I’ve just received an email from Amnesty International, following a review by their Secretary-General, Irene Khan, of the living conditions in Utopia, central Northern Territory. This email calls for people to sign a petition destined for Jenny Macklin, urging the government to develop ‘a new approach [to Aboriginal health and wellbeing] grounded in genuine respect for traditional cultures’.

Having spent some time in various remote Aboriginal communities, I am not surprised that Ms Khan was shocked by what she saw in the community she visited. Appalling living conditions and a sense of hopelessness are the impressions that most people would take from a first visit to such a community.

My first experience with Aboriginal communities was on a cultural tour organised for ten students from my medical school. It changed my perspective on Australia; I had no idea that such poverty existed in this country.

It was also the first taste of a tapestry of indigenous culture of which I had previously been unaware. During all of my contacts with Aboriginal communities, including working for Aboriginal-controlled health organisations in the Kimberley and now in Melbourne’s inner north, I have experienced warmth, loyalty and selflessness that is rare in the society in which I was raised. From the Karajarri people of the Kimberley to the Koori in Melbourne, these traits seem to be part of the fabric of Aboriginal Australia.

Nonetheless, it is not hard to see that a sense of despair links many Aboriginal Australians. Nor is it hard to find reasons for this sentiment – reasons beyond the effects of extreme poverty.

Modern Australia has existed for about 200 years – a period in which a penal colony has grown into a wealthy society with a sense of ownership of this vast and remote island. If all the millennia of Aboriginal life in Australia were condensed to one day, the arrival of Europeans occurred with less than ten minutes remaining until midnight. Through the eyes of a culture that have revered and worshipped this land for so long, would our sense of belonging not be justly regarded as precocious and arrogant?

The origins of the gap

Our censure of Aboriginal history has deepened the rift between Aboriginal and non-Aboriginal Australia. In Perth, I grew up surrounded by concrete evidence of prosperity, but not a trace of the culture of the original custodians of the land on which the town was so recently built.

Australia’s failure to improve the life expectancy of its indigenous people sets it apart among modern countries. To this day, Aboriginal people are expected to die twenty years younger than the average Australian. This infamous ‘gap’ is not only a tangible target for welfare programs, but also a reminder to us that there is profound social injustice here in Australia.

In the face of such alarming statistics, recent governments have made poorly researched gestures of ‘charity’ towards indigenous Australians.

Yet it is clear that welfare is not the answer to the problems of Aboriginal people. If Noel Pearson is correct, injudicious welfare may indeed have caused the persistence of the gap and all of its associated ills. It has even been suggested that welfare has served as a form of bribery of the dispossessed.

It’s not hard to see that welfare dependence could lead to high rates of unemployment, a loss of purpose in people’s lives and ultimately to poor health. That is, a pervasive sense of futility undermines people’s instinct to take care of themselves, leading to lifestyles associated with high rates of preventable illnesses such as diabetes, kidney failure and heart disease.

Tinkering at the edges: the limitations of health services

While working on a program to tackle diabetes in a remote community, I realised quickly that although some gains can be made by health services, we could do little to address the most important causes of disease. Rather, our role was to manage problems that had taken root in a void of hope and purpose.

While it is true that poor health is a significant handicap for children to carry through life, early-intervention health programs do not alone offer an escape from a life of poverty. It is hard for most of us to imagine attending a barely staffed school where few students are expected to graduate, or being raised in a community where employment opportunities are scarce. It is not reasonable to expect young people – even those whose health is good – to generate motivation or confidence to participate in the wider community on these foundations.

Australia is home to the oldest surviving culture on earth; the living conditions of many of its people are unacceptable. Irene Khan is right that our approach to the problems needs to be ‘grounded in genuine respect for traditional cultures’.

I have had the chance to ask senior Aboriginal people about what they believe can be done to help their people. The most common answer has been education. Most of my colleagues in Aboriginal Health Services share this view. If the clock could be wound back those 10 minutes, the answer may be different. But many Aboriginal people have accepted that a return to traditional life is no longer feasible.

This being the case, the challenge for government and industry is to empower Aboriginal people to pursue careers befitting the modern world and its evolving economy.

It’s time for us to face reality

We should all be exposed to the sobering realities of remote community life. We should also be aware of the hardships for urban-dwelling Aboriginal people, who face not only generational poverty, but also the negative racial stereotypes that have yet to die out of mainstream Australia.

Now that we’re approaching midnight, how does Australia move into the new day? Irene Khan is right that the plight of Aboriginal Australia is unacceptable. But the problems require practical solutions, and equity in education should surely be our top priority. And, from those of us not directly involved with Aboriginal people, a simple gift of empathy and respect may help to overcome a great Australian injustice.

Dr James Beetson is a Melbourne-based GP who works in the field of Indigenous Health.

Where do you stand?

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