The current Federal Government is very keen to tell us what our responsibilities are as citizens of this beautiful country. Apparently we need to engage in some “heavy lifting” and there is some team or something we are supposed to join.
When it comes to health care there is a rising tide of instruction. We must take heed of an ‘economic signal’ regarding primary health care and that, in future if we want rapid access to services, we may need to pay a private health insurer for the privilege .
Here in Victoria I am also subjected to a ‘fat shaming’ advertising campaign because, clearly, any weight problem I do or do not happen to have is purely the fault of my hedonistic lifestyle and not at all contributed to by the cost of food, lack of public transport or ridiculously long working hours.
I also receive frequent reminders about screening – cervix, breasts, bowels and these closely follow the multiple checks that we as a family have fully immunised children.
OK – I get it, you want me to look after my health. Like most of the people I know, I am more than happy to do this. In fact, not only are we the guardians of our own health, often we are also the guardians of others’ health as well, children, partners, elderly relatives….
Where did all these responsibilities come from?
Well they were born out of the provision of a high quality universal health system that was put in place with the fundamental principle that your income shouldn’t dictate your access to health care.
Where did that idea stem from? The internationally acknowledged principle that health (and access to health care) is a human right.
This right is recognised in various international laws, other countries also have them enshrined in local law. We see glimmers of this ideal in our own laws regarding prisoners and children.
If you think that a human right to health is not an issue in a wealthy country such as Australia, just take a moment to consider the concerns regarding the quality of care provided to asylum seekers, that we detain children at the cost of their mental health, that some Aboriginal communities don’t have access to running water, and that we currently seem determined to impose an economic barrier to accessing primary care.
In the hurdy gurdy of the bizarre relationship between politics and health services , the discourse often rests purely on costs, economics and personal responsibilities.
It is my hope that this year’s Federal Budget has seen a change in all that. Equity, fairness, burden and impact are all considerations coming to the fore in an unusually united campaign against the policy position of the Government.
Is this the beginning of the required shift away from a purely economic approach to health service provision?
Is now the moment where we begin to remember that health is a human right? (That is not to say we have a right to be “healthy”; there is a fair chunk of that equation that rests on the individual, but a right to health and health services is another matter.)
The Attorney General’s Department website has an information page on the international law regarding a right to health. It refers to the UN committee on Economic Social and Cultural Rights in stating that:
the right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment. This entails a right of access to a variety of public health and health care facilities, goods, services, programs and conditions necessary for the realisation of the highest attainable standard of health. The precise nature of the facilities, goods and services will vary depending on numerous factors, including the country’s developmental level. In this regard, developed countries such as Australia will be held to higher standards than developing countries.
It is not possible in this blog to cover all aspects of the evolution to a right to health but perhaps the most important observation is how Australia is failing on this journey.
On a visit to Australia in 2010, the UN Special Rapporteur for Health recorded serious concerns about the right to health for the Indigenous population, those in prison and asylum seekers. The concerns discussed in that report clearly remain relevant today.
Sadly, one might argue that since this report the situation for the Indigenous population is improving too slowly, reports from the Victorian prison system suggest that prisoner access to mental health services remains a substantial issue, and the health and health care of asylum seekers seems to have hit an intolerable low where the mental health of children is considered collateral damage in a fake war against ‘people smugglers’.
It is my hope that the growing focus on inequities and the debate regarding co-payments and their impact on access to health services for broader sections of the community, has provided a tipping point.
There is always a place for economic debate regarding healthcare – we don’t want an expensive, less effective system such as that provided in the United States – but let’s remember the starting point.
Basic healthcare is a human right, it is a right that comes with responsibilities both for individuals and for government, access and equity amongst them.