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The Forum > Article Comments > Owning our own health > Comments

Owning our own health : Comments

By Peter Baume, published 8/3/2006

Time to take ownership of our own health and the services we expect.

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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.
Posted by Perseus, Wednesday, 8 March 2006 10:08:18 AM
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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.
Posted by Don Aitkin, Wednesday, 8 March 2006 10:12:32 AM
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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.
Posted by The alchemist, Wednesday, 8 March 2006 3:11:41 PM
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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
Posted by kalweb, Wednesday, 8 March 2006 5:39:43 PM
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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....
Posted by miacat, Wednesday, 8 March 2006 7:34:52 PM
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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.
Posted by kalweb, Wednesday, 8 March 2006 9:51:25 PM
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Aah Yes, mental health. Isn't it interesting that after Martin Bryant ran amock with a rifle in Pt Arthur, that everyone blamed the gun. No one blamed the mental health system for failing to protect both victims and perpetrator. No one blamed the de-institutionalisation policy for allowing a very dangerous person to wander the streets. And still, we get them back out the door as soon as possible, it sure is cheaper that way. But it is a pity that we can no longer ensure that the simplest things, like medication, is maintained, without which the entire policy is a failure. But I'm not too sure that the victims families appreciate the savings.
Posted by Perseus, Wednesday, 8 March 2006 10:52:50 PM
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Perseus,
As a survivor {victim} I can assure you that the survivor's family do not appreciate the savings. They would rather recieve proper treatment for their family member.

You draw a very interesting analogy with Martin Bryant, my illness is not of that type, however the specture you have raised could have enormous ramifications.

Could you hazard a guess as to why a government with a projected budget surplus of $17 billion wouldn't deal with Health, including mental health?
Posted by SHONGA, Thursday, 9 March 2006 4:53:11 AM
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Interesting question, Shonga. I suspect part of the problem is that proper treatment of some mental illness can involve the removal of the patient's freedom to act according to their wishes. And rather than develop a clear philosophical position as to exactly when why and how a patients freedom is subordinated to the communities responsibility to care, they just shovelled them out the door in the hope that neither patient nor public will come to harm.

This is probably also driven by legal liability issues. If the person is in the care of a responsible entity then the entity has greater obligations that are easily established. But if they are not in care then there is a much bigger burden to establish that the act of letting the patient go, was negligent.

Again, it comes back to a refusal to confront the issue of when a patients immediate desires are subordinated to the communities duty of care.

This issue also has a city vs regional dimension. In the city, a wrongfull discharge can release the patient into a highly stressful environment with illdefined support obligations, even complete anonymity. But in the smaller towns this is less likely but the release may also mean the loss of privacy for the patient who is returned to the community in a condition that may adversely impact on their capacity to regain their former social and economic position.

Either way it is a cop out and it sucks.
Posted by Perseus, Thursday, 9 March 2006 1:12:52 PM
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This article seems to be about encouraging us to take an interest in our own health. As I said in a previous health topic, if most of us looked after our homes, cars and businesses in the way we look after our bodies, then our homes etc would be uninsurable.

I'm going to talk about the way I see things and I hope this will be accepted in good faith and not regarded as me being self satisfied, because that is not the case.

I have never smoked, done drugs, been a heavy drinker, or been overweight. [Nothing to do with religion BTW.] Ever since I was a little kid, I have been very physically active. When I was 16, my mother told me that the best way to meet girls was to learn to dance. How true! It's also healthy exercise and improves balance, posture, flexibility and muscle tone. And if you can dance, you don't need a few beers before you dare approach a girl.

I indulge myself now and again with a bit of tasty fast food, but my general diet is mainly healthy. When I was a kid, I loved cakes and biscuits, but I listen to my body and over the years have found myself gradually not wanting that kind of food. I go dancing 4 or 5 times a week and some of the dances include supper. As I don't eat cakes, sweet biscuits, meat pies, sausage rolls and suchlike, I generally do without [unless there's chocolate which I do enjoy]. Some of my overweight friends notice that I'm not eating and ask what's wrong with me.

