The health impacts of the Federal Budget extend way beyond the health portfolio, according to Sharon Friel, Professor of Health Equity at the ANU.
Cuts in education, employment, social protection, taxation and transport will increase health inequalities and contribute to much preventable suffering, she warns.
Does the Australian Government really wish to harm the majority of the people they were elected to serve?
What has the majority of the Australian population done to deserve such a brutal cull of services, livelihoods, and for many people a sense of self-worth?
The 2014 budget delivered by the Coalition government makes a mockery of the duty that any democratically elected government has to ensure that its citizens’ physiological and safety needs are met.
Over the next days, weeks and probably months we will hear ongoing debate, praising and critiquing the government’s new budget pronouncements and what it means for education, healthcare, employment, accountability and productivity.
All of these matter for people’s wellbeing and health, and it will really matter for people lower down the social ladder. Not just the poorest of the poor but people in precarious employment, those with lower levels of education, people with disabilities, those living in housing stress, and many Indigenous Australians.
We already have a society where the opportunity to live a long healthy life is unequally distributed.
Within a prosperous country such as Australia it seems unfair that the poorest 20 per cent of the population can still expect to die younger (six years on average) compared to the richest 20 per cent of the population (1).
Australians who are more socially disadvantaged (by income, employment status, education) and Indigenous Australians also have a higher risk of chronic disease, including depression, diabetes, heart disease and cancers (2, 3).
In our cities, suburban areas are marked by concentrations of very disadvantaged residents – long term unemployment, low levels of education, poor and dangerous housing conditions, and in some situations extreme poverty, leading to very poor physical and mental health outcomes. The health experience of people living in rural and remote Australia is often worse than the urban average.
It does not have to be like this.
Social differences in health outcomes are not explained by genetic variation or because of some mythical deviant behaviour that is particular to socially disadvantaged groups.
Peoples’ wellbeing is affected by three core things: we need the basic material requisites for a decent life, we need to have control over our lives, and we need voice and participation in the policy decisions that affect the conditions in which we are born, grow, live, work, age and die.
These three things are influenced by public policy and the way in which society chooses to run its affairs (4). Economic and social policies generate and distribute power, income, goods and services between and within countries.
This means therefore that depending on who you are and where you live will affect the type of exposure and access to quality and affordable education and health care, sufficient nutritious food, good conditions of work and leisure, and quality of housing and built environment. Together these factors affect health and health inequities.(5)
What does all of this mean in light of the 2014 budget?
Health inequities are produced (and prevented) by policies and actions within the health sector – a $7 co-payment for a visit to the doctor and increased cost of medicines will undoubtedly affect lower income groups more than others, thereby potentially resulting in higher mortality and morbidity for some and increasing costs and suffering.
But the health and health equity effects of this budget go way beyond the health sector. Health and wellbeing is also strongly influenced by other policy areas such as education, employment, social protection, taxation and transport.
A two tier education system is on the cards. The deregulation of university fees, with inevitable increases in fees for students, and increased support for private education will disadvantage lower socio-economic households, keeping them on a different life trajectory that exposes them to greater health risks.
Unemployed young people will have to wait longer for welfare and will be put on the youth allowance, rather than the higher rate Newstart; people under 35 on the disability support pension will face more stringent assessment; Family Tax Benefit B will no longer be available when a family’s youngest child turns six and the income threshold will be reduced to $100,000.
Money brings purchasing power and prestige. Income inequity – which will widen certainly as a result of this budget – creates barriers of status between people and reduces trust, self-worth, sympathy and community within societies, which give rise to feelings of social exclusion, insecurity, stress and can lead to early death (6).
Cuts in regulatory oversight functions could see deregulation of working conditions widen the gap between good and poor quality jobs, which are often worse for health than no job at all.(7)
The health of the 16,500 public servants who are about to lose their job or be redeployed will not be affected due to them being poor. But the loss of control that they are currently experiencing due to the pending job losses is a recognised stressor, increasing their risk of e.g. coronary heart disease by 50% (8).
So why has the Australian government chosen to ignore the needs of most of the population that it is supposed to serve, and why has the government in fact chosen to make the situation worse?
Apparently Australia has a (revised) deficit of about $30 billion and we need to tighten the financial belt. A new reality as a colleague said recently.
But history has shown that it doesn’t have to be that way.
The British National Health System was established in 1948 under the auspices of the Health Secretary Bevan.
A principle was established – one of fairness, where good healthcare should be available equally to rich and poor, young and old and regardless of where one lives.
For the first time, hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under one umbrella organisation to provide services that were free for all at the point of delivery. The national debt at the time was almost 260% of GDP.
“Despite our financial and economic anxieties, we are still able to do the most civilized thing in the world – put the welfare of the sick in front of every other consideration”
More recently, analysis by Stuckler and colleagues shows that social spending saves lives and austerity kills.
Following the GFC in 2007/8, Greece made radical cuts to public spending in 2010, axing pensions, healthcare insurance and health programs such as the needle-exchange programs. Between Jan and May 2011 HIV infections increased by 52%.
In contrast, Iceland’s total debt stood at >800% of GDP. What did the government decide to do? They introduced currency controls, they let the banks fail, they provided support for the poor (social welfare increased and there was no loss of healthcare access apart from dental care) and they didn’t introduce austerity measures. Health measures increased. Economic growth rate increased by 12 percentage points (9).
There is a fundamental issue behind all of this discussion.
What sort of society do we have and what sort of society do we want to live in?
Reducing health inequities will not be achieved overnight – it requires a long-term view, political will at the highest level, and support by an empowered public sector based on principles of fairness!
The current dismantlement of the public service and the focus on austerity measures to reduce the ‘deficit’ suggests that we have a long way to go in Australian society and politics if we are to create the conditions that support all people to achieve their potential.
Is Australia a country built on the principles of a fair go? Most certainly not now.
1. Leigh A. Battlers & Billionaires: the Story of Inequality in Australia. Collingwood: Redback; 2013.
2. AIHW. Australia’s Health 2012. Canberra: Australian Institute of Health and Welfare; 2012 Contract No.: Document Number|.
3. Major Cities Unit. State of Australian Cities 2013. Canberra: Department of Infrastructure and Transport; 2013 Contract No.: Document Number|.
4. CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organisation; 2008 Contract No.: Document Number|.
5. Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet. 2008;372(9650):1661-9.
6. Stiglitz J. The price of inequality. London: Penguin; 2013.
7. Broom D, D’Souza RM, Strazdins L, Butterworth P, Parslow R, Rodgers B. The lesser evil: Bad jobs or unemployment? A survey of mid-aged Australians. Social Science & Medicine. 2006;63:575-86.
8. Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, J V. Work stress in the etiology of coronary heart disease – a meta-analysis. J Scand J Work Environ Health 2006;32:431-42.
9. Stuckler D, Basu S. The Body Economic: Why Austerity Kills. London: Penguin; 2013.
Further reading at The Conversation by Professor Fran Baum: Why the federal budget is bad for health and worse for society
And from Twitter: