Health and the crises in our health system, such as the ever expanding waiting lists for surgery, are likely to be major issues in elections this year. However, a more important issue for the long term health of Australia, which will also be a prominent election issue, is the increasing divisions and social inequality within our country. As pointed out by Wilkinson in the British Medical Journal last year (Vol 314: 591-5) one of the most important predictors of overall health status in developed countries is the extent of social inequality. The more equal a society the better the overall health status. Unfortunately social inequality in Australia is increasing and worsening health for the country as a whole is the likely consequence.

While divisions on the waterfront have occupied the media over recent weeks it is divisions and inequalities based on race that are likely to have a greater long term effect on health status in Australia. Central to these divisions over race is the Governments response to the High Court Wik decision. All Australians will have a diminished quality of life unless solutions to issues such as access to land are negotiated in good faith with Aboriginal and Torres Strait Islander people.

Dispossession is one of the most important underlying causes of Aboriginal ill-health and this has been recognised for many decades. The National Aboriginal Health Strategy report (1989) and the Royal Commission into Aboriginal Deaths in Custody (1991) being just two of the more prominent relatively recent major documents that have emphasised this point. It is no accident that the Indigenous people of Australia, who until recently did not have any official recognition of prior ownership, have even worse health status than the Maori in New Zealand or the Aboriginal inhabitants of Canada who at least have had the limited protection of treaties.

It has also been recognised for decades both in Australia and elsewhere that part of the solution to the health problems of Indigenous people is the return of some of the land from which they have been dispossessed. The effect on social and cultural cohesion, the acknowledgment of historical reality and the ability to preserve a range of cultural practices that land rights can give all have major impacts on long term health for communities as well as the individuals within them.

The need for land rights was recognised by both the Federal and South Australian Governments by the passage of Land Rights Acts covering the Northern Territory and South Australia in the 1970s. In many communities in these areas the granting of land rights have had a profound positive effect on social, cultural and economic development. Non-Aboriginal people visiting Uluru or Kakadu will have seen some of the progress resulting from the recognition of the original inhabitants who have owned this land for millennia. Native title under the original Mabo decision, the Native Title Act and the Wik decision has the capacity to extend some of these clear benefits of Land Rights legislation to Indigenous Australians other than those living in the middle third of the country.

The Mabo decision, while being a very important landmark, potentially had fairly limited effect because it only applied to Crown land. Wik extended a very limited form of tenure to pastoral leases and hence potentially could apply to a much larger proportion of Australia, although nothing approaching the extent shown in the scurrilous maps used by our political leaders. Wik did not dispossess pastoralists indeed it confirmed the supremacy of their rights. What it will do is allow people like the Wangkatjunka people from Christmas Creek to at least negotiate for the removal of the padlocks that have prevented access to their sacred sites on the edge of the Great Sandy Desert for most of the past decade.

Despite opposition from Indigenous negotiators, the Senate was prepared to pass an amended piece of legislation that gave pastoralists almost everything that John Howard promised them. This probably could have been achieved six months ago but will now not occur at the earliest until well into 1999 and possibly much later, if ever. The Government appears to be using pastoralists to help move public opinion so they can clear the way for mining companies to mine sacred sites without any negotiation (as was the case at Noonkenbah in the 1970s). The Government is pursuing a divisive winner take all political strategy.

Pastoralists might in fact benefit from Aboriginal people having the right to negotiate over mining since the interests of pastoralists and Aboriginal people to preserve land generally have more in common than either group has with the interests of miners. Certainly the pastoralists have nothing to lose from Aboriginal people having this supposedly ‘greater right’ in this one area.

The way in which governments have responded to the Wik decision by the High Court has already had serious negative repercussions for the health of many Aboriginal people. The rise in overt racism over the last couple of years and the associated media coverage are having serious impacts on the emotional and spiritual well being of Aboriginal and Torres Strait Islander people throughout the country and this will increase as elections draw near. The day to day reactions faced by Aboriginal and Torres Strait Islander people in urban areas of Australia has worsened dramatically. Examples of racist behaviour such as people crossing the road rather than walking past an Aboriginal person are common and racist violence is increasing. This is certainly a major health issue: people subject to persistent discrimination have a seriously diminished quality of life even if they do not suffer direct physical health consequences.