Government has a role to play in reducing inequality... a role it has largely abandoned over the last few decades, working on the assumption that it is 'not their job'.
There is a large body or research and academic writing that points to our growing inequality and the role it plays in stagnating economies, as well as leading to adverse social outcomes around health as well as Law and Order. If it isn't the government's job to support a thriving economy and to ensure the delivery of a good level of social services to ensure everyone has the same opportunity to flourish, then what is its job? And if it is the government's job, then why aren't they doing more to address inequality?
An excellent example of where the government has failed in addressing (or failing to address) need - as outlined by the Gonski recommendations. It is uncontested that higher levels and higher quality education generally lead to higher income and better health outcomes. By not implementing the Gonski reforms as recommended (not as conceived by Labor or the Coalition), we are ensuring poorer health outcomes for disadvantaged groups.
This is the essence of the last of this year's Boyer lectures - addressing issues of fairness and equity at every opportunity. Professor Marmot refers to the principle as 'make every contact count'.
In the fourth Boyer lecture Sir Michael suggests that we need government action as well as action by communities. He insists we should be seeking to create the conditions for individuals to take control over their lives with the aim of creating a more just society that enables social flourishing of all its members.
This touches on issues such as a fairer taxation system, the better funding and targeting of services, but also the refusal of people to look at a problem and say 'not my job'.
Professor Marmot's fourth lecture is well worth a listen and you'll find it here.
The third of the Boyer Lectures by Professor Marmot is on a timely subject. With our ideologically driven government seeking to push people into under-employment and temporary work as way of cutting social security spending. While Christian Porter pushes the idea of 'self-reliance' and 'obligation' it is worth asking are the government acting in people's best interests.
Professor Marmot underlines that while unemployment is bad for health, work can damage health too. Jobs characterised by high demands and low control, imbalance between efforts and reward, organisational injustice, shift work and job insecurity increase risk of physical and mental illness. The lower the position in the social hierarchy the greater the concentration of these stressful characteristics. When work is no longer the way out of poverty, health suffers.
Porter is seeking to push people into any work, and the question is will this cost more than it saves? As he is following a conga line of blinkered neoliberals into a social experiment that has repeatedly failed... the answer is YES. For the evidence on why Porter is wrong.... Listen to the Third Boyer Lecture Here.
The second of this year's Boyer Lectures (delivered by Professor Sir Michael Marmot) focuses on enabling good health outcomes through preventative approaches, and by starting early... especially with at risk groups. This includes addressing both the positives and negatives of early childhood experience.
According to Professor Marmot.... the positives include nurturing of psychological, linguistic, social, emotional and behavioral development. The negatives that need to be addressed are adverse child experiences. An absence of nurturing and the presence of the harmful are strong contributors to inequalities in health in adult life and there is a great deal we can do to make things better through national policy settings and by supporting families and children.
You can hear the full talk by clicking on this link.
The 2016 Boyer Lecture Series is titled Fair Australia: Social Justice and the Health Gap, to be delivered by Professor Sir Michael Marmot, President of the World Medical Association, Director of the Institute of Health Equity and a leading researcher on health inequality issues for more than three decades. Sir Michael’s lectures will explore the challenges faced by communities in solving issues around health inequality.
In the first lecture, professor Marmot explains how the conditions in which people are born, grow, live, work and age, determine their risk of poor health. According to Sir Michael “The causes of the causes are the social determinants of health and they influence not only lifestyle but stress at work and at home, the environment, housing and transport,”
You can listen to his lecture by clicking this link.
Housing is a significant issue in Australia. We do need to address affordability through removing tax breaks around negative gearing and capital gains tax as per Greens Policy.
This is important for a number of reasons. It is a question of equity and of ensuring our monetary policy doesn’t widen the divide between the haves and the have-nots, between the landlords and the renters, between the young and the older members of our community.
It is also important to ensure that an essential service (or even a right) such as housing is taken out of the hands of those who seek to profit from it (developers, investors and bankers) and put into the hands of end-users… people who actually want a nice affordable place to live.
If it sounds like a pipe dream, it’s not. It’s already happening in Melbourne in an architect-driven project called Nightingale 1.0. You can read about it here.
