No amount of belief can create a fact

Australians all let us rejoice, the weekend now is near, we've worked all bloody week for this, dear god let's go and get a beer… Sound familiar?

It's part of a new national anthem written by my mate Aussie Dave. He reckons it's a better reflection of life in the lucky country. The lucky country? You know, the place where colonists carved out a new society in the bush across Terra Nullius, where Aussies were equal and entitled to a 'fair go'. Times haven't changed much for Dave. Maybe he's right. Dave's white, got a wife, job, house, a car, education, seems healthy and critically, can afford a beer. Aren't we all like Dave? Isn't Australia a land of opportunity? If not, maybe with some hard yakka, we'll get there too.

Sadly, preoccupation with egalitarianism in Australian society seduces us from looking at underlying processes and structures that make assertions about egalitarianism in Australia difficult to sustain.

Them's fightin' words I hear you say. So what is the issue? Health! Whose? Yours, mine, everyone's.

If Australians are equal, why do some of our 'mates' have poorer health and reduced quality of life? If a 'mate' is likely to die younger or suffer more illness because of where he lives, his colour, his job or how much his parents earn, are things really equal? Would you like a share in that kind of equality? I think not!

Naaaaah, garbage you say! Australia consistently ranks in the top ten OECD nations on life expectancy and mortality rates due to high living standards, our world class health care system and Medicare. I say in response, don't confuse the issue with facts.

The Senate is reviewing Australia's domestic response to a report: Closing the gap in a generation: Health equity through action on the social determinants of health (WHO, 2008). The report shows that substantial, systematic health inequality can't be attributed solely to individual physiology or behaviour and says that health inequality is both systematic and avoidable. The ACOSS Poverty Report (2011) reported "approximately 2.2 million people, 11% of Australians lived in poverty in 2006 compared with 10% in 2004 and 8% in 1994 ". Poverty means good health isn't shared by all Australians and it's getting worse mate!

Aaaaarrrrggghhh! Who gives a stuff? I'm OK.

Not necessarily. You pay for it. What?

Health inequity costs in two ways. First you have to be healthy to work, cook a barbie after the footy and be smart enough to read a paper to work out who to vote for every three years. If you can't do that because you're sick, or excluded through disadvantage, productivity drops and your slice of the 'Aussie pie of life' shrinks. Secondly, and this is the killer, health inequities are a direct economic cost to us all. That's you and me mate! We pay for it through our taxes. As inequity grows, so does the burden, in billions of dollars, on our health system.

Orright right then, I'm getting sick just thinking about how much tax I pay. How can we fix this whole schemozzle?

Well, Catholic Health (2012) found that if Australia adopted the WHO model of 'health in all policies' then "500,000 Australians could avoid chronic illness; 170,000 extra Australians could enter the workforce, generating $8 billion in extra earnings; saving $4 billion in welfare support payments annually; 60,000 fewer people would be admitted to hospital annually, saving $2.3 billion in hospital expenditure with 5.5 million fewer Medicare services, saving $273 million annually".

Sounds good, lets do it, maybe I'll get a tax cut so I can get that five metre LCD telly I've always wanted.

Well, I said there were two problems. Some Australians still have poor health due to inequality. Oh fer gawds sake, will you ever let up about that? Well I'm a social worker and I do care! Lets talk about the original Aussies. Wot?

Australian Indigenous people. Oh yeah, right!

Indigenous health outcomes are improving right? WRONG! A non-Indigenous male born in 1997-1999 might live for 77 years, an Indigenous male born in the same period might live only 56 years, a 21 year difference. That's equivalent to a non-Indigenous male born over 100 years ago. A non-Indigenous female born in 1997-1999 might live for 83 years, whilst an Indigenous female born in the same period might live only 63 years. That's equivalent to a non-Indigenous female born in the 1920s. How about a 'fair go' for these guys hey?

Yes, well err……

There are differences between rich and poor too. No not that kind, I'm talking about health! Health gradients cut across the whole population. You can get a feel for this thinking about 'excess mortality', defined as the percentage of deaths avoided if all people enjoyed the same mortality rates as the least disadvantaged.

In 1998-2000, excess mortality for males and females aged 25 to 64 years was 29.6% and 20.3% respectively. This equals 19,000 premature deaths attributable to disadvantage.

What a waste!

Ahh, you're starting to get it then? We have to ask ourselves as a nation is this OK or not?

Err yeah, well orrright, what needs to happen then?

Tricky. Health must be seen in wider terms than individual pathology. Increasing our health burden risks losing social capital at a time when social cohesion in our increasingly diverse AND multicultural society is even more essential than in times past.

Changing structural inequality is a big ask. The government could implement the WHO "health in all policies" proposal, that's as good a place to start as any. Planning could address inequality in health, education, housing, early childhood, disability, aged-care, employment, mental health and safe communities. If we're reeeeally smart, interventions will track lifespan stages making the odds of a 'fair go' for Australians a better than even chance.

Oh so that's what's called Closing the Gap? You've got it in one.

The fact is that Australians are not all equal and no amount of belief can say otherwise!