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out of pocket costs
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A Croakey #longread: remembering those we’ve lost – and a call to action for planetary health

This week marks the first anniversary of the traumatic loss of Professor Gavin Mooney and his partner Dr Delys Weston.

The lengthy article below captures some of the themes from a recent conference that honoured their work and their activism for a fairer, more sustainable world.

It includes a remarkable cri de coeur from Siobhan Harpur, Director of Population Health Operations for the Tasmanian Department of Health and Human Services.

She urges us to seize our “individual and collective responsibility to make a difference”. Reading her speech is a good place to start.

***

“We need new ways…”

At a recent forum in Hobart, leading public health experts painted a grim picture of the state of planetary health, warning of eco-collapse and growing inequalities.

Associate Professor Peter Sainsbury, of the University of Sydney, told the forum that humanity is in “a mess of our own making”, which threatens the future of our species.

“I’m very pessimistic there will be anything more than very rudimentary human life on this planet in 200 years time,” he said.

Sainsbury said that this mess of “unprecedented proportions” had arisen because humanity had ignored that we’re part of part of complex, adaptive ecosystems and that we live in a world of finite resources, and because we had failed to learn from what science tells us.

“This emphasis on ‘me’, here and now, this disregard for people elsewhere and future generations – this is a failure of morality,” he said. “This is clearly manifest by the inability of western democratic governments to see a way through.

“We need new ways of collective decision-making that are responsive, inclusive, and that include minorities, not just the majorities, and that create maximum harmony.”

Associate Professor Marilyn Wise, from the University of NSW, stressed the importance of ensuring that those groups who traditionally missed out were represented in decision-making within institutions, organisations and governments.

“We need to share power, create spaces, conversations, examine our own institutions and look at how they are perpetuating old ways of thinking,” she said. “We always need to ask who’s in the room when decisions are being made.”

The forum, “Our health – who decides”, was convened by Tasmania’s Social Determinants of Health Advocacy Network to honour the memories of the late Professor Gavin Mooney (a prolific Croakey contributor), his partner Dr Del Weston, and also Ms Linda Jamieson, an advocate for the rights of older Tasmanians.

There were few dry eyes as we heard courageous presentations from Weston’s children – lawyer Katherine Weston and community development student Alex Soares.

Their talks, which cannot be reported, were a powerful reminder of the toll that mental illness and unresponsive services take upon families and communities.

The forum also heard a strong presentation on the economic and political drivers of health inequities from Professor Sharon Friel, Professor of Health Equity at the ANU (the image behind her in the photograph below is from the album Unity Creates Strength.)

Like Mooney, Friel grew up in Glasgow, and shared his outrage at the “completely avoidable injustices” that continue to occur in that city (as shown in variations in life expectancy between rich and poor areas) and elsewhere in the world.

She described the “structural pathologies” that contribute to health inequities by shaping peoples’ everyday living conditions, including access to a healthy food supply.

The major drivers of an unhealthy food supply are unfettered liberalisation of international food trade, increased foreign direct investment, and globalised advertising and marketing, she said.

Friel added that Coca Cola is more easily available than water in some countries in Africa, and that for low and middle income countries, having a Free Trade Agreement with the US was associated with increased soft drink consumption.

Friel also described how the Trans Pacific Partnership trade and investment agreement that is currently under negotiation may limit governments’ ability to regulate industries that manufacture and market products that are potentially harmful to health – such as the tobacco, alcohol and processed food industries.

Friel (pictured to the left with CEO of the Heart Foundation in Tasmania, Graeme Lynch): said:

“Governments need to be able to raise the prices of unhealthy goods, to restrict marketing and advertising, sale and distribution, and to regulate labelling of these products.

“We want to, for example, retain the ability to put warnings on alcohol products, or to introduce new rules around nutrition labelling for food.

“But many parts of the TPP could allow the private sector to meddle in government policy, and restrict the flexibility – or policy space – for governments to be able to set and implement these important public health policies.”