This development ensures a triple bottom line… of social, financial and environmental sustainability. It delivers affordable, quality house that meets the needs of occupiers, not other rent seekers. And it is very, very popular.
The loser should such an initiative become more widespread would be the rent-seekers mentioned above. People do have a right to invest and to profit, but not on the misery of others and not is such a way that it 'ties up' money rather than allowing it to circulate and create wealth - which is how the current housing market is working.
While this is surely enough reason to drive change, there is another more compelling reason… we are in danger of returning to a situation where large numbers are living in ‘Slum Housing’… a situation we haven’t seen for more than a century.
Issues like overcrowding, houses in a poor state of repair, poor insulation, and insufficient heating and cooling are not just an issue for remote Aboriginal communities. Students and the unemployed (or under-employed) find themselves in similar situations. Not only is this unfair, it also means poorer health outcomes for these people… just as it did over a century ago.
The scale of this issue was recently revealed by researchers from South Australia and Victoria, who applied the HILDA survey and found that more than 100,000 people were living in properties regarded as very poor or derelict.
Many of the people living in this accommodation are already disadvantaged, and the state of their accommodation only increases their disadvantage.
Unless Governments take steps to ensure the supply of affordable, good quality housing we will see the re-emergence of slums, and the associated reduced life chances and shortened lives. The well-meaning architects working on the Nightingale project can’t do it on their own.
In Townsville we are suffering under an economic downturn, with high levels of youth and general unemployment. Some people have moved away, but others are still here suffering in relative silence. We have a responsibility to address these issues now.
There is more we can do. There is more we need to do. These issues are preventable, waiting for a time when we have to resort to the slum-clearing of a century ago is not an approach we should even contemplate.
by Wendy Tubman
The first thing that needs to be said about vaccinations is that there is absolutely no link between childhood vaccinations and Autism. Numerous studies have confirmed this. And while vaccines do have an adverse effect on some people, the vaccination process is closely controlled and monitored to ensure very high levels of safety for recipients.
It is also worth noting that not vaccinating actually carries a higher level of risk for children. The decision not to vaccinate is not entirely a personal one - unvaccinated children put all those they come into contact with at greater risk. That is the reason behind the government's policy of 'no jab - no pay' for welfare recipients.
The government has hailed their program a success. The problem is that the children of lower income earners and those dependent on government payments are not the most important target group.
Some of the wealthiest suburbs are at high risk due to dangerously low vaccination rates. There are numerous explanations for this (none of which relate to vaccine safety), but what is clear is that families living in areas such as Mossman and Manly are unlikely to be influenced or affected by a 'no jab no pay' policy.
The other areas with dangerously low levels of vaccination are among indigenous people and among select indigenous communities (especially in NT). There is no evidence that these groups are avoiding vaccination based on personal choice or fear of side effects. and the government's own website suggests:
These disparities point to the importance of identification of Indigenous status, particularly in mainstream health services, and particularly in urban areas. The use of patient information systems to record Indigenous status and schedule preventive health services has the potential to increase opportunistic vaccination and enable the provision of patient reminders, with resultant improvements in coverage and timeliness. Culturally appropriate service delivery and communication strategies, as well as use of Indigenous-specific Medicare items, will also assist in improving access to health services for Indigenous Australians.
No mention of 'no jab no pay' so clearly these measures are not intended to close the gap.
Peter Mares from the Swinburne Institute for Social Research suggests that there is another large group that the government isn't targeting and is in effect withholding support from.
Vaccination rates are low is among the 800,000 temporary residents in Australia, people the government has allowed and even encouraged to enter. Public health staff have been instructed not to give free vaccinations to the babies of workers on 457 visas, international students and other temporary visa holders. Instead they have been instructed to seek out a GP and pay for the vaccinations themselves. By asking people from a group that largely has very limited financial resources to pay for immunisation is a formula for low vaccination rates.
Based on the way the government is treating the above higher risk groups, it does make you wonder whether the government is really interested in driving up immunisation rates, or whether immunisation is being used as an excuse for using another tool (no jab no pay) to hit the poor and those depending on financial support from the government. It seems plausible that this government wouldn't be overly disappointed with less than 100% take up as this would be an opportunity to both make savings in the budget and to level blame at those in need for their increased financial hardship.
