Michael Green

Writer and producer

Is this the end of Medicare?

In Social justice, The Age on

A national institution, Medicare turns 40 this year. But are budgetary changes such as the doctor co-payment the beginning of the end for universal healthcare?

MEDICARE was always a shit-fight. It became law in the most extraordinary circumstances: one of a handful of bills passed during the only joint sitting of federal parliament in the nation’s history, after the double dissolution election in 1974.

As the Whitlam government prepared to introduce the system – then known as Medibank – its opponents rallied.

The Australian Medical Association marshalled a million-dollar “Freedom Fund”, donated by members. Determined to stop bureaucrats interfering with patients, it hired a former Miss Australia to front its publicity campaign. The General Practitioners’ Society of Australia circulated a poster depicting social security minister Bill Hayden dressed in Nazi uniform.

And that’s just the opposition from outside. Dr Anne-marie Boxall, co-author of Making Medicare, says Whitlam had little support, even from within the Labor Party. The party platform advocated a fully nationalised model, along the lines of the British National Health System (even though it may have required a referendum).

By contrast, Whitlam’s plan was for a public insurance scheme. Health services would be delivered by a mix of public and private providers, but paid for by taxpayers and guaranteed for everyone.

“The crucial members of his caucus didn’t agree with him, but he was adamant,” Boxall says. “He’d done a lot of thinking about it. So he waged the war of public opinion and he won.

“It’s an amazing political story.”

Medibank began full operation on October 1, 1975, just six weeks before the dismissal of the Whitlam government. The Fraser government tinkered with the system several times before abolishing it – only for it to be revived by the Hawke government in 1984 in almost exactly the same form.

Thirty years later, Medicare enjoys overwhelming public support. Politicians will swear to defend its honour, no matter their stripes or the system’s shortcomings.

And yet, in the wake of the federal budget, many people believe Medicare is under threat. The target of most ire is the proposed copayment for doctor’s visits, under which even the poorest will have to pay for up to ten appointments each year.

But are these changes the beginning of the end of universal coverage, or another nail in its coffin? Or are they in fact a distraction from the deeper afflictions at the heart of Australia’s health care system?

Health minister Peter Dutton describes the Coalition as “the greatest friend Medicare ever had”, echoing a line Tony Abbott employed during his days as health minister.

The coalition has demonstrated its amity with a host of surprise announcements, including the copayment, which also affects diagnostic tests, such as x-rays, blood tests and prescription drugs. (These charges will be capped for children, low-income earners and the chronically ill.)

More people will pay the Medicare levy surcharge, and fewer will qualify for the private health insurance rebate. Billions of dollars have been cut from public hospitals, and the preventative health agency and other health promotion programs have been shut down. The savings will be directed to a $20 medical research fund.

Dutton says that without these reforms, spiralling costs will jeopardise Medicare’s viability. “The government is very keen to keep Medicare and strengthen it. To keep it universal, we have to make sure it’s affordable. In my view Medicare is only sustainable if those people who have a capacity to pay contribute to the system.

Professor John Deeble, now 82, was one of the original scheme’s architects. He says that although costs have been rising, they’re manageable. Health spending by our governments is low compared with other wealthy countries.

“This is not really about the sustainability of Medicare or anything like it,” he says. “They just want to spend the money on something else, simple as that.”

The Medicare levy – currently 1.5 per cent of taxable income – was established as a premium for public health cover. If the nation’s health costs rise, the government can raise the levy, Deeble says. In that way, people’s contributions are determined by their capacity to pay – their income – not by how often they need treatment.

By introducing copayments instead, the government is embracing something fundamentally different: a ‘user-pays’ notion of fairness in health funding.

In Medicare’s first incarnation, when social security minister Bill Hayden introduced the bill to parliament, he declared that the new health system’s three motivating principles were “social equity, universal coverage and cost efficiency”.

Although the full details of the Coalition’s reforms haven’t been released, public health experts have been unanimous in their critique: as a package, it’s simply bad policy.

“We’ve actually tried all these solutions before, which is why we know they don’t work,” says Boxall, who is the director of the Deeble Institute for Health Policy Research.

“We need to step back and look at the structural problems with our health system.”

Among these are two key vulnerabilities, unforeseen at the time of Medicare’s design: the rise of private health care, and the growing burden of chronic illnesses.

“What we like about Medicare are the principles it was founded on,” Boxall says. “Things have changed. So what are we doing to improve universality, equity and efficiency?

*

For most of the 20th century, Australia had a two-tier medical system : a very basic insurance system for the working class and a fee-paying model for those who could afford it.

“Doctors offered quite different services, and in many cases different waiting rooms for each group,” says Associate Professor James Gillespie, from University of Sydney’s school of public health, and co-author of Making Medicare.

The World Health Organisation says “universal coverage” means “all people have access to services and do not suffer financial hardship paying for them”.

But under Medicare, we’re already failing the test on equity. More than one-in-six Australians say they don’t see a doctor or fill prescriptions because of the cost, according to an international study published last year by the journal Health Affairs. Other research has shown that people who live in poorer neighbourhoods are much more likely to delay medical care than those in the wealthiest suburbs.

