It's all about health

The Australian “health debate” is dishonest - and the tragedy is that those taking part might not realise just how for “off the mark” they are. The results are that the public is being short changed and Australia is not providing for today or for tomorrow.

The “health” debate should not be about hospitals, or about clinics, or about practitioners, or about particular prescription drugs: important as these things are, they are means of effecting and delivering some deeper policy goals. They themselves are not the policy itself - yet they are presented to us as if they are what the policy is about.

Premiers, prime ministers and chief ministers might talk about secondary things because they do not know better, and at election time, particularly, wicked promises are made in this area - to get votes and not to improve health. Medical practitioners, acculturated to believe that they are the centre of the universe, have threatened ministers (particular ministers have given me details) and “waved shrouds” if they did not get a blank cheque for what they wanted to do.

The debate should be about health. And it is not. We want citizens who are not obese, who do not smoke, whose blood pressure and blood sugars are normal, who exercise a lot, who protect themselves with immunisation and early detection of a whole range of diseases, who display moderation in their eating and in their drinking and in their driving, who drink fluoridated water to prevent dental decay - and more.

What we want is mostly within the power of people to provide for themselves - it is us acting for ourselves and not expecting others to do it for us. Not only that, but the factors which have had greatest effect in the last century or so are things related to water supply, to sewage removal, to better roads, to better nutrition, and so on - only a smaller percentage of the gain in life expectancy has much to do with medical care.

Ours is a country which has taken more than 50 years to get one major health hazard (smoking) under control - that is awful and is not the “success” that some people proclaim it to be. And all through that more than 50 years the tobacco manufacturers have knowingly done all they could to prevent what the public health people were promoting, even though they knew all about addiction to nicotine and damage from tobacco smoke. Obesity is our challenge now and too little is occurring. Again, many commercial interests are working actively against us. Let us pray that we have quicker success with that problem than we had with cigarette smoking.

We do not have enough practitioners - not enough doctors, or general nurses, or specialist nurses (such as psychiatric nurses), not enough radiographers, or physicist (to keep radiotherapy machines working well) not enough social workers, or occupational therapists, or physiotherapists. We do not have enough people of any kind in the sector. So there is no point in opening new facilities (too often close to elections with plaques) if there is not enough staff now. Our training of new staff is below what is needed, our retention of trained staff is suboptimal and it is hard for trained people to re-enter the workforce when they wish to. So we take trained (those who followed the Patel case might wonder what this word means) staff from many countries that call ill-afford the loss of those people.

We do particularly badly and will do worse in the area of dementia. Australia has an ageing population and therefore has more and more people with dementia. A Harvard Professor named James Martin says that some trends are already “locked in” and enormous increases in numbers of people with dementia (“brain failure”) are certain.

For the early parts of the journey people with dementia need community support - but where is that in many areas? It does not exist for most people and those responsible for providing facilities do too little. People in need often cannot find it - often it does not exist.

For the later parts of their journey sufferers need residential care - but where can demented people go now and where can they go in the future? There are too few facilities now and the lack will become more marked as the years progress. Not only is there a lack of residential places overall for Australians with disability, but there is a particular lack of places for demented people.

The things that Australia need are not related to Medicare rebates, or drugs on the PBS. They relate to teaching us what to do ourselves to keep healthy - after all, the “slip, slap, slop” campaign really engaged people - where a lot of heavily printed matter (prepared by earnest, middle class professionals) does not, and did not, engage people. But if we ourselves can limit our weight, take exercise, fluoridate our water, immunise our children, exercise moderation, avoid too much sun, we will improve health quickly.

There is a valid complaint that too much of our limited resources are spent in the last month of life. The problem for some practitioners is that, at the time decisions are made to use resources, it is not clear that the end of life has been reached. I well remember an old lady with a perforated ulcer. I was convinced by someone else that she should have surgery (it looked like a mis-use of limited resources) but she proved me wrong - she walked out of hospital and lived for another year.