Because based on the evidence, and based on what strategies are most likely to target key at risk groups, the government isn't being effective and isn't following its own advice. Either they are incompetent or they have a different agenda.
by Mark Enders
It is difficult making good health choices for many reasons. And one of the key issues is hidden sugar.
While Mary Poppins told us a spoonful of sugar helps the medicine go down, too many spoons of sugar make us very sick. And our modern diet has more sugar in it than it ever did.
In the last 20 years, the amount of sugar each person consumes yearly in the United States has soared from 12 kgs per person to more than 61 kgs per person, with similar changes all over the world. Since 1983, sugar consumption has been steadily increasing every year by an average of 28%, fueling an epidemic of obesity, dental disease, diabetes and other health problems.
An analysis of 175 countries over the past decade showed that when you look for the cause of type 2 (non-insulin dependent) diabetes, the total number of calories you consume is irrelevant. It’s the specific calories that count. When people ate 150 calories more every day, the rate of diabetes went up 0.1 per cent. But if those 150 calories came from a can of fizzy drink, the rate went up 1.1 per cent. Added sugar is 11 times more potent at causing diabetes than general calories
The American Heart foundation when exploring the relationship between dietary sugar intake and heart disease recommends that high sugar intake should be avoided
The World Health Organisation has recommended that people significantly reduce their sugar intake.
Leader of the Australian Greens Dr Richard Di Natale has announced a new tax on sugary sweetened beverages to help tackle Australia's obesity epidemic.
Added sugar is very bad for your health, and puts an enormous strain on our health system. We have a major health crisis on our hands with over a quarter of Australian adults and children overweight or obese. 30% of the added sugar kids consume comes from sweetened drinks, which are a major contributor to increasing rates of childhood obesity. If this trend continues our children may be the first generation to have a shorter life expectancy than their parents.
Earlier this year, Jamie Oliver laid down a challenge to Australia and called on us to follow the UK and introduce a tax of sugary soft drinks. The Australian Greens have accepted that challenge, and will push for the introduction of a 20 percent tax on sugary drinks which the evidence shows will reduce uptake by at least 12 percent. Every cent of the expected $500 million per year raised by the tax on sweetened drinks will be reinvested back into positive health initiatives for Australians.
Over four years $2 billion could be raised by ensuring that sugary sweetened drink manufacturers contribute to the harms their product causes. This tax is part of a broader prevention strategy for obesity, including clear food labeling; restricting junk food advertising to children; and encouraging physical activity through active transport.
The sweetest part of this policy will be the longer term benefits to Australians by reducing chronic disease and achieving better health outcomes,
This is another great primary health initiative from the Greens
by Wendy Tubman
This far in to the longest election in living memory, you'd be forgiven for thinking there is nothing good about an election, other than it being over.
Elections are interesting times. We starts to see more of our local representatives, whether we want to or not. On one side we are reminded how well we are being served by our government, and on the other we are reminded of how we are being failed by those same people. Interest groups become more vocal, and those who are given the biggest megaphone can leave us wondering why.
And in among all that, we start to have the kind of conversations we need to have… about the present and the future.
The Conversation website is always a great source of information and inspiration. During this election period they have provided some great stories. Below are a few worth checking out.
The storm system along the East coast has done a great deal of damage, led to a number of tragedies, and has got people asking great questions… like - Is climate change playing a role in these events?
It also has people considering the unseen damage occurring from water run-off and the associated pollution of our waterways caused by the way our cities are designed. There is clearly more we should do, and you’ll find some suggestions in the article by Katherine Dafforn and Emma Johnston from UNSW.
Innovation has been a word that Malcolm Turnbull has been using frequently, without well-defining what he is talking about, or even proposing where our innovation investment should be focussed. Perhaps he doesn’t know, or perhaps he just needs a distraction from the record of his government. Either way, there are people who are making real and concrete suggestions about where our potential lies.
Peter Fisher from RMIT asks what a smart modern city looks like. This includes digital entanglement, densification and managing the risks of climate change. The Greens see these same risks and are addressing them through its policy on the NBN, protecting the envirnoment, addressing the reef's challenges, meeting our future transport needs, supporting and investing in innovation and research.
