Access to Australian health care is not universal or fair

Improving employment and long term plans for improved housing affordability and availability will help to address the inequitable distribution of power, money, and resources. There is a reluctance to address structures, which guarantee inequitable income distribution and therefore power. Thus, despite the Henry tax review which did have improving equity as one of its intentions, the government has made only minor changes in the budget this year and the tax changes attached to the climate change policy are aimed at ensuring inequities do not increase rather than decreasing the current inequities.

Education is crucial to equity. The basic funding structure in primary and secondary education continues to support inequitable access to high quality well resourced schools. Despite lots of programs and projects to address these issues the federal government continues to fund the richest schools in the nation with money that could be spent on the most disadvantaged schools.

Barriers to addressing social determinants

There does not seem to be sufficient recognition that there are fundamental structural barriers to equity in our society, particularly in the health and education systems and in income distribution. There also appears to be a lack of recognition of the social gradient, which therefore supports the concept of targeting the most disadvantaged and ignoring those structural barriers.

Instead, the approach to health inequities appears to be largely focused on targeted programs, safety nets, and other forms of charity. The other concern about a reliance on charity is that it deflects those interested in equity from pursuing that idea through the much harder to achieve structural reform. Those who spend all their time in charity work including well targeted programs, feel they are doing the right thing. They are. But while they may believe strongly in equity, they have no time left for the pursuit of the big changes required.

Politicians who start off with ideals of equity must turn into practical people, doing what is possible. Thus, even the well intentioned target gross inequity and feel they are doing well, and then they ignore or have no time and energy to address the structures which are amenable to change. The changes required to tackle the root causes of the inequity are major, but well within the power of governments. What is being done is minor if not minimal. For politicians, targeting gross inequity is perfect as they don’t actually believe in equity, and much prefer the idea of charity, which fits well with their belief in a class based tiered society.

There is recognition amongst our politicians that to achieve health equity one needs to address both the health system and many factors outside the health system. There is a failure of recognition however that heath inequity follows a social gradient, and structural change is required to address this issue. A targeted approach to the most affected groups ignores this gradient and ignores the structural causes of the inequities. Indeed, one could view the approach of relying just on targeting as another form of charity, striving to reduce gross inequity but ignoring the goal of equity.