I also swim every morning and do resistance exercises in the pool. I'm not inclined to put on a lot of weight easily [maybe genetic, maybe lifestyle], but if I wasn't careful I'd have some extra just where I don't want it, around the middle. To me, it's a point of honour that I can wear the same trousers I have worn for years and, if necessary, I modify my food intake.

[cont]
Posted by Rex, Thursday, 9 March 2006 7:59:20 PM
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I'm careful what I put on my body and use around my home. Read The Chemical Maze by Bill Statham and books by Dr Peter Dingle of Murdoch University in Perth.

I have also taken health supplements for many years and I know what I am taking and why. Some would say that I am wasting my money, but my GP, a physiotherapist I saw after I tore a muscle in my chest mixing cement and a specialist I had cause to see a little while ago all believe that the supplements are part of the reason for my remarkable fitness level.

When I was working full time, I had term insurance on my life. Because I was a lifetime non-smoker, I got 40% discount on the premium. But there is no incentive to have a healthy lifestyle when it comes to private health insurance, which I prefer not to have. And I have to pay GST on my supplements, so the govt is taxing me for helping to save them money.

I don't believe that we can have a health system based on user pays. But I strongly believe that it should be based at least to some extent on abuser pays. If that meant that I would pay a little more for my wine, pizza and fish and chips, then I would understand and agree.

There are no guarantees in life, but we can shorten the odds or lengthen them. And presumably that's what health funding strategies are based on.

I was born in 1934, so you can figure out my age.
Posted by Rex, Thursday, 9 March 2006 8:01:50 PM
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2006 - 1934 = 72 whoopie years!
Good on you Rex. Thank you for your post.
Cheers
Kaay
Posted by kalweb, Thursday, 9 March 2006 9:37:30 PM
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Rex has touched on a very interesting issue. Should the health system be paying for the treatment of conditions caused by illegal activities? The links between early marijuana use and psychosis and the impacts of Heroin and other drug abuse are very well documented.

The community has made it very clear that it does not sanction this activity and has made it illegal. So a drug user has ignored the community's measures to protect the user, potential users, and the community itself. And users have made their purchases in a manner that precludes any legal recourse to recover damages from the supplier.

The supplier provides no proof of identity or evidence of the transaction, no warnings on the consequences of use, no list of ingredients, no contact details in the event of a warranty claim and pays no tax on the profits.

So why are we continuing to pick up the tab for people who have made no effort to assist the community in helping themselves?

Clearly, if we want to reduce the size of the health budget, then putting those who have failed a blood test at any time in the previous 10 years on a full user pays health system will do it.

If we want to deliver the best care to those who deserve it, when they need it, then user pays health care for drug users will do the job.

If we really want to shut down the illegal drug industry then removing free medical care for their customers will do the job quicker than anything else. And if we want to keep our community free of drugs then annual blood testing of people who have failed a test in the past will do the job.

This should not apply to nicotine addicts or alcoholics because the suppliers are known, liability can be traced and the community has collected large sums in tax from the sale of the products that can, at least partially, fund the resulting medical expenses. But we have no obligation to pay for the treatment of the consequences of unlawful activity.
Posted by Perseus, Friday, 10 March 2006 12:19:36 AM
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A little draconian, isn't it, Perseus? The logical extension is that if someone smashes himself up in a stolen car, he should be left on the road to bleed to death. Many might think this reasonable enough, but would we think it reasonable to do the same to someone hit by car while jaywalking?

A more consistent response would be to let injuries and illnesses take a back seat for treatment when they can be attributed to risks the sufferer could reasonably be expected to have known. This would see BASE jumpers, for example, treated for their injuries with much the same urgency as junkies, and those whose problems are beyond their control given priority.

Just a suggestion, but not one I'd like to try to enforce.
Posted by anomie, Tuesday, 14 March 2006 6:51:09 PM
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Peter. Thank you for pointing out that prevention is better than treatment.
There is of course much more money to be made from treatment and this may be why the focus is not on prevention.
Posted by Peace, Tuesday, 14 March 2006 9:51:47 PM
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