Introduction by Croakey: In the wake of health policy announcements by the Federal Government and Opposition this week, a senior doctor has urged colleagues to advocate for action on the wider social determinants of health.
When weighing up the health credentials of the various parties this election, Dr Louis Peachey, who was a founding president of the Australian Indigenous Doctors Association, says it is important to prioritise the needs of the most disadvantaged.
“My challenge to my colleagues is to write letters to your local federal election candidates to ask them what they plan to do about poverty,” he writes below, drawing upon the work in the 1800s of German physician and politician, Dr Rudolf Virchow.
Louis Peachey writes:
Our profession is innately conservative, we are not phobic to change, but deeply sceptical of new things. We are deferential towards authority, which is to do with the nature of our work.
As juniors, we will find ourselves undertaking procedures for which we are insufficiently experienced to undertake independently, thus a supervisor is by our side, and a failure to respect hierarchy and the chain of command may well see the procedure in front of us go awfully wrong with terrifying swiftness.
It is essential, as we offer care to our patients, that we do so absent value judgments of their beliefs or ideological persuasion.
As guardians of life, we tend to find the business of politics grubby and a little distasteful.
In this milieu, it is unsurprising that many of us avoid the vortex of politics, and prefer to live above the slings and arrows of partisan politics.
The paradox for First Nations doctors is that it is exceedingly difficult to enjoy the privileges of our profession, and avoid the obligation to advocate for the people of our communities who remain voiceless and live in the torment of powerlessness.
Politics is said to be the art of the possible. The purists will sacrifice the good for the perfect, with the end result of getting neither.
As health practitioners, every day we deal with the reality of odds ratios, shades of grey, and hoping to achieve the most good, and least harm, in a less than perfect environment.
As scientists and intellectuals, I believe we have an obligation to put our shoulders to the wheel of democracy, and use our skills to assist those around us make sense of their options.
This is the point Rudolf Virchow was making in his landmark report on Germany’s mid-nineteenth century Typhus Epidemic with the observation that “medicine is social science and politics nothing but medicine on a grand scale”.
Recent context
So, what are our choices in the upcoming election?
There is a cost of living crisis for many of our citizens, so who would best manage this: an Albanese Government, a Dutton Government, or a minority government?
Our current Government took a referendum to the people, and in the failure of the referendum took a significant political hit, which made them somewhat gun-shy for the remainder of their current term.
Their optimism for The Voice became hubris, whilst the Opposition saw an opportunity to score a political victory, the end point of which was to ensure no progress in the outcomes for First Nations people during this term in office.
Many Australians were convinced that listening to the voices of Indigenous Australians would erode the Sovereignty of our Parliament, and usher in a race-based order. Many Australians believed that had the referendum been successful, it would have inserted race into the constitution, blissfully unaware that it already exists in Section 25 and Section 51(XXVI).
As the present Government commenced work in 2022, inflation was already on the rise, and was at 6.1 percent in the June quarter of 2022, the Target Band of the Reserve Bank being two to three percent.
A substantive inflationary pressure was the oil price spike driven by the invasion of Ukraine. Inflation reduced to 2.8 percent for the 2024 September Quarter, and 2.4 percent for the 2024 December Quarter.
So the current Government has fulfilled its obligation in bringing inflation back to target.
We are in a housing crisis, and the citizenry has not felt any real improvement during this term; however, the great Ponzi scheme of rising house prices began during the mid 20th century, following World War Two.
There were plateaus during the Fraser and Hawke/Keating administrations, but the current rapid rise was triggered during the Howard administration.
This will require bipartisan agreement to ever tame this trend, and we might wish to have pause making a property developer as our preferred Prime Minister.
History matters
Access to healthcare is relatively stable and although bulk billing rates have fallen, this was after the artificially inflated bulk billing rates of the COVID pandemic policies.
Before Medicare, general practice was a private business, which typically carried around 20 percent bad debt. Largely this was caused by citizens who were impoverished and unable to pay for their medical needs.
Medicare offered GPs 85 percent of the fee, paid directly to the GP from the new universal insurer. The incentive to the GP to bulk bill was to reduce their balance of bad debt from 20 percent to 15 percent.
The Coalition was deeply opposed to Medicare and in the first decade kept promising to abolish it. By 1996, Prime Minister John Howard understood that openly opposing Medicare was costing him votes, so he had a new tactic of simply letting it fall into disrepair. That way when bulk billing died, the ‘Greedy GP’ could be scapegoated.
When Labor returned to office in 2007, as much as they wished to repair Medicare, they were frightened to appear too generous to ‘Wealthy Doctors’, and the world was undergoing a Global Financial Crisis as a result of banking deregulation in the USA.
