John Boffa has dedicated his life to helping those who find it hard to help themselves. 

He has spent more than 40 years in the medical field and has become a leading advocate for reforming Aboriginal healthcare in the Northern Territory. 

The once-aspiring Jesuit priest had a profound sense of altruism instilled in him as a young boy. 

“The spirituality of the Jesuit order is exceptional – they teach you the value and meaning of working with underprivileged people,” he says. “They instilled that in me, and then I knew I wanted to do medicine. I wanted to help people.” 

After graduating with a medical degree from Melbourne’s Monash University, he went to work as a doctor in the healthcare system, but soon found himself disillusioned. 

“When I got into the hospital system it wasn’t what I hoped. I didn’t find it as meaningful as I thought I would – it just felt technocratic. It felt like when people were really in need, they discharged themselves and that was it. We’d go on to the next person and forget about them.” 

He decided to work with disadvantaged communities in India. 

While waiting for his visa in 1988, John took a temporary job as a doctor at Anyinginyi Congress in Tennant Creek. It was a decision that would change his life. 

“I was blown away by the disadvantage in Tennant. I had no idea that people were living like this in Australia. It was not just the lack of healthcare but people were living in corrugated iron houses with dirt floors, no running water, no bathroom.” 

By the time his India visa came through a few months later, he had decided to stay in Central Australia. 

He is now the chief medical health officer public health at the Central Australian Aboriginal Health Congress in Alice Springs – and has doggedly led campaigns for more healthcare funding, lead-free petrol and a minimum alcohol floor price. 

The doctor knows that Indigenous people have suffered generations of dispossession, poverty, poor health, low educational standards and lack of self-esteem. 

But he says things can be improved. A report on the 50 years of the work carried out by the congress shows that improvement is possible – it just takes hard work and proper funding for the Aboriginal-controlled health sector and hospital system. 

For instance, the life expectancy of Aboriginal men went up from 47 in the late 1960s to 65 in 2018 and slightly higher for women at 69. 

John attributes the initial improvement to the decline in deaths from assaults, injuries, infections, including diseases such as pneumonia. 

But from the mid-1980s to 2000, “things got a lot worse” as the chronic disease epidemic began. 

“When I was first in the Territory, things were bad. The health system was terrible, the hospitals were bad, primary health care was incredibly poorly resourced. 

“People used to say, ‘if in pain get on a plane’, and it was true. The hospital system in the Territory was in a disaster situation.” 

Diabetes, heart disease and kidney disease soared among Aboriginal people. 

“People were dying of absolutely preventable diseases, of really poor medical practice.” 

By 1999, the life expectancy gap between Indigenous and non-Indigenous Territorians had blown out to 23 years for men and 18 years for women – the highest gap on record. 

“But since then, things have got a lot better.”

John, in partnership with Aboriginal leaders in the community-contolled health sector, has successfully pushed for the Territory and Commonwealth governments to spend more on the healthcare for the most vulnerable community.

“In 1989, we tried to get the Royal Commission into Deaths in Custody to look at deaths in hospital. It was obvious that people were dying in hospital of preventable diseases, sometimes of absolute malpractice or even possible manslaughter at times And that was being ignored.

“People in jail were much healthier at that time and that was really obvious.”

The newly published historical report demonstrates that reforms demanded congress, such as more funding for primary health care, transferring health responsibility and funding from Aboriginal Affairs departments to the Health Department and introducing unleaded petrol and alcohol reforms, have worked.

“The whole primary healthcare system is dramatically improved. The per capita funding has gone from about $700 per person in 2000 to about $5000 or more.”

The life expectancy gap has closed by nine years for men and four for women since 1999.

“There’s been an absolute improvement in life expectancy and a very significant closure of the gap.”

But John accepts there is still a long way to go because the health system alone cannot close the gap in spite of how much it has improved. The present gap of 14 years is still unacceptable for a wealthy first world nation.

“We’ve seen a big improvement and the gap closing, but education has hardly changed, not enough to make a difference. Poverty has got worse, particularly in remote communities. Employment hasn’t changed. Average income in remote regions has got worse.”

John, who was named NT Australian of the Year in 2012, believes that the failure of the education system, including pre-school education, is at the heart of much of the Aboriginal community being disadvantaged and is the major barrier to closing the gap further .

A congress paper called Education and Health shows that for every year of educational attainment completed, beginning with the first year of transition, leads to a 1.9 percent reduction in all-cause mortality across a lifetime.

So six years of primary school is nearly 12 percent and finishing year 12 about 24 percent. Completing a tertiary degree is at least a 33 percent reduction. 

“This is now the main game in terms of further closing the gap. Every remote community needs a child and family daycare centre as a precursor to entering school. 

“If every Aboriginal person was to have a qualification, you’d close the gap by a third. Unfortunately, remote schooling is the worst it’s ever been. Only 27 percent of kids are attending four days or more a week.”

John hopes to encourage the Territory and Commonwealth governments to do more to address the systemic failures in the early childhood and education systems.

“They’re not able to recruit and retain enough teachers, especially senior teachers. I don’t think they’re paying enough. There’s no focus on bilingual education. There’s a lot still that has to happen if we’re going to turn educational achievement around.”

John wants other healthcare professionals to work in Central Australia.

“I’d love health professionals to read this and think of a life or a career in remote Australia, particularly in Aboriginal health, particularly in community-controlled health services.

“It’s well worth taking a risk on. It’s a great way to contribute – and remote Aboriginal communities need them.” TQ

JOHN WITH DONNA AH CHEE AND JOSIE DOUGLAS AT A FABALICE CONCERT