Even without the new copayments, Australian patients fork out a lot for treatment from their own pockets, compared with other developed countries.

The two-tier system has re-emerged. One reason, says Gillespie, is that “both sides of politics have refused to think seriously about the role of the private system”. Major reviews commissioned by both the Howard and Rudd governments specifically excluded an examination of its role.

When Medicare began, private hospitals were a small industry, run by churches and charities. But in the last two decades, they’ve become big business, where doctors earn much more for their work.

Until the 1990s, private health insurance was in terminal decline. But spurred on by the Howard government’s incentives – the Medicare levy surcharge and lifetime cover discount – just under half the population now has private cover.

“We’ve ended up with a private system that shifts services away from the public and creates more privileged ways of doing things,” Gillespie says.

He says private funding can contribute to universal care, so long as core services are delivered the same way to everyone. Canada has a similar system to ours, but private insurance isn’t allowed to cover the services offered by its public system.

“If there’s a different system for those who can afford better, you end up with a residual service, which gets squeezed and becomes second best,” Gillespie says.

*

The coalition argues the copayment is a “price signal” to alert people to the real cost of treatment. But there’s something unusual about healthcare – even economists say so. In simple terms: you can judge how you’ll feel if you forgo buying a hamburger, but not if you forgo visiting the doctor.

“In the case of healthcare, part of the product itself is giving you that information,” explains Professor Jeff Richardson, from Monash University’s centre for health economics. “You’re not in a position to judge what life would be like with and without it.” All of which means that promoting efficiency is more complex than imposing a price signal.

Likewise, the relationship between health expenditure and outcomes is not straightforward. The nation’s health costs have been rising, but compared with other OECD countries, our total health spending – both private and public – is just below average. It’s half that of the United States, as a percentage of GDP.

“When the government says Medicare is unsustainable, it’s lying,” Richardson says. “The Australian government could spend much more on health if it wished. It’s simply a political and social judgement that it doesn’t want to.”

Curiously, despite Minister Dutton’s warnings about unsustainable health spending, his reforms – which aim to push more people into the private system – will end up costing more overall.

When the government acts as our single-insurer under Medicare, it has the power and incentive to bargain hard: as a result of bulk billing, GPs incomes are low by international standards. But with many different payers – like in the US system – it’s easier to for private insurers increase fees than control costs.

And for now, GPs and pharmaceuticals are the most cost-effective parts of the health system. Increasing their price will push more patients into hospitals, which are much more costly.

The measures are not a question of efficiency, Richardson says, but rather, an ideological choice that health is an individual responsibility, not a shared one, like defence or policing.

“If we swing over to the private sector and push it back on individuals, the health of poorer people will suffer and overall costs will almost certainly rise,” he says.

Dutton, however, maintains the measures aren’t about ideology, citing the Hawke government’s plans to introduce a $2.50 copayment for GP visits in 1991. (Paul Keating scrapped the idea when he took over as prime minister.) “I strongly believe that the changes we’ve put forward will improve access and the standard of care provided by GPs,” he says.

But the biggest challenge to the standard of care now comes from an entirely different source, one his reforms do nothing to address.

In Australia, the greatest healthcare inefficiency is found in a disconnect between the system – the fragmented network of hospitals, specialists and GPs, and their mishmash of state, federal and private funding – and the kinds of illnesses we have.

Where once we suffered acute ailments, we now need ongoing support with chronic conditions, says Dr Steve Hambleton, the outgoing president of the Australian Medical Association.

This change is partly a measure of success. The number of deaths from heart attacks, for example, peaked in the 1970s. But living with heart disease requires continual treatment and adjustment, especially as you develop other conditions. “The system doesn’t treat those people all that well,” Hambleton says.

Patients with chronic diseases need to see a broad range of health professionals and have frequent tests – but they are often seeing them in a piecemeal way with little continuity or communication between experts. Many of these, such as physiotherapists, psychologists or dieticians, are excluded or receive only limited funding under Medicare.

Both parties have attempted limited reforms to address the rise of chronic illnesses and the needs of our aging population. The Coalition brought in chronic disease management plans, which extend benefits to other kinds of treatment, beyond doctors. Labor’s super clinics and Medicare Locals aimed to bring together and coordinate different health services for patients. But the changes have been piecemeal.

“We need a proactive, long-term approach to care, supporting primary healthcare to keep patients out of hospitals, and make sure people don’t fall through the cracks when they move between community and hospital care,” Hambleton says.

*

THE wide, bright, hallway of the Victorian Aboriginal Health Service in Fitzroy is humming: people young and old are waiting and chatting; some are on the go, others hovering around a wood heater.

Today, a specialist is visiting today to conduct an ear, nose and throat clinic.

Jason King, the centre’s CEO, says they offer an holistic service. There are GPs, dentists, allied health professionals, visiting specialists, social workers and financial counsellors, all supported by Aboriginal health workers from within the community. “It’s not pumping them out every ten minutes. It’s ‘How’s mum and dad going? How’s uncle going who lives with you?’