When the Coalition returned to power in 2013, they continued with the ‘Death by a Thousand Cuts’ policy.
A few days ago, the Federal Health Minister announced a new plan to revive bulk billing. Unfortunately, it would appear the Health Minister does not quite comprehend his relationship with the 39,000 GPs in Australia.
The GP provides a service to the patient, for which a private bill is generated, just like when one sees their lawyer, physiotherapist or acupuncturist. How much of the cost is paid by the insurer (Medicare) involves a relationship between the insurer and the insured (patient).
Nevertheless, this policy is masterful electioneering, because after the election, when it does not bring the promised bounty of free consultations, GPs will be the scapegoats.
In response, the Opposition demonstrated the level of their intellectual investment into a future solution to providing affordable healthcare with an announcement that might be reasonably summarised as ‘Yeah, same’.
The current alternative Prime Minister, Peter Dutton, was voted by our profession to have been the worst Health Minister of our lifetime just a decade ago, something one ought to be mindful of at the upcoming election.
His performance as Federal Health Minister was unencumbered by the usual constraints of empathy.
There will always be criticism of government waste at election time. When the Opposition announced its new policy of introducing a Trump-style portfolio of Government Expenditure into the ministry, their very first offering to tackle government waste, in an annual budget of $734,000,000,000 AUD, was to cease paying for Welcome to Country ceremonies saving ($225,000/year) – or 0.00003 percent on total budget costs.
Instead of a serious attempt to curb government waste, the Coalition chose the low hanging fruit of “Blaming Aborigines” for the current budgetary maldistribution.
Some of my colleagues have expressed a concern that neither of the two major parties have a substantive platform on First Nations policy in the run up to the coming election.
As an Aboriginal man, it has been my lifelong observation that any mention of my people in an election campaign never bodes well for us. The best we can ever hope at election time is to be not mentioned at all.
For those who would prefer a change of government, I would merely ask that they consider what goals they believe this will achieve, and compare this to the proven track record of the candidates to assess the genuine likely outcome of the two alternatives.
Virchow’s lead
As health practitioners, we ought to acknowledge our privileged place in society, knowing that we are unlikely to be personally disadvantaged by either of the political parties in government – but I would hope we consider how the most disadvantaged will fair in the respective scenarios.
In the mid-nineteenth century, Virchow had already identified the effects of poverty in public health.
Who will offer the best outcome for our fellow citizens in poverty?
We know that poverty causes bad health, we also know that poverty leads to incarceration. The much ignored 2017 report from the Law Reform Commission, entitled ‘Pathways to Justice’, noted that we were using our penal system to warehouse citizens with health issues.
My challenge to my colleagues is to write letters to your local federal election candidates to ask them what they plan to do about poverty.
When you write this letter, make sure you include your title and post nominals. The major parties have large databases to cross reference the correspondence arriving at their electoral offices.
If 10 percent of GPs were to write letters of this nature in the next week or two, that would mean 3,900 letters being entered into those databases, and this would let the major parties know that the sleeping dog just woke up, and may well be just a little miffed.
Author details
Dr Louis Peachey is from Girrimay, Djirribal, Quandamooka and Badtjala ancestors. He is a highly respected Rural Generalist and medical educator, as well as a mentor for Aboriginal and Torres Strait Islander doctors and medical students. Founding president of the Australian Indigenous Doctors Association, he was awarded Life Fellowship of the Australian College of Rural and Remote Medicine (ACRRM), and was instrumental in establishing the College’s Aboriginal and Torres Strait Islander members group. He is based in the Atherton Tablelands in Far North Queensland. Read more here and here.
See Croakey’s archive of articles on poverty and health
I have a number of Medical Heroes. Louis Peachey and Rudolf Virchow stand high among them. My 1978 book: The Dark People of Bourke. The Doctor as an agent of Social Change, quotes liberally from Virchow’s writings.
In 1986, the result of the WA election was dependent on 6 marginal seats. 4 were in rural areas with a shortage of GPs. I persuaded the GPs and senior nurses in those electorates to write to their MP ( all were Labor ). Labor diffused the situation by promising to have an inquiry into the recruitment and retention of country doctors. It had considerable influence and achieved some kind of a world record by having its 51 recommendations actually carried out.
One Labor Party political advisor told me that if a sitting member gets more than three letters on the same topic, they go into a panic.
My theory about reports being shelved to gather dust is that chairman and writers of the report are so exhausted when it is finished that they hand it in and never want to see it again. Reports, like causes, need a persistent person to fight for their recommendations and to make sure they are not forgotten.