Media Release re COVI-19 and asylum seekers in immigration detention

MEDIA RELEASE

3 April 2020

COVID-19: Government must act to avoid a catastrophe in immigration detention

The Chair of public interest think-tank Australia21, Mr Paul Barratt AO, today called upon the Federal Government to act as a matter of urgency to enable all people in immigration detention to behave in accordance with the physical distancing guidelines which have been introduced to limit the spread of the highly infectious and potentially lethal new coronavirus COVID-19.

“The Commonwealth Government, with the support of the States and Territories, has issued enforceable physical distancing guidelines considered necessary to help manage the threat to public health posed by COVID-19”, Mr Barratt said. “As a humanitarian matter, and in conformity with its obligations under international law, the Commonwealth has a duty to ensure that refugees detained under its authority, whether in Australia, PNG or Nauru, are able to practice the required distancing. This is not only a humanitarian issue, it is also a public health issue. Any cluster of people not practicing the required distancing represents a threat to the health of all, via cross-infection of each other and infection of those with whom they come into contact.”

“This process would be greatly facilitated if the Government were to respond to this new situation by resolving all outstanding claims as soon as practicable and resettling all refugees in Australia, regardless of their date or mode of arrival.”

Mr Barratt said that Australia21’s position is supported by a large body of its research:

·       Our work on empathy and compassion reveals how a nation's spirit  and resilience can be influenced positively by the way it treats its most vulnerable members

·       Our work on resilience indicates that consistent narratives are a key component of a nation's ability to cope with shocks and allowing people in our care to suffer will undermine our national narrative of being a caring nation of people who care for all who are disadvantaged or downtrodden.

·       Our work on resilience also indicates that, apart from the humanitarian aspects of how we treat asylum seekers, allowing discontent to build among these people and their supporters could undermine both confidence in government and ability of government to rely on the broader public to play their part on cooperative efforts to address COVID-19 challenges

·       Our work on drug reform reveals how being tough on social issues frequently causes backlashes that make the problem worse.

Political support for pragmatic drug policies

The former British Prime Minister, Mrs Margaret Thatcher, who died this week, was universally regarded as a no-nonsense 'conviction politician'.

Few know of her important role in the early adoption and vigorous implementation of a needle exchange programme to control the spread of HIV in the United Kingdom. At that stage, in 1986, the Netherlands was the only country in the world to have started a similar policy. The discovery of the condition, now referred to as HIV/AIDS, was first announced to the world on 5 June 1981. It was clear very early on that this condition was a serious health, social and economic threat to the world but little was known about the nature and extent of this threat.

Mrs Thatcher accepted the recommendation to establish a national needle exchange programme to slow the spread of HIV among and from people who inject drugs. The recommendation was made by a UK committee established to develop an effective response to HIV. The UK needle exchange programme undoubtedly prevented many HIV infections and much needless suffering as well as saving many lives and many pounds. Mrs Thatcher's decision influenced many other countries to adopt needle syringe programs. Australia's first needle syringe programme was established on 12 November 1986 as an act of civil disobedience and prompted the then NSW Government to establish a state wide system. All other states and territories followed within two years.

Many assume that pragmatic drug policies are generally a product of left wing political parties and governments. This is not so. The experience of Mrs Thatcher in establishing a needle exchange programme in the UK in 1986 and President Nixon establishing a national methadone treatment programme in the USA in 1969 are examples of conservative politicians adopting pragmatic drug policies. Both were excellent decisions though still often criticised.

On 2 April 1985, the then Prime Minister of Australia (Mr Bob Hawke) convened a 'Special Premier's Conference' (the 'Drug Summit') at which it was agreed by all eight governments represented (the Commonwealth, six states, the Northern Territory) that 'harm minimisation' would henceforth be Australia's official national drug policy. At the time, five of the governments were Labor while three (Queensland, Bjelke-Petersen; Tasmania, Gray; and Northern Territory, Tuxworth) were centre-right (National, Liberal and Country Liberal respectively). For many years, Australia's response to HIV and drug policy enjoyed bi-partisan support. All nine Australian governments have continued to support harm minimisation since 1985 whatever the political hue of the party or parties forming government.

Global drug reform in 2012

Post by Dr Alex Wodak, AM

That was the year that was: global drug law reform in 2012

In 1912 the International Opium Conference met in The Hague.  This meeting marked the beginning of the international drug control system which still prevails. But one hundred years after the birth of this system, 2012 was a watershed year for global drug law reform. It seemed to mark the beginning of the end of global drug prohibition. The case for global drug prohibition is now beginning to collapse. Unprecedented pressure is being applied in an increasing number of countries.