“We’re the central hub, this is where people come and see family,” he says.

Last year, the health service celebrated its 40th anniversary, a history that has coincided with that of Medicare. Each year, about a third of the state’s Aboriginal population pass through its doors.

The centre’s model of integrated care, embedded in the values of its community, is exactly what doctors and experts have ordered – along with the World Health Organisation, the OECD and several Australian inquires going back decades.

But King says the co-payment and cuts to preventative health will either cost the centre patients or take a chunk out of its budget. Either way, that means fewer services.

There are 28 Aboriginal community-controlled health centres around the state. Jill Gallagher, CEO of their peak body, says Aboriginal health remains worse than the rest of the nation, and Victoria is no different.

“The life expectancy in Fitzroy is the same as the life expectancy in Fitzroy Crossing,” she says. “For every dollar spent on Medicare for a non-Aboriginal person, about 60 cents is spent on Aboriginal people. Access to primary healthcare is still not equitable, in spite of the fact there’s four times the burden of illness in the Aboriginal community.”

Dr Mary Belfrage, the Fitzroy service’s medical director, says any barriers to accessing health care cause people show up later, with advanced conditions, which are more expensive to treat. “It all translates to worse health outcomes, but it’s also inefficient,” she says.

“This isn’t about party politics or a particular budget. It’s about the principle of equity and how it impacts on health.”

Read this article at The Age online

 

Flirting with disaster

In Environment, The Age on

Big business is calling for increased spending on disaster prevention. But with climate change set to cause more fires, floods and heatwaves, are we doing enough?

AFTER the deadly summer of 2010-2011, executives at Insurance Australia Group made a decision. Floods had swept through the eastern states, killing more than two-dozen people and causing billions of dollars of damage. 

“We have a whole ‘natural perils’ department made up of scientists and engineers who constantly model risk,” says Mike Wilkins, IAG’s managing director. “But it’s bigger than us. We needed to be part of a coordinated national conversation.”

The team began planning a “risk summit”, with 60 invitees from the business world, community groups and government. Together, they took aim at Australia’s record on disaster prevention. They identified two key problems: not enough spending on mitigation and poor land-use planning. Out of that summit, the Australian Business Roundtable for Disaster Resilience and Safer Communities was formed. It comprises a handful of very large and influential corporations: IAG, Westpac, Optus, Munich Re and Investa Property, as well as Australian Red Cross. 

The big end of town seems an unlikely champion for the cause, but Wilkins says each of the members sees the consequences first-hand when disasters hit. And above all, so do taxpayers.

The group’s research shows that for every $10 the federal government spends on post-disaster recovery, it spends less than $1 to reduce the risks beforehand.

In a joint statement released last year, the six CEOs said the economic cost of disasters will nearly quadruple by mid-century, rising to $23 billion annually. Wilkins says the costs of disasters could be halved with smart precautionary spending. His group wants the federal government to appoint a national resilience advisor and commit to long-term, pre-disaster spending.

However the roundtable’s figure of $23 billion annually does not even factor in the future impact of climate change. Statistics from Munich Re show that the number of extreme weather “loss events” for insurers in Australia has risen steadily over the last three decades. But Alexander Allmann, the company’s head of Geo Risks, says while anthropogenic climate change has had an impact on losses from weather catastrophes, it’s  not yet quantifiable. 

Yet last month, the Intergovernmental Panel on Climate Change (IPCC) released two new reports. The first details the impacts of global warming. Among the biggest risks for Australia are more deaths and damage caused by heat waves and wildfires, and increasing frequency and intensity of floods. 

It warns of diminishing agricultural production, less fresh water and increasing threats to coastal infrastructure caused by rising seas. A 1.1-metre sea level rise – possible by the end of the century – “would affect over $226 billion of assets” including nearly 300,000 homes.

The IPCC’s other new report says global greenhouse gas emissions rose nearly twice as fast in the last decade than during the 30 years before, and current reduction targets aren’t enough: we’re still on course for 4 degrees of global warming by the end of the century.

The World Bank has warned that if the worst comes to pass, “there is no certainty that adaptation to a 4 degree world is possible”. 

The Victorian Centre for Climate Change Adaptation Research was established by the state Labor government in 2009. In last week’s budget, the Napthine government did not extend its funding. It will close at the end of June.

The state Environment Minister Ryan Smith declined to be interviewed for this article. 

Prime Minister Tony Abbott’s controversial response to the recent IPCC report meanwhile, was this: ‘‘Australia is a land of droughts and flooding rains,’’ he said. ‘‘Always has been, always will be”.

*

Earlier this year, the federal attorney-general’s department sounded a similar alarm to the business roundtable. “Existing funding arrangements for natural disasters present a significant fiscal risk for the Commonwealth,” it wrote, to an inquiry into public infrastructure. 