Professor Peter Doherty suggests that we play to our strengths and take advantage of our abundant renewable resources and our ability in medical and scientific research.
And what about the issues facing rural and regional Australia? According to Stewart Lockie from JCU they are: Infrastructure, Unemployment, Diversification and New economy jobs, ATSI participation, Health, Education and Social services, Climate change, Natural resource management, and Agriculture. You can read more of his views here.
The Greens understand this and have policies which include supporting our clean energy future, community owned energy, getting the community into active transport, investing in health, closing the gap, and empowering ATSI peoples.
Part of the process of being clear about the facts and the truth, is the ability to identify the lies, the exaggerations, and the popular myths. Again The Conversation and their fact checking unit is a great source of information.
While most rational people would take anything Pauline Hanson said with a grain of salt.. fact check has debunked her claims that crime is getting worse in Australia. And while Pauline relied on anecdotes, sensationalist news reports and her own gut feeling, fact check looked at the official data.
So rather than feel like you are being let down by politicians or news services who want to sell you the idea that all we need is a big new dam, or a new football stadium and all our problems will be solved for the next three years… feel encouraged that you can always search out other, more reliable sources of information, advice and opinion.
The Greens want people to be informed, they embrace a diversity of ideas and opinions, they support the research and the science, and they want people to make their own informed decisions. And the Greens have a full suite of policies which supports and integrates all the outcomes it believes in.
We might be in the middle of an election campaign but we will keep telling the truth, we will keep the hyperbole under control, and we will continue to highlight the kind of ideas that will serve the interests of all Australians.
In our opinion The Conversation website is such a reliable source. When you get the chance, check it out.
by Wendy Tubman
Tertiary health care might be the most reactive form of treatment we have, but it is still very important.
It is our last line of defence against injury and disease, but it is equally important that we are spending wisely and driving great outcomes. We do need to only direct funds only towards best practice treatment, as mentioned in the previous blog. But we also need to know when to stop spending and treating.
Just one example of poor health spending that sadly leads to poor mental and physical health outcomes for patients was revealed on 4 Corners on Monday night – in the IVF industry. In part through poor regulation and loose Medicare funding guidelines, and in part as a result of the manipulation of desperate patients for financial gain, an insidious anti-health industry has sprung up where we should have had health care.
Cutting off inappropriate funding, will bring an end to unethical and unproductive practices. And we should make moves in this direction as soon as possible.
Better end- of- life options are also an important factor in ensuring we are more able to stop treatment appropriately. Properly resourced Palliative care is an essential part of good health care as it provides people with more choice and more certainty, alleviating mental anguish for patients and their families.
Beyond Palliative care we need to give people the surety and the security that comes with maintaining control and personal dignity at the end of life. Voluntary euthanasia is a difficult area to manage legally, but there are many international examples of countries who that have taken steps ahead of us. We can learn from their efforts and move forward in this issue in a safe and a sensitive way.
But the first step is to start a national conversation discussion about how we want to proceed, because doing nothing is inhumane.
The impact that climate change will have on human health is well documented. The effects will be significant. Any health policy that doesn't address climate change is both narrow and misguided.
It is important to recognise the essential role protecting the environment plays in good health outcomes. As the coal industry continues to decline we will see fewer respiratory disorders, reducing the load on tertiary health care.
By fast tracking an end to burning coal there will be fewer particulates in the air (less health impact), and we will see a limit to extreme weather events (also fewer health impacts). We will see a halt to the spread of tropical diseases like malaria, ross river fever, and zika virus into the sub-tropics.
By avoiding dangerous climate change we will have a greater chance of maintaining environmental biodiversity… which is a critical resource for medical science and research.
Many of our new and innovative medications and treatment regimes come from studying plants, and in particular the Rreef. There are a great many new treatments, as yet undiscovered, that we may never see if we don’t preserve our biodiversity. Developing these treatments takes time, and when it comes to preserving biodiversity it is a race against time.
The Greens are driven to provide better health outcomes for Australians (our leader is a Medical Doctor), and all our policies… whether they be social, environmental, economic, or sector specific (like in health and education) have at their core an interest in caring for all Australians and ensuring they have the best chance possible to achieve good health outcomes in their lives.
