Most of the
monographs I have read for this section present a general narrative: official
actions pertaining to Indigenous health and welfare had the primary goal of
reducing financial expenditures and government responsibility, while also
reducing the threat of Aboriginal people’s behaviour and contagion. At times
this manifested in a lack of policy; at other points, “welfare” served as an
active “weapon to undermine First Nations cultures and…induce their
assimilation and hence disappearance.”[1]
Fragmented policies resulted in the fragmented provision of health services. In
Canada and Australia, there was no national strategy for Aboriginal health. As
such, Australian Aboriginal health was shaped by social and educational
policies, often shaped primarily by missionaries, with piecemeal government
involvement entailing limited commentary on Aboriginal wellbeing.[2]
These monographs are replete with examples of exceptionally poor provision of
Aboriginal health, particularly in comparison to surrounding non-Indigenous
communities, and inadequate government support as they attempted to divest
themselves of responsibility for Indigenous health in a move towards
self-government. Other general trends included that medical pluralism was
common, often frustrating for missionaries and governments, and that non-Indigenous
discourses constructing Indigenous bodies as unhealthy and claiming the likely
extinction of Indigenous peoples shaped policy and practices that were broader
than health. The aim of several of these texts (Briscoe, Shewell, and DeJong are
the most notable) seems to be to chronicle particular elements of policy. I am
focusing on the ones with more sustained analysis.
The absence of
Indigenous perspectives in many of these studies is striking, particularly as
Indigenous agency, albeit constrained, is clearly apparent as a force in
shaping actions and attitudes surrounding health. Gordon Briscoe’s book does
not consider Aboriginal Australian voices from the past, which is perhaps
surprising as he is himself Aboriginal. This absence is particularly apparent
given his stated goal to show Aboriginal Australians as “authentic actors in
their own right rather than as either resisters…or passive recipients of
welfare.”[3]
In Hugh Shewell’s work, Indigenous perspectives are entirely absent in chapters
that present lengthy quotations from predominantly white, male health reformers
and officials. Waldram, Herring, and Young claim that the diversity among
Aboriginal peoples means that an “Aboriginal perspective” does not exist and
therefore will not comprise part of their work; the closest they seem to come
is a Western perspective on Aboriginal perspectives of health.[4]
Judith Raftery
points out that, despite documentary evidence of Aboriginal activism, individual
Aboriginal people are often nameless in written sources.[5]
This has required historians to become particularly conscious of their
methodology. Laurie Meijer Drees centres her work on the sharing of stories.
Meijer Drees sees stories as more than an oral history; they are also, she
argues, a form of healing. The stories she presents are not merely vignettes,
but the central element of each chapter, which reinforce and further
personalize what I had already learned from reading Kelm, Burnett, and Lux, who
also use oral testimonies and recollections in their work. The work of these
historians, who emphasize Indigenous voices, stands in stark contrast to those
who zero in on Indigenous bodies, furthering constructions of Indigenous bodies
as available to a Western scholarly gaze and silencing Indigenous perspectives
and agency. The most obvious example of this is Warwick Anderson’s work, which
is illustrated with an overwhelming number of photographs showing Fore people
who were dying of kuru, a disease unique to that population and of significant
scientific interest. While portraying yet failing to sufficiently question the
research of Gajdusek, the scientist most prominently involved in researching
kuru, Anderson’s own disrespectful representations of Indigenous bodies gives
the whole book a nauseating air. Gajdusek quite literally collected Indigenous
bodies, dead and alive, in a fetishistic manner, sometimes using deception to
do so and not reliably considering the spiritual issues involved in this, of
which he was aware. [6]
Anderson emulates this with his collection of photographs of these people’s
bodies, anonymous and with no mention of consent. Gordon Briscoe similarly
presents a section of black and white photographs showing Aboriginal people
with leprosy. His attempt to afford them some humanity by blurring or blacking
out their faces and genitals does not make this any more palatable.
