There is an illness that is causing untold pain and suffering and premature death across the globe. Here in Australia there are half a million Australians who are chronically sick as a result of it.
Of these 60,000 are admitted to our overstretched hospitals each year. Just think of the costs of this illness — the costs of PBS and Medicare services are getting on for half a billion dollars a year.
The illness? Well, there are several names for it. A new report from Catholic Health Australia and prepared by the prestigious National Centre for Social and Economic Modelling calls the illness “The Cost of Inaction on The Social Determinants of Health“. Other names might be Class Differences or The Malaise of an Uncaring Society or again Not Spreading the Benefits of the Mining Boom. Fundamentally the “illness” can be summed up as poverty and inequality.
When we look across the planet as a whole it is immediately clear that to argue that malaria and heart disease and so on are the major health problems misses the point. Better to see these as symptoms of a wider malaise — poverty and inequality. This is also true in Australia but in the clamour of competing voices and vociferous vested interests in the media, the impact on this nation’s health of these social determinants of ill health has not been so readily acknowledged.
Thus in Australia one of the sad things about this illness is that so little is being done about it and when some minor efforts are made to address the major inequalities that exist in power and income, as in the recent budget, the cries go up (from the well-heeled) of “class warfare”, “envy” and so on. This is despite the current toll of these social determinants of ill-health, as the report states: “There are no regular reports that investigate and monitor trends in Australia in health inequality over time nor whether gaps in health status between ‘rich’ and ‘poor’ Australians are closing.”
Does any other illness of such proportions go uninvestigated and unmonitored?
The good thing about this illness is that it is largely curable and doing so will not cost a fortune. The health benefits are potentially staggering: “If the health gaps between the most and least advantaged groups were closed, i.e. there was no inequity in the proportions in good health or who were free from long-term health conditions, then an estimated 370,00 to 400,000 additional disadvantaged Australians in the 25-64-year age group would see their health as being good and 405,00 to 500,000 additional individuals would be free from chronic disease.”
I haven’t worked it out yet but given all these benefits and the cost savings that would follow, the benefit cost ratio here must be massive.
But there’s a snag. Cost benefit analysis is not good at dealing with issues of redistribution and what is needed if this “illness” is to be addressed is major redistribution of income, wealth and power.
The economics, as this report clearly demonstrates, points to action on these social determinants of health and especially on poverty and inequality. Getting the action, however, is not economics; that is politics.
The opposition will brand this report a salvo in the class warfare and won’t have a bar of it. But the ALP, which was founded on the principles of social justice, just might. In doing so instead of listening to the mining magnates, they might resurrect these principles, get to grips with this malady and, who knows, maybe retain government.
It would not be hard. The PM could simply ask all ministries to recognise that each and every one of them — but especially the Treasury — has a responsibility to foster the health of the nation. Each ministry might then conduct a health impact assessment of its existing policies and see how these might be altered so that they would be aimed at addressing specifically these social determinants of health.
The Treasury would then have to arrange funding of the “best health buys” but in doing so recognise that the way that funding is organised can assist the process by being aimed at reducing one very important social determinant of ill-health — income inequality.
As the NATSEM report states: “People’s satisfaction with their lives is highly dependent on their health status.” If people were happy with their lives, might they not be happier with their government?
*Professor Gavin Mooney is a health economist with honorary positions at the University of Sydney and the University of Cape Town, and visiting positions at Aarhus University in Denmark and the University of New South Wales.
This is not new news. It has been known for some years that health
status is affected by position on the social gradient and the impact of
social determinants on a person, or community or a population. I
could see a Labor Government taking the action that Gavin Mooney
suggests but then wait for the howls from the Coalition and their
media attack dogs about class warfare!!
But work is already underway in this country trying to address the
social determinants of children’s health eg the work of Fiona Stanley
in the West. Her work has been very important in establishing new
standards for the health and education of children and take note
Coalition – the world has not fallen in!
Setting aside the possibility of someone disagreeing with the author’s political
or ideological preferences it is still reasonable to ask him for some decent empirical evidence of causation.
People in the lowest quintile of cognitive ability will, on average, have worse
health status than smarter people. A little of it will be because poor health
can, in some cases, lower performance on IQ or any other test, including the
practical ones involved in most jobs, of cognitive abilities. But most of it probably
has to do with causation in the other direction, including stupid lifestyles which
benefit from neither learning about cause and effect or discipline in applying
the lessons.
So, social justice has us move resources from all sorts of other
uses, including looking after demented old people, helping alcoholics and drug
addicts (who are only sometimes in that lowest quintile), spending money of
a little is actually useful on indigenous affairs, defence (assuming there is any
more to cut) etc. etc. in order to spend money, probably as effectively as on
indigenous affairs, to improve the health status of the relatively poor. What
are the longer term consequences and which of them will count as a good thing?
No doubt our top executives and mining engineers will not, even if tax legislation
and administration does manage to take more or the income, leave Australia
any time soon – though one shouldn’t discount the likelihood that they will
take their money on retirement to less redistributionist countries – but that
only means that the good fortune of our forbears having occupied Australia and
some of them having been clever enough to find saleable or useable minerals
will allow us to spend without regard for cost-benefit calculations on Australians.
If we limit ourselves to tokenism in relation to the 99 per cent of mankind which
is much needier (and unhealthier) than nearly all Australians that will no doubt
fit in quite nicely with the perception that it doesn’t make sense to throw money
at people and problems where one can’t exercise much influence on the outcome
or the use of the money. But isn’t that exactly what many already feel towards
the “humble and meek” (especially when they are perceived instead as obese,
undisciplined, under class and useless if not idle) and “poor in spirit” (who may
or may not be given much sympathy for genuine serious mental illness) who
the near majority of non-taxpaying Australians? Howard’s battlers might not
be too knowledgeable about boat people and their potential to be taxpayers but
they have a pretty good knowledge of people who take more than they give
or pay, and they resent it. And they are not monsters. If they know someone
who is in trouble because of a traumatic brain injury or lupus or MS they know
perfectly well that they are not bludgers and accept that they should be helped..
The reactionary riposte, “the poor do not benefit by making the rich less so”, invites the response, citation/reference required so I’m willing to give it a test whirl.
Warren Joffe have you read the work of Marmot and Wilkinson?
They are some of the primary reading you should do.
I’d question Warren’s correlation between poor IQ and bad health lifestyle choices – I think we could name at least two highly successful wealthy mining entrepreneurs in this country who seem to have trouble (like a lot of us) with their “choices”