The Greens understand the need to have integrated policy that provides transformational leadership on important issues, and there are few more important issues than health.
As the saying goes… if you don’t have your health, what do you have?
by Wendy Tubman
Following on from the previous blog on primary health care... Secondary prevention is a smart and essential part of health care also.
Secondary prevention is about early detection, early treatment and effective long term management. It saves patients a great deal of money and suffering, not to mention saving them from premature death. Early detection occurs in part through education – the Cancer council has recently been running ads that encourage people to keep an eye out for suspicious signs.
Doctors surgeries have their walls covered with posters encouraging people to keep an eye on their weight (by looking at which hole on their belt buckle that they are using), and encouraging men in particular to have regular checks.
There are the screening services like those provided by Breastscreen, endoscopy procedures that look for early danger signs, and simpler and less invasive procedures like the blood pressure and blood sugar checks we should all have after the age of 50.
The reason why we have these education and screening services is that early detection means simpler, less expensive treatment and better outcomes. It helps us detect a problem before we experience symptoms (like bleeding, pain, or even lumps), which can be critical. And it helps us overcome our natural complacency… if we feel well, we assume there is nothing wrong, when sometimes there is. Screening gives us the peace of mind we are well, and just in case we aren’t it puts on the road to early treatment and recovery… keeping us well.
It promotes wellness, it keeps us happy and healthy, and it is relatively inexpensive. At the same time, it is the kind of service that governments can cut without people noticing too much. And sadly, that is what short sighted governments who focus on election cycle time frames do.
The Abbott/Turnbull government’s move to introduce GP co-payments undermines secondary health care because it discourages people going to the doctor early and getting screening done. The freezing of the Medicare rebate (slowly) undermines secondary health care in the same way. Limiting people’s access to affordable medications through undermining the PBS has the same effect. And even providing funding windows for specific and emerging health problems undermines long term secondary prevention. Because when the special funding runs out… the service stops, regardless of its effectiveness.
In contrast, the Green believe that secondary prevention is exactly where we need to invest our health dollars. Greens leader Dr Richard Di Natale has today announced a proposal to expand the cover Medicare provides for a significant and growing health problem for Australia in general and Townsville in particular … better treatment for diabetes. And of course, there are other emerging health risks which we need to address now… mental health, oral health, dementia and aged care.
The Greens have the major parties worried because they understand the issues that matter to most Australians and they have workable solutions.
But it is not just about spending, it is also about saving.
Medicare currently funds many procedures for which there is limited clinical evidence that they are best practice. Last year Four Corners highlighted many areas of waste in health funding.
You can watch that episode of Four Corners by clicking this link.
But despite that, the government has not sought to address wasteful spending, just to restrict access to health for people who can’t afford to pay.
The Greens support a great deal more spending on primary and secondary health care, and believe that in turn good health will be affordable for all. We also believe that good health for us all is tied to managing the health of both our built and our natural environment.
When we draw all those threads together... our nation and our citizens will prosper as a result.
by Wendy Tubman
Primary prevention, efforts made to stop people getting sick in the first place, are the best strategies to ensure good health outcomes. Not only is this the least expensive approach, it also preferences wellness over the treatment of illness. It produces the best possible health outcomes for the smallest spend.
Australia has done primary prevention well in the past.
The ‘Life. Be in it.’ campaign was incredibly successful locally and was exported to the US in the 1980’s. Unfortunately, Federal funding was ceased in 1981 to redirect money to elite sports, and, while the program went into a hiatus, it was picked up by private interests and continues (in a much diminished form) to increase physical activity today.
‘Slip, Slop, Slap’ was an equally successful campaign. It markedly changed people’s behaviour in the sun and was responsible for seeing reductions in skin cancer rates. As often happens with successful campaigns, the government took its foot off the pedal (assuming the problem was fixed), behaviour changed again and we saw increasing prevalence of sun- related skin damage.
As a result that campaign has been effectively re-launched as Slip, Slop, Slap, Seek and Slide.
When AIDS blindsided the world in the mid 1980’s, Australia again responded with a very effective public education campaign:, The Grim Reaper Ads which encouraged people to wear condoms and not to share needles. AIDS affected every corner of the planet, but it left Australia relatively untouched… saving many individuals from a premature death or a shortened life time of health issues and saving the economy billions.
