When healthcare is a remedy for cruelty

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Earlier this month the UK National Health Service (NHS) celebrated its 70th birthday. When I lived in London over a decade ago, I didn't take the free care from the NHS for granted; however, I did wonder if the suboptimal care I received was in part due to a health system under pressure.

'Uncle Sam' watches on in envy as an emu and kangaroo epitomise Australia's better health system. Cartoon by Chris JohnstonWas this a glimpse of Australia's own future? As it is, our healthcare system is far from perfect and requires improvement, as El Gibbs recently described. Lately there's been much critique about the need to improve our care coordination.

The NHS launched a few years after the end of World War II with three core principles: that it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay. At the time, such a service was almost unprecedented because few nations had universal health coverage.

As a colonial outpost, Australia often looked to the UK when it came to national matters — though not when it came to healthcare. It took us several more decades until we had a comparable universal healthcare system. This was mainly due to opposition from the medical profession, which seems surprising now.

To briefly recap the history of Australian healthcare as Jeffrey Braithwaite tells it: 'hospitals slowly emerged in the 19th century, financed chiefly by subscription fees. Doctors, like their counterparts in England and Canada, offered services as entrepreneurs, largely to the wealthy. Charity hospitals were initiated and run by religious institutions, with a charter to treat the sick poor.'

It's no wonder Australia was not spared in an essay by Atul Gawande in The New Yorker, 'Getting there from here'. Gawande discusses how 'in every industrialised nation, the movement to reform health care has begun with stories about cruelty'. He recalls a 1954 letter to the Sydney Morning Herald written by a young woman with lung disease who couldn't afford to refill her oxygen tank. It's a scenario in Australia that now seems unconscionable, yet it occurred in living memory.

Australia has the rare distinction of being the only industrialised country in the world to introduce universal health coverage (1974), abolish it (1978), then resurrect it (1984), as outlined in this parliamentary brief. These immense changes occurred during a turbulent decade under the Whitlam, Fraser and Hawke governments.

 

"Such a reality partly illustrates how our social circumstances determine our health-related burdens, and how communitarian healthcare is delivered unevenly."

 

Looking at the history of our modern healthcare is instructive, particularly as many challenges from then continue on in some form. We've only had universal health coverage for a relatively short time so it's not something we can take for granted.

The World Health Organization was another institution that turned 70 this year. It used its milestone anniversary to highlight the importance of universal health care in enabling populations to flourish. So if we look across the world, Australia does have good healthcare and perhaps it's no coincidence that we're one of the world's healthiest countries.

But when it comes to Indigenous populations the health gap is actually widening. Such a reality partly illustrates how our social circumstances determine our health-related burdens, and how communitarian healthcare is delivered unevenly.

Not long ago I had a prolonged interaction with the healthcare system, not because of illness but because I decided to opt for care through a public hospital for my pregnancy and birth. During that same year my husband regularly visited Papua New Guinea for work, which included strengthening maternal and child healthcare.

The contrast between my situation with the women in the provinces of PNG couldn't be more stark. I inevitably found many things to be frustrated about, questioning various aspects of my care, but ultimately I received what can only be described as first-rate care — and that's not something to be taken for granted.

Australia's healthcare system is more than just the way we care for each other writ large and has become a cultural institution in itself. It reflects some of our best values, which surely demands us to think about how we can make it work better.

We need to keep ensuring care is extended beyond our immediate, visible communities because we're all interconnected — including asylum seekers on Manus and Nauru. Currently they're being denied appropriate medical care, another modern day act of cruelty. Time for further reform.

 

 

Sheila PhamSheila Ngoc Pham is a writer, producer and radio maker. She currently teaches public health ethics at Macquarie University and is a PhD candidate at the Australian Institute of Health Innovation. She tweets as @birdpham

Topic tags: Sheila Ngoc Pham, health care

 

 

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Thanks Sheila! You say, "We need to keep ensuring care is extended beyond our immediate, visible communities because we're all interconnected — including asylum seekers on Manus and Nauru. Currently they're being denied appropriate medical care, another modern day act of cruelty. Time for further reform." I fully agree with you Sheila! Voters need to be very discerning at the next Federal election if Australia is to remove this terrible blot on our reputation.
Grant Allen | 27 July 2018


Thank you Sheila Ngoc Pham for bringing together, in such a clearly written article, the principles that should underpin our health care system, and the historical reasons why they do not always do so. I look forward to reading more of your work in future. The cruelty inflicted on asylum seekers and refugees on Manus and Nauru appals many of us, and I, like many, pray for the day when our government policies change for the better.
Janet | 01 August 2018


Thank you for reminding us about how we need to improve our health care system in Australia to make it more effective and available to all.. I think that we need to make some radical demands to ensure that the system works well for all Australians - especially the poorer ones. Most caring Australians would agree with you comments about the poor health system provided by our political leaders for asylum seekers. We have heard numerous reports from medicos providing health care to these people urging the government to drastically improve medical support to people who should not be detained and who, in most cases, have already suffered great trauma. We should be demanding a national health scheme that provides universal cover including dental treatment and very cheap access to expensive drugs - especially to cancer and leukaemia sufferers. We should also be demanding that we spend more to cut back the high levels of pollution as many thousands of Australians have chemical hypersensitivity health problems because of this. It is a matter of priority - putting the welfare of Australians before spending billions on getting involved in US wars of aggression.
Andrew (Andy) Alcock | 05 August 2018


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