then the competing interests between and across the jurisdictions only further interrupt the relationship between political ideologies and policy. Political ideology, whatever its complexion, while important to the policy process, is not the only social process that shapes the evolution of policy. In health, for example, the structure of the health professions and the nature of biomedical knowledge have been at least as influential as political ideology in framing the Indigenous health policy agenda.
These qualifications do not, in my view, detract from the importance of Sutton’s critique. Unsettling ideas and intellectual provocation may be a productive way to get policy actors to question and re-examine policy positions. Sutton takes on some of the more difficult and contested issues in Indigenous policy, including violence and child abuse, customary law and health. He argues, for instance, that those forms of cultural relativism that disallow debate, judgement and interventions on issues which are causing considerable social harm within Indigenous communities produce a social paralysis that leads to the further reproduction of these harms. Indigenous suffering is morally compelling. You do not necessarily have to agree with all the nuances of Sutton’s argument to be convinced that it is imperative that we ensure that these issues are debated as fully and frankly as possible.
Sutton does not set out to undertake a study of Aboriginal politics per se, although he makes numerous references to Aboriginal political actors and provides some fascinating personal insights into Aboriginal political history. As an anthropologist he has been in a position to witness Aboriginal political life unfold over nearly forty years through his work in northern Queensland. He has developed an enduring relationship with the Aboriginal community of Arukun and has been intimately connected to the lives of many Aboriginal Australians. It is this lived experience that gives a particular depth to his critique. The Politics of Suffering is not a collection of the superficial insights of a policy tourist who bungy jumps in and out of Aboriginal reality, commentary intact.
As a young anthropologist Sutton experienced a significant moment in the transformation of Aboriginal lives when the protectionist regime in North Queensland unravelled. A highly regulated way of life, with restricted rights, was replaced by a more liberal regime and a dominant paradigm that stressed self-management and self-determination. As a result, he writes:
A central focus of progressive political and governmental thinking in Australian Indigenous affairs since the 1970s has been on recovery; recovery of lost political autonomy, lost property rights, lost regional integration, lost economic self-sufficiency, lost pride, lost languages, lost identities, lost sacred objects, lost human remains. Many have put their trust in the promise that “culture” and its particular recovery will do more than restore dignity and the respect of others...
For someone like me who grew up in the wake of this social transformation, Sutton’s account of Aboriginal politics in Queensland over this period is deeply fascinating. He provides some revealing insights into how his views have transformed over this time and the impetus for this transformation. But his conclusion – that the “emergent consensus of the early 1970s” is now “undone, and many of its hopes... unrealised” – is bleak.
The despair and pessimism that colours this book is perhaps most palpable in relation to the northern Queensland communities, where the removal of social controls gave rise to the increasing social dysfunction characterised by a number of commentators as “passive welfarism.” As a counter to the loss of hope, Sutton does provide a more optimistic frame in his documentation and celebration of significant and enduring intellectual partnerships between Aboriginal and non-Aboriginal people over the past two centuries, including Biraban (John McGill) and Lancelot Threlkeld, Mahkarolla and W. Lloyd Warner, Billy Mammus and Ursula McConnel and Durmugam and W.E.H. Stanner. These relationships provide a metaphor for a more collaborative approach that would transcend some of the problems Sutton identifies with the current political paradigm.
In his analysis of the political values underpinning thinking in Aboriginal health, Sutton posits that “The standard progressive line on the causes of the gap between Indigenous and non-Indigenous health is that these are pretty much entirely the historical outcomes of past dispossession, ill treatment and racial discrimination.” He argues that this confines thinking about interventions in Indigenous health to the development of Aboriginal political processes that enable “voice” and “representation” at the expense of tackling those behaviours and values that undermine health.
I personally don’t subscribe to the view that there is a simple causal relationship between political intervention and improved Indigenous health – although Sutton draws the inference that I do. As Rosemary Aldrich’s work empirically demonstrates, he does accurately characterise progressive political discourse in relation to Indigenous health. But contemporary Indigenous health policy has significantly more complexity and nuance than would be expected if it were simply an expression of progressive political values. Over the last fifteen years, Aboriginal health policy has been progressively integrated into the dominant health policy paradigm. Not without its significant problems, this approach produces a policy framework in which the key tensions are between a health systems and services development framework and a biomedically defined set of vertical interventions in key disease and risk priorities such as cardiovascular disease, diabetes, tobacco or alcohol. It is arguable whether this health policy paradigm has produced an appropriate balance between health systems development and the focus on prevention and risk reduction through the individual behavioural change strategies that Sutton correctly identifies as important. But in order to grapple with the problems inherent in Indigenous health policy our analysis needs to extend beyond the influence of political values in relation to Indigenous affairs and consider it within the context of the health policy domain.