But primary prevention goes beyond education. All the measures that have been taken to reduce tobacco use… plain packaging, banning smoking in some places and relegating smokers to out-of the-way places, support to quit through the Quitline. All that has driven smoking rates in this country to 17%, from where we now lead the world in rates of non-smoking.
Councils have played their part… providing active transport options like great bike path networks, and, in bigger cities, providing end of trip facilities and integrating bike transport with other public transport options. They have provided gyms in the park, like what is currently available in Sherriff Park.
But there is more that can be done… like increasing the Walkability of suburbs.
Federally, we will push further for clear labelling of processed foods, taking the Traffic Light labeling system beyond a voluntary scheme to a mandatory one. We will push for greater availability of healthier choices for kids and the banning of junk food advertising being broadcast during prime viewing times for kids.
There is also a great deal of support for other measures, like a sugar tax.
In addition to what’s been mentioned, there are a great many more opportunities for the government to drive down health costs, and at the same time increase the general health of the population. But while we are focused on emergency department waiting times, and waiting times for elective surgery, our eye is off the real game.
The Greens don’t support cuts to health… but we do support a smarter spend. We recognise that an effective health system must be based on primary health care and preventative health care measures — such as health promotion, disease prevention, risk reduction and early intervention — in order to manage chronic disease, reduce ill-health and avoidable hospital admissions.
The Greens will work in government to achieve this and have established, clear policies on:
Health Care, and
Check them out by clicking the relevant link.
Greens policies, and all the examples of great primary health initiatives are innovation in action. Malcolm Turnbull is good at talking about innovation (and getting excited about it), but terrible at translating it into real world solutions.
Only the Greens are making sensible proposals in this space.
by Wendy Tubman
While it is risky to generalise, it would be uncontroversial to say that all Australians believe in a decent standard of health care for all.
Not many would suggest that if people want good health care they should pay for it, especially if their circumstances make it unaffordable. We do believe in looking after each other, and going the extra mile to help the less fortunate among us.
Yet we are seeing increasing levels of obesity, more and more people developing chronic diseases and suffering from chronic illnesses, and we are facing emerging mental health epidemics across all demographics. Despite the huge amounts we are spending.. our health is getting worse.
We are all concerned about the ever increasing cost of health care, to us as individuals, and to the society more broadly. And we are right to ask if money is being wasted.
The truth is that it is.
Not because we are employing too many doctors, nurses and allied health professionals. Not because more people aren't taking out private health insurance. And not because we don't have 'price signals' in the system. It is being wasted because spending is prioritised on the wrong things.
There is a solution to both problems, and we've known the answer for a very long time.
Primary health care is the business of preventing illness and maintaining wellness. It leads to better health outcomes and it is far less expensive.
But when governments talk about 'health' they are largely talking about treating illness. We know this based on how governments measure success.
There is an old saying 'What gets measured gets done'. Its roots go back to the 1500's, and the reason that it has survived is that it retains a kernel of truth.
When governments report on the state of the health system they typically quote only two measures... waiting time in Emergency, and elective surgery waiting times. The truth is emergency surgical procedures are almost always performed in a timely fashion, and emergency presentations at Emergency are almost always seen immediately. And that is the service working as it should.
In contrast... People requiring elective surgery are in most part evidence of the health system failing them.
If they require joint replacement, the question should be asked 'could their joints have been protected through all manner of preventative measures' (like diet, exercise, better shoes, better work conditions)?
If they require gastric banding, the question should be asked 'could a better, conservative management approach have prevented their obesity and the accompanying health issues' (like diet, exercise, education, making better nutrition information available, a sugar tax, subsidising fresh food).
If they require organ transplantation, could better lifestyle choices (like not smoking, drinking in moderation, better diet and exercise choices) have negated the need?
In many cases the answer is yes. But by not measuring physical and mental outcomes.. like body fat percentage, blood sugars and lipids, cardiac and respiratory output, the self reporting of wellness and happiness.. we are not measuring the real effect of our society on our health, and we are not seeking good health outcomes for all.
By measuring the treatment of illness we are in effect ensuring there are more illness to be treated.
