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World Health Day: closing the gap on access to safe drinking water

This year’s World Health Day (7 April) theme was ‘my health, my right’, championing the right of everyone, everywhere to have access to quality health services, education and information, as well as essential services, including safe drinking water, and freedom from discrimination.

Recent data released from the Productivity Commission on progress toward meeting the National Agreement on Closing the Gap targets reveals that, overall, only five out of 19 targets are currently on track, highlighting the urgent need to invest in Indigenous-led solutions designed for and by communities.

The National Agreement on Closing the Gap has 19 national socio-economic targets across areas that have an impact on life and health outcomes for Aboriginal and Torres Strait Islander people across Australia.

Target 9B outlines the goal of ensuring “all Aboriginal and Torres Strait Islander households within discrete Aboriginal and Torres Strait Islander communities receive essential services that meet or exceed the relevant jurisdictional standard” by 2031. Progress against target 9B is not reported due to a lack of complete data.

Research from the Australian National University estimates that people across more than 400 remote or regional communities lack access to good-quality drinking water.

Completely refreshed in 2020 in partnership with the Coalition of Aboriginal and Torres Strait Islander Peak Organisations (Coalition of Peaks), the objective of the National Agreement is to enable Aboriginal and Torres Strait Islander people and governments to work together to overcome inequality.

At the table

Speaking at the AWA/WSAA Voices for the Bush Conferences in 2022, National Aboriginal Community Controlled Health Organisation CEO Patricia Turner AM, who is of Gurdanji/Arrernte heritage, said water services and initiatives will have limited impacts unless they are controlled in their co-design and delivery by Aboriginal and Torres Strait Islander organisations.

“The targets will neither move quickly, nor in the right direction, until all the structural impediments are dealt with. Aboriginal and Torres Strait Islander people need to be at the center of the closing the gap policy,” she said.

“No gap will close without our full involvement. How can Aboriginal perspectives and co-design ever be truly represented and incorporated in policy, technology, and delivery, if we are not at the table?”

Following the most recent data, and now four years into the refreshed National Agreement, Coalition of Peaks’ acting Lead Convenor and Arrernte/Luritja woman Catherine Liddle said governments were failing in their commitments and urgent action is required.

“As Aboriginal and Torres Strait Islander people, we know what is best for our communities, but governments across the board are still not meaningfully giving us a voice in the decisions that affect our lives,” she said.

“The National Agreement sets a road map, informed by our communities across the country, on what is needed by governments to help close the gap. This includes making sure Aboriginal and Torres Strait Islander representatives are at the table with governments to share and lead in the decisions that impact on our communities’ lives.

“This review involved extensive community consultation, and it confirms what our own countless conversations have told us – that governments still don’t understand that Aboriginal and Torres Strait Islander people know what is best for our communities.

“When Aboriginal and Torres Strait Islander people are given ownership over the decisions that affect their lives, the resources they need, and the opportunity to partner with government, we see better outcomes.”

Raising the bar

'University of Queensland School of Public Health’s Associate Professor Nina Lansbury said people are often shocked to hear that not everyone in Australia has access to safe water that comes out of their tap.

“In many remote locations around Australia, when people turn on the tap in their home they are not assured of two things: potable and palatable drinking water,” she said.

“Australia is a wealthy country, we have signed up to attain the Sustainable Development Goals, including SDG6 specifically – the right to safe drinking water. Australia is also a member of the United Nations, and there is a human right to safe drinking water, as well as the Declaration on the Rights of Indigenous Peoples.

“When we talk about health and the essential services that support health, such as safe drinking water, we need to be thinking about what a country like Australia, with strong governance around the delivery of essential services, should be expecting and accepting.”

When it comes to closing the gap on access to safe drinking water, Lansbury said all the pieces of the puzzle needed to create sustainable and effective solutions are already available.

“In the case of drinking water, nothing new needs to be invented or developed. The tools we need already exist. We know how to treat water from a range of contaminants,” she said.

“We also have some amazing examples around Australia of really effective community-based water management in remote communities, where local Aboriginal or Torres Strait Islander residents are managing their community’s water services at a high standard.

“In the nine years since the SDGs were signed, there has been much more focus on this issue. Drinking water equality across this country has become a national conversation. More recently, Government funding has been committed to the delivery of safe drinking water to remote communities. We are heading in the right direction there, but there is still a lot of work to do to ensure solutions are sustainable.”

Fit for purpose, place and people

In 2021, Lansbury and colleagues from the University of Queensland made a submission to the National Water Initiative, outlining five key elements critical to enabling safe drinking water provision for all Australians: supporting people; cross-agency collaboration; technologies fit for purpose, place and people; sustainable funding; and taking a systems view of water and sanitation.

While many water professionals will be familiar with the phrase ‘fit for purpose, fit for place’, Lansbury said solutions also need to be fit for people.

“Including people here is about recognising that there are some incredibly high-tech water treatment solutions, but there are challenges faced with getting treatment products, training and the right infrastructure into remote communities,” she said.

“Sometimes the most high-tech option is not what’s appropriate. We need all the options on the table, but the particulars of place and people really need to drive the solutions that are selected. Whoever is running the system in the long-term needs to be supported in that work.

“Undertaking research in the Torres Strait, I’ve seen a range of issues emerge. Even transporting chlorine supplies by barge from Cairns to the islands can pose problems, including heat and sun exposure impacting the efficacy of the chemical, which impacts dosing.”

Lansbury said that while some of these issues seem simple, water managers in remote communities can feel very isolated and unsupported: “The regulatory setting risks being punitive, rather than encouraging, which can lead to a breakdown in the relationship with those communities”.

“There is a massive burden of responsibility there: the water operators are the front line in protecting their community’s health. Operators’ support needs to be ensured, and every community needs a tailored solution that is chosen by the community.

“Cultural competency and two-way learning is crucial. This is not about engineers going into a community with some pre-selected technology and installing it. It is instead about spending time with the community to learn about the extensive knowledge they have about their Country and their water.”

Closing the gap

Lansbury said the refreshed National Agreement is a powerful document, more so than previous iterations, and the increase in funding committed is a step in the right direction.

“Created in partnership with the Coalition of Peaks, the new National Agreement is quite a self-determined document and it’s much deeper and richer than previously,” she said.

“There are estimates circulating about how much funding is needed and the amount committed is much less than that. But the promising news is that dollars are on the table and more so than previously.

“There is a lot of Indigenous knowledge that is completely relevant to managing natural resources. That has not been privileged in the past in policy development, but the national conversation is widening.

“In the near future, I think we will see some really advanced examples of communities managing all of their water resources independently, and reaching out to state or industry partners when required.”