Those warnings have now been heeded, in part. On April 28, the federal government issued the terms of reference for an inquiry into the way we spend money on natural disasters. It will be conducted by the Productivity Commission, with a final report by the end of the year.

However, there’s no mention of climate change in the terms of reference for the inquiry.

The risks are not just borne by the Commonwealth. In Victoria, state treasury estimates that the government has spent $4 billion in the last decade responding to bushfires, floods and droughts. 

A recent report by Friends of the Earth suggested an even higher figure, at over $6.7 billion, as well as private insurance payouts of more than $13 billion over that decade. 

The biggest challenges lie within existing neighbourhoods, according to the roundtable’s research. It says our existing buildings must be retrofitted or, if necessary, relocated, with monitoring done by councils. 

In a worst-case scenario, it says, a bushfire could hit the suburbs of Melbourne’s northern fringe, cutting critical electricity lines and contaminating some of the city’s drinking water supplies. We should, it says, be equipping those homes for bushfire resilience – sealing gaps and vents, installing sprinkler systems, clearing around houses – and electricity wires should be buried.

For now, however, it seems we’re only making things worse. When disasters do strike, we build back the way things were. Reconstruction to a higher standard is known as “betterment”. The term has been included in the national disaster relief programme since 2007. But according to the attorney-general’s department, only one betterment project has been funded since then.

Meanwhile, the federal government poured $5.6 billion into reconstruction after the Queensland floods.

 “Those billions of dollars have largely been wasted because there was no requirement to spend in a way to reduce the risk of those impacts happening again,” says Dr Jamie Pittock, a flooding and climate change expert from Australian National University.

In comparison, the federal government’s  spending on preventing disaster – through the National Disaster Resilience Fund – totals only $52.2 million over two years. 

Pittock says the mistakes of early settlers are being repeated. “Across Australia we’re seeing poor state government regulations allowing local governments to develop land that should never be developed,” he says.

Climate change makes this problem much, much worse: many of these threats are beginning to come harder and faster. We’ve built homes, towns and suburbs in locations at risk of disaster, and those risks are rising.

The outgoing director of the Victorian Centre for Climate Change Adaptation Research , Professor Rod Keenan, says we’ve made progress adapting to some aspects of the climate threat. The long drought and the scorching Black Saturday summer prompted gains in water efficiency, along with better heatwave warnings and bushfire responses.

But overall, we’re still beset by the “notion that ‘she’ll be right, we’ve always had disasters and we’ll deal with them when the time comes’,” Keenan says, “rather than anticipating and planning to avoid the worst impacts”.

Even when we do consider the threat of floods and fires, we’re neglecting to account for the way global warming alters the risks. When Pittock and his colleagues analysed four major reviews commissioned after the 2010-11 floods, they found that the documents “virtually ignored the issue of climate change and its impact on flooding; some reports didn’t refer to it at all”.

Pittock says our estimates of flood frequencies are already unreliable and climate change makes them even less certain. This matters, because it makes hard defences such as levees, which are often favoured by governments and insurers, more risky. 

“If you miscalculate or are over-optimistic about flood frequency, you can make the situation far worse,” he says. The better alternative is to allow rivers room to flood, while relocating or raising infrastructure and homes. “Countries like the United States, the Netherlands and China are pulling down levee banks,” he says.

“It’s about time Australia learnt from that. There’s an upfront cost, but once you’ve invested in a more resilient strategy, the benefits accrue over decades or longer.”

Professor Keenan says he’d like to see communities holding informed discussions to pinpoint local risks and responses. Governments could fund their adaptation ideas by bringing forward recovery spending. 

“This matters because we can save lives,” he says. “We can reduce the impact of disasters on people’s livelihoods. And we can reduce the financial impact on the state government, so it can continue to spend money on hospitals and schools and public transport services.

“It’s far more sensible to invest a smaller amount of money now, rather than pay out more down the track when disasters happen.” Keenan says while it’s disappointing that the state government hasn’t allocated funding to his centre, he’s hopeful it might have a change of heart.  

 But Professor Jean Palutikof, the head of the National Climate Change Adaptation Research Facility – which is funded by the federal government and based at Griffith University – cautions that its very hard to put money into preparation for a disaster, ‘‘because no government can easily justify the expenditure on something that hasn’t happened’’. 

Her words are borne out by the state government’s Climate Change Adaptation Plan, released just over 12 months ago. It allocated only $6 million in new spending, mostly in grants to local councils. The plan also failed to impose any requirement that climate change be taken into account in planning or infrastructure decisions. It won’t be revised until 2016.

*

Creswick flooded three times in the disastrous summer of 2010 and 2011. The deluge took the small town, north-east of Ballarat, by surprise. But its predicament – both before and afterwards – illustrates the challenges replicated around the country.

 In the 1850s, settlers had diverted the creek so they could extend the main street. “The lower end of town is built just about entirely on the flood plain, and no one realised,” says Don Henderson, the Mayor of Hepburn Shire, and a local builder in Creswick. The council was “totally unprepared” for the floods, he says, as were the catchment management authority and emergency services. Years on, the floods’ consequences have lingered. Some insurers no longer offer policies for low-lying homes. 