With activity based funding (which encourages hospitals to perform more and more surgeries) we are making surgery the most likely outcome for patients when often the research suggests surgical outcomes are not the best option. Performing arthroscopies for osteoarthritis of the knee is a good example.
By measuring waiting times for non-urgent ED presentations and elective surgeries... we are making health more expensive and we are accepting poorer health outcomes for all.
A first step to fixing our health system, is to start measuring (or perhaps reporting) on the right things. Things like the percentage of the population who are in a healthy weight range. These things are measured reported in the background but are never held up primary evidence about the effectiveness of our health system.
Most of us would believe that if health ministers were held accountable for societal obesity levels, we would see a bigger focus on primary health care. And with that changed focus we will quickly a slowing in the rate at which people are getting heavier and more unhealthy.
But instead we have MP like Ewen Jones telling fat jokes.
But I'm not going to leave you with questions... or Ewen's terrible jokes. There are ways we can reform the health system, and this can be led Federally.
More about that in upcoming blogs
by Wendy Tubman
Across the world we are seeing increasing levels of inequality – between developed and under-developed economies, and within national boundaries. In Australia the gap between rich and poor has been rising for over 30 years, and that has accelerated in the last decade and a half as we have moved away from a progressive tax regime and the means-testing of government financial support.
But is this a problem? According to those on the Right it isn’t. Their arguments include: our duty is to reward success and ‘lifters’ rather than ‘leaners’; that wealth accruing to the rich ‘trickles down’ to the poor; that income inequality is healthy because it inspires lower income earners to work
The arguments may, at first hearing sound plausible, but do they really stack up?
It has long been accepted, following the Whitehall studies, that your position within a large organisation, and within society as a whole, has a significant impact on your life expectancy and other health outcomes. Those higher on ‘the ladder’ clearly experience much better outcomes. In 2010, the Marmot review in Britain found that people living in poorer areas die on average seven years sooner, but also spend more of their lives with disability – an average total difference of 17 years.
These health inequalities are not just limited to life expectancy but also include infant mortality, mental health, physical health and so on. This is not a localised effect, the results having been largely replicated in a study that looked across 50 countries. In their 2009 book The Spirit Level: Why More Equal Societies Almost Always Do Better, Wilkinson and Pickett found a clear relationship between income inequality and health and social outcomes. See below.
Looking at all these indicators separately, the effect of income inequality is quite stark. (Note, a score of zero means no correlation, and a score of 1 or -1 means a perfect positive or perfect negative correlation.)
So we can see that income inequality has a significant impact on increased teenage births, higher imprisonment levels, mental illness, reduced levels of social trust and higher levels of obesity. There is also a notable effect on increased rates of homicide, reduced educational performance, and increased infant mortality.
Recent studies have investigated whether or not income inequality causes health and social problems, independent of other factors, and some rigorous studies have provided evidence of a relationship. Kondo, et al (2009) estimated that about 1.5 million deaths (9.6 per cent of total adult mortality in the 15–60 age group) could be averted in 30 OECD countries by reducing income equality below current levels.
Another study suggested that the loss of life from income inequality in the US in 1990 was the equivalent of the combined loss of life due to lung cancer, diabetes, motor-vehicle accidents, HIV-related causes, suicide and homicide.
As an indication of where Australia sits in relation to the rest of the world, see the chart below.
We're being outperformed by both Spain and Italy who both have much bigger domestic financial headwinds than us.
Significantly, the most (over) used argument by the Right –that income inequality may have positive effects on economic growth by providing incentives to work – while it may sound good at an LNP conference, in an IPA position paper, during budget speeches (that launch an election campaign), or during a doorstop interview, the evidence to support this is weak.
The relevant research unambiguously points towards positive and important society-wide outcomes being achieved through reducing the rich-poor divide. Even from a purely economic perspective, the very thorough work of Thomas Piketty has demonstrated that significant income inequality damages economic growth – the one strategy the government is relying on to return the economy to surplus.
Given that inequality is a major problem for us all, both economically and socially, this suggests that a return to more means-testing of government financial support programs, and a return to a more progressive taxation regime and a crack down on tax minimization by the wealthy, is needed .