Friel said Mooney wrote about how to create just, fair and compassionate institutions in the face of neoliberalism and injustices in the distribution of money, resources, and power.

“He writes about reclaiming power,” said Friel. “We need to celebrate the fact that it can be done.”

Indeed, the two-day event was marked by duelling themes of light and dark – and of people power mustering against unjust institutions and political systems.

One of the conference organisers, Miriam Herzfeld, noted that while the gathering had arisen out of sadness at the traumatic loss of friends, it was also about looking to a future filled with activism and a commitment to tackling the big and difficult issues.

This dualism was powerfully captured in a very personal speech from one of the forum’s organisers, Siobhan Harpur, Director of Population Health Operations for the Tasmanian Department of Health and Human Services, reproduced below.

***

In this sometimes dark world….what is the inspiration that we can find for a brighter future?

By Siobhan Harpur

I will share with you some my own personal reflections – some of them are dark observations that sit beside the hope that I have for a brighter future.

What right do we have to ownership of the earth and its resources? The earth’s resources, economic, social, the land itself – the split between ourselves and people who are much poorer than ourselves, the split between ourselves and those of future generations who may not have what we have because we have used so much of the collective entitlement up.

This observation is true for our care of the earth itself, and it is also a reflection of our relationship to money and to power; to democracy and the fundamentals of civil society.

We have been captured by individualism.  We have been captivated by the comforts, the conveniences and opportunities that the system has offered. We have had too much to lose, and we have refused to see.

The extraordinary success of the system for so many of us individually has blinded us to its failure to care for the whole. I have been told that I am too unrealistic in my expectations, too much of a purist. It is impractical, they say, to expect too much of large organisations and contemporary society.

I challenge this limiting view and say that we can tread gently, treat people kindly and live simply.  And I know that I am not alone.

We are the stewards and the custodians  – the temporary beneficiaries of this land we stand on and the life we have been given – our responsibility is to work with it, to do our very best to pass it on in an improved condition to our future generations.  To put it simply we should take responsibility for “paying it forward”.

If our values are not fundamental to the way we see society more broadly, then how can we expect to see them in our organisations?

I invite you to come with me.  I stand here today because I am challenging myself to personally to share my truth. I look to that of good in everyone, and an interconnectedness that surpasses people and extends to all living things.  I am challenged by this personally, professionally and spiritually.

These are not new thoughts. When I was at primary school my friend Billy and I used to talk about running away to visit the zoo.  I knew there were separate rules for those of us who lived at the top of the hill, and my friend Billy lived at the bottom, so I took the initiative and stole two bicycles in order for us to get there faster.

The result – without sharing all of the adventure that ended with us being brought back by the police – was that the headmaster spoke to me about responsibility and modifying my behaviour, and Billy got the cane in front of the rest of the school the following morning.

In the last 50 years we have lived through a period of extraordinary growth built on debt, and which has given free market globalisation its veneer of success. I was fascinated by the loss of the gold standard when I was at school and its implications.

And now, money, and even gold itself, has become its own commodity, trading in currency fuelled by speculation and no longer linked to goods and services, which are themselves fuelled by a rampant consumerism that more and new is always better than making do with what we have.

Poverty kills people and here and now thousands of people are dying prematurely or unnecessarily. There are 97,000 people living in poverty in Tasmania, which is one fifth of our population.

I am shocked that the difference in life span in Australia today is predicted at birth to be as much as 15 years shorter for an Indigenous or Aboriginal person, and 10 years between the wealthiest and the least wealthy in society generally. So many people in generational difficulty.

It is by leaning into this pain and suffering that I can foster my own compassion.

What is it that I am responsible for, and what am I complicit in not challenging?

When I ask the question who makes the decisions about my health, I am reminded that international corporations are influential, and outside of my control, or even the control of the State or National Governments.

