The cohort study of 296 residents over ten years showed a mortality rate 40% lower than the NT average for Aboriginal people. Earlier observations showed a drop in smoking, and successful prevention of obesity and diabetes.

Scientists and others involved in the study comment below.

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Dr Lisa Jackson Pulver is a Senior Lecturer in Public Health and Community Medicine at the University of New South Wales

“This study proves a lot.  To see something coming from the NT where Aboriginal people’s lives are able to resume some kind of normality proves of course that outstation life is useful. These people have access to country and are caring for themselves.  It’s amazing that people are even surprised by this. Of course it has a positive effect. The key thing is that local people are able to guide the delivery of services according to what they believe are their needs.

I have no doubt that this study could be used to improve conditions in any other community , remote or urban, by focusing on listening to what the people in that community want and  having services provided in a way that they can direct them to meet their needs.”

Professor Ian Anderson is Research Director at the Cooperative Research Centre for Aboriginal Health at the University of Melbourne

“There are a range of possible reasons why Utopia has substantially better health outcomes than the average NT community, but  when we look at the standard macro indicators, employment, education and housing , there’s no difference between Utopia and the average community so the results have to be partly related to what’s happening in the social organisation of the community. This is a decentralised community with a long history of running its own affairs and a very well established primary health care service. So these things are very likely to be the contributing factors to explain the better outcomes.

There’s an assumption that all remote community outcomes are uniformly bad  and yet  here we have an example of a remote community where apparently things are much better and we need to understand why, because   it provide insights that might enable the development into  other communities. The decentralised model of outstation has benefits in physical activity, diet, and less access to alcohol.  The risk factors indicators show that obesity is more noticeable in communities near the store rather than in the remote outstations.

Cohort studies like this, following the health of a group of people, have been notoriously difficult to achieve but this study has a very representative sample,  over 90% and with 99% follow-up .There was a high degree of ownership of this study – it’s emblematic of what makes Utopia different.”

Ricky Tilmouth is Senior Health Worker at Urapuntja Health Service at Utopia

“This study gives hard evidence that community outstations and a community lifestyle do actually work if the primary healthcare is delivered properly. We’re very strong on our law and culture here, bush tucker and bush medicines too, and all that empowers our community.

With the health audits being done at present as part of the intervention, it’s an opportunity to try this model elsewhere, and also to extend these current mobile services to include hearing and dental health support services.”

Dr Karmananda Saraswati is a doctor with the Urapuntja Health Service at Utopia

“This study is important because it shows that if we deliver services in a culturally appropriate way we get much better health outcomes.   At Utopia people still have a traditional matrix, with food seeking, ceremonies and most importantly of all traditional land.  We’re providing primary health care in a mobile way and supporting them in that setting and the combination of those two means we’re getting better cardiac health outcomes.

If people are going to be visionary and say where are we going to go in Aboriginal health to get outcomes then I think this is important because he health outcomes here show the importance of land and traditional practices but also qualitatively what we observe is the more subtle thing of people being empowered and being in charge of their own lives.”

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Dr Amanda Gordon is president of the Australian Psychological Society

“Many people will experience mixed emotion on sorry day. Many people will be happy and relieved that the Australian Government is finally acknowledging the wrongs done, other people are more anxious about it.

It is a fundamental principal that relationships damaged by one party can only really start to heal when the doing of that harm is fully and frankly acknowledged. We know as psychologists how important it is to be acknowledged – it is about excuses, about buck-passing and just saying we acknowledge that bad things were done. It is a turning point.

But when people finally escape from a traumatic experience, as well as relief there can be some negative feelings that emerge. When you think of grief, anger is part of the grieving process. When you think of people who have suffered a big trauma, often anger can be a response. My concern as a psychologist is that people may be re-traumatised. Everyone is garnering their memories, thinking about what happened to them and their families and there is significant risk that people are going to be re-traumatised and that there is going to be an outpouring of grief that is going to feel worse in the short term. The other thing that will happen is a feeling of anti-climax – that we have been working towards this for so long – now so what?

Many non-indigenous Australians will really finally get it, that an apology is needed. The fact that it is coming from their elected representatives, not just political activists, means that for many people the realisation of what was actually done to the stolen generation may just be hitting home. It is really important that if people are traumatised and distressed that they are supported.”

Professor Martha Augoustinos is a social psychologist in the School of Psychology at the University of Adelaide. She lead a research project in 1997 looking at public attitudes towards an official apology to the stolen generation.

“When we conducted our research ten years ago, a larger proportion of people responded negatively than positively to the idea of a formal apology. This polarisation reflects different understandings in the community about what an apology means, with those against more likely to assume that an apology constitutes acknowledgement of blame and individual accountability. Those in favour of an official apology tend to believe that saying ‘sorry’ is not about blame but about empathy, sympathy and acknowledging past wrongs.

Interestingly, research indicates that collective anger and outrage are more powerful motivating forces than collective guilt to bring about social change.

I believe we must not under estimate the symbolic importance of a formal apology. We know that these kinds of symbolic acts are very important to people’s self-esteem. When you listen to indigenous people speak about this issue you can tell that it has profound meaning for them and will be an important boost to their morale. On the other hand, it is also an important event for non-indigenous Australians because it provides us with an opportunity to reflect on our own history and identity.

We frequently view emotion as an individual experience but it is often more powerful when the experience is shared. This apology tomorrow will be an outpouring of emotion by both indigenous and non-indigenous Australians.”