For the first time ever in the history of the international drug treaties, a country withdrew from a drug treaty. Despite opposition from the USA and some other countries, Bolivia announced its intention to withdraw from the 1961 Single Convention on 30 June 2011. The withdrawal came into effect on 1 January 2012. But Bolivia is re-acceding to the Single Convention minus some sections of the treaty it objects to. Bolivia’s reservation concerns the ban on coca leaf and its traditional uses. Bolivia had earlier attempted unsuccessfully to delete the Single Convention’s obligation that ‘coca leaf chewing must be abolished’ (Article 49). Bolivia’s new constitution in 2009 acknowledged respect for chewing coca leaf as part of its national patrimony. Thus Bolivia’s commitment to the Single convention and its national constitution were irreconcilable. Bolivia’s proposal to re-accede was opposed by a number of countries, including the United States. Bolivia will still be bound to not export coca leaf after the process of re-acceding has been completed.

The inclusion of references to coca leaf was controversial when the Single Convention was first negotiated. An understanding that these references would be reviewed after 25 years was never acted on. The human rights of indigenous peoples are somewhat more respected now than at the time the Single Convention was first negotiated. Indigenous people in South America are thought to have chewed coca leaf for at least hundreds of years. Bolivia and some other South American countries with substantial populations of indigenous peoples have resented the prohibition of the Single Convention extending to coca leaf. There is no evidence that chewing the coca leaf is harmful. President Evo Morales is the first indigenous person to become President of his country (and the first indigenous person to become President of any South American country). The withdrawal from the Single Convention had been approved by the Bolivian legislature. Bolivia had followed the procedures laid down in the Single Convention in this process. The event demonstrates that the treaties are now out of date.

Drug law reform was often discussed in Latin America in 2012. The Presidents of several Latin American countries began to publicly acknowledge the comprehensive failure of current policy and the need to consider alternatives which had until recently been excluded even from consideration. Critical comments about the futility of drug prohibition first came from retired Presidents. Then serving Presidents began to repeat the same perspective.

Leaders of more than 35 countries met at the Summit of the Americas in Cartagena, Colombia, on 14-15 April. In the lead up to this meeting, the President of the USA dispatched his Homeland Secretary and Vice President Biden to separately visit half a dozen Latin American countries in unsuccessful attempts to dissuade discussion of major drug law reform. Eventually President Obama was forced to concede (in a Presidential election year!) that discussion of legalization was ‘entirely legitimate’ although he emphasized the USA would never countenance this option. As the host country of the meeting, President Santos of Colombia was able to insist that drug policy was included in the agenda (despite opposition from President Obama).  There was overwhelming support at the Summit for the notion that the War on Drugs had failed and that a new approach was indeed needed. The meeting resolved to invite the Organisation of American States to identify policy options for consideration. Meanwhile several Latin American countries have begun to reduce the penalties for personal possession and use of illicit drugs. In some countries, criminal sanctions have been replaced by civil sanctions. 

On 20 June, President Jose Mujica referred a bill to Uruguay’s legislature outlining a plan to tax and regulate cannabis. Uruguay thus became the first country in the world to begin the process of legalizing cannabis.  At the beginning of 2013, this process was still underway.

The recent experience of severe and uncontrollable violence in Mexico precipitated by a major national effort to stop drug trafficking influenced many other countries in Latin America. President Felipe Calderon declared a War on Drugs soon after assuming office in December 2006. Drug traffickers, police and the army had murdered about 60,000 Mexicans by the time President Calderon left office at the end of November 2012. Kidnapping and extortion had also soared. Seared by this experience, President Calderon near the end of his term in office called for a drug policy consistent with ‘market mechanisms’, a phrase generally assumed to be a euphemism for legalization. At the 2012 Presidential elections in Mexico, President Calderon’s party was badly beaten into third place with many observers attributing this result, at least in part, to Calderon’s ‘War on Drugs’. President Calderon’s successor announced during the election campaign that, if elected, he would not continue the War on Drugs approach.

