What a missed opportunity.
The intense media interest in the Prime Minister’s recent visit to western Sydney created a perfect opening for some public debate about the wide-ranging factors that contribute to the health of communities, including the importance of place (and active transport options) for health.
To paraphrase this important report (which argues for more creative approaches to talking about the social determinants of health), we missed the opportunity to “stop thinking of health as something we get at the doctor’s office but instead as something that starts in our families, in our schools and workplaces, in our playgrounds and parks, and in the air we breathe and the water we drink”.
In the article below, a GP who works in Aboriginal health in south-western Sydney, Dr Tim Senior, provides a real-world reminder of the importance of the conversation that we didn’t have last week (despite the well-timed release of the National Performance Authority’s report, Healthy Communities, showing that people in western Sydney are less likely than those from the northern suburbs to rate their health as excellent, very good or good – 85 per cent vs 91 per cent).
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How “Katie” misses out when we don’t talk health and policy
Tim Senior writes:
I had Julia Gillard’s National Press Club Address on in the background when she announced 14th September as the election date, and I marked the event by sending out a surprised Tweet. I wasn’t the only one – it seemed everyone else in Australia did the same.
I realised in clinic the next day, not everyone had done the same. Not one of my patients mentioned the election. Not one of the staff mentioned it.
I wasn’t surprised. I can remember only one or two people during this whole parliamentary session that has said anything about party politics to me. And remember this is in south-west Sydney, one of the areas we are told is an election battleground.
However, that’s not to say people are apolitical. One of the privileges of being a GP is the window into people’s lives, and what I see is profoundly political, and shows how distanced party politics has become from people’s real lives.
Let me introduce you to *Katie*, a 21-year-old Aboriginal woman, who was seen by our GP Registrar, Dr Michael Bonning. We discussed her blood results.
She has had a mostly persistent mild anaemia over the last 5 years, with low levels of iron. One result shows this having improved when being put on iron, and it’s dropped back again now she’s off iron. We discussed the medical management of iron deficiency anaemia – essentially replace the iron, with supplements, and work out the cause of the iron deficiency. That’s the easy part.
It turns out, not unusually, that Katie’s diet is low in iron, because what she mostly eats is fast food. So Michael and I discussed how we might be able to change her diet. Of course we’ll discuss it with her, we’ll give advice. We will probably refer her to our in-house dietician – we can fund this through Medicare by doing an Aboriginal Health Assessment, which is a bureaucratic process of unproven value, but generates income and access to allied health.
So Katie will get some more knowledge about what constitutes a healthy diet, and she might even get to go on a guided shopping trip at the supermarket, looking at labels of salt, sugar and fat content. (I’ve tried this. You need to set aside quite a bit of time!)
Michael and I were discussing this on the day research was released showing that under self regulation, the salt content of ready cooked meals has increased by 13% over the last 4 years.
We discussed how much easier it would be for Katie shopping if there were a traffic light system on food labels, rather than having to read the small print, and how the food companies are opposed to this. Of course, traffic light labelling might actually result in people making the free choice not to buy their “edible food-like substances,” and I suspect that is why it is resisted.
Michael and I discussed the Food Switch App from the George Institute and BUPA, which allows you to scan a barcode on your mobile phone, and the app gives the food a traffic light label and suggests a healthier option.
However, this depends on the supermarket having the other option, and depends on Katie having a smartphone with a 3G data connection and enough credit to run the search. Though smartphone usage is increasing, there is still a digital divide along income and geographic lines. (This also has implications for Katie’s use of the PCEHR, of course, too.)
Making the choice to buy healthier food at the shops requires more than just knowledge or guidance about what those foods are. It requires knowledge about how to cook the food, usually gained from a parent, perhaps more difficult in situations of family breakdown.
It also requires a working cooker and fridge with a connected and ongoing electricity and gas and water supply for which she is able to pay the bills. It requires money to afford the healthier options in the first place.
Now, Katie might be on Newstart, from which her rent, phone, electricity, gas and food bills will have to come. (I’d be surprised if she could afford the iron tablets we’ve just recommended).
She will have to go regularly to Centrelink in return for her benefits, which will require transport too. There is plenty of evidence now that Newstart is placed so low, that it actually means you can’t afford to seek work.
Of course, Katie might be in work. It’s not usually paid well at this age, and pressure from businesses for “flexibility” means making it easy to pay Katie as little as possible and fire her as easily as possible. Of course, as she’s not white, she will experience racist comments, which will also impact on her, possibly making her at risk of mental health problems.
In the meantime, there won’t be any fun runs to help iron deficiency anaemia. The food lobby and supplement lobby will have a louder voice than Katie (or me or Michael) and the phone number of government ministers and so their profit will trump Katie’s health.
Katie will come in for her results. She’ll be feeling tired as usual because of her anaemia. She will be ably helped by our health workers, dietician, exercise physiologist, nurses and doctors.
But the solutions to this simple medical problem can be framed in the political.
Not the personality sport and game-playing of Canberra, but the impact of lived experience in navigating complex care pathways, in saving enough for tablets to give you energy to complete your Centrelink requirements, but never having enough for proper food if you want to pay the rent and the bills that week.
That is the experience of living day to day in an environment that makes you more and more unwell. That environment is determined by policy, not just health policy, but transport, housing, employment, education, welfare…
So as the election gets closer, and the campaigning gets more fevered, let’s keep on asking, where’s the policy? What’s the impact on people like Katie?
Let’s stop asking, what’s in it for me?, and instead ask, what’s in it for Katie? That’s where the Fair Go is.
It won’t really be until we get a proper policy discussion that we’ll start to see an interest in politics beyond my Twitter feed.
• These are personal opinions and don’t reflect those of the organisations which employ me.
• Note – Katie’s name and the details discussed here have been changed to preserve confidentiality.
