Usually, when you’re doing research, you know what to expect. I set out to write a report, released today, looking at Australia’s health care system in two ways — how well it performs overall, and how fair it is.

I knew what was coming for most of it. There were some very good bits — the average lifespan of Australians continues to improve, mainly through our ability to keep older people alive. It may also be that older Australians are fitter than their forebears — fewer smoke, drinking is down, exercise is up and blood pressure is down. Yes, waistlines are expanding, but that’s not the full picture. In most ways, on most days, Australians are fairly healthy in comparison to people elsewhere, and are fairly well-served by our health system.

But I was struck by the unfairness of it all, even when I knew inequity abounded. I knew the health of Indigenous Australians was far worse than that of others, but it is still painful to see figures such as this: that an Indigenous person, on any given day, is twice as likely to die as a non-Indigenous person of the same age and gender. That’s a situation that’s got slightly worse, if anything, over the past 15-20 years.

There’s an enormous issue with dental health. If you rely on the public dental system, then you’re three times as likely to have teeth pulled than fixed. It seems that by the time you get care you need, it’s too late.

And rural people — there are twice as many doctors per person in the city as the bush. That’s not just to do with where the hospitals are — the spread of nurses around the country reflects the population. By and large, it’s a lifestyle choice and their families. Those choices are reasonable, but the country people suffer.

A real surprise, though, was finding data which showed a link between socioeconomic status and survival with cancer. This is different from the well-known links between poverty and conditions like heart disease. This says once you get cancer, you’ll live longer if you’re wealthy and well educated.

That, on the face of it, is remarkable. It shouldn’t happen in a nation where the ideal of egalitarianism still exists. And it’s probably got very little to do with lifestyle, as lifestyle matters little once cancer hits. It’s almost certainly to do with the type of health care provided.

I still don’t know exactly why this should be so. Why should a disease that is so impervious to outside influence that it kills half of those it afflicts be affected, in how it plays out, by wealth and education? Is it the result of hundreds of individual decisions by doctors that result in the more assertive and articulate in society getting better care? Has all the money poured into private health insurance finally allowed the private system to do what it has always implied but never shown – provide better care? You would hope neither are true.

There’s enough inequality around without adding that to the mix.

Dr Mark Ragg is director of the health and communications consultancy RaggAhmed and adjunct senior lecturer in the School of Public Health at the University of Sydney.

Peter Fray

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