Monday, May 16, 2016

The Case for Change: Health in the ACT

My talk  at the Canberra Nurses conference, May 31, 2016 Slides at:

Australians are living longer, and so are people overseas. Yet, some of the underlying foundations of health, both here and globally, are eroding. This has not yet translated to a fall in Australian health indicators, but could such a decline be around the corner?
Evidence of deterioration in health status, for some vulnerable groups, has already been documented in the US and elsewhere.
Government services in Australia, as in many countries, face increasing pressure to manage more with less. This applies not only to the health system, but also for social security, Indigenous affairs and other sections where budget cuts have the potential to harm health.1
Additionally, within health, there is a perception not only of increased patient2 expectations, but increasingly powerful (and costly) technologies and treatment to diagnose and treat illness. Do we really get value from this?
Another underlying health “determinant” is adverse global environmental change. A prominent example is the warming and “wilding” climate. While some effects may seem sleeping, far in the future,3 others, on reflection, may already be with us – and not that hard to understand.4
Some have even argued that adverse “eco-social” 5 changes have the potential to harm the life support system of civilisation, with effects far worse than even the 2008 financial crisis.
Such gloomy futures are not inevitable. Canberra, compared to most places, is a wealthy and privileged city in a wealthy and privileged nation. Together, we can contribute to the profound transformation that is needed for a better future.


1. eg the Australian government can no longer bail out the car industry and this will worsen unemployment. At the same time, unemployment benefits remain far below the poverty level.
2. I know most nurses used to prefer the word “client” (and this may still be the case) but for me the word “client” sound too business like, too market-driven. It is actually a symbolic evidence of one of the problems I’m trying to explore, regarding health cost blowouts and unreasonable expectations; eg if I am rich and sick and a “client”, it suggests to much that the dr/nurse/health system is for sale; with services (including basic care) to be purchased .. but if I am poor I can’t purchase as much care, and then I resent it ..  and my expectations also rise (as I see what others get) .. increased inequality erodes overall health. It’s also a question of what kind of society do we want?
4. Most of Tasmania was shrouded in smoke in January 2016, in part from drying and increased temperature. Almost its entire population is inhaling high levels of smoke particles for at least a week. This significantly harms the health (cardiac as well as respiratory and general) of vulnerable people.
5. Causes that are neither entirely environmental or social, but arise through the interaction of environmental and social factors.