History was also made in the USA. Ballot initiatives in Colorado and Washington states in the USA on 6 November included a proposal to tax and regulate cannabis in a manner similar to tobacco and alcohol. A majority (about 55%) of voters supported these initiatives in both states (although a similar ballot proposal in Oregon was defeated). As one observer commented ‘the context of the Colorado and Washington ballot victories is that there is no context’. The Colorado and Washington ballot initiatives were the first time in the world where a majority of voters had supported the regulation of a prohibited drug. This ballot initiative attracted more voters in Colorado than Barak Obama had in running for President in that state. These ballot initiatives breach Federal law and national commitments to international drug treaties (1961, 1988). In the US system, as in other federations, in the event of any conflict Federal laws trump state laws. Therefore, it is likely that the ballot decisions will be challenged and may eventually end up before the US Supreme Court. However, the votes in Colorado and Washington states on cannabis regulation are likely to be followed in other states in the coming years.  These votes in 2012 undoubtedly represent a milestone in the unraveling of drug prohibition. President Obama has commented on the outcomes of the Colorado and Washington votes noting that ‘he has bigger fish to fry’. Ron Paul, who came third in the Republican race for presidential candidate, argued explicitly that the War on Drugs had failed and that the US had to legalize drugs. He was often cheered when making these comments. This is the first time that such a high ranked aspirant for President of the USA has argued for major drug law reform. At the beginning of 2013, medicinal cannabis was available in 18 states (plus Washington DC) covering more than 40% of the national population. There were victories for medicinal cannabis in several state ballot initiatives in the November elections. Challengers supporting drug law reform defeated incumbents supporting drug prohibition in primary elections in Texas and Oregon. These victories attracted some attention as previously candidates in US elections supporting drug law reform have been decisively beaten.  

In 2012 New Zealand began to establish a novel system for regulating certain psychoactive drugs. The system is still being established but essentially, producers of some psychoactive drugs will be allowed to offer proof of the safety of psychoactive drugs they wish to sell and if the evidence is accepted, and after also providing a substantial administrative fee, the producers may be able to sell their product. It is understood that the scheme will commence with some drugs which are said to produce ‘synthetic highs’.

In 2012, two high quality films were released advocating drug law reform. ‘The House I Live In’ was released in cinemas in October while ‘Breaking the Taboo’ was released on the internet in December. Both received a very positive reception. Several major former political leaders agreed to be interviewed for these films.

Australia21 hosted a Roundtable (based on a Discussion Paper) in January and released a report based on this meeting in April. The report concluded that Australia’s drug policy was heavily reliant on law enforcement and by many measures had failed comprehensively. None of the many prominent members of the community known to support drug prohibition accepted invitations to participate in the Roundtable. The release of the report at a press conference in the national parliament provoked a spirited debate lasting for well over a month. Few questioned the major findings of the report. A second Australia21 Roundtable, also based on a Discussion Paper, was convened in June and a report released in September. This report compared the generally positive results of drug law reform in the Netherlands, Switzerland and Portugal with the often disappointing results of the more punitive approach adopted in Sweden.  The second report also provoked national discussion for some weeks and again the overall conclusions of the report were not challenged.

An international conference on drug policy at Ditchley, UK, attended by 40 participants from 14 countries broadly supported the view that future drug policy should be based primarily on health measures rather than criminal justice measures as in the past. In the United Kingdom in December, Deputy Prime Minister Nick Clegg conceded in an interview in The Sun that drug prohibition had failed and major new approaches were needed. The Prime Minister, David Cameron, had made a number of unambiguous public statements in 2002 reaching the same conclusions. But in 2012, Cameron declined to support his Deputy Prime Minister. 

The Global Commission on HIV and the Law, established by the United Nations Development Programme, issued a report in August 2012 entitled ‘HIV and the Law: Rights, Risks and Health’. This added additional support from within the UN system for a drug policy more respectful of human rights and public health.

Overall, international support in 2012 has been growing for the notion that global drug prohibition with a ‘one size fits all’ approach has failed abjectly. However there is still little agreement on what approach to drugs should follow and a general recognition that countries should be able to pursue approaches seen to be more consistent with their national circumstances and interests. Support for the notion that drugs are primarily a health and social issue is increasing.  The notion that political support for drug law reform is suicidal while political support for drug prohibition guarantees electoral victory also appears to be breaking down. The severe fiscal problems experienced by governments in the US and Europe is another major factor undermining continuation of expensive government programs for which benefit is difficult to identify while severe adverse unintended consequences are increasingly difficult to ignore. 

Dr Alex Wodak AM

Director, Australia21

Global Commission on HIV and the law

The Global Commission on HIV and the Law consisted of fourteen distinguished individuals who advocate on issues of HIV, public health, law and development. Fernando Henrique Cardoso, former president of Brazil, chaired the Commission.