Despite the
challenges faced by historians in finding and representing Indigenous voices,
there are several examples of Indigenous people that figure prominently in
health reform. Maori Dr. Pomare is one such leader, whose work emphasized a
need to work with, rather than for, the Maori people. Among his contributions
was the publication of health materials in Maori, so that people could access
information on their own terms.[7]
Raeburn Lange shows that, alongside Pomare, the Maori people had significant
control over their health and were instrumental in reform. Their leadership was
essential for good health, and Maori were quite responsive to health reforms
initiated from members of their own communities. Notably, despite the role of Maori
leaders in reform, Paheka—non-Maori people—took credit for early 20C reverse in
population decline.[8]
The use and
manipulation of demography is an important element of research into Indigenous
health, past and present. Kue Young, in one of the earlier historically focused
treatments of Indigenous health, says that he does not aspire to explain the
health situation of Aboriginal people, merely to document and describe
evidence.[9]
As such, he makes extensive use of epidemiology and official statistics. Gordon
Briscoe’s work is particularly focused on demography, noting gaps in evidence
and presenting a significant amount of quantitative data. Often, he attempts to
allow this data to speak for itself, an approach that I find lacking. He does,
fortunately, consider some of the shortcomings of the demographic data he uses,
noting that colonial observers tended to present Indigenous peoples in a
monolithic way, not separating full- from half-caste people, that reports of
causes of death were often based on speculation rather than diagnosis, and that
the “heaping” of ages in population pyramids indicates that census enumerators
guessed or rounded ages of Indigenous people, particularly those over age
fifty.[10]
Enumerators also illustrated their ethnocentrism in carrying out the census and
health research, which assumed European family/community structures that did
not always map neatly in Aboriginal settings.[11]
Mary-Ellen Kelm takes a more critical approach to data, which she uses to show the
information that underpinned health policy decisions, not assuming that this
data was an accurate depiction of Aboriginal health. Often, she notes, this
data confirmed stereotypes.[12]
Demographic
data about Indigenous people, particularly immediately following initial
colonization, had and continues to have intense political implications. In New
Zealand, Paheka claimed that Maori population had been declining prior to
contact. New research indicates that this is unlikely.[13]
Further, once census showed reverse in population decline, some Paheka claimed
this was due to changes in enumeration, and persisted in believing that the
Maori race was dying.[14]
Evidently, they found this idea of population decline to be convenient, rather
than embarrassing, as it was a construction that furthered their colonial
ambitions. I will discuss this in more depth later. At present, historians use
demographic information to illustrate the resilience of Indigenous people and
impact of ongoing colonial violence. Suzanne Alchon cautions not to attribute
demographic changes too much to disease, as this underplays the impact of the
violence that colonialism entailed, while Maureen Lux notes that the remarkable
factor of First Nations population change is not that it declined upon
colonization, but that it did not collapse entirely, showing the strength of
First Nations societies.[15]
Young reminds twentieth-century public health professionals that improvements
in health cannot be solely attributed to increases in the provision of
Euro-Canadian health care, but also to broader changes in Aboriginal lives.[16]
It is thus clear that while medical provision was important, it was far from
the sole determinant of Indigenous health.
