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.
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
The Townsville Greens will publish blogs considered to be of merit. The opinions expressed are those of the Author.