Good health starts with a good home

11 November 2019


I'd like to acknowledge the Larrakia people on whose land we come together for this important gathering of poeple across Australia to talk about something we so deperately need - that is good houses, good homes and a place to call our own.

In acknowledging the Larrakia and also the Tiwi Islanders and the beautiful performance by our elders from the Tiwis I just want to add to Jamie's introduction, for those of you who are visitors here, take the time to really immerse into the wonderful culture of the Top End of the Northern Territory, but also be astute in discerning significant issues that we do have which actually come from a lack of homes, homelssness and indeed health issues for our First Nations people..

It is a simple proposition the building blocks for strong, healthy communities start with the provision of adequate housing.

We all know this policy makers, advocacy groups, service providers, community leaders, home owners and tenants.

Yet for such a simple statement, its something we are continually challenged to get right - especially when it comes to the provision of adequate and appropriate housing in remote Indigenous communities.

The reality is we spend a lot of money on an Indigenous housing system that is not sustainable and is not making inroads fast enough or effectively enough.

We examine and judge our successes and failures in remote Indigenous housing through particular lenses.

And I'd like to go through a couple of those.

Firstly, whether its a financial lens going back to the dollars, how much is spent, how much a house costs, why it costs so much, the chestnut about how many millions are spent on remote housing when there are so many claims there is little to show for the expenditure.

What about the social lens the impacts of housing on health, education, community safety.

Housing always seems to be on the deficit side of the ledger whether its in dollar terms or social outcomes.

And then of course there is the political lens, where provision of social and community housing becomes a real point of differentiation and sometimes sadly a battleground.

Earlier this year we saw the conflict and confusion arise over the way forward for the National Partnership on Remote Housing and the differences in opinion between the Commonwealth and States over the progress that had been made through NPARIH.

There is still uncertainty over the future of remote housing funding and provision in many regions.

The Northern Territory was able to secure a funding commitment from the Federal Government prior to the May election for $550 million over 10 years, but not without a knock down battle with the then Federal Indigenous Affairs Minister.

Labor committed double that amount to address the enormous need that exists in the Northern Territpry but of course, that was not to be on a Federal level.

There is still no Federal clear strategy or policy on remote housing and funding certainty

There are new Federal Ministers for Housing and for Indigenous Australians.

Neither Minister Ken Wyatt nor Minister Michael Sukkar have so much as mentioned remote housing or Indigenous housing.

Before he became Indigenous Australians Minister, Ken Wyatt told an Aboriginal housing forum in Perth last year that housing policy is a key element of closing the health and longevity gap we have in society. And he's absolutely correct.

Yet three months after the election there is still no agreement with the Queensland Government, and WA only has an agreement for a year.

States such as New South Wales, with high Indigenous population centres, have forecast huge needs. The NSW Aboriginal Housing Office using their housing supply and demand model estimated that the total undersupply of housing for the NSW Aboriginal community in 2017 was 36,025 dwellings.

The new Federal Housing Minister Michael Sukkar has flagged housing affordability as one of his key areas for action.

But the Minister has said absolutely nothing about remote housing. Zero. When he talks about housing affordability Minister Sukkar is talking about cutting red tape for prospective home owners in major metropolitan centres, not in places such as Wadeye or Yuendumu or Lajamanu or Borroloola or Ramingining.

There is this lack of a coordinated approach at Commonwealth level to delivering essential housing infrastructure.

A bipartisan and long-term commitment is needed to ensure that the lives of people living in the most impoverished communities in this country are not in political and policy limbo.

The effect of this political and policy wasteland leads to what can only be described as a wicked mess. A wicked mess.

I heard a long time manager in this sector describe it as a multi-jurisdictional, multi layered, resource-hungry system which did not filter down to meeting consumers' expectations.

They described Aboriginal housing policy as a cauldron of spaghetti rather than a clear and articulated strategy shared between all stakeholders.

The complexities of land tenure, leasehold agreements, homelands, the desire for community control competing with governments of all descriptions desiring some level of control of their own has created an abyss of unmet expectations.

Its not all grim of course. There are significant advances in some areas over the past 15 years, but they're really not enough.

The latest report from the Australian Institute of Health and Welfare found rises in home ownership and housing provided through the private rental market, and falling levels of homelessness.

The main type of homelessness experienced by Indigenous Australians was living in severely crowded.

Of those homeless on Census night 2016, 70 per cent of Indigenous Australians were much more likely than non-Indigenous Australians (42 per cent), to be living in severely crowded dwellings, yet the gap has narrowed over the past decade.

Indigenous Australians were 68 times more likely to live in severely crowded dwellings in 2006; decreasing to 16 times more likely in 2016.

At the same time, regional and remote Indigenous people were far more likely to be living in severely overcrowded conditions.

The consequences of living in overcrowded conditions are well known and are the focus of previous and current efforts that go into Closing the Gap of Indigenous disadvantage.

Yet I note that of the nearly 40 members of the Coalition of Peaks who are currently involved in negotiating under the new Partnership Agreement on Closing the Gap, there is only one representative from the Indigenous housing sector - the Victorian Aboriginal Housing Board.

This is in no way a criticism of the Coalition. But I would urge the Indigenous housing sector to look at how to get involved with this extremely important work at that national level.

I was very pleased to see the launch yesterday of the Northern Territorys first peak body for Aboriginal housing.

Id urge Aboriginal Housing NT to consider how they can work with the Coalition of Peaks to ensure housing issues, particularly those involving Territorians, can be reflected in the important work they are undertaking.

