Bridging the Gap

 

Remote living won’t bridge gap in life expectancy

CLAIRE LEHMANN

For almost all of human history, life expectancy hovered around just 30 years. Of course, many people lived into old age. But because so many children died in infancy or early childhood, average life expectancy remained low. This persisted for millennia, until something remarkable happened.

During the Enlightenment, and the industrial revolution that followed, increasing knowledge about disease combined with technological innovation, meant average life expectancy started to climb.

In 1900 it reached 42 years, and by the 1950s, it reached 62. Today, global life expectancy sits at 71 years, and in rich countries such as Australia it has reached 84.3.

This achievement of modernity is rarely acknowledged, let alone celebrated. This achievement did not occur by magic. It occurred because men and women created the intellectual tools to understand and treat disease, and successive governments invested in public health.

Recently, discussions about the upcoming voice referendum have highlighted a paradox. On the one hand, there is a widespread desire for governments to preserve traditional Aboriginal culture – which includes remote living – as much as possible. On the other, there’s a passionate drive to Close the Gap between the Indigenous and general population in life expectancy and other outcomes.

In an ideal world, these two goals could coexist harmoniously, but it would be dishonest to suggest they are not currently in tension.

And it is unlikely any real progress will be made until this tension is resolved.

At the heart of the Closing the Gap mandate is the significant life expectancy gap between the Indigenous and non-Indigenous populations. From 2015-17, Indigenous males had a life expectancy of 71.6 years and females 75.6 years. Compared to the rest of the Australian population, an average gap persists of around eight years.

The life expectancy gap is often blamed on the effects of colonisation and institutional racism. Of course it is necessary to consider these factors. But they do not explain everything. For example, a gap in life expectancy exists between people who live in the regions, and those who live in our major cities – regardless of Indigeneity.

And Indigenous people who live in the city are arguably more likely to experience institutional racism. Yet on average, they live longer lives than those in remote communities.

The Australian Institute of Health and Welfare has found that Indigenous people in remote areas are 4.3 times more likely to be hospitalised for preventable conditions than the Indigenous living in major cities.

The reasons there is a life expectancy gap between those in the cities and those in remote communities are not hard to comprehend.

In any emergency, geographic distance from a hospital will increase the likelihood of preventable death. Indigenous Australians also have a higher prevalence of chronic diseases.

Without regular monitoring – which is challenging in remote areas – such conditions worsen. A lack of specialist services coupled with inadequate infrastructure, such as clean water and sanitation, compounds the disadvantage.

“The consequences of past wrongs have transcended generations – they can still be felt today,”

Linda Burney told the parliament in 2020. “We can see it in the child who doesn’t have a safe roof to live under. I have visited remote communities where the town has literally run out of water – let alone clean water. I have seen dams empty and children given soft drink instead of water.”

There is no question that historical trauma can influence present circumstances. Yet living in remote areas presents deep challenges, regardless of historical context. The reality is that before industrialisation, all traditional cultures had poor life expectancies.

It didn’t matter if you were a rice farmer in China, or a tin miner in Cornwall. The evidence shows that right across the board life expectancy was low.

Historical records from the 18th century in Sweden show 40 per cent of children did not live past the age of 15. In Bavaria, 50 per cent of children were buried before they reached adulthood. In England and Wales in the 1850s, only 70 per cent of children reached their 10th birthday. Children died from smallpox, tuberculosis, typhoid fever, scarlet fever, dysentery and pneumonia. When the British colonists settled in Australia, their life expectancy was half of what it is for Indigenous Australians today.

Many people who live in a modern society, furnished with hospitals and flushing toilets, romanticise traditional cultures and pre-modern ways of living. Such cultures are imagined to be tranquil and balanced with nature.

While some aspects of this mythology are true (traditional

huntergatherers eat a healthy diet, for example), the historical data shows us no traditional culture has ever had life expectancy outcomes that were not terrible.

The romanticisation of the premodern past is perhaps one reason why the Whitlam government encouraged Aboriginal Australians to leave towns to live on outstations in remote locations in the 1970s. This push has led to a variety of unintended consequences. One of these consequences is that preventable illnesses such as rheumatic heart disease are more common in Aboriginal children than they are for children in Sub- Saharan Africa.

When populations in China, Japan and various regions of Africa have modernised, large numbers of people have migrated from rural areas to cities. They leave some of their cultural traditions behind in the process. But what they get in return is better health, economic opportunities and a better future for their children.

Of course, the government cannot compel those living in our remote regions to move to the city.

To do so would be reminiscent of historical assimilationist policies that are now widely considered harsh and discriminatory. And it is also true that retaining traditional customs and heritage may have benefits far beyond what can be measured in health or in longevity statistics. To attempt to Close the Gap is itself a Western concept.

At the same time, however, governments shouldn’t financially support decisions that hinder the progress of a vulnerable population based on misguided nostalgia.

If they wish to get serious about making change, policymakers must decide what’s more important: preserving the remote lifestyle or closing the gap.

Claire Lehmann is founding editor of online magazine Quillette