Bindi MacGill is currently undertaking a PhD in Indigenous education at Flinders University, Adelaide. She has had wide experience in Indigenous communities and specialises in education.

“The term ‘sorry’ is significant as it carries symbolic weight for many Indigenous families. ‘Sorry Business’ or ‘Sorry Camp’ occurs when someone dies. Mourners go through a long period of remembering and mourning the dead. After a period of time mourners are able to move to a space of healing. In a similar way, Rudd’s ‘sorry’ gives public recognition to the families and their children who were taken away for over 60 years by those in power at the time. This is a profound opportunity for all Australians to remember and acknowledge this sorry business and to move to a place of healing.”

Reverend Leslie Baird is a Lecturer in Community Organising and Development at Wontulp-Bi-Buya College, Cairns. He managed the Gurriny Yealamucka Health Service in Yarrabah from its inception. He is also the Anglican priest in Yarrabah and a certified drug and alcohol counsellor.

“I live in Yarrabah and have been involved in 12 months research here into issues relating to health. In Yarrabah when we consulted with the community we discovered that 80% of people are descendents from the stolen generation. Stemming from the stolen generation times, there is a lot of hurt and pain that comes through at all levels including the individual, family and community and as a result we have the social determinants of health we see today, like alcohol, drugs, domestic violence and sexual abuse. To have an apology is the first step towards healing and reconciliation but it must go further than apology. It must be followed up with compensation. The reason compensation is important is because the government was involved in taking children away from their parents so they are the ones who have to be accountable and they must compensate the people for the losses. When you think about the losses children who have been taken away from their parents suffer, there is confusion, anxiety, loss and grief – it is a human life you are taking away. I hear politicians talking about compensating people through putting money into programs, but that is their idea and this is disempowering for indigenous people. If you want to empower indigenous people, say sorry, but also compensate them directly for their loss.”

Dr Wodak is Director of the Alcohol and Drug Service at St. Vincent’s Hospital, Sydney. He has a major interest in prevention of HIV among injecting drug users, treatment of drug users, health aspects of prisons and drug policy reform. He is President of the Australian Drug Law Reform Foundation and former President of the International Harm Reduction Association. He helped establish the first needle syringe programme and the first medically supervised injecting centre in Australia (when both were pre-legal) and often works in developing countries on HIV control among injecting drug users.

There is virtually universal agreement among Australians that the health and social conditions of our indigenous citizens are intolerable. Numerous reports confirm that this has been the case for many decades. Multiple diverse interventions based on widely differing assumptions and perspectives have failed to achieve substantial or sustained progress. The excessive consumption of alcohol and other drugs, including tobacco, has had a profoundly devastating effect on many Aboriginal and Torres Strait Islanders and their families and communities. Alcohol and other drugs have exacerbated multiple, severe, adverse factors. The situation for indigenous Australians is similar to, but even worse than, the situation applying to indigenous people in other developed countries including New Zealand, the USA and Canada. It is impossible to develop effective interventions to deal with the problem of psychoactive drugs among indigenous Australians without also taking into account and at least partly correcting the other multiple severe factors disadvantaging this population in health, social, education, housing and employment areas.

The intervention by the Prime Minister on 21 June rightly draws attention to the immense contribution of alcohol to the distressing problems of Aboriginal and Torres Strait Islander children today. The importance of alcohol was rightly highlighted in the recent Northern Territory report ‘Our Children are Sacred’. However, action taken in this difficult area should be considered and consultative and based on sound evidence and best practice. There is always a risk of making a bad problem even worse by producing policy on the run.

Policy in such a contentious and sensitive area announced during the run up to an election will inevitably be dismissed by some or even by many as purely politically motivated. Many Australian governments have launched initiatives to deal with the alcohol and drug problems of Aboriginal and Torres Strait Islanders with great fanfare, poorly identified objectives, limited budgets, inadequate consultation and deficient research and evaluation. However, one policy framework that has been well prepared is the ‘The Complementary Action Plan 2003 – 2009′, endorsed in 2003 by Australia’s paramount official drug policy making body, the Ministerial Council on Drug Strategy. Has this plan been given a chance to work?

Alcohol was prohibited for indigenous Australians for over 100 years from the 1850s until the 1960s (and even beyond in some areas). The result of this policy was disastrous. Alcohol prohibition may be beneficial in some isolated Aboriginal communities in remote areas provided that this has the overwhelming support of the members of the community. But alcohol prohibition has been adopted in many countries in the world apart from the USA. The record has generally been profoundly disappointing. Even in the Islamic world, only a handful of countries have adopted and persisted with total alcohol prohibition because of the unpleasant effects of only being partially effective.

The Northern Territory government started the ‘Living with Alcohol’ programme in 1992. This involved increasing alcohol taxation by about 5% with a tiny fraction of this revenue allocated to alcohol prevention and treatment programmes. Careful independent evaluation showed 20-40% improvement in several important parameters. However, after a 1997 High Court decision, the Northern Territory government was forced to close the ‘Living with Alcohol’ programme. The ‘Living with Alcohol’ programme should be reinstated nationally. Only the Commonwealth Government has the capacity to do this. It is not by any means the only action which is needed to control the problems highlighted by recent publicity. But it is probably one of the most important measures needed to reduce the nature and extent of problems due to alcohol which are central to the serious other problems now being discussed.

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