The Commission’s unique convening power allowed it to focus on high-impact issues of HIV and the law, which have important ramifications for global health and development. The Commission advocated for evidence and human rights based legal environments for effective and efficient HIV responses.

HIV is one of the world’s most important public health issues. The Commission writes:

In just three decades, over 30 million people have died of AIDS, and 34 million more have been infected with HIV. The HIV epidemic has become one of the greatest public health challenges of our time. It is also a crisis of law, human rights and social justice. The good news is that we now have all the evidence and tools we need to radically slow new HIV infections and stop HIV related deaths. Paradoxically, this comes at a time when bad laws and other political obstacles are standing in the way of success.

34 million people are living with HIV, 7,400 are newly infected daily and 1.8 million died in 2010 alone. The legal environment—laws, enforcement and justice systems—has immense potential to better the lives of HIV-positive people and to help turn the crisis around. International law and treaties that protect equality of access to health care and prohibit discrimination—including that based on health or legal status—underpin the salutary power of national laws.

But nations have squandered the potential of the legal system. Worse, punitive laws, discriminatory and brutal policing and denial of access to justice for people with and at risk of acquiring HIV are fuelling the epidemic. These legal practices create and punish vulnerability. They promote risky behaviour, hinder people from accessing prevention tools and treatment, and exacerbate the stigma and social inequalities that make people more vulnerable to HIV infection and illness. HIV-positive people—be they parents or spouses, sex workers or health workers, lovers or assailants—interact intimately with others, who in turn interact with others in ever-larger circles, from the community to the globe. From public health to national wealth, social solidarity to equality and justice, HIV affects everyone. The prevention, treatment and care of HIV—and the protection and promotion of the human rights of those who live with it—are everyone’s responsibility.

The Global Commission on HIV and the Law undertook 18 months of extensive research, consultation, analysis and deliberation. Its sources included the testimony of more than 700 people most affected by HIV-related legal environments from 140 countries, in addition to expert submissions and the large body of scholarship on HIV, health and the law.

The Commission’s findings offer cause for both distress and hope for people living with or at risk for HIV. In June 2011, 192 countries committed to reviewing legislation and creating enabling legal and social environments that support effective and efficient HIV responses. The Commission’s recommendations offer guidance to governments and international bodies in shaping laws and legal practices that are science based, pragmatic, humane and just. The findings and recommendations also offer advocacy tools for people living with HIV, civil society, and communities affected by HIV. The recommendations take into account the fact that many laws exist for purposes beyond public health, such as the maintenance of order, public safety and the regulation of trade. But they place the highest priority on creating legal environments that defend and promote internationally recognised human rights and legal norms.

The Commission’s Report (PDF) may be downloaded from here.

On Bernard Keane, Public Health and the Neglect of Social Determinants

Richard Eckersley, director, Australia 21 Ltd (formerly at the National Centre for Epidemiology and Population Health, ANU).

A colleague once caught me helping myself to some cakes left over from a staff party. Getting your fix of fats and sugars, she quipped. Yep, I replied, I was rebelling against public health fascism. I had in mind the growing number, and sometimes authoritarian tone, of health messages telling us how we should live. Hell, even sitting down (for too long) harms health these days.

So [Crikey Canberra correspondent] Bernard Keane’s attack on the ‘preventive health industry’ is understandable and partly right, but for the wrong reasons. It’s not that the health messages are unwarranted: There are real concerns about trends in both physical and mental health, especially among young people (http://blogs.crikey.com.au/croakey/2011/04/22/challenging-accepted-wisdoms-about-young-peoples-health-and-wellbeing/).

But there is a public or preventive health ‘industry’ in the sense of a professional body that applies a specialised, and restricted, view of how to improve people’s health. You can, as Keane does, talk of ‘social elites anxious to impose control on what they disapprove of’, but it is not particularly helpful.

The ‘industry’ emphasises modifying individual risk factors and lifestyles, particularly tobacco use, poor diet and lack of physical activity, and harmful alcohol use (http://blogs.crikey.com.au/croakey/2011/04/06/challenging-mainstream-thinking-about-health-and-medicine/). It largely overlooks the broader perspective of the social determinants of health (broadly defined to include social, cultural, economic and environmental factors). In doing this, it downplays the political or ideological significance of sickness and ill-health.

As we learn more about health, the bar of healthy living keeps getting raised - at the same time as the weight of unhealthy cultural expectations, or pressures, keeps increasing. Something has to give, and one result is the frustration and resentment expressed in Keane’s articles.

