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    Jenny Haines

    We need to be careful not to get into the position of trading hospital beds against initiatives in community health and health promotion. I well remember the ugly debate in NSW in the 1980s where it was said that monies for community health were being spent on maintaining hospital beds. The truth is that we need both, but in a tight budgetary situation, health professionals should not be placed in the position of having to fight one another to get funding. Although it is not fashionable to recognise it, hospital beds still have a very big role in caring for people who are forgotten or neglected by our society what used to be called “social admissions”. You are not allowed to use that terminology anymore but if the opportunity for the admission of these people is not there, there will be a lot more homeless on the streets, a lot more elderly people die alone in their homes undiscovered for many months, a lot more single mothers suffering depression. a lot more mental health crises. Hospitals are melting pots in our society. Hospital staff care for the unwanted who become ill. Health promotion and community initiatives can reduce the numbers of these people presenting to hospitals over time.

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    Hi Jenny
    The reality is that the health budget is finite and the allocation of health resources is an unending contest. The current power balance is stacked very strongly in favour of hospitals and specialist care (particularly private hospitals and private medicine), rather than in favour of primary health care and prevention, which, from all my reading of the evidence, represent the best value for investment and also the best chance of achieving an equitable system. The unfortunate reality is that if we want a fairer health system and a more equitable distribution of good health, this will require hard-nosed advocates for public health and primary health care who are willing to question the mantra of “more hospitals beds equals better health”. There is no limit to how much money could be spent in health, but there is a limit to the health returns from that spending.

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    Bile or not, Swinburn’s piece should be required reading for any health bureaucrat and actual/aspiring politician. Beautifully said. And I can’t help but recall that the AMA did take a leading role in drawing attention to health inequalities and the need to address them — when Brendan Nelson was AMA President and he championed (if that’s not too strong a word) the health needs of Indigenous people. I am convinced that he was a more effective advocate and leader in that position than in anything he has done since.


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