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To Your Very Good Health

posted 8 Dec 2019, 18:44 by Michelle Stewart   [ updated 8 Dec 2019, 18:50 ]

The state of the nation

Why am I writing about health? I have consulted in and around health for some 20 years and have a deep interest in, and have a relatively well-informed perspective on, human health and the broader health sector. One could say that health is both a professional interest and a personal passion. But health is not just a dominant sector of the economy nor is good health an end in itself. For example, a healthy nation is more economically productive on the one hand, and its population better able to participate in, and contribute to, important cultural and community activities, on the other. I also wanted to draw attention to the fact that despite Australia spending some 10% of its GDP on health, many citizens miss out on access to health services when and where they need them. Whole sections of our community suffer chronic ill health and die younger than they should, facts often directly related to where they live, how much they earn and their race. The benefits of the Australian health system are spread in an inequal way. This should not be considered an acceptable outcome.

It not only about the money – but we spend a lot

Australia spends a great deal of money on health. In 2017–18 total health spending was $185.4 billion, equating to $7,485 per person. $74B was spent on hospitals while two thirds of the total $s was funded by Federal and State governments. Millions, perhaps billions more is expended on vitamins, supplements and alternate treatment modalities. The good news is that Australia consistently ranks in the top 30% of OECD countries by key measures of health outcomes such as longevity.

But a healthy expenditure on health does not equal health outcomes for the Australian population as a whole, a fact I was reminded of this week when working with the leadership team of a remote aboriginal health organisation in Central Australia.

Who misses out in the health stakes?

The most recent estimates show that an Aboriginal and Torres Strait Islander male born in 2015-2017 is likely to live to 71.6 years, about 9 years less than a non-Indigenous male (who is likely to live to 80.2 years). An Aboriginal and Torres Strait Islander female born in 2015-2017 is likely to live to 75.6 years, which is almost 8 years less than a non-Indigenous female (who is likely to live to 83.4 years). Aboriginal and Torres Strait Islanders have 1.2 times the rate of cardiovascular disease compared to the rest of the population. Diseases such as acute rheumatic fever (ARF) and rheumatic heart disease (RHD), that are preventable health problems occur almost exclusively in Aboriginal and Torres Strait Islander people and communities. More than 90% of those suffering ARF are Aboriginal and Torres Strait Islander persons. Aboriginals in remote areas also suffer from diseases such as the eye condition trachoma which is virtually never seen in the non-Aboriginal community. (Figures from the Australian Indigenous Health Infonet)

Having an address outside a major urban area is bad for your health. Around 3 in 10 (29%, or 7 million) Australians live in rural and remote areas where they can face  a number of challenges due to geographic isolation, including difficulty accessing services. As a result, they often experience poorer health outcomes than people in Major cities. To put it bluntly, the more remote your address, the shorter your lifespan, the more likely it is that you smoke, drink to excess and don’t get early diagnosis for cancer. When you do get your cancer diagnosis you will travel further for treatment and get poorer outcomes than your city-based cousins! The statistics speak for themselves: median age of death in very remote areas is an astounding 67 years compared to 82 years in a major city. Something is not working. (Australian Institute of Health and Welfare)

LGBTQI and other minorities in Australia also suffer poorer health outcomes than the mainstream further reinforcing that fact that the benefits of our health care system are not equally distributed.

It there a simple cure?

Neither the diagnosis nor the cure for systemic health inequalities is simple. The causes are complex and if the solution was as easy as writing a prescription, the issues would have been addressed years ago. Systemic problems nearly always require multi-factor, system-wide solutions. In summary, I have no easy answers but my work in remote and regional Australia just prompts me to highlight the issues.

It is difficult to attract health workers to regional and remote areas, for example. Australia relies enormously on overseas trained doctors to fill positions in regional and remote areas where in some cases, they comprise the majority of specialists and general practitioners. Despite graduating more medical students than ever, Australian doctors do not want to practice in The Bush – a fact which in itself has multiple causes. Similarly, anyone who has worked in remote area health in Central Australia would have noted the large number of New Zealand nurses who swap the green grass of home for the wide brown lands of the outback! Long distances to travel to see health professionals, high levels of smoking, the expense of fresh food and vegetables and, believe it or not, lower levels of exercise, contribute to poorer health outcomes. In Aboriginal communities lower than average health has several overlays of causes but key factors include lack of access to health knowledge, cultural issues, language challenges, complex and ever-changing funding arrangements, distance, and the tendency of governments to act prior to consulting and to ignore the evidence they have often paid for. It was recently revealed that almost 20 formal reports had been commissioned into the spate of suicides and serious mental health challenges in the Kimberly region which governments appeared to ignore when grappling for solutions.


There should be no such thing as a health status quo

In closing, please, don’t settle for the health status quo, particularly if you are, like me, a city dweller. We need to remember that our health system’s benefits are not distributed equally geographically, socially or in terms of race, and nor are the outcomes. City folk are doing well out of the $185B. Finally, some of the very worst off in this scenario, Aboriginal and Torres Strait Islanders, are often marginalised socially and economically. It is not for me to speak for them, but I do have a role in ensuring where I can that their voices are heard, and their health needs addressed. We will be a better society if we lift our game.

Philip Pogson FAICD Director, The Leading Partnership