Being Indigenous in one of the richest countries in the world is a risk factor for COVID-19, quite apart from the other factors dispossessed people struggle with, such as high rates of incarceration, unemployment and suicide.
NITV reported on April 2 that five health workers in the Kimberly region of Western Australia — where 50% of the population is Indigenous — had tested positive to COVID-19. This news added to growing fears about the impact the virus could have on already vulnerable Indigenous people and communities.
Health experts and community leaders began raising their concerns as soon as the virus arrived in Australia. Aboriginal people — whether they live in remote, regional, or urban communities — carry a complex burden of disease, disadvantage and poverty, which means they are more at risk of contracting infectious diseases.
This was laid bare by Prime Minister Scott Morrison, who on March 29 spelled out who should stay at home: people aged over 70, people aged over 60 with pre-existing conditions, or any Indigenous person over 50.
Risk factors
Green Left asked Mark Kilpatrick, a registered nurse who has worked in Aboriginal health in the Northern Territory, Western Australia and Victoria, about the particular risk factors that are worrying experts.
“COVID-19 risk factors include living with a chronic disease, especially heart and lung disease, which are very high in Aboriginal communities”, Kilpatrick said. “But we also see a lot of diabetes and renal failure.”
Some estimate that about 50% of Indigenous adults live with a chronic disease, such as heart disease, kidney disease or cancer. Almost one-quarter have two or more of these chronic conditions.
“Also, it appears that smokers are at higher risk — and there’s lots of smokers in Aboriginal communities”, Kilpatrick said.
“There’s a high level of disability in Aboriginal communities: they are more at risk of COVID-19, but they also might be more likely to need close contact with family and carers.”
Reflecting on what would happen if COVID-19 spread in Aboriginal communities, Kilpatrick said: “First, the much higher chronic disease burden compared to the general population means there’s more people at risk.
“Then, there’s the lack of services in remote communities. For example, it’s a big drama to do pathology in the outback: it can take days to get results back. If you have to wait a few days for the mail plane just to get the swabs sent off … everything just gets more complicated.
“Also, there’s the different social structures people live by, and the importance of extended family. For example, in my work in a small community, I might only have direct contact with eight people in a day. But the community is so interconnected that, within 24 hours, an infection in those eight people could be passed through the whole community.”
Health and social service workers have also pointed to the near impossibility of many communities being able to follow physical distancing rules.
Many Aboriginal people live in overcrowded living conditions, the result of decades of inadequate funding of housing and its maintenance.
James Ward and Jason Agostino writing in The Conversation on March 19 said: “The COVID19 risk factors [faced by Aboriginal people] are compounded by where we live. One in eight First Nations people live in overcrowded housing. This means COVID-19 could spread rapidly. And overcrowding poses real challenges for isolating suspected cases.”
Community action
Before any state, territory or federal governments took any clear, decisive action, Aboriginal and community organisations sprang into action to protect communities. They were concerned to avoid the worst-case scenario and build protective capacity within communities.
Community organisations and Indigenous leaders quickly saw the need to educate people about the concept of physical distancing and isolation. Independent Member of the Northern Territory Legislative Assembly Yingiya Guyula used his widely-followed social media accounts to advise and support his constituents — in Yolngu Matha and English.
Devastatingly, but necessarily, organisations recognised the need to tackle funerals and sorry business, a tragically central part of life within Aboriginal communities. “Don’t go to funerals and sorry camps. Stay safe at home,” read a social media meme circulated by the Central Land Council and Central Australian Aboriginal Congress.
Land Councils revoked permits and urged that all non-essential travel to remote communities be postponed. The Northern Land Council in the Northern Territory partnered with Larrakia Nation to assist Aboriginal people to return home by March 26, when travel to and from communities shut down. Anyone returning home since then has had to go into quarantine for 14 days.
But many remote community residents are still stuck in towns, and often sleep rough. ABC News NT reported on April 4 that community organisations are now lobbying the government to provide accommodation for these vulnerable people before the pandemic really hits the Northern Territory.
New challenges
In South Australia, however, the effective lock-down of communities in the Anangu Pitjantjatjara Yankunytjatjara (APY) lands and the return home from the city of many Anangu people, brought a whole new set of challenges.
On April 3, The Guardian reported on efforts to encourage the SA government to evacuate elders to safe accommodation in Adelaide, away from the overcrowded housing and under-resourced health services of their homelands. Although, at the time of writing, the state government had rejected this humane proposal.
Elders at the Mimili Maku Arts Centre wrote: “During the past week, our communities have seen an influx of estranged family members sent back from the cities as part of the government’s strategy of returning Aboriginal people to their communities.
“Already crowded houses are now beyond capacity as we try to accommodate the newcomers, many of whom have a recent history of substance abuse and associated challenges.
“Self-isolation and best practice hygiene are not an option in this environment.
“It feels like our people have been herded up and locked down in communities where facilities, housing and medical support are severely lacking.”
For many Aboriginal people, especially in remote parts of the country, English is not their first language. This also puts them at a disadvantage at a time when the health advice and strict new measures are changing daily.
Community response
Community organisations, although largely underfunded by governments, have carried out amazing work translating and disseminating potentially lifesaving information in people’s first languages, using radio, social media, and also face-to-face education in places where people gather, such as a soup kitchen in Darwin.
The factors that place Indigenous people and communities at particular risk of COVID-19 are not new. Indigenous people and their allies have been fighting for decades to address the racism, dispossession and poverty that put them in the vulnerable position they are in today.
While the resilience, connectedness and creativity of communities and their organisations will hopefully see them through this immediate crisis, the underlying structural issues must also be addressed.
Now, more than ever, we see just how dangerous racism can be.
[Emma Murphy is a linguist who has worked in community development and language revitalisation with Indigenous people and communities around Australia.]