A council flood recovery office, opened on the main street, has only just closed its doors. It guided reconstruction works worth $30 million across the shire, including levee banks along the Creswick Creek, only just completed. 

For the council, the influx of federal cash has seemed like an act of god. Although only required to rebuild as things were, it has made a point of lifting its standards, Henderson says. For instance, it could have never have afforded to rip out the drains under local roads and replace them with bigger ones. ’’With the recovery funding, we were able to say ‘Yes this caught us with our pants down, but into the future we’re designing this town to be resilient’.”

Even so, the new level of flood protection – decided in consultation with the community – leaves some townsfolk exposed. 

Like so many of our disaster inquiries, the new Creswick flood modelling and mitigation plan doesn’t mention climate change, or take the increasing risk of extreme weather into its rainfall predictions, or cost-benefit analysis.

Russell Castley lives at Semmens Village, a pocket of 32 public housing units across the creek from the main street. They’re vulnerable to rising waters from three directions. During floods, the road becomes submerged, blocking both ways out. 

“Really, these units should never have been built here,” Castley says. He climbs the low mound near his home and points at the gaps. The levee system is designed to guard against a 1-in-50 year flood, without accounting for the shifting climate. 

“I’m 74 now,” he says. “I don’t know whether we’ll have another flood here in my lifetime. But I think the floods will become more frequent and possibly more violent, and I don’t believe this levee bank will protect this complex.”

After consultation on the town’s flood plan finished, a team from the Victorian Eco-Innovation Lab, at University of Melbourne, arrived with a different approach: scenario planning.

They presented locals with three stories outlining the livelihoods of different people in Creswick in 25 years time, based on plausible but severe climate projections. Then, they asked how residents wanted to adapt.

The responses were distilled into a series of future visions, and displayed online and in shop windows on the main street. 

In one, the creek is returned to its original course by 2025. Low-lying land becomes a commons and flood-prone homes and businesses are moved uphill to the railway station. In others, the town converts its historic post office to a ‘Resilience Centre’ and constructs a water storage network to guard against drought. 

“When you’ve got an uncertain climate and radical changes in the pipeline, our old planning standards become a liability,” says Che Biggs, who led the research project. “We don’t know the exact likelihood of extreme events in the future and we never will. It’s time to stop asking for certainty before we begin to adapt. 

“It makes more sense to explore what can go wrong by using worst-case scenarios tailored for different regions. With the right process, communities and agencies can have these conversations without pointing fingers. “Otherwise, we’ll wait and see what hits us, then start the blame game afterwards.”

Read this article at The Age online

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In Social justice, The Age on

Victoria Police is commencing its most significant reform in two decades. But can it tackle a problem it won’t name?

IT could be any city office. But on the fifth floor at Victoria Police headquarters, something particularly uncommon is going on. A brand new division is beginning its work.

The 20-odd staff members in the Priority Communities Division – a mix of uniformed and unsworn members – are tasked with transforming the way the force deals with the most vulnerable members of society, including recent migrants, Aborigines, the disabled and others who too often find themselves the target of police attention.

“It is a watershed moment for the organisation in terms of how we create better engagement across the community,” says the unit’s boss, Commander Sue Clark. “It hits all parts of the organisation.”

In scope, she likens the changes to Project Beacon, which began in 1994, in a bid to reduce the number of police shootings. Then, all officers were trained in conflict resolution techniques that didn’t involve their guns.

Police reform is always hard won. This time, it began with a group of teenagers in Flemington. In 2008, sixteen young men lodged a complaint with the Australian Human Rights Commission, saying they were repeatedly stopped, harassed and abused by members of the Victoria Police, sometimes violently, and that it was a breach of the Racial Discrimination Act.

One of the young men, Maki Issa, estimates that police asked for his name and ID at least 100 times in the two years from 2006. One day he was stopped five times, he says. One officer in particular would greet him by name and then insist on asking for his ID. “I was thinking: ‘Is this guy sick, or is it me?’” Issa says.

At the time, he was 15. Besides schoolwork, Issa was training hard for a high-level soccer team, and volunteering as a coach for younger kids from the flats. He’d never been charged with any crime. When the case finally settled in the Federal Court, in February 2013, he was 22.

Maki Issa at a forum in North Melbourne. Photo by Aaron Claringbold. 

Victoria Police still denies the allegations, but as part of the settlement, it agreed to review its practices.

Last year, Chief Commissioner Ken Lay described the case as “a waypoint”. “We were going along and we hit this point, and now we’re going in a different direction,” he said.

The force sought public submissions and commissioned expert reviews. On December 30, it released a report, entitled ‘Equality is not the same’, which included a three-year timetable for change.

Among the reforms is human rights training to help members understand and undercut their own unconscious biases and stereotypes. Officers will also receive clearer guidance on when they can legitimately stop people, with definitions of what is meant by the grounds of “reasonable suspicion” and “high crime locations”.

