Owning our own health

The “health” debate in Australia is awful. It is not about health at all. It is about illness and the loss of health.

The giving of advice about weight and exercise, exhortations about smoking, immunisations, vaccinations and routine health checks are all good preventive activity. So it is wrong to say that there is no preventive activity at all. However it is not enough. Moreover many of the procedures we regard as preventative are in fact not. Breast screening, pap smears, faecal occult blood tests, measurement of blood pressure and blood sugars, for example, are all means of making early diagnoses when disease is present. They are not true preventive activity.

We know what is needed to keep us healthy. But instead Australians are increasingly obese, are undertaking less exercise, are still exposing themselves to too much sun, drink and smoke too much and are as subject to sexual excess as anyone else. No wonder then that we are unhealthy.

But that is not what community discussion is about.

Certainly one only has to consider the reduction in smoking, moderation in the use of alcohol, balanced diet, exercise, the importance of cleanliness, as well as the “non-medical” interventions that include better roads, provision of clean water, provision of sewerage, to see how many advances have occurred outside the recognised curative areas.

Discussion is too often about how to restore our well being when health is lost - when instead we should be talking about how to remain healthy. We could do much more in this direction.

It is the old story about the fence at the top of the cliff making better sense than a fleet of ambulances, even a fleet with bells and whistles, down at the bottom of the cliff. Mind you, I met a good doctor who told me he intended to stay at the foot of the cliff and that he was a good ambulance driver!

There are other major problems too. The current “debate”, poor as it is, is about how to provide everything for everyone, at all times, when they are sick. Much discussion occurs just before elections when people who should know better outbid each other with fantastic promises that cannot be redeemed.

Politicians make utopian promises to provide for all the sick, and to do it quickly, when it is not possible. Indeed they understand this truth so what they say is difficult to excuse. They need to come clean with consumers because they cannot deliver.

They have never been able to deliver. And they never will be able to deliver.

Providers should also be ashamed. Too often they are self-interested, putting their own interests ahead of those of the community, and they object to propositions that might assist the community, but which might not be in the interests of their own particular guild.

There are long queues to see many providers, and yet there is a demand, from many provider organisations, for the monopoly provision and control of particular services. Standards are high in Australia, but those high standards are obtained at a cost - in our case a cost of chronic under provision and an impoverished debate. High standard qualifications will always be sought by those who are good or ambitious.