NO Voice to Parliament - so what next?
Although Australians voted NO to establishing a First Nations Voice to Parliament, we must not let that result set back the important work that we need to do to close the gap.
Like many people, I was disappointed with the outcome of the referendum to establish and indigenous Voice to Parliament. We had an historic opportunity to recognise First Nations people in the Constitution and take another important step along the reconciliation path, but a negative campaign of fear and misinformation turned early support for the Voice towards maintaining the status quo. It’s worth reflecting on the result, and what it means for the nation. Although only 40% of people voted in favour of the change, overwhelmingly the available data shows that indigenous Australians voted for change. They did so recognising that there is a significant gap in outcomes across a range of measures including life expectancy, incarceration and suicide, and that a Voice would provide one mechanism to help address these disparities.
From an oral health perspective, we know that a similar gap exists. Indigenous children aged 0-4 years are hospitalised for dental causes at nearly twice the rate of non-indigenous children, and for children aged 5-13 years at 1.3 times the rate. In 2018–19, only 58% of Aboriginal and Torres Strait Islander children aged under 15 had a dental visit in the previous 12 months, much lower than the 80% generally reported for non-indigenous children. As Australia’s first indigenous dentist Dr Chris Burke noted, ‘Aboriginal and Torres Strait Islander peoples have higher levels of dental disease, including more untreated tooth decay and gum disease, than other Australians. Those who do receive treatment have fewer preventive appointments and many more extractions. The impact on general health of dental disease is significant. When inadequately treated, dental diseases can result in higher rates of malnutrition, low birthweight, preterm births and cardiovascular disease. Many Indigenous Australians have insufficient teeth to eat nourishing foods.’
Why is this the case? We know that as little as 50 years ago, indigenous children actually had better oral health than other Australian children, but now we double the rate of tooth decay. And the gap is growing – oral health has worsened across a range of oral health measures between the 2004 and 2017 national adult oral health surveys. Colonisation, socioeconomic disparity and remoteness have all played a role in worsening oral health. Indigenous children living in regional and remote areas have poorer access to public dental services and population based prevention measures like water fluoridation.
As a health practitioner, I know that when we listen to our patients, they get better outcomes. We also know that consultation works, and involving people with lived experience, who are directly impacted by the decisions that are made, is important. Recent history tells us that clearly a top-down approach doesn’t always deliver the best result. It remains to be seen what actions governments will now take to closing the gap, but there is an opportunity for the dental profession and dental practitioners to look at the role they can play in improving oral health for indigenous Australians.