The force will revise its data collection so it can analyse disparities among the ethnicities of people being stopped. And, in a major reversal, it has agreed to hold a trial in which citizens will be given receipts explaining why they’ve been stopped.

*

For the police force, the Priority Communities Division has an unusually flat structure. But at the top, Commander Sue Clark is its star recruit.

She is renowned for her work on cultural change, both in her earlier stint at Victoria Police and then at the AFL, where she was responsible for reshaping the code’s attitude to women. Her role with the league expanded to dealing with vilification and racism, and social inclusion in general.

It was a rewarding role. The AFL has “led the conversation with the community about really difficult issues,” Clark says. “Footy enabled people to talk about violence against women.”

She began her career with two decades “on the front line” as a police officer at Frankston and Dandenong, working with victims of sexual assault and child abuse. “You could see the problem: the limitations on policing and also on social services,” she says.

Under former chief commissioner Christine Nixon, she helped connect policing with a range of agencies and counselling services for domestic violence, sexual assault and men’s behaviour change. For the first time, they established referrals and confidential information exchanges so people wouldn’t get lost in the system. “When I think back, it was amazing,” she says.

Reports of family violence to police have tripled since the early 2000s – a sign that people have more faith in the system as a whole, she says.

That experience forged her approach to reform: a strong trust in collaboration with “critical friends” outside the force. Her new division is in the process of forming a number of advisory committees, which will represent multicultural, Aboriginal, youth and aged, disabled, and gay and lesbian communities.

“This is a long term journey,” Clark says. “This is not a short sprint. It’s not even a couple of kilometres. This is about changing the way we think, the way we operate and the way we draw on our community to help solve broader community problems. We’re in it for the long haul.”

*

When the police announced its reforms, the immediate response from advocates was positive, even from those most critical of the force in the past, such as the Flemington and Kensington Community Legal Centre.

Recently, the centre held public forums together with senior police to explain the proposed changes. Anthony Kelly, the centre’s CEO, is cautiously optimistic. “We see this as a crucial first step in a long-term shift to more impartial and democratic form of policing,” he says.

“One of the things we’re facing is that historically Victoria Police have always acted upon the social and political prejudices of the day. We’ve seen that with the policing of Indigenous people, the Irish, and then the Greeks, Italians and Vietnamese.

“The policing of the African community was heavily influenced by the statements of politicians and reflected through intense media stereotyping of African people as ‘problems’.

“Our clients say they were continually trying to explain to police they weren’t part of a gang, they were just hanging out.”

Finally, their complaints have been acknowledged. But the tension between African communities and Victoria Police remains. It can be traced back through many years of warnings and reports issued by advocates, youth workers and the Victorian Human Rights and Equal Opportunity Commission. After so long, police have much ground to regain.

Near the high-rise flats in North Melbourne, a small audience gathered for one of the joint forums. After presentations from assistant police commissioner Andrew Crisp and others, the panel took questions.

Assistent commissioner Andrew Crisp addresses the forum in North Melbourne. Photo by Aaron Claringbold. 

Khadija Alihashi, from Flemington, described herself as “one of the mothers” from the Somali and broader African community. She said there had been ten years of meetings and no change. “You guys bring the big bosses, but where are the local police? They never come,” she said. “We talk and we talk, but where’s the action?”

Maki Issa also attended the meeting. He said that when he joined the racial discrimination complaint, he wanted a receipting policy and better training. But he also wanted an apology – and he still hadn’t received one.

He said the police’s report didn’t acknowledge racism and shied away from using the r-word. “We cannot be scared of the word anymore. As long as we keep the word away from the public arena, it can be okay for people to behave that way.”

When Victoria Police does discuss racial profiling, it chooses its language carefully. Its report reiterates its “critical concern” about the community’s “strong perception of racial profiling by police”.

Likewise, in an hour-long interview about their work, Commander Clark and two senior members of the new division – Superintendent Charlie Allen and Leanne Sargent – managed not to say the words “racism”, “racial profiling”, or even the less-contentious “unconscious bias”.

Clark offered this construction: “the feedback from the community indicated there were instances of behaviour that has caused concern”.

Asked about how it is possible to enact cultural change without naming the problem directly, Clark said Chief Commissioner Lay had “acknowledged that there had been instances and behaviours that we deeply regret”.

Yet, it was clear that all three are enthusiastic about the task confronting them. “There is absolutely a fundamental acknowledgement that we need to change,” Clark said. “We can do things better.”

Such self-censorship may be a nod to the rank-and-file, which has often resisted reforms from high command. There are more than 12,000 uniformed members around the state, many of whom come from a very different era of law enforcement.

When these reforms were announced, the then police union boss, Greg Davies, said a receipting system would be a “rod for the backs of police… already cowed with the responsibility and oversight as it is”.

His replacement, Ron Iddles, says he wants to talk with Clark before passing judgment, and he’s looking forward to Victoria Police consulting with the association on the issue.

One of the independent reports feeding into the reforms, prepared by Professor Michele Grossman and colleagues from Victoria University, included interviews with 20 serving members.

