Perspectives

www.thelancet.com Vol 384 November 15, 2014 1739

In his compelling film Utopia, John Pilger shows the stark disparities that exist between Indigenous Australians, who make up less than 3% of Australia’s population, and the non-Indigenous population. Inequity in housing and primary health care, alongside police brutality and high rates of incarceration are just some of the injustices that Indigenous Australians are subjected to. Although disturbing, Utopia is a thought-provoking film that gives Indigenous Australians a much-deserved voice.

When I discussed with Pilger his motivation for making the fi lm, he told me that he hopes Utopia will “inform international and Australian audiences of the dire situation and gross injustice suff ered by the oldest continuous culture on earth” in one of the richest countries. “Historical amnesia and indiff erence to the First People are as Australian as Bondi Beach”, Pilger adds. “The National War Memorial, as I show in the fi lm”, he continues, “even denies a place for the only war fought by Australians against invaders—by the native people against the British”.

The disparities that Pilger documents in his film are also of concern to health professionals. At the Uni versity of Western Australia in Perth, Angela Durey, a research associate professor, and Sandra Thompson, Winthrop Professor of rural and remote health, have done research into disparities in Indigenous health and recognise the effects of enduring discrim-ination on Indigenous Aust ralians. “Discrimination and lack of access to resources mean many Indigenous people have not had opportunities for good education and financial security, which impact in other areas of their life like employment and housing”, Durey tells me. In health

care, such discrimination “occurs at institutional and interpersonal levels”, she says. “Hospital pharmacy policy to discharge people with 2 days of supply of medications disproportionately impacts on Indigenous people who live in a remote community and are less likely to have the money or opportunity to buy additional medications”, Durey adds. She recommends, “embedding education and training from school through university to the workplace that acknowledges the legacy of colonisation on Indigenous health and wellbeing, fosters communication with Indigenous Australians that is respectful of cultural diff erences, and encourages building intercultural relationships, and engaging Indi-genous people in the process”.

Australia’s Indigenous people have many health issues. Yuejen Zhao, a principal health economist in the Department of Health, Darwin, NT, Australia, tells me that the high incidences and prevalences of chronic diseases, injuries, and substance misuse among the Indigenous population are partly due to “lower levels of education, high unemployment, poor living conditions, and poor access to health services”. Zhao also notes that “primary health care in remote Indigenous communities is grossly inadequate and poorly funded”. To address health inequity and secure adequate health-care resources, Zhao says, “firstly, we need sustainable community economic development locally, and to improve education, employment, and family income for remote Indigenous communities; secondly, we need to combat

discrimination against Indigenous people; and fi nally, we need to enhance social and political opportunities for Indigenous people”. Durey adds that “not until there is genuine inclusion of Indigenous people into Australian life so that they live, work, and play alongside other Australians and have the same opportunities to fulfi l their dreams and potential will Australia have come of age with respect to its treatment of Indigenous Australians”.

However, as Pilger shows in Utopia, Australia has a long way to go in this respect. Australia is the only high-income country not to have negotiated “some form of treaty” with its Indigenous people, says Pilger. In his fi lm, he calls for such a treaty, which would be a bill of rights to health care, education, land tenure, and a share of Australia’s resources. “Nothing can change substantially until Indigenous Australians have these rights—rights that are taken for granted in the majority population”, he tells me. “The Australian Government is hostile to the First People...so a treaty is unlikely in the near future, but as the situation deteriorates, and more of an international spotlight falls on Australia’s dirty secret, pressure will build”, warns Pilger.

Farhat Yaqub

FilmUnfairness in the land of the fair go

“Although disturbing, Utopia is a thought-provoking fi lm that gives Indigenous Australians a much-deserved voice.”

UtopiaWritten, produced, and presented by John Pilger, directed by John Pilger and Alan Lowery. Dartmouth Films, 2014 (Australia and USA)http://utopiajohnpilger.co.uk/

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