Picture, for example, the action by Coca Cola Amatil in the Tiwi Islands. (Coca Cola itself was started by the company British American Tobacco – but that’s an older story).  The Islanders were supported in their campaign to ban the sales of Coca Cola in their general stores, and then shocked when Coca Cola Amatil negotiated directly with individual citizens to install vending machines on peoples’ decks.

That population with its high incidence of type 2 diabetes, was making a stand to invest in preventable action, and it was thwarted with the action of a powerful multi national. Big pharma, big food, big banks – they are here and now and we can acknowledge the facts – whatever my level of education and income, where I live will impact on my health because I may not have the access to making healthy choices in what I eat, how I live, or whether my children can play safely.

In Tasmania we know that there are many food “deserts” – identifiable places where there is little or no access to fresh fruit or vegetables for sale within a reasonable distance from your home. But most places have access to a takeaway with a deep fryer, and the answers are not simply giving people fresh food.

Just like by friend Billy who didn’t choose to live at the bottom of the hill.

The world is more complex and we appreciate that there are many more competing forces, and everything happens instantly, especially globally.

But we can’t keep hoping for a gold class standard public system without paying more than the equivalent value of a 20 year old Holden for it.  But we can look together at what we have, and consider how we can use this precious investment wisely and effectively so that it can be much better. Especially how it can be more equitable.

If I squeeze my values into a very narrow area of spirituality that doesn’t deal with public life, I am denying the very opportunity of life itself.  Living life honestly, with integrity, questioning and reflecting on our actions, speaking truth to power.

Like many of you at this Conference, my faith and confidence were shattered on the 19th of December 2012 when Gavin Mooney and Del Watson so tragically died at Mountain River.

I would describe myself as a reluctant leader, increasingly coming to terms with this perhaps being my leading, and confirmed very deeply in the brief friendship that we made as a family with Gavin and Del during the 18 months they were here.

Gavin encouraged me to feel proud to be in public service, reminding me often that it is a most important job.

I have been thinking about how I can be more effective and influence what is possible as I find myself meeting head on all of the challenges of living in this complex world.  I know that by challenging ourselves in the decisions and choices that we make every day, and throughout each day is not only more meaningful and rewarding, it also offers the real and tangible opportunity for a brighter future for all Tasmanians.

What is that you will bring of yourself, what is your commitment?

There is three times as much mental distress experienced by people who have less power in their own lives.  And it isn’t just about income, it is about equity.

The person with an intellectual disability or impairment whose behaviour brings them into the criminal justice system. Someone with a mental illness who ends up homeless and struggles to settle in accommodation of any sort long term. Or another person with the experience of trauma or abuse who has turned to alcohol or drugs as a coping mechanism.

Any or all of these people may need help to find work and support for themselves and their families. We have both an individual and a collective responsibility to make a difference.  I have a passion for creative innovation and bringing out the very best in people and in my job as a Director in Population Health inside Government I am committed to improving the health, social and economic outcomes for people and communities.

One of the theoretical arguments for change is that there needs to be a burning platform before people will want something different enough to jump from what they are used to, to an unknown future. Isn’t that the very basis of trust and belief?

All systems can change and are transient.  Everything has its time. And the time for action is now. The social and economic consequences of doing nothing to challenge and to question are huge – increased suicide, people in prison, obesity, homelessness, risky use and violence as a result of drugs and alcohol, crime, low literacy. We are paying this price now, and we should not be silent about it.

The biggest difference that we can make is to provide meaningful work for all. Fulfilment and self worth have an economic and social consequence that has a health outcome. Putting values into action is not a unique conversation in community sector organisations or the public service.  There are increasingly enlightening board rooms as executive and non executive directors realise that the focus on risk reduction and financial return is not enough to truly succeed in business and create wealth overall.

We can do so much here in Tasmania, and we have the advantage of our size and agility, and all of our relationships. We can re build trust in business by enabling small and new enterprises to grow, especially worker owned, cooperatives, partnerships, social enterprises, business that is creating wealth and is founded on values of integrity, fairness and exchange.