In the academic literature on Aboriginal health, increasing attention is being paid to developing multi-level models that attempt to grapple with the complexity of Indigenous health inequalities and an analytical framework that integrates the impact of individual psychosocial and behavioural factors with a broader social and cultural ecology. This approach pushes past the simple dualisms of structure versus agency that Sutton rightly identifies as problematic, and is evidence of an enhanced analytical capability that partly reflects the deepening engagement with Indigenous health issues within the social sciences. Nevertheless, a greater conceptual clarity could be brought to bear on such key constructs as “culture,” which have too often been used with a degree of theoretical naiveté.
So, while I don’t think the view that “Indigenous self-government and voice-power will deliver improvements by some kind of automatic rule” is particularly dominant in the policy arena, I should acknowledge that within public health policy more generally importance is attached to processes of social engagement. It is recognised that non-government agencies – health service providers, community organisations and stakeholder forums – play an important role in the formulation and delivery of public health strategy. Both in Australia and globally, the role of civil society organisations in developing and implementing public health strategy is relatively uncontroversial. In Indigenous health policy over the last two decades in particular this approach has resulted in the development of participatory policy processes, intergovernmental agreements, regional planning processes and capacity building within the Aboriginal health services. Although these strategies and processes are not sufficient in themselves for Indigenous health gain, they are seen to be important enablers for delivering strategies that range across the spectrum of system/institutional reform to individual behavioural and value change.
While there is a body of evidence that points to the efficacy of this approach, it shouldn’t be assumed that Aboriginal processes and organisational structures are necessarily effective or enabling just because they provide voice or representation. It is fundamentally important to evaluate the impact and efficacy of these organisational structures; they deserve the same degree of critical scrutiny that is applied to non-Indigenous institutions or governmental processes. Further, it is my view that Aboriginal political actors and organisations have a responsibility to show leadership for value and behavioural change where this is known to have important health and social benefits.
Data and evidence have an important role in enabling informed policy judgement, and in many respects we are much better placed than a generation ago. There is also a growing impatience in the Indigenous policy world with formulaic “policy by anecdote” strategies. Sutton makes this point when he answers those he sees as promulgating liberal political values: “there is an obvious reply: conditions in remote Aboriginal communities, especially, but also in urban ghettos like Redfern in Sydney, have generally become worse, not better, since the transfer of power from church and government to locally elected bodies in the 1970s and 1980s.” While I think that a valid case can be made that outcomes in particular contexts and regions have deteriorated, we need to be careful in generalising to all of Indigenous Australia. Indeed, the analysis of health and social trends reveals a complex pattern of change.
A more detailed analysis of these trends – one that explains both the complexity and apparent contradictions – is long overdue. But some readily available figures illustrate the point. Since 1967 Aboriginal life expectancy in the Northern Territory has risen by about eight years for Aboriginal men and by fourteen years for women. The improvement in Indigenous peri-natal and infant mortality is unequivocal across all those jurisdictions where the data is of sufficient quality – and it is likely that this pattern of improvement is also occurring more broadly for Indigenous children up to the age of five years.
Trends in relation to causes of mortality are mixed. There has been a clear and significant decline in infectious diseases mortality, but a much more mixed picture in relation to chronic diseases – with some, such as chronic respiratory deaths, declining and others, including diabetes and heart disease, still trending up. The analysis of the mortality patterns across Indigenous populations at one point in time also reveals some surprising results. It is generally assumed that health and social outcomes get worse the more remote the population – and there is data to support this observation. But the pattern is not uniform. Some remote communities appear to defy this trend – Urapuntja (or Utopia) in the Northern Territory being one such example. Further, a recent analysis of Indigenous mortality patterns in the Northern Territory demonstrates a consistent pattern in which mortality outcomes were better in very remote Indigenous communities than in remote communities.
The challenges for Indigenous policy are compelling and they require an intellectual and moral commitment to rigorous policy thinking, including the intelligent use of evidence and data. Sutton has achieved his goal of “stimulating discussion and getting people to think the unthinkable.” Our responsibility, with this evocation in mind, is to formulate and implement policy that to the best of our judgement can make a positive difference for Indigenous Australians. •