There is an illness that is causing untold pain and suffering and premature death across the globe. Here in Australia there are half a million Australians who are chronically sick as a result of it.
Of these 60,000 are admitted to our overstretched hospitals each year. Just think of the costs of this illness — the costs of PBS and Medicare services are getting on for half a billion dollars a year.
The illness? Well, there are several names for it. A new report from Catholic Health Australia and prepared by the prestigious National Centre for Social and Economic Modelling calls the illness “The Cost of Inaction on The Social Determinants of Health“. Other names might be Class Differences or The Malaise of an Uncaring Society or again Not Spreading the Benefits of the Mining Boom. Fundamentally the “illness” can be summed up as poverty and inequality.
When we look across the planet as a whole it is immediately clear that to argue that malaria and heart disease and so on are the major health problems misses the point. Better to see these as symptoms of a wider malaise — poverty and inequality. This is also true in Australia but in the clamour of competing voices and vociferous vested interests in the media, the impact on this nation’s health of these social determinants of ill health has not been so readily acknowledged.
Thus in Australia one of the sad things about this illness is that so little is being done about it and when some minor efforts are made to address the major inequalities that exist in power and income, as in the recent budget, the cries go up (from the well-heeled) of “class warfare”, “envy” and so on. This is despite the current toll of these social determinants of ill-health, as the report states: “There are no regular reports that investigate and monitor trends in Australia in health inequality over time nor whether gaps in health status between ‘rich’ and ‘poor’ Australians are closing.”
Does any other illness of such proportions go uninvestigated and unmonitored?
The good thing about this illness is that it is largely curable and doing so will not cost a fortune. The health benefits are potentially staggering: “If the health gaps between the most and least advantaged groups were closed, i.e. there was no inequity in the proportions in good health or who were free from long-term health conditions, then an estimated 370,00 to 400,000 additional disadvantaged Australians in the 25-64-year age group would see their health as being good and 405,00 to 500,000 additional individuals would be free from chronic disease.”
I haven’t worked it out yet but given all these benefits and the cost savings that would follow, the benefit cost ratio here must be massive.
But there’s a snag. Cost benefit analysis is not good at dealing with issues of redistribution and what is needed if this “illness” is to be addressed is major redistribution of income, wealth and power.
The economics, as this report clearly demonstrates, points to action on these social determinants of health and especially on poverty and inequality. Getting the action, however, is not economics; that is politics.
The opposition will brand this report a salvo in the class warfare and won’t have a bar of it. But the ALP, which was founded on the principles of social justice, just might. In doing so instead of listening to the mining magnates, they might resurrect these principles, get to grips with this malady and, who knows, maybe retain government.
It would not be hard. The PM could simply ask all ministries to recognise that each and every one of them — but especially the Treasury — has a responsibility to foster the health of the nation. Each ministry might then conduct a health impact assessment of its existing policies and see how these might be altered so that they would be aimed at addressing specifically these social determinants of health.
The Treasury would then have to arrange funding of the “best health buys” but in doing so recognise that the way that funding is organised can assist the process by being aimed at reducing one very important social determinant of ill-health — income inequality.
As the NATSEM report states: “People’s satisfaction with their lives is highly dependent on their health status.” If people were happy with their lives, might they not be happier with their government?
*Professor Gavin Mooney is a health economist with honorary positions at the University of Sydney and the University of Cape Town, and visiting positions at Aarhus University in Denmark and the University of New South Wales.