Sunday, June 29, 2014

The future health of the emerging Australian underclass

Perhaps unconsciously and because they perceive the world in a different way, the Tony Abbott-led Australian Federal government policies resulting from the budget and more generally will deepen the poverty and thus the ill-health of the poorest in Australia (including people living in shipping containers), leading (if these trajectories continue) to grossly increased health inequality; this will be accompanied by widened public acceptance of this situation. Already, and increasingly, affluent populations believe and will increasingly believe that the poor have “caused” their own illth and thus also the poor should pay for their treatment. But already this is increasingly difficult, by 2030 it will be impossible.

As the population of the emerging Australian underclass grows and their health deteriorates the future public purse may well be spared, as the rest of the population accept that it will be cheaper (and morally acceptable) to allow the poor to die quickly rather than struggle heroically to keep them alive a bit longer. We already see people with under-treated mental health, in future we will see gross under-treated physical health. People with mental health are currently threatened by a loss of their disability pension in exchange for cheaper payments.

Australia's current Minister of Health, Peter Dutton, boycotted Kevin Rudd’s apology to the stolen generation, on the grounds that it would do nothing tangible for Indigenous health. The GP co-payment will particularly harm Indigenous people, especially in more remote parts of Australia.

TONY JONES: Okay, well, we've got a few people with their hands up. Keep your hands up, but first of all we've got a web question that's come in from Andrew James Brown on this subject. "To Peter Dutton: Why did you choose not to attend the apology to the stolen generations?"

PETER DUTTON: "Well, for pretty much the same reasons. I support any legislation whatsoever that would go through our parliament that I thought would provide a tangible outcome for, particularly, Aboriginal children. I..."

Dutton has little if any
understanding of the psychological underpinnings of health. This may be excusable in a drug squad policeman but is disgraceful for a minister of health. (He's not much chop as minister for sport, either.)

The government persistently defends the co-payment for general practice visits by the poor as similar to a pharmaceutical benefit co-payment. This also reveals a bias to a biomedical “curative” view of health.

So too is the illusion that the GP co-payment will produce a treasure chest of miracle drugs sometime after 2035.

As part of its strategy for punishing the poor the Federal Government also proposes to compel people to “learn or earn”, under threat of losing their already meagre benefits. But how can someone who lives 90 mins away from a centre afford to travel to “learn”.. who will pay for that? Many people who are functionally illiterate cannot effectively learn these skills over the internet. (Ninety minutes is close for many people in remote Australia).

Instead of all punishing and taxing the poor proportionately more, I would rather people like me paid more tax, also companies like Glencore, Google and Apple, and that there were genuine policies to promote fairness.

The author is professor of public health at the University of Canberra. In the past I worked for almost 10 years full-time equivalent as a general practitioner (1988-2008) mainly in very poor rural areas of Tasmania, where I learned all too much about the relationship between poverty, social exclusion, and ill-health, whether from ischaemic heart disease, type II diabetes, smoking, depression, domestic violence, unemployment, drug addiction and other forms of attempted escape from social exclusion.

There is a postscript for this.