Reviewing the current National Indigenous Reform Agreement and finalising the refresh of the Closing the Gap targets must include a strong housing voice at every level.

Good health starts with a good home and not just bricks and mortar, but the environmental health aspects that go into appropriate, well maintained housing.

Alleviating overcrowding and other forms of housing stress has a direct impact on diseases such as Rheumatic Heart Disease and kidney disease.

More than 2500 Territorians are affected by Rheumatic Heart Disease or RHD, a disease that has been all but eradicated from the developed world. But not here.

Aboriginal and Torres Strait Islander people are 64 times more likely than non-Indigenous people to develop rheumatic heart disease, and nearly 20 times as likely to die from it. About 100 people, mainly Indigenous children or adolescents, die from RHD every year.

RHD is a disease of social disadvantage and it is completely preventable.

Incidence of RHD falls dramatically with improved living conditions and increased hygiene standards, along with better access to appropriate health services and penicillin-based medications.

I, along with our Lingiari MP Warren Snowdon, advocated strongly for the $33 million dollar Labor commitment to tackle RHD. I hope this is a commitment that will be matched by the Morrison Government.

Dr Bo Remnyi the 2018 Northern Territory Australian of the Year describes RHD as a strong marker for disadvantage between communities, and if we can prevent RHD, we can prevent a lot of other diseases.

RHD Australias Senior Cultural Advisor, Vicki Wade, said the social determinants of RHD are common with many other health problems in Aboriginal and Torres Strait Islander communities, including skin, eye, ear respiratory and kidney diseases.

Kidney disease is of particular interest to me. I recently received a copy of a research paper from the Deeble Institute,Improving access to housing for Aboriginal and Torres Strait Islander renal patients with complex care needs, authored by Stefanie Puszka (Push-Kar) at the Menzies School.

We know Aboriginal people living in remote Northern Territory communities experience extremely high rates of end stage kidney disease.

Most patients must relocate permanently to urban areas for treatment due to the limitations of remote area service provision, even where those services are improving.

Patients with complex care needs require affordable, accessible and culturally safe housing and accommodation.

The research found that a lack of appropriate, accessible and affordable housing, poorly targeted housing strategies, and delays in income support payments can result in housing exclusion and risk of homelessness amongst patients.

Failure to address the housing and accommodation of renal patients can also lead to inefficiencies and wastage in health services.

Ms Puszka puts forward that the Commonwealth and Northern Territory Governments should consider an integrated care package that addresses the broader care needs of renal patients, including housing needs.

An integrated care package scheme would address the housing and support needs and preferences of each patient and their family, with an emphasis on providing choice

The Commonwealth Government has provided funding to the Northern Territory Government, which tendered to the Central Australian Affordable Housing Company for the refurbishment and management of 10 public housing properties for renal patients in Alice Springs and Tennant Creek

While this initiative has improved access to appropriate housing for a small number of patients, their carers and families, it is a limited response.

We need to see housing strategies that address housing needs created by health service delivery models that require people to relocate permanently to access medical treatment, such as renal patients.

I am very keen to further pursue these ideas. The notion that improved housing has better health outcomes is not a new one, but the nuances in the policy development and funding commitments must be followed through.

In 2018 the then Labor Shadow Minister for Housing Doug Cameron convened a meeting in Sydney to discuss Indigenous Housing policy.

The round tables view was that mainstreaming hasnt worked well in the Indigenous housing sector.

There was a strong view regarding a lack of accountability to Aboriginal communities where mainstreaming has taken place. Examples mentioned included the impact of the Going Home Staying Home reforms in NSW, where small Aboriginal services couldnt compete with large mainstream organisations.

The mainstream organisations have not so far been able to set up Aboriginal teams and there has been a significant increase in Aboriginal homelessness as a result. There are no longer any Aboriginal wrap around services in Sydney. Mainstreaming in the NT also led to a range of culturally inappropriate services.

Smaller providers are struggling to compete and this is leading to the loss of culturally appropriate services and a drop in service quality.

The strong message to come out of this roundtable was that Aboriginal organisations need to be at the heart of housing strategy development.

While there is a crying need to step it up when it comes to remote housing provision and servicing, as well as policy development, that deficit can also be seen I think as an opportunity for you the experts when it comes to housing policy and advocacy.

There is something of a policy void take the opportunity to fill it.

Provide the evidence base and solutions, the proofs of the contributions good housing makes to health, stable families, education, employment and incarceration levels.

Ensure Aboriginal people and communities are involved in policy and planning at all levels of government, with Aboriginal community control over local planning, services and homes wherever possible

Reverse the trend toward top down and paternalistic approaches.

There must be an Aboriginal voice in housing development and in all other areas of policy development that affects our lives

We dont have that. That is why we must have an Indigenous Voice to Parliament, as set out in the Uluru Statement from the Heart

We must change the system to change our circumstances. And our Constitution is the very basis, the heart, of our system.

The effects of Constitutional change, of recognition, of an enshrined Voice, will have impact far beyond just a change in law

Constitutional recognition and a Voice will drive the change we have to progress. This Government must get on with the job of co-designing the Voice to Parliament and ensuring its security into the future

Finally, Id like to thank everyone here for the work you do in the housing sector.

Your work matters, your advocacy makes a difference and I look forward to seeing the positive changes this sector will continue to drive.

Im sure sometimes its overwhelming. I know sometimes thats how I feel when I see the human cost of our failure to provide adequate housing for vulnerable people

But at the end of the day we all need to remember we have a common goal a place to call home.

Thank you