UN on Australia

This was emailed to me a few days ago:
> Mr Anand Grover
> Preliminary observations and recommendations
> Canberra, 4 December 2009

> However, I would like to emphasize my overriding concerns
> regarding the situation of persons in detention centres: the
> fact that detention remains mandatory, with no maximum
> limits on duration of stay, and that there are no binding
> legal standards that must be met in providing services.
> These factors impact negatively on the status of health of
> persons in detention.
> Moreover, the excising of the Christmas Island under the
> Migration Act, whereby refugee claims are determined by a
> non-statutory process, means that Island detainees lack the
> same rights to judicial review as their mainland
> counterparts.
> Although processing time on Christmas Island has decreased,
> major problems remain concerning the accessibility and
> appropriateness of the facility. These factors, particularly
> the logistical difficulties associated with airplane access,
> make rendering health and other services extremely
> challenging and present a significant obstacle to ensuring
> on-going monitoring by non-governmental and independent
> stakeholders. It is telling that I was unable to visit the
> island during my Australian mission, as the charter flight
> schedule would have meant I would have had to stay for four
> days – this rendered a visit impossible in terms of my
> schedule, and would represent a major impediment for other
> professionals, such as legal aid or healthcare workers.
> The health of Australia’s prison population was also an
> issue of concern to me. I had the opportunity to visit two
> prisons during my time in Australia: Long Bay, in Sydney,
> and Alice Springs Correctional Centre. There are clearly
> positive initiatives in place in both – for example,
> establishment of a tertiary prison hospital in the former,
> and the Elders Visiting Program in the latter – however
> they share many challenges. These include adequate provision
> of primary health care, resourcing of health promotion
> projects, and provision of appropriate services to a
> population of Aboriginal and Torres Strait Islanders
> disproportionately represented in prisons. I would recommend
> that the Government invests additional funds with a view to
> ensuring sustainable delivery of primary healthcare
> services.
> Individuals with mental illnesses are overrepresented in
> all types of custody. The deinstitutionalization of mental
> health services over recent times is a welcome development
> in healthcare, but inadequate resourcing of alternative
> services has resulted in a shift of individuals with mental
> illnesses to the nation’s prisons.
> Indigenous populations are also vastly overrepresented in
> the prison population. There is a triad of vulnerability
> that I have observed, consisting of incarceration, mental
> illness, and being of Indigenous descent. Aboriginal and
> Torres Strait Islanders with mental illnesses who become
> involved in the justice system invariably experience
> negative health outcomes. A vicious cycle appears to be
> occurring whereby this population is, in effect,
> criminalized. This is exacerbated by issues of dual
> diagnosis: that is, drug and alcohol problems coexisting
> with mental illness. As such, diversion programs, sentencing
> policies and criminal laws must all be considered when
> broadly assessing the health of Aboriginal and Torres Strait
> Islander populations, as incarceration has wide-ranging
> detrimental health effects.
> Whilst Aboriginal and Torres Strait Islanders are
> overrepresented in the prisoner population, they are
> underrepresented in the prison staff cohort; this should be
> addressed through targeted programs that recruit and engage
> Aboriginal and Torres Strait Islander health workers and
> correctional staff in a culturally appropriate manner.
> Additionally, there needs to be an increased and proactive
> focus on health promotion activities as well harm reduction
> interventions, such as needle and syringe exchange
> programmes, to address the preventive health needs of
> inmates of all cultural backgrounds.
> Knowing Australia to be a developed, prosperous country, I
> was moved by the stories told to me by indigenous
> communities, the living conditions I saw, and the extent of
> preventable disease and health-related disability I
> witnessed among those of Aboriginal and Torres Strait
> Islander descent. The right of a significant proportion of
> Australia’s indigenous populations to the highest
> attainable standard of physical and mental health is being
> violated. Basic needs, such as adequate housing, safe
> drinking water and sanitation and access to education are
> not being met. Unresolved issue surrounding native titles
> and land rights continue to have a detrimental impact.
> Communities are not benefitting from the equal access to
> primary healthcare facilities which are at times
> inaccessible or inappropriate. This is sometimes due to lack
> of transportation and communication infrastructure, but more
> often due to direct discrimination and culturally
> inappropriate services being provided. Institutions and
> processes, particularly those linked to tertiary care, and
> staff are not adequately supported to address the specific
> needs and vulnerabilities of the indigenous communities they
> serve. Such inequities are incompatible with basic
> principles of the right to health including equality and
> non-discrimination.
> Decades of neglect, racism and discrimination have
> stigmatized and disempowered these populations, impeding
> equal access to basic services, leaving them on the margins
> of the Australian society. Since the official recognition of
> Aboriginals as citizens in 1967 there have been improvements
> made, but more remains to be done.  Certainly,
> Australia’s support of the United Nations Declaration on
> the Rights of Indigenous Peoples and the apology to the
> Stolen Generations were commendable, but there is much more
> to be done. Progress cannot be made on this important issue
> without respectful and open dialogue and cooperation among
> all parties. I would like to strongly encourage this
> dialogue in the quest for truth and reconciliation about
> difficult issues concerning colonization and consequent
> disempowerment of the Aboriginal and Torres Strait Islander
> populations.
> Including the indigenous population in policy and
> decision–making processes is necessary to build
> relationships which would ensure genuine protection of their
> interests, while securing their respective cultural
> identities and self-determination, and restoring respect and
> dignity. I note that the Government has signaled an
> intention to establish the National Congress of
> Australia’s First Peoples, which represents one mechanism
> by which this engagement could occur. However, I would
> stress the importance of legislative guarantees, or other
> such mechanisms, to ensure that the opinions of any such
> body must be taken into account.
> Initiatives such as this are a welcome development, and
> represent major progress – but other initiatives in recent
> times have proved not as successful. The Northern Territory
> Emergency Response has unfortunately undermined some of this
> progress in efforts towards reconciliation, as communities
> describe the NTER as paternalistic, disempowering and
> racially motivated. It exposed the weaknesses in protection
> of the Aboriginal and Torres Strait Islander populations,
> and highlights the need for entrenched Constitutional
> protection for them.
> Furthermore, the NTER failed to meet basic standards of a
> rights-based approach to health, such as the development of
> a transparent plan with clear benchmarks and indicators,
> participation, the meaningful engagement of communities and
> the establishment of mechanisms for monitoring and
> accountability. Some aspects of the NTER have been
> considered beneficial; notably, that it sent a message of
> unprecedented political and financial commitment to address
> the rights and needs of indigenous communities. Income
> management aspects of the intervention were described
> favourably by some, but as disempowering by most – and my
> attention was drawn to similar initiatives in other States
> that have been implemented on a voluntary basis with
> success. The specific approach regrettably undermined
> existing health structures and the ongoing efforts of
> service providers in the Northern Territory, rather than
> strengthening their role in providing the solution. Overall,
> the NTER has undermined Aboriginals’ and Torres Strait
> Islanders’ self-determination and progress made to date by
> the communities themselves in addressing their own health
> needs and therefore has presented an obstacle to continuing
> further significant improvements in the health outcomes of
> these communities.
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