A funny thing happened in Britain recently. A researcher who has done a huge amount to put health inequalities on the international radar of policy makers and researchers became president of the British Medical Association.
Furthermore, when Professor Michael Marmot made his acceptance speech, he said how relieved he was to realise that the BMA president does not engage with the “trade union side of the house”.
Instead of focusing on doctors’ incomes and conditions, he will dedicate his term as BMA president to pushing for action on health inequalities, both in Britain and globally.
“My year as president will have real meaning if I can help encourage other doctors to be active in the challenge to reduce avoidable inequalities in health, not just here within Britain, but globally between countries,” he said. (You can read an abstract of his speech for free here or pay to view the whole thing at the BMJ website),
Marmot, you may recall, chaired the World Health Organization’s Commission Commission on Social Determinants of Health, and chaired a report released earlier this year in Britain, Fair Society, Healthy Lives, that makes recommendations for creating a fairer distribution of health.
Marmot told the BMA meeting that he was excited by how many countries had taken on the social determinants agenda, including Chile, Brazil, Costa Rica, Sri Lanka, Norway, and Denmark. Even France, with a right-of-centre president, was embracing action on the social determinants of health.
Marmot made no mention of Australia showing any particular interest in the area (and this despite his longstanding connections to Oz). And why should he? We haven’t been able to shift our health debate beyond hospital beds or doctor numbers.
I can’t help wondering how different this election and indeed our broader public discussions about health might have been if the AMA exerted its considerable muscle towards reducing the social and economic inequalities that contribute to some Australians living far longer and healthier lives than others.
But perhaps that overstates the power of the AMA.
On Wednesday, Health Minister Nicola Roxon and her Opposition counterpart Peter Dutton will debate health policy at the National Press Club. If it produces yet more hospital bed auctioneering, I think I might be reduced to my sick bed.
Meanwhile, it transpires that Croakey is not alone in suffering from election ill-th syndrome.
Professor Boyd Swinburn, Director of the WHO Collaborating Center for Obesity Prevention at Deakin University, told me that he wrote the piece below to help relieve the build up of bile he has been suffering as a result of the election campaign. (It also appeared today in the Crikey bulletin.)
The election mantra of “more hospital beds” is not what we need
Professor Boyd Swinburn writes:
“Most of Australia’s disease burden is driven by preventable risk factors, yet prevention is virtually nowhere to be seen in this election campaign – it is all hospital beds and GP Super Clinics. There are a few positive snippets being dropped into the prevention policy vacuum, but they are nowhere near enough.
The message on mental health seems to have got through to the parties, and Labor is to be congratulated for its stance on plain packaging of cigarettes, which will clearly be effective in reducing sales judging by the tobacco industry screams.
The Greens have traditionally given a priority to prevention and having Richard di Natale, with his public health background, leading the health initiatives is very positive.
But where are the plans to implement serious policies on obesity, alcohol and tobacco as outlined by the Preventative Health Taskforce?
The blueprint is there and the government has really missed a golden opportunity to show some leadership in prevention by grabbing the report with two hands and implementing its recommendations.
Regulations to restrict junk food marketing to children is the litmus test of commitment to prevention. The Greens have a clear policy to support it and if they achieve a balance in the Senate, this would be a critical piece of legislation for them to champion.
The Liberals, under Tony ‘individual choice’ Abbott would allow the junk food corporations to continue to bombard Australian children with ever more sophisticated marketing techniques and place all the responsibility on parents to struggle to provide the counterweight.
His position when he was Health Minister was that government would not correct this obvious market failure and if more diabetes and disease was being caused by this obesogenic barrage from the food industry, then the health system would just have to pick up the pieces. Ever more beds seemed to be the solution.
The Taskforce recommendations on junk food marketing regulations were much weaker than the public is calling for. In every poll taken on the issue, public support for regulations to ban junk food marketing to children is over 90%.
That is far higher public support for legislation than was seen for regulations for smokefree environments when that legislation was first enacted.
The Government’s response to the Taskforce report has been disappointingly weak and piecemeal, with regulations on junk food marketing delayed until two more elections – which is essentially political infinity.
What this issue reflects is the increasingly and, frankly terrifying, influence of corporations in public policy. Their fingerprints (or boot prints) are everywhere – an abandoned ETS, a grossly watered down tax on mining super profits, a Prime Minister kicked out of office, watered down alcohol taxes, abandoned regulations to protect children from junk food marketing and so on.
Democracy has been pulled from the hands of citizens by the corporations, and a much wider reform is needed if we are going to get it back.
Election campaigns should be tax-payer funded, political party donations should be much more transparent, lobbying should be more tightly restricted and transparent, there should be requirements on corporations for goals and reporting around social and environmental outcomes and processes as well as financial outcomes and processes.
In a book Garry Egger and I have just published (Planet Obesity, Allen and Unwin), we trace the causes of the causes of obesity back to its roots, and find that the economic and policy structures in place that put a premium on growth and consumption have resulted in a predictable set of corporate and individual responses towards overconsumption.
This is normal business and human behaviours, given the laws and mindsets we have created for modern, capitalist societies.
While economic growth is good to get poor countries onto the ladder of prosperity, further increases in growth give fewer and fewer dividends while the detrimental consequences start piling up. These include climate change, obesity, excess waste, loss of natural resources, diminished biodiversity and on and on.
We have two paths to take. One is to go the usual path that humans seem to take which is to stay in denial until the overwhelming crisis occurs which forces action – which at that stage may be too late. When climate change really bites, the first wars will probably be over food because a diminished food production for an increasing global population will create more desperate, starving people.
The second course is of course to act before the real crisis hits. That requires leadership, boldness, a big picture vision, strength to stand up to corporate pressure and a premium placed on prevention policies.
But unfortunately, the two major political parties cannot seem to muster any prevention policies to save our health system, let alone the planet.
Our only hope is that the Greens get a sufficient balance of power that they force a greater vision and responsibility into our corporation-dominated political system.”
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.
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.
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.