A good Article, Peter. One interesting feature of our system that has recently become more apparent is the fact that the supply of medicos is determined by the extent of any oversupply in the capital cities. When city numbers drop below certain levels the number of new university places is increased. And when a surplus in city places looms then numbers are cut back.

The only problem with this is that the supply to regional areas lags the city supply situation. An adequate supply of medicos in the bush is only achieved when the city is in serious over supply. So when a mild city surplus is trimmed back the bush goes into serious deficit.

And this situation will continue to produce the sort of disasterous results that we have recently seen in Queensland for as long as supply for both sectors is managed under the one administration. The bush, being the minority, will always miss out.

The Queensland Coalition has adopted the policy of restoring the Regional Health Boards that were scrapped by Labor in favour of centralised, and therefore partisan, management systems. But while this is a welcome improvement in regional autonomy, it will not address the supply and other structural issues.

These can only be dealt with effectively through the complete separation of the health service managent function on geographical grounds. And that is only a realistic prospect if it is associated with the complete separation of the executive and elected arms as well. It is the only means of examining the full range of regional health delivery issues in their own context.

There is certainly more scope for rationalising and clarifying Federal/State health responsibilities. But this is best done for the bush when they are being represented by their own regional state government who's focus is entirely on the needs of their own constituency. And this would mean a number of rural states with similar interests could structure appropriate programs in consultation with the Commonwealth.

They couldn't do worse than what the existing state is already doing. The only way from here and now is up.

Great piece, Peter! In health, as elsewhere, we have the constant problem that we cannot start with a clean slate and build a much better health system from the ground up. So the urgent is always driving out the important. Your last comment is vital: we must shift the balance of health spending (especially in research) from the search for cures to the search for prevention. We know it works: there's good evidence in seat-belt use, the decline in smoking, safe sex practice to counter HIV-AIDS. And prevention is much more a national responsibility, though the states should act here too. We need a leader to dramatise and persuade. Given the high levels of education in the community, public health campaigns should work relatively quickly.

It will never happen, because there is to much vested interest in bad health. The education system is designed to turn out economic slaves, not healthy knowledgeable people. We all understand hygiene and how to look after our external appearances, but not the functioning of our internal systems.

Prevention is easy, its diet and lifestyle. But what can you do when you have cities that provide pollution of all descriptions, from air, water, noise and food. Yes most of the food we eat is pollution to the body, so we have a vicious circle.

It starts with the propaganda relating to certain types of foods. Then its enhanced by the promotion of junk foods containing huge amounts of untested chemicals and additives. Then we have the medical profession in bed with the drug companies, that provide the drugs to mask the effects of the chemicals they provide for the food processing industry. Combined with the wrong foods and wrong food combinations and we have a national health disaster. Follow that up with more drugs in hospitals and surgery to remove or replace the damaged parts, with synthetic parts provided by the same companies that provide the additives and drugs, that contributed to the cause in the first place.

Thats our health system,very simple, corrupt, inefficient and inadequate. Its not the fault of those trying to make a difference, its the fault of those that hold power and receive huge amounts of money in the form of donations and kickbacks, from these multinational corporations.

So there is not chance of anything changing until we alter our entire system and approach to life. Whilst life is determined by growth and profits, instead of sensible sustainable progress. Nothing will change and we will continue down the path of biological destruction. You can see how much people really care, by the number of posts to health threads, compared to economics and ideology.

Professor Baume

A timely and insightful article. Much appreciated.

It reminds me of the mantra that we espoused back in 1985 when I first entered nursing academia. Primary Health Care philosophy and Health Promotion principles were the guts of the then Diploma Nursing Program.

In 1988 I moved on to another university nursing program where the traditional medical model undid any health promotion strategies that I tried to implement.

1990, another university nursing program with a different thrust - Health Promotion and Primary Health Care were the students' daily diet - to the point that they [the students], on clinical placement, refused to acknowledge anything about the notion of health. They just wanted to know about illness and how to "cure" people.

You know as well as I do, that health is primarily a political issue. There are very few political votes in the notion of health. Rather, there are heaps of political votes in illness related issues, for example: mega heart surgery, kidney and liver transplants, IVF and the like.

And there are certainly no political votes in relation to mental illness, let alone mental health.

1995 saw me in another university nursing program - back to the illness model for me.

There are very few illnesses which are "cured" perse, rather, they are treated - and that is an entirely different conceptual framework. For example: when a person has a myocardial infarction, they are treated, not cured. The person's heart muscle is always vulnerable for a further episode. But they can be taught health promotion and prevention strategies.

In 1996 I was privileged to work for Lifeline Sunshine Coast, and to be sponsored by the Queensland Health Promotion Council for a year. I was in my element out in the community - teaching people about good mental health. I had a ball, and the project was an oustanding success, and acknowledged as such by Ms Fiona Simpson MP in Hansard. But it was only a one off - sadly. Feedback from the community asked for more and more, but I could not get any funding.

Cheers
Kay

There are no egalitarian principles in Australian or Queenland Health! Conditions in rural areas such as Cooktown and Cape York are increasingly dire.

Health is worse where people are disadvantaged or where access to Health resource program services lack proper Preventive Communtiy Health "cultural" protocols through healthy community engagement.

I find local staff lack the policy depth and innovation required to engage with community at ground level. This I believe occurs as individual staff members are "threatened" by the very thought of "sharing and exchanging knowledge". Much of this I believe happens because local staff members are "controlled" as a "silo culture" from regional Cairns, Brisbane and Canberra.

This "might offend those with egalitarian principles", but it partly explains the poor health of Aboriginal people and other minority groups- who are by mass disadvantaged and therefore often left very poor.

Obvious and vicious inequalities increasingly make health matters worse, have impacting consequences which make the present condition even more worse and this cycle will get even worser, for the next generation who will have to cope with the coming swell of ill-health by numbers predicted with a lesser funding poole to share over the larger sectors of the comming baby boomers.

Poor Australia... if health is seen as the wealth of the next generation?

Thank God for the whistle blowers.

Thankyou Peter and everyone else....

miacat

If I was a betting woman, I would have predicted your response. Thank you.

Professor Baume

You were once a politician. How do you marry your current views with your past views about politics, medical practitioners and health issues?

Lots more to say
Back later
Kay

PS: Prof Baume: narrow view in your argument, vis a vis, the value of: nurses, physiotherapists, occupational therapists, clinical psychologists, social workers, welfare workers, paid consumer representatives.