Change starts with me. I am both incredibly important, at the same time as being of absolutely no consequence at all.

What I realise, and what I endeavour to make sense of every day in my work, and in my encounters with people, is that every encounter matters. Where people feel humiliated, afraid, ashamed, and unwanted – these experiences are passed on through other encounters.

Where people experience respect and acknowledgement, this too holds the possibility for change. And big changes happen because of the actions of individuals.

There is an urgent argument for all of us individually and within our families, our neighbourhoods, our workplaces, work teams, organisations, businesses, schools and communities – to invest our time and effort for a brighter future.  We can claim health as a resource for living. We can trust in the capability of one another.

So I invite you to come to the table with curiosity, and bring your friends and colleagues – including those you don’t yet know – let’s listen to new perspectives and find new solutions together.  It doesn’t matter where we have come from, or what we bring with us, what matters is how we go forward together.

The opportunities that we can make with one another if we hold our hearts open with compassion, the knowledge that each person and each living thing is of good intent, gives us the courage to be with each person, in service each day.

• Siobhan Harpur manages 100 staff across the health protection and health promotion responsibilities of Public and Environmental Health, and Population Health and Wellbeing Services in Tasmania. She also has an additional leadership responsibility for the State Government commitment for preventive health – called a Healthy Tasmania. The picture above was taken when she climbed Cradle Mountain in 2012.

***

Commentary by conference participant and community advocate John Mackean

The address by Siobhan Harpur was extraordinary. I have known her for a decade or more, but had never suspected the depth of her beliefs and feelings. I found her address and sincerity were very moving.

Regarding Peter Sainsbury’s presentation, it was a surprise to find someone whose pessimism about the future of civilisation was almost as severe as my own – he at least gave us 200 years!

It was salutary to have the problems of our capitalist society so clearly stated and the problems of countering the power – economic, constitutional, environmental and military – of the plutocracy laid out so starkly for this audience.

Sainsbury was very strong on the need for complex adaptive systems and strategies, that we had to be prepared for deep failures of thinking and execution. He echoed Siobhan Harpur on the fundamental problem of unrestrained global capitalism and the concentration of effective power and decision making in so few hands.

****

Tackling the social determinants of health

The argument for tackling the social determinants of health must be made – and won – with the treasury and finance departments, according to Martin Laverty, from Catholic Health Australia and the SDOH Alliance.

The Federal Health Department had stated it has no responsibility for addressing the SDOH, and that this had been moved to the Department of Prime Minister and Cabinet, he said.

Laverty urged state health departments to advocate on SDOH to a “federal government that needs some nudging around the importance of this topic”.

***

Book launch puts focus on need for radical change

Del Weston’s book arising from her PhD, “The Political Economy of Global Warming”, was launched at the conference.

Professor Dora Marinova from Curtin University, who was Del’s PhD supervisor and a close friend, argued for a new model of “global green system of innovation”, saying that the two possibilities for future are either massive ecological destruction or massive systematic change.

She cited Del in arguing that “an urgent and radical change in the direction of human activities needs to occur within less than a decade to prevent a wide scale catastrophe”.

***

A vision for the future

Professor Fran Baum from Flinders University ended the conference by outlining a vision for the future.

 

 


 

As you may have gleaned from the above compilation, the conference was quite an extraordinary event: a mix of the personal, professional and political; and a blend of hope and despair.

Since then, my thoughts have returned many times to Peter Sainsbury’s bleak warning about the future.

• Thanks to citizen journalists at the conference who contributed notes and tweets, and particularly to volunteer tweeter Heidi La Paglia (@heidilapaglia)

• Declaration: Conference organisers paid for Melissa Sweet’s travel and related expenses to attend the event.

****

Update, 17 December. 

The report on Sharon Friel’s presentation below is by Heidi La Paglia, a UTas student in the Sociology and Gender disciplines, who hopes to do further research in the area of gendered health inequality.