If the government were serious about fiscal repair they would commit to the funding guidelines in Gonski, they would properly fund health, they would address the excesses of superannuation and cut back aggressively on negative gearing concessions, they would build a proper and effective social safety net, and they would make big business pay the appropriate amount of tax.
Whether or not the government is representing the interests of all Australians, present and future, will be partly revealed on budget night
by Wendy Tubman
Greens leader Richard DeNatale recently spoke at the National Press club. It was forward looking with a vision for the future... something neither of the major parties is doing. Watch his speech below.
Life is complex – socially as well as biologically.
The current, devastating, coral bleaching event Is primarily the result of ongoing warm seawater associated with the climate change happening around us. But climate change also increases the acidity of the ocean, another problem for the coral.
Then again, stresses like nutrient-rich run-off and coastal development, also decrease the extent to which the coral is able to cope with the warm water And the bleaching isn't just an issue for the coral itself but for everything that depends on it.
These dependents are not only fish and other sea creatures which depend on the coral reefs for food and protection, but also many groups of people, including commercial and recreational fishers and those who sell and consume fish, fishing rods and boats; the tens of thousands working in reef-related tourism; those who travel to the reef and experience transformative joy at seeing its beauty, and those who fly them there; those who research the coral looking for things with medical benefits; and those who live on the coast and depend (whether they know it or not) on the coral reef to protect the coastline from cyclones and tsunamis.
To make matters even more complex, the impacts of climate change stretch further than to the reefs around the world and the issues linked to that.
It is estimated that, as a result of the adverse effects of climate change, 400,000 people die every year
The Climate and Health Alliance in their latest report has described climate change as both the “defining health issue” and the “greatest global health threat” of the 21st century.
Worsening levels of health impose financial burdens on individuals, the community and the economy. For example, there are limited funds for health care and, as more funds need to be allocated to dealing with the direct fallout from climate change, less can be spent on the most efficient form of health care: preventative health.
Reduced health has productivity outcomes – from reduced output at work, to chronic illness and work absences, and on to early death, which means skill sets are lost forever.
Poor health also leads to poorer educational outcomes – for children as well as adults.
Lower levels of education not only mean reduced productivity, less innovation, and a reduction in high value work, it also leads to poorer health choices, which in turn mean poorer health outcomes.
As you can see, environmental outcomes affect economic outcomes, they affect health outcomes, which affect educational outcomes, which in turn affect economic and health outcomes. And as we live in the global village, this all has an effect on foreign affairs, and immigration.
Everything is co-dependent and interconnected. What this should mean is that policy frameworks are likewise interconnected. As we develop educational policy, we must have an eye to economic policy and health policy; as we develop health policy we should be mindful of how this might affect or be affected by environmental policy, education policy, economic policy, foreign policy. Etc, etc.
You get the picture... interconnectedness.
But does government policy take this into account? When the health minister announces policy changes (like the $7 co-payment) do they mention the impact this will have on workplace productivity, educational outcomes, or economic outcomes (outside of the direct savings they believe this change will drive).
They don't. Not just because they don't know (the modeling is never that robust) but because it hasn't been a consideration in the policy development process. Instead, policy has been developed by adhering to particular philosophies – like 'living within our means'; 'small government'; 'only doing for people what they can't do themselves'.
You hear the philosophies repeated again and again... which is symptomatic of the problem with the major parties.
The budget will be delivered soon. It will outline where the spending priorities lie. It will present all the expected benefits of addressing those priorities. But will it be a coherent statement that highlights the interconnectedness of our everyday lives?
It may, but the signs aren't good.
Ewen Jones appeared on Q&A on Monday. Ewen can be relied upon to repeat the governments talking points, push their key themes, and, at the same time, say as little as possible. On Monday Ewen was asked about youth unemployment and the future for North Queensland.
You can watch his answer by clicking on the video below
Basically... mining, coal, coal fired power, poles and wires, dams... if you build them the jobs will come (including for youth), and the country towns will thrive.
Very narrow. Possibly it represents where the government's thinking is. But don't take my word for it. Decide for yourself when the budget is released
by Wendy Tubman
The Townsville Greens will publish blogs considered to be of merit. The opinions expressed are those of the Author.