These
monographs explicitly consider the role of colonialism in shaping approaches to
health, and offer an in-depth consideration of a range of determinants of
health, including housing, access to land, and education. Health was evidently
a significant component of the colonial project, which, as Kelm argues, rested
upon the construction of Indigenous bodies as sickly or inferior to those of
Europeans, also entrenching inequalities of gender, race, and class. This link
of Aboriginal bodies with illness generally ignored the impact of colonial
history and government actions.[17]
The construction of Indigenous bodies as inferior was a means of effecting
dispossession. In a conflict over Poonindie land in South Australia, the assumption
that Europeans were more suited to fertile land and Aboriginal people to
dessert conditions served as their justification to divide and sell the land to
white Australians.[18]
Similarly, in New Zealand, a belief that Maori would become extinct enabled the
Paheka to justify their own settlement of Maori lands.[19]
The provision of welfare rested on an assumption that Indigenous peoples had
less physical needs. In Canada, the government issued rations of a quality they
deemed unfit for their own use, while blaming the poor health that resulted on
“immoral habits.”[20]
Maureen Lux’s oral histories portray the contamination of flour rations that
caused considerable death and illness in Treaty Seven land as deliberate,
indicating that these inadequate government provisions worsened health, rather
than merely failing to improve it, and may have been an intentional means of
subduing the Aboriginal population.[21]
It is important to note that these discourses were mutable, as can be seen in a
shift of constructions of Aboriginal health through the century. By the 1940s, there
was a prevailing assumption that health was a product of policies intertwined
with Indigenous ignorance, rather than innate racial characteristics.[22]
In New Zealand,
the Paheka believed that the elimination of the Maori people, through
extinction or being subsumed into the colonizing population, was both
inevitable and natural. The medical reforms that they encouraged were not to
reverse this decline, but to provide comfort to a dying people. Though aware
that this decline was at least partly due to Paheka actions, they justified it
as a product of Western science.[23]
The Maori, to some degree, shared this sense of inevitability, and prioritized
their physical survival over maintaining cultural heritage, preferring
assimilation rather than extinction.[24]
This assimilation resulted in expressions of medical pluralism. Pomare’s
successful health reforms in New Zealand built links to Maori spiritual views
of health and illness, and despite legal restrictions on their practice,
spiritual healers known as tohungas continued to work in Maori communities,
alongside Western medicine.[25]
In the late nineteenth and early twentieth centuries, low standards of health
among Europeans meant that colonial medicine could not displace Aboriginal
concepts of health and healing.[26]
Additionally, health infrastructure was insufficiently funded to reach most of
the Aboriginal population; in Canada, this resulted in the persistence of
Aboriginal healing practices alongside colonial ones as Aboriginal people made
use of the resources available to them while resisting assimilation.[27]
The narrow
colonial definition of health as simply the absence of disease was insufficient
for Indigenous people, who selected practices from both medical models
depending on the nature of the disease they wished to treat, often using
Western medicine for unfamiliar diseases or as a last resort if their usual
remedies were unsuccessful.[28] Aboriginal people in British Columbia
braided medical models together, using colonial medicine for their own
purposes, and integrating it into their traditional healing. As such, an
“atmosphere of medical pluralism…subverted the colonizing intent” of government
and churches.[29]
This pluralism and selective incorporation of Euro-Canadian medicine did not
displace Aboriginal healing, or change Aboriginal beliefs about disease
causation.[30]
Instead, Aboriginal ideas of health and the body disrupted the non-native
“medical monologue” blurring boundaries between natural and spiritual realms.[31]
This contrasted with Euro-Canadian medicine that attempted in clinical settings
to reinforce a dichotomy between the natural and spiritual worlds.[32]
In British Columbia, missionaries were almost successful in dispossessing
Aboriginal peoples, but were restrained by Aboriginal maintenance of agency,
values, and traditional healing.[33]
It is important to note, however, that Western medicine was not homogeneous,
and that spiritual explanations of health and illness were not exclusively
Indigenous. Many missionaries explained disease as divine punishment, and
healing practices that were based on placebos were common to both Western and
Indigenous concepts of medicine.[34]
It is thus unsurprising that many Maori combined Christian faith-healing with
their own traditional practices.[35]
Medical
syncretism was neither peaceful nor harmless, as many Indigenous people
resisted the incursion of colonial medicine. In Australia, a widespread belief in
sorcery influenced how Aboriginal people used medical treatment, as many saw
cures as the result of sorcery, rather than Western medicine.[36]
The disruptions caused by colonialism could intensify Indigenous spiritual
beliefs that underpinned concepts of health. Fore beliefs in sorcery increased