Power Money and Resources

By Heidi La Paglia

In her keynote speech ‘Power, Money and Resources,’ Sharon Friel spoke about the world’s unequal distribution of resources and how this contributes to health inequities between individuals. Her explanation of health inequality was interesting and well substantiated; I found it a pleasure to hear her speak at the social determinants of health forum in Tasmania.

In a tribute to Gavin Mooney who died in 2012 after writing his insightful book, The Health of Nations, Sharon Friel discussed the downfalls of capitalism and individualist ideology. In societies with democratic political systems like Australia, it is often noted that citizens have equal opportunities. However, as Friel emphasized, unequal distribution of resources prevents equality from existing in reality.

According to Sharon Friel – “people in less affluent neighbourhoods are much less likely to have access to the resources that to lead good health outcomes.”

While political structures which support individualism create the potential for all individuals to achieve good health; the reality is that an individual’s well-being is largely determined by their access to resources. In her keynote, Sharon Friel emphasized that people with more money and power are much more likely to have access to the resources which keep them healthy. In contrast, structural inequalities keep the health of less powerful individuals poor.

According to Friel, economic structures maintain that people with less money and power around the world have better access to the things that are bad for them than the things that are good. In Africa for example, evidence suggests that the sugar packed soft drink “Coca-Cola is more readily available that running water.” This is largely due to the power of transnational corporations, which care more about making profit than maintaining global health.

Around the world, trans-national fast food corporations have a huge amount of power. This allows them to control global trade; food exports and imports to countries. While policy measures could regulate the system; the western emphasis on neoliberalism and the free market has resulted in many countries signing a free-trade agreement with the United States (US). According to Sharon Friel, this has allowed US companies and transnational corporations to sell poor quality, “rubbish” food around the world. Mass fast-food corporations like Coca-Cola and McDonalds are subject to very few constraints and regulations.

Unfortunately, for countries like Africa, free-trade agreements have resulted in an increased consumption of high-fat and unhealthy foods by already disadvantaged populations. The rise in the soft-drink consumption in Africa is a good example of this. Since their free-trade agreement with the United States, the soft-drink consumption in Africa rose by 55%. Alongside poor African’s limited access to water and fresh fruit and vegetables, the rising consumption of high sugar “rubbish” foods poses a considerable threat to their health.

In her keynote, Sharon Friel noted that while alternative public policies could improve this sad state of affairs, free-trade laws have put considerable constraint on domestic policy measures. Under the laws of free-trade, large corporations have the opportunity to sue states and countries if they try to regulate the types of foods that are imported. This puts poor countries like Africa in highly vulnerable positions; and makes it extremely difficult for them to improve their populations health.

However, while poor health is maintained around the world by major structural inequalities and disproportionate ownership of money, power and resources, the picture is not all bleak. As Sharon Friel’s Keynote emphasized, changing global policies can improve the situation. While this may be difficult to achieve, every big endeavour starts somewhere. Sharon Friel emphasized that in order to make change, “grass-root action is needed!”

While most of Friel’s keynote was focused on the sad statistics of global health inequality, the end of her speech emphasised the role of citizens to stand up and say that the current situation is not acceptable. In democratic countries like America and Australia, governments are held accountable to citizen wants and desires.

If everyone stands up and says that something must be done, the government will eventually be forced to take action. While health inequality has emerged out of a long history of power inequities and unequal economic structures, it is not impossible to alleviate.

Around the world, health inequality has been socially constructed. With the right steps, a more equal world can be created. While this may not happen tomorrow, it is not impossible. Change always starts small. In democratic countries like Australia, it starts with protest. Citizens have to start saying NO.

•  Alongside her studies and part-time work, Heidi has many volunteer positions related to her interests. She is currently the Media and Communications Officer for Vision Generation (VGen) Tasmania, holds the Women’s Officer position for the Tasmanian University Union (TUU), fundraises for the Hobart’s Women’s Shelter and is a regular writer for the feminist online magazine LipMag.

 

 

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