A long-term, mid-ranking officer said many friends of his vintage “are still struggling with the shift in the organisation in the last five years” away from “an us-and-them scenario”.

Nevertheless, the academics found that the members they interviewed overwhelmingly wanted better cross-cultural training, not only in the academy, but also throughout their careers.

One officer described attending an incident between groups of African- and Anglo-Australian teenagers, where they immediately told the white youths to leave. It turned out, with video footage as proof, that they’d held the wrong group.

He reflected that he’d been “programmed” to make those assumptions: “we’ve heard about how much trouble [African-Australians] cause… therefore they must have been the ones that caused the trouble,” he said.

Melbourne University academic Tallace Bissett is completing her PhD research on the experience of young African-Australians with police.

In general, the young men she has interviewed would like less police presence in their lives. Strangely enough, their request may match the wishes of front line officers.

“It is clear that a lot of police officers feel overwhelmed and under-qualified to deal with many of the situations they face. They’ve had all these new expectations heaped on them but their training hasn’t developed at the same pace,” she says.

“Victoria Police is investing a lot of money into Priority Communities. An alternative would be to stop leaving it all to police, and invest in community infrastructure instead – to create places where young people can meet without being criminalised. Maybe what we want is a smaller police force, not a bigger one.”

*

Abraham Nouk is sitting in his makeshift recording studio in Collingwood, the walls lined with egg-carton soundproofing. Nouk runs an unfunded, informal youth centre and arts space called Creative Rebellion Youth. This afternoon, a young man is travelling in from Narre Warren for help to record a demo.

Nouk’s story demonstrates the personal and societal cost of policing gone wrong.

As a teenager, he lived with his family in Lilydale and Ringwood, and hung out around Dandenong with other friends who’d come from Sudan. He says they attracted constant, unwarranted police attention.

“When it comes down to African youth, we’re perceived as people who are involved in gang activities,” he explains. “That already fuels police hostility towards us. That’s where the boundaries are created.”

He has been held in custody and fronted court. It was getting worse, until four years ago, when he made what he calls his “concession”.

To avoid the police, he avoids the public. He no longer drives, because he was stopped so frequently. When possible, he doesn’t go out after dark.

He believes it is his only choice. “You have to adjust,” he says. “It’s not an easy process – it’s almost like exempting yourself from living fully. That’s just the way it is.”

Recently, Nouk has found acclaim as a performance poet, under the name Abe Ape. He’s been invited to perform at the Glastonbury festival in England in June. “I thought I logged into the wrong email when I received that one,” he smiles. “I logged out and back in again.”

In other ways, he has checked out completely. His lack of faith has bled beyond policing. He is skeptical, too, of social workers paid to pick up the pieces; of businesses that won’t employ African kids; and of people who clutch their bags at the sight of him.

The lesson, Nouk says, is to “acknowledge the fact that nothing is going to change”.

“That’s what I do, that’s what most of us do.”

He has little hope for the proposed reforms, and says the consultation hasn’t found its mark.

“Bottom line, if Victoria Police doesn’t want to admit the problem, it’s going to be a long time before these reforms have an impact. The people affected by it aren’t even speaking about it.”

Read this article at The Age online

For more on this issue, see this article about the police inquiries and cross-cultural training, and this account of the Racial Discrimination case brought by the young men from Flemington. 

Fever

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AFTER sneezing a thousand times, I went to the chemist for a cure. The only one open nearby was one of those large, bargain-basement pharmacies.

“How’s your day been?” I asked the checkout dude.

“Just peachy,” he replied. “It’s been a rollicking, rambunctious day.”

The store was very quiet. My guy was somewhere between 16 and 20, with dark, wavy hair swept back from his forehead. His lively word choice took me by surprise and I laughed, but then felt chastened, unsure how much of his displeasure was directed at my question. I like to make that kind of small talk, but I suppose it’s bitter for someone working a menial job on a Sunday afternoon.

He stepped back from the terminal and shook his head. “I’ve had it. I can’t do this anymore, you know.” His blue eyes were wide, and his voice flat. “I just can’t.”

Then he stepped forward and leant in over the counter. His voice took on a peculiar energy. “There’s got to be a better way to make money. You know those people who rob banks and never get caught? That’s the smart play.”

I looked around. No one was waiting to be served. “I’m not sure if those people exist,” I said. “Don’t they get caught?”

“You know when internet banking began in like 2001 or 2002?” he said, gathering momentum. “Hackers were just breaking in, and shovelling it out. It’s just numbers on a screen. No one got busted – they got rich. And the banks added the zeroes again, just making up the money. They can just make it up. That’s why we have inflation.

“But what I’m saying is, what if all the hours I’d spent here, all those hours in this place, instead I was learning how to be a hacker? Wouldn’t I be better off?” He glanced left and right at the lifeless store, and its garish signs promoting vitamins. “It’s too hard to make money the honest way.”