as the kuru epidemic became most severe, sometimes practices of cannibalism that
increased incidences of the disease.[37]
Often, a disjuncture between beliefs provoked suspicion. In Australia, the
isolation of quarantine stations led some Aboriginal patients to attempt to
escape; some died in the process, or were confined in large wire cages within
the stations.[38]
Maori patients in New Zealand were reluctant to seek hospital treatment as this
entailed isolation.[39]
Medical infrastructure was thus fed by a cycle of fears with colonial fears of
Indigenous contagion and Indigenous fears of their loss of freedom producing
punitive institutions and a link between the legal and medical systems. In
Australia, lock-up hospitals for leprosy patients took a punitive approach,
with life-long incarceration and corporal punishment for inadequate work. Where
patients resisted, police became involved as “surrogate health workers,”
monitoring and restricting the movement of Aboriginal people.[40]
In Canada, this monitoring resulted in cultural restrictions: since dancing
brought people together, attempts to control the spread of tuberculosis were
linked to sanctions on First Nations ceremonial dancing.[41]
Indian Agents were responsible for relief and medical assistance, and could use
this to manipulate or control their communities.[42]
The impetus here was, as Raftery puts it, to control the ill, rather than the
illness.[43]
One of Judith
Raftery’s key contributions to the literature on the history of Indigenous
people’s health is her probing of the concept of the “public” as an element of
health and welfare. With the “public” being a construction based on patriarchal
colonial ideas of liberalism, Aboriginal people, rather than being “public,”
were a problem for the “public” to solve; while Aboriginal people were not public, but their health was subject to public scrutiny.[44] I found Raftery’s
deployment of this concept useful in considering how welfare played out in
other situations, as this construction of the public was central to approaches
to Aboriginal health, and health outcomes, with assimilation a prerequisite to
joining the “public.”[45]
Raftery’s contribution here, I would argue, is a succinct statement of the
nuanced relationship between Aboriginal peoples and colonizing peoples in
relation to health and welfare. In Canada, welfare was a means of confirming
Euro-Canadian sense of superiority. As Hugh Shewell puts it, “For First
Nations, social welfare was a touchstone that symbolized everything that was
wrong with the relationship between Canada and themselves.”[46]
Applying Raftery’s concept to Shewell’s findings, welfare was a means of
defining and policing the ragged boundaries of the “public.”
This denial of
Aboriginal people as “public” can be seen particularly clearly in Peter Bryce’s
unsuccessful proposal that Aboriginal health be placed under the jurisdiction
of the Department of Health, rather than the Department of Indian Affairs.[47]
The provision of medical services to Indigenous peoples has continually been a
matter of contention. Indian Health Services in Canada saved Euro-Canadian
consciences rather than Aboriginal lives, with substandard care limiting the
assimilative potential of Euro-Canadian medicine.[48]
Humanitarianism was rarely the goal; early colonial medical provision served to
preserve trading partners for the Europeans, or form relationships with
potential converts.[49]
Nonetheless, the Canadian government saw themselves as charitable for providing
health services, rather than considering this to be their legal responsibility.[50]
This reluctance to take responsibility played out in Canada, Australia, and New
Zealand. In Australia, Aboriginal peoples saw their health as a government
responsibility, while officials blamed poor health on the Aboriginal people
themselves.[51]
In Canada, jurisdictional disputes undermined any responsibility for the
provision of health care, as First Nations and the government argued over the
role of medical care in treaties. While only Treaty 6 codified medical
provision in its infamous “medicine chest clause,” some extent of medical services
were implicit in other treaties, and an inducement for Aboriginal people to
enter treaty relationships.[52]
Residential
schools was one venue in which medical care was ostensibly to be provided. Officials
thought schools could save children from maternal neglect, in 1935 citing
residential schooling as a solution to poor health despite previous
acknowledgement of high mortality in schools.[53]
Nonetheless, infirmaries were a way of recruiting students to schools, and
keeping students in school.[54]
There was constant interplay between residential schools and their infirmaries
and other facets of the medical system, particularly sanatoria; stories
presented by Meijer Drees recount children being shuttled back and forth
between school and hospital as their health improved or declined.[55]
In nineteenth-century New Zealand, schools for Maori children, established
through Maori initiatives but following a western model, served as the most
comprehensive site of health work reaching most Maori communities. In several
of these schools, teachers dispensed medications to pupils and often to other
community members, worked to manage epidemics, and initiate hygiene reform.[56]
As well as being a site for the provision of health, residential schools for
Maori youth, particularly boys, enabled the emergence of a generation of Maori
health reformers. Alumni of the prominent Te Aute College—the alma mater of Dr.