In promoting individual behavioural change, the orthodox public health approach misses the crucial point that social conditions act on population health in ways that cannot be reduced to individual choices. As British epidemiologist Geoffrey Rose observed, there is a relation between the mean of a characteristic in a population (for example, blood pressure or depressive symptoms) and the prevalence of the related disorder. ‘(T)he deviants are simply the tail of the population’s own distribution; they belong to each other…’ Or, as he also said, ‘The visible part of the iceberg (prevalence) is a function of its total mass (the population average)’.

This relationship shows that disease and disorder are the result of social conditions, not just individual lifestyles. Rose also argued that causes of cases can differ from causes of incidence: that is, explanations of why an individual becomes ill can differ from the explanations of why rates of illness in a population rise or fall. Efforts to improve health must match, or be appropriate to, the scale or level at which we seek improvement.

The two approaches – individual and social - are not completely separate and distinct; they represent the ends of a spectrum of interventions. Public health programs, while they are directed at individual behaviour, aim to produce changes in the population as a whole. They range from public education to substantial legislative and regulatory changes to promote healthier living. And it can be argued that social conditions are addressed elsewhere in government: through taxation, welfare, consumer safety and environmental protection, for example.

However, individual and population perspectives are conceptually different in important respects, and the effects of social conditions on population health need to be better understood and acknowledged as a basis for improving public policy and national goals and priorities.

It is very difficult for us to make healthy choices when the social conditions encourage unhealthy preferences. It puts us under considerable stress. As Keane demonstrates, we can respond angrily to attempts by governments and others to interfere in our private lives and to tell us how to live (which is ironic given a vast media-marketing complex spends billions of dollars doing just that, with little opposition).

Industry research on the recommendations of Australia’s National Preventative Health Taskforce (which include tax increases and advertising bans) found more than half of Australians reacted negatively, including agreeing that its report was a political document ‘intent on overturning much of the way we choose to live’.

Richard Wilkinson, co-author of the influential 2009 book, The Spirit Level: Why Equality is Better for Everyone, once told me that people can't keep to good intentions about healthy eating, giving up smoking and taking exercise unless they feel on top of life. ‘When we feel unappreciated, stressed and (with) no way out, we are more likely to eat for comfort and resort to alcohol, drugs, tobacco, and to become more sedentary.’

Wilkinson and others focus on the harm to health of inequality. I’ve emphasised the role of culture, arguing that modern Western culture, with its growing psychological stresses and pressures and its focus on consumption, pleasure and other external trappings of ‘the good life’, is a health hazard.

   

I’ve sometimes illustrated the importance of the social determinants of health by telling ‘the parable of the drowned’, modelled loosely on Hurricane Katrina’s devastation of New Orleans in 2005. Let’s assume most of those who perished drowned. On this basis, the response (reflecting the individual focus of public health campaigns) might be to issue life jackets, or to teach everyone to swim.

Going further, we find that most of the losses occurred in low-lying parts of the city, so the response might be not to build there. We then learn people lived there because they were poor and could not afford to live anywhere else, so poverty needs to be addressed. Then there were problems with the construction of the city’s storm and flood levees and the filling in of coastal wetlands that used to buffer storm surges, raising more questions about governance and city development.

But none of these explanations acknowledges the fundamental cause of the deaths as the hurricane’s severity, and the role of climate change in increasing the probability of such extreme weather events. This implicates industrial civilization. The parable makes clear that understanding and addressing health problems at the level of individual causes of death and disease are very different from understanding and addressing the social causes of a population’s health. As with climate change, so it is with social change.

This wider social perspective tends falls between stools. Public health pays too much attention to the individual; political commentators and analysts have too much regard for political theatre and policy detail. Both perspectives are too restricted. Both need to consider in greater depth the ways in which our world view - the whole framework of our way of life - works against better health and higher wellbeing.

Citation/original source

Eckersley, R. 2012. On Bernard Keane, Public Health and the Neglect of Social Determinants, Croakey, 16 December.

http://blogs.crikey.com.au/croakey/2012/12/16/richard-eckersley-responds-to-bernard-keanes-attack-on-preventative-health-wowsers/

Further reading (available at www.richardeckersley.com.au ):

Eckersley R. 2012. Whatever Happened to Western Civilization? The Cultural Crisis, 20 Years Later. The Futurist, Nov-Dec, pp. 16-22.

Eckersley, R. 2012. The science and politics of population health: giving health a greater role in public policy. Canberra: Australia 21 Ltd.