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The health system is a social indicator

By Peter Baume - posted Wednesday, 23 November 2011

This series of articles is about the varying views of Australia today. Let us consider our health system when we consider the current Australia. People might think this series is solely about economic matters but the quality and reach of our health system helps measure whether or not we are a truly civil society.

So let us have a look at the health system we have. It might tell us something about our society, about our values, and about our aspirations.

First, our health system is really an illness system and its name is not an indication of what it is really about.


It is concerned with medical services; with the provision of pharmaceutical drugs; with the numbers of hospital beds; with the numbers and adequacy of many services; with the staff needed to service the facilities we have; with the actual numbers of staff we have; with shortages of staff now and in the future and with rationing as it exists and manifests itself in Australia.

There is altogether too little health related work in prevention - although a lot is known and we could do a lot more using this present knowledge.

Australia has a vicious two-tiered health system. The affluent and powerful go as private patients generally and when they go as public patients - as a former Prime Minister did with a family member – they receive special and quick attention.

They have enough money to pay medical practitioners; they have enough money to pay for pharmaceuticals for themselves and their families and to purchase services privately.

They have good rates of compliance with treatments and with instructions they receive from those who care for them (they are educationally similar to those who write the health messages). They do not have to wait for services and they know how to make systems respond to them.

They lead healthier lives, undertake more preventive activities, avoid smoking and drinking to excess, exercise more, and so on. They find it easier to understand health professionals.


Those who are poor and powerless often cannot pay the doctor; often cannot pay for pharmaceuticals; cannot purchase services privately; have poorer rates of compliance; eat, smoke and drink more and have demonstrably worse health outcomes.

Queues for admission, treatment and for devices are longer in the public sector; the public sector has worse food, worse conditions (males and females share wards in many public hospitals), dirtier hospitals and busier, more demoralised staff.

There are chronic shortages of staff - advertisements are slow to appear, and when they appear there may be few or no applicants for positions. In public psychiatric hospitals (and elsewhere) patients are occupying beds inappropriately in acute wards because "step down" facilities are not available.

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About the Author

Professor Peter Baume is a former Australian politician. Baume was Professor of Community Medicine at the University of New South Wales (UNSW) from 1991 to 2000 and studied euthanasia, drug policy and evaluation. Since 2000, he has been an honorary research associate with the Social Policy Research Centre at UNSW. He was Chancellor of the Australian National University from 1994 to 2006. He has also been Commissioner of the Australian Law Reform Commission, Deputy Chair of the Australian National Council on AIDS and Foundation Chair of the Australian Sports Drug Agency. He was appointed a director of Sydney Water in 1998. Baume was appointed an Officer of the Order of Australia in January 1992 in recognition of service to the Australian Parliament and upgraded to Companion in the 2008 Queen's Birthday Honours List. He received an honorary doctorate from the Australian National University in December 2004. He is also patron of The National Forum, publisher of On Line Opinion.

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