The problem of poor health, substance addiction, unemployment, domestic and sexual abuse, suicide, violence, and hopelessness in Australian Indigenous communities has been a wicked policy problem emerging from the 1970s onwards. Also since the 1970s activists, experts and policymakers have tended to focus on rights and politics-based approaches to ameliorating such conditions: land rights, apologies, and a treaty between Indigenous and non-Indigenous Australians. While such measures are not without any intrinsic value, there is simply no reason to see them as effective measures in alleviating the horrific living conditions of so many Indigenous Australians. In this respect, a focus on civic rights is a distraction from the real problems, not a solution.
Peter Sutton is a distinguished linguist and anthropologist who has spent much of his life living with and researching the culture and communities of Indigenous Australians. Sutton calls for a redirection of our attention to the day-to-day challenges faced by Indigenous Australians, and to policy initiatives that are evidence-based and tailored to specific problems. He also calls for an end to the tendency of policy makers and activists to shy away from suggesting that there might be a cultural dimension to the challenges faced by Indigenous Australians, suggesting that, as all human cultures are malleable and adaptive, so Indigenous Australians may need to adapt to some extent to the requirements of flourishing in the context of a modern economy and health system.
- Notwithstanding the paternalism of the government and missionary-run reserves and missions, Aboriginal Australians enjoyed a level of health, care, routine, and structure that has been impossible to recapture since the end of that system in the early 1970s.
- The causal connection between land rights, apologies, a treaty, and symbolic gestures and improved living conditions of Aboriginal Australians is doubtful.
- Activists and policy makers too often refuse to admit that there are traits within Indigenous culture – violence, demand sharing, nepotism, silence, and traditional medicine – that contribute to their poor living conditions.
- Alcohol consumption is probably the single biggest problem in Indigenous communities, thus effective measures against it would do the most to improve quality of life.
The Rights Approach to Indigenous Policy
It is now common for the most prominent activists for Indigenous welfare to focus on so-called Indigenous rights as the most effective means to achieving good health, employment, education, and welfare outcomes for Aboriginal Australians. But Sutton points out that many Aboriginals’ “descent into a seriously dysfunctional state” coincided with “liberal progressive policies based on the rights agenda.” 
“By definition”, says Sutton, according to this approach, “those who deliver the people from extraordinary levels of rage, fear, anxiety, neglect, malnutrition, infection, diabetes, renal failure, sexual abuse, assault and homicide will thus allegedly be politicians, barristers and political activists.” 
Sutton’s main thesis is that the rights programme, for all its passion and good will towards Indigenous Australians, has failed to deliver effective public policies to ameliorate the worst challenges faced by Indigenous Australians in their day-to-day lives. Thus, while the programme of land rights, self-determination, and national apologies has marched on, the conditions in many Indigenous regions has steadily deteriorated since the 1970s: “…the generous-hearted, clumsily-applied progressivist programme had failed.” [xi]
Sutton says that activists need to refocus on the actual daily problems faced by Aboriginal Australians and thus refocus on practical approaches to improvement.
Causes of Indigenous Disadvantage
Although it is common to say that Indigenous disadvantage stems from colonialism, Sutton says that a helpful analysis of it really begins with much more recent history, especially since the 1970s. Sutton lists and discusses the historical processes and other causes that led to and perpetuate the dysfunction of Indigenous communities. These are:
- Welfare dependency, which, to quote Noel Pearson, leads to “boredom and purposelessness of life in so many communities”. 
- Withdrawal or defeat of disciplinary regimes. Notwithstanding the paternalistic nature of the missions, Indigenous Australians lived under an imposed discipline that enforced work, hygiene, abstinence, and rules in general. This was not entirely unlike the strict cultural expectations and regulations placed on Aborigines from within their own tribes pre-colonisation. Many Indigenous Australians have not coped well with the post-mission liberal emphasis on freedom and individualism, ideals quite alien to Indigenous culture. 
- Legally imposed equal wages on employers of Aborigines, and mechanization, that cost Indigenous Australians their jobs. While Sutton is in favour of equal wages for equal work, the introduction of equal wages legislation meant that many farmers ceased employing Indigenous Australians, which led many of them to leave their small communities on the land and meaningful jobs and start “artificial Aboriginal townships”.  This was a case of good intentions leading to detrimental consequences.
- Alcohol consumption owing to the liberalization of Indigenous drinking rights since the late 1960s is perhaps the single greatest scourge on Indigenous communities. It is to a large degree responsible for their excessive violence, domestic abuse, health maladies, and general dysfunction. 
- Aspects of Indigenous culture such as male violence towards women , training children from infancy to be comfortable with aggression, and demand-sharing with family members which makes it difficult to manage a budget or keep an orderly and safe house. Sutton says, “One of the obstacles to effective debate in the present context is that so many people are still in denial over the need for cultural change.”  Improvement in Indigenous communities cannot occur without the resolve for cultural change, and thus non-Indigenous policy-makers need to resist refusing to admit that aspects of Indigenous culture need to change.
- Badly thought-out and poorly targeted public policy initiatives, also often hampered by an inefficient, multi-layered bureaucracy. 
Policy Responses to Indigenous Challenges
Reducing alcohol consumption would probably bring about the single greatest improvement in people’s lives in the most afflicted and disadvantaged communities. Activist Noel Pearson said that notwithstanding the repression involved, the 2008 Northern Territory Intervention was more beneficial than not to the most alcohol affected communities. Measures to limit alcohol consumption, though invasive, work. When severe alcohol restrictions were imposed on Aurukan in 2003, sutures for head wounds reduced in demand by 90% by 2006. Suicides and homicides also dramatically decreased. 
More proactive parenting would, according to Sutton, make a big difference regarding violence against women. Currently it is very common for children not to be disciplined, especially sons who lash out violently against girls and their mothers. Of course, they also learn this from the example of their male relatives.  Sutton points out that tribal restraints on behaviour were continued by missionaries, except with a Christian moralistic emphasis, which, in the absence of tribal law, prevented Indigenous communities from devolving to chaos. Now the restraints are to a large extent gone entirely. Community restraints and expectations need to be re-imposed on children for the sake of the next generation.
As intuitive as it seems to have more Indigenous police on the ground, it presents a big problem in communities in which the police officers are expected to exercise ultimate loyalty to their own kin. This can pervert the course of justice and allow violence to continue. In other words, non-Indigenous police officers should not be discouraged. Indigenous women in particular benefit from non-Indigenous police officers who have no kin-debt to abusers or their families. 
Treating traditional medicine, which includes supernatural remedies, as equal to Western medicine is not conducive to better Indigenous health outcomes. Traditional medicine should not be promoted by social workers. Modern medicine should be encouraged. 
Sutton’s Politics of Suffering is one of the most important books on the challenges facing Indigenous Australians available. Although it was written before the current Voice to Parliament became a prominent national debate, its findings and insights are highly relevant to that issue. Sutton’s genuine concern for Indigenous Australians shines through on every page, but this is also what drives his rejection of politically correct shibboleths when writing about the causes and responses to problems in Indigenous regions.
Sutton refuses to blame all of the challenges faced by Indigenous Australians on colonisation or racism, and in doing so gives Indigenous Australians the gift of agency. As difficult as it is to hear that Indigenous Australians often directly contribute to their own hardships, it is a necessary premise of any effective programme of amelioration.
One does not just come away from this book with an eye-opening revelation of the challenges faced by Indigenous Australians, but one comes away with a grasp of how these problems came to be and, more importantly, what may be done to bring peace, order, and flourishing to many of these communities.