A constitutional Voice in parliament would improve the health of Aboriginal AustraliansBMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1828 (Published 09 August 2023) Cite this as: BMJ 2023;382:p1828
- Pat Anderson, co-chair1,
- Megan Davis, pro vice-chancellor Indigenous and professor of law12,
- Toby Freeman, director of research3,
- Fran Baum, director3
Later this year Australians will vote in a referendum on whether the constitution should be changed to incorporate an Aboriginal and Torres Strait Islander Voice to parliament. The Voice will be a constitutionally enshrined body representing the views of Indigenous communities to the Australian parliament and the executive government on legislation and policy of significance to Aboriginal and Torres Strait Islander peoples.
The idea for this constitutional amendment arose from a nationwide process with Aboriginal and Torres Strait Islander communities resulting in a visionary document, the Uluru Statement from the Heart.1 The inspirational statement calls for a First Nations Voice to parliament, a treaty between the government and First Nations peoples, and a Makarrata commission to supervise a process of agreement making and truth telling. The Voice is intended to ensure that parliamentarians fully understand the impact of proposed legislation on First Nations people. Australia is currently debating whether and why people should vote “yes” or “no” to the Voice.
Those advocating a “no” vote claim that the Voice is purely symbolic and won’t result in any improvement in the health of First Nations peoples.2 Improving the health of First Nations peoples and reducing inequities is already a national priority for Australia that has broad political support.3 Despite this, however, the life expectancy gap between Indigenous and non-Indigenous Australians was estimated to be 8.6 years in males and 7.8 years in females in 2015-17.4 The connection between the Voice and health is not immediately self-evident, even though the supportive evidence base is strong.
The Voice will enshrine self-determination for Aboriginal and Torres Strait Islanders in the constitution. Self-determination and cultural identity are vital to health.5 Evidence shows that First Nations people involved in managing and caring for their land have less disease including diabetes, renal disease, hypertension, and obesity. They also have better self-esteem, self-identity, and connection to culture than those not involved in these activities.67 In Canada, First Nation communities with greater autonomy over their land and community have been found to have lower suicide rates.8
Given the lack of control imposed by colonisation, capacity to influence the governance and policies of vital institutions is particularly important to Indigenous peoples and vital to good mental health. A lack of control influences a range of physical health issues through stress pathways.9 Aboriginal community controlled organisations are an example of self-determination having a positive effect on health.10
Interpersonal and structural racism is an independent risk factor for ill health.11 A Voice to parliament can be particularly effective in tackling racism by preventing racist public policy. The Voice would be an important step in making Australian public policy culturally safer—meaning that it is reflexive, results from dialogue with Aboriginal people, reduces power differences, and is focused on decolonising.12 This is vital, as past public policy has often been damaging to the health of Aboriginal peoples.13
This was reflected in the original Australian constitution in 1901, which stipulated that “Aboriginal natives shall not be counted” in any census. This was not reversed until 1967. Another example was the policy that enabled state and territory governments to remove Aboriginal children from their families. The harm to the health of the “stolen generation” has been recognised14 and was the subject of a formal apology offered in 2008 by Australia’s then prime minister, Kevin Rudd. If a Voice to parliament had been in place it would likely have predicted the damage that such child removals would cause. It might have also determined how to reduce the number of First Nations children living in out-of-home care, which has more than doubled in the past decade.15
In 2007 an Australian government implemented the Northern Territory National Emergency Response in reaction to a report on the abuse of Aboriginal children in the Northern Territory. This intervention has been judged to be a racist policy with negative health effects on Aboriginal and Torres Strait Islander peoples, including through increased racial discrimination, stigma, incarceration, and decreased community control.13 A Voice to parliament would reduce the likelihood of such damaging policies passing into legislation.
The Voice would ensure that a First Nations perspective would be considered in all policies. The “Closing the Gap” strategy, which aims to reduce the gap in life expectancy and in the underlying determinants of health, goes some way to achieving this, but its failure to meet many of its goals indicates that more work is needed. Only four of 18 targets are on track, and progress is poor on others, including closing the life expectancy gap and reducing suicide rates.3 A Voice in parliament would bring greater urgency to understanding why there’s been little progress on achieving these goals.
Social determinants of health—such as employment, education, economics, welfare, housing, criminal justice, and climate policies—all significantly affect First Nations peoples’ health. Australian government policies that affect Aboriginal and Torres Strait Islander people are often framed negatively and rob these communities of power and control. A guaranteed Voice would help to remedy these paternalistic views.
Finally, the Voice can benefit the wellbeing of all Australians. Recent years have seen growing acknowledgment of the violent history of the British colonisation of Australia. For many non-Indigenous Australians this is a “whisper in their hearts”16—an uncomfortable truth leading to feelings of guilt and shame. The Voice is a chance for reconciliation of Australia’s violent colonial history of the dispossession of Aboriginal and Torres Strait Islander people.
The result of the Australian constitutional referendum will have resonance for Indigenous peoples worldwide. Enshrining a Voice to parliament in law would signal willingness from the Australian people for their national government to take responsibility for past and current injustices that have led to such glaring health inequities for Aboriginal and Torres Strait Islander people. The Voice’s contribution to health will go way beyond symbolism and, once instituted, will enable multiple pathways to improve health and wellbeing.
Competing interests: Pat Anderson was co-chair of the Referendum Council.
Megan Davis is Scientia professor at the University of New South Wales, holds the Balnaves chair in constitutional law, and is director of the Indigenous Law Centre. She is also a commissioner on the Australian Rugby League Commission and was a member of the Referendum Council.
Toby Freeman receives funding from the Australia National Health and Medical Research Council to research Aboriginal health services.
Fran Baum receives funding from the Australia National Health and Medical Research Council to research Aboriginal health services. FB was sponsored to give keynote/plenary addresses in the past three years: the Royal Australian College of General Practitioners (airfare, hotel, and speaker fee paid to University of Adelaide); the Global Health and Welfare Forum, Taipei (Taiwan Department of Health Promotion) (airfare and hotel); and the Australian Academy of Health and Medical Sciences annual meeting 2022 (airfare and hotel). FB is also a board member the Cancer Council of South Australia.
Provenance and peer review: Not commissioned, not externally peer reviewed.