The brave new world of Indigenous policy has been built on the promise of evidence-based outcomes — especially in relation to Indigenous health.
The Indigenous Affairs Minister, Jenny Macklin, has repeatedly voiced her support (pdf) for "evidence-based policy interventions that close the gap between Indigenous and non-Indigenous Australians". This apparent belief in evidence is the same sentiment that was used by the Howard government to justify the Northern Territory Intervention and its removal of Indigenous rights to land, welfare income, self-determination and non-discrimination.
That government maintained that quarantining Indigenous welfare income improved health because it encouraged people to consume more fruit and vegetables. Before the Intervention, Mal Brough, the former Indigenous affairs minister, stated (pdf) that evidence "proves that reducing discretionary income and ensuring payments are directed to their intended purpose makes a real and positive impact on those we are seeking to assist. The question, therefore, is how do we achieve this more widely."
So where does that leave the current Government when evidence emerges that the Northern Territory Intervention is not leading to improved Indigenous nutrition? This was the revelation last week when researchers in the Northern Territory’s Menzies School of Health Research reported that income quarantining was not increasing purchases of fruit and vegetables.
The new study is significant because it’s the first quantitative study of food sales in prescribed Indigenous communities that used qualitative data to directly test the Government’s evidence-based claims.
The finding that the Intervention was not improving Indigenous health outcomes was not new, and indeed a series of independent reports had found that Indigenous health was not improving under the Intervention. Irene Fisher, the Chief Executive Officer of the Sunrise Health Service, revealed (pdf) that anaemia rates (which are a direct result of poor nutrition) among children under the age of five rose from 20 per cent in June–December 2006 to 55 per cent in June–December 2008. The University of Technology Sydney’s Jumbunna Indigenous House of Learning identified that the Intervention was not promoting the consumption of fruit and vegetables because their prices in community stores were prohibitively expensive (pdf).
The Menzies School’s research is new in that it is the only quantitative study that assesses food purchases. It compares expenditure across 10 stores in Northern Territory Indigenous communities in the 18 months before and the 18 months after income quarantining was introduced. Accordingly, it tests the Government’s claims and qualitative studies that Indigenous people are eating more fruit and vegetables since the Intervention.
The Menzies study, published in the Medical Journal of Australia, found that income quarantining was not making any difference to healthy food sales in Indigenous communities. Incidentally, there was also no impact on tobacco sales — another major health issue for Indigenous people. The only remarkable increase was expenditure on soft drinks. The authors concluded:
"These findings suggest that, without an actual increase in income as occurred with the government stimulus payment, income management may not affect people’s spending overall. The findings challenge a central tenet of income management — that people’s spending habits will be modified in a positive way with mandatory restrictions on expenditure alone."
With her passion for evidence, the Minister should have welcomed the first empirical report on fruit and vegetable sales. However, Macklin’s response to the Menzies School’s research was dismissive. Instead, she referred to an earlier qualitative study (produced by the Australian Government’s Institute of Health and Welfare) which claimed that the perception of healthier food choices proved the positive impact of income quarantining. That study (pdf) had been based on telephone interviews with 66 store owners, an earlier survey of 49 Government business managers and an earlier report of consultations with Indigenous people from four communities. According to it, two-thirds of Indigenous people interviewed "had a positive view" of income quarantining.
However the Australian Institute of Health and Welfare (AIHW) report expressed a number of serious concerns with its methodology. One problem related to the fact that the study’s point-in-time and qualitative research were not very convincing, and "would all sit towards the bottom of an evidence hierarchy". As well, they found that in the Government’s research the "overall evidence about the effectiveness of income management in isolation from other [Northern Territory Emergency Response] measures was difficult to assess". Those "other measures" include the increase in the supply of fruit and vegetables in Indigenous community stores, and the greater numbers of non-Indigenous government workers in communities, which would likely have an impact on fruit and vegetable purchasing.
Further, the AIHW pointed out the fact that interviews with Indigenous people "included only a relatively small number of clients (76) from 4 locations, who were not randomly selected for interview", and found that overall, "There was a limited amount of quantitative data on which to base the evaluation findings."
The shortcomings in the Government’s evidence have attracted widespread criticism from experts in Indigenous policy indicators. The Director of the Centre for Aboriginal Economic Policy Research (CAEPR), Professor Jon Altman, noted that "in the area of income quarantining there is still fraught methodology, so it is store operators rather than customers that are surveyed, and while 68.2 per cent of store operators report more healthy food purchased, it is unclear if this ‘more’ is in dollar terms or quantity."
The United Nations Special Rapporteur on Indigenous Rights, James Anaya, who has reported on the racial discrimination underpinning the Intervention, also stated (pdf) that evidence of the success of the income quarantining "is ambiguous at best". The Government’s own review of the Intervention concluded that, "there was little evidence of baseline data being gathered in any formal or organised format which would permit an assessment of the impact and progress of the NTER upon communities."
So if the Government was to use the empirical evidence of the Menzies School to improve Indigenous nutrition, what would it do? The answer is that it would provide subsidies for fruit and vegetables in community stores. The Menzies School found that the one time that food spending increased was at the time of the government stimulus payment. This corroborates Jumbunna’s finding that Indigenous people weren’t buying fruit and vegetables because of the very high cost of these foods in their communities, and affirms Jumbunna’s recommendation to subsidise food.
However Macklin has decided to take a different path. Rather than seeking to verify evidence, the Minister is leading a bipartisan push to extend income quarantining to non-Indigenous communities in the Northern Territory and Australia-wide by 2012. This leaves one wondering what evidence has to do with any of this. A senior fellow at CAEPR has noted (pdf) that, in reality, "evidence in Indigenous affairs plays just a small role in a much larger argumentative struggle" between different "ideological tendencies". The current Government’s ideological tendency has been away from Indigenous rights and towards neo-paternalism, according (pdf) to the director of CAEPR.
This form of paternalism, however, may not be for "their own good".
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