Pomare—were particularly active in health reforms among their own people. Most
of these students assimilated significantly to colonial culture, and held
aspirations to be missionaries to their own people.[57]
Of these
studies, Kristin Burnett’s is the only one to focus most significantly on
gender. She shows how women’s healing activities and relationships affected how
health was carried out, and how constructions of Aboriginal health went hand in
hand with ideas about gender as well as race. Some of the other books mirror
Burnett’s findings; Waldram, Herring, and Young note, for instance, that some doctors
and government officials saw lack of adherence to Euro-Canadian gender roles as
one cause of poor welfare.[58]
Others could do to consider gender more explicitly. Meijer Drees, for instance,
includes the story of a male nurse, but offers no analysis of the implications
for a racialized man working in a feminized profession. I have largely been
silent on gender in this paper, as I plan to address gendered issues in
Indigenous health and welfare when I write up my section on gender, which is
based on far fewer books.
[1]
Shewell, iv. Also see Raftery, 73, who argued that in South Australia, the
distribution of rations was “a coercive instrument of assimilation”[1]
[2]
Briscoe, 146, Waldram, Herring, and Young, 209, Raftery, 11-12, 93, 201, 233.
[3]
Briscoe, xxvii
[4]
Waldram, Herring, Young, xi.
[5]
Raftery, 170.
[6]
Anderson, 155
[7]
Lange, 155-159
[8]
Lange, 229
[9]
Young, 5-6
[10]
Briscoe, 4, 257, 9, 51.
[11]
Briscoe, 298.
[12]
Kelm xx, 15.
[13]
Lange, 17.
[14]
Lange, 232
[15]
Alchon, 5; Lux, 18.
[16]
Young, 125.
[17]
Kelm, xvi-xix.
[18]
Raftery, 108-109.
[19]
Lange, 60.
[20]
Lux, 36, 44.
[21]
Lux, 60
[22]
Kelm 41
[23]
Lange, 57, 59, 65.
[24]
Lange, 118-121.
[25]
Lange, 162, 255.
[26]
Waldram, Herring, and Young, 153.
[27]
Kelm 129
[28]
Kelm, 156, Raftery, 70, Lange, 44..
[29]
Kelm, 152.
[30]
Kelm, 172
[31]
Kelm, 83.
[32]
Kelm, 84; Waldram, Herring, and Young 130.
[33]
Kelm, 151.
[34]
Alchon, 111, Waldram, Herring, and Young, 136-137.
[35]
Lange, 46.
[36]
Briscoe, 225.
[37]
Anderson, 168, 172
[38]
Briscoe, 271
[39]
Lange, 40.
[40]
Briscoe, 117-118, 241.
[41]
Lux, 194.
[42]
Waldram, Herring, and Young, 188.
[43]
Raftery, 186.
[44]
Raftery, 50, 145.
[45]
Raftery, 14, 19.
[46]
Shewell, x, 4; also Waldram, Herring, Young, 128.
[47]
Waldram, Herring, and Young, 190.
[48]
Kelm 128, 150.
[49]
Waldram, Herring, and Young, 153.
[50]
Lux, 27.
[51]
Briscoe, 174-175.
[52]
Waldram, Herring, and Young, 177.
[53]
Kelm, 61, 66
[54]
Lux, 103.
[55]
Kelm, 124; also see much of Meijer Drees
[56]
Lange, 75, 81-82
[57]
Lange, 97.
[58]
Waldram, Herring, and Young, 195.