I thought about quoting the old aphorism devised by a freelance writer in ancient times (I think it was Plato): the greatest wealth is to live content with little. It’s been particularly useful for me, and it must become useful for many people if we’re to avoid and withstand the harder times ahead. These things crossed my mind. Then I thought about checkout dude’s measly hourly wage, and I thought better of it. “Well I guess it depends on whether you get caught,” I said instead.

“What if I could guarantee, like 99 per cent sure, you won’t get caught? What then? I could be millionaire. I could be out of this place.”

He was animated now, slightly breathless, and – happily – I was certain that some part of him had already left.

Lucky Dave

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THIS is how all my stories about hitch-hiking begin: I was waiting on the side of the road, near x, when y pulled up. This time, read: Seymour and a mid-sized truck.

The set up is the same, but what happens next is always different.

Dave wore a baseball cap and wrap-around sunnies. “I’m not allowed to give you a lift,” he said as I climbed up. “But stuff it, I’ve lost my job anyway.”

His boss had called him the previous night, asking him to turn in his keys, only to call back an hour later to see if he could do one more shift. He needed the money more than his pride. So there he was, delivering car parts up the Hume Freeway. I accompanied him on his stops at Benalla, Wodonga, Albury and Holbrook.

Dave was from a large town in central Victoria. A week ago, he’d had an altercation with a manager in Melbourne. The guy had wanted to fight. “I don’t fight anymore – did all that when I was younger. If it was a few years ago I would have smashed him,” Dave said. “Yeah, I fought a lot when I was younger.”

He shifted his cap, showing a close-shaved, balding head. Sitting behind the wheel, he had a lanky aspect, with a slight paunch, and it was hard to imagine him as a fighter. We talked about what work he might do instead. “Hospitality. I’ll go into hospitality again,” he said. I couldn’t really imagine that either.

He’d been a glazier, but had three hernias from lifting glass. (“I’m a bit weak through my middle bits.”) He’d been an arborist, but got a rare fungal infection from a eucalypt. (“I’ll always have it – it’s scarred my lungs.”) He’d been a truck driver. Until now.

“Lucky Dave, they call me. I say it’s a good thing I’ve got bad luck, otherwise I’d have none at all.”

It was a nice line – so good, in fact, it seemed incongruous, like his fighting past and his hospitality future. Our conversation was hard won. It wasn’t that Dave didn’t want to talk, I thought. More that he wasn’t used to giving much away. And our lives didn’t overlap in the ways that would make it easy.

So I asked lots of questions and he didn’t ask any. He gave the clipped, limited answers common to many Australian men. I’d leave it rest for a while, not wanting to overreach. Then he’d proffer something: about his busted four-wheel drive, or his father’s dodgy heart, or his wasted mates.

This last one gave me the fear. Dave’s portrait of his town and his social life was dystopian. “Ice is easier to get than marijuana,” he said. “I’ve lost two mates to it.”

He used to smoke it too, every day for a while, along with weed, and then clock onto his job. He told me about friends – a husband and wife with kids – who’d received a large transport accident payout and spent it all on ice. They couldn’t stop. He’d taken a couple of mates into his home, to help them get off it, but had to kick them out again.

“If it wasn’t ice, would it be something else?” I asked.

“Yeah, they’re so used to being high, they can’t handle being sober anymore.”

Now he’d offered a room to another mate, who’d been drinking too much. Dave recognised the signs, because he’d been through it himself. In any case, he was glad of the company – he had a rule not to drink alone anymore. Now when his friend walked through the door each night, he laughed, they could drink together.

All this made me think of an op-ed I’d read a month or so ago, by a journalist and former Liberal Party member, Chris Earl. He was taking aim at economic reforms that lead to fewer regional jobs in agriculture and manufacturing.

“Who would be left to pick up the pieces?” he asked, and decried the situation now: “government at all levels… today prop up country towns” and, further, “country people are increasingly beholden to government for survival”.

Last year, as I hitched through Western Queensland and NSW, I noticed that major towns like Charleville, Cunnamulla and Bourke seemed, above all, like government service centres. I’m in no position to generalise; the causes and effects are complex and solutions hard to imagine. Maybe that’s why smoking ice seems like a good idea.

Earl proposed one answer: “Perhaps the way forward can be found in history – the return of more locally owned co-operatives and enterprises capitalising on local resources and skills, towns taking back responsibility for their future”.

Hours up the freeway, Dave dropped me off. I jumped out of the cab, but he looked on the seat beside him and beckoned me back. Wide-eyed, as if surprised by what he was doing, he passed me a glad-bag. “Go on, take these,” he said with a nod.

I looked down at my hand. They were his driving snacks, I guess: two tubes of instant tomato soup, a muesli bar and a packet of strawberries-and-cream lollies.

Earlier, we had stopped for fuel. I was looking for food in the shop, and turned to see Dave at the counter. He’d raised his sunnies onto the top of his head, and his long, dark eyelashes startled me. His eyes were honey-brown, and he looked much younger, almost unrecognisable from the man in the truck, soon-to-be unemployed, who had described those hopeless scenes.