Health economist, Professor Gavin Mooney, writes:
In a recent paper from the European Parliament on reducing health inequalities, that parliament has chosen to endorse policies for ’reducing health inequalities in the EU’, arguing for ‘making a more equitable distribution of health part of our overall goals for social and economic development’ and ‘building commitment across society for reducing health inequalities’.
We know from the work of many, but particularly Wilkinson and Pickett, that income inequality is bad for population health.
Yet here in Australia we continue to see two things: the disparity between rich and poor growing, and the seeming neglect of the impact of this on health.
What is deeply worrying is that that 9.8% is growing – up from 8.8% just 5 years earlier. This is not really surprising given what has been happening to the wages share of total national income. This peaked at 62.4% in 1974-75.
But as the ABS states: ‘In more recent times, the wages share has been trending down to be 53.7% in 2006-07 and 53.4% in 2007-08.’ The profits share has had a great boost – up to 26.5% in 2007-08 higher than at any time since the late 1950s.
Inequality kills. The Australian Government fortunately is not Gaddafi-led and has not turned its guns on its own people. But by allowing – as a minimum – and, more accurately in my view, promoting inequality, it is just as certainly killing its own people.
Where in all the health reform documents in Australia is there a solid commitment like that of the EU to address inequalities?
Primary Health Care is being subjected to reform through the creation of Medicare Locals. But where are the social determinants of health in this reform? Where are the efforts to reduce inequalities? Where is our Australian commission to address these issues?
John Menadue fingered the key health service villain – vested interests – in his talk last week at the National Rural Health Alliance Conference entitled ‘Beating the Hospital Obsession’. He is right. But why is there this hospital obsession?
One need look no further than the medical lobby. And while it is largely responsible for the focus on hospitals, it also dominates policy formation in other areas of health care. Thus for example Medicare Locals have been captured by AGPN and risk being just bigger GP Divisions.
In the end I don’t blame the doctors’ lobby although I could hope for better. We live in a democracy, albeit a thin one. The problem here lies with spineless and spin-full Government Ministers. They were not elected to serve the interests of the medical profession.
They must try listening to the voices of critically informed and critically concerned citizens. And, having listened, act.
Citizens are not irresponsible or thick especially when they have the chance to have their voices heard. But citizens do want a thicker form of democracy. As John Menadue remarked at the Rural Health Conference: ‘when the community is informed and engaged in structured discussions it comes to good decisions about the choices that need to be made and the priorities set’.
That is also my experience with citizens’ juries. Particularly relevant here are two things: informed citizens want greater fairness; and in setting priorities more hospital beds are often at the bottom of their list.
The current system has failed. The parallels with the story revealed in the film ‘Inside Job’ of how the global financial crisis came and went are very great. Those ‘in charge’ stuffed up at the expense of ‘the little people’.
But those in charge are still in charge of a largely unchanged system. The problems lie in the global financial system as a system and in those who exercise undemocratic control over it.
Australian health care? The problems lie in the system and in those who exercise undemocratic control over it. It is the little people who (continue) to suffer.
Some of us still try to believe that deep down the ALP remains the party of social justice. On health, that party is also generally seen as being more likely to deliver.
Julia, Nicola: how about it? Why not give critically informed citizens what they want which, if you allow them to be critically informed, seems to be more voice, more fairness and less emphasis on hospitals?
Your standing in the polls is pretty low at present. So, let’s face it: you have little to lose.