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Citizens singing a whole new health song

By Stephen Leeder and Anne-Marie Boxall - posted Wednesday, 21 December 2005

The “Vive la revolution!" says a group of over 70 health workers. NSW hospitals need radical surgery because they are unsafe, understaffed and unaffordable, according to the newly established Hospital Reform Group. Maybe, but there is nothing revolutionary about ringing alarm bells about the state of the health system.

In fact, saying the health system is "in crisis" is a theme song for health workers. Everyone knows the words to all the verses, and the chorus too. It's become a classic ballad, remixed every now and again. The Health Care in Crisis ballad was a hit back in 1986, when the (Sydney Morning) Herald ran a story entitled, "Doctors give their treatment for health care ills".

The article described the plummeting standards in NSW hospitals and recommended smaller hospitals be closed. Sounds familiar. In 1991, the song was top of the pops again ("Health crisis as doctors dry up"). And in 1996, it topped the charts again ("Hospitals buckle as flu epidemic strikes"), a version that has a real chance of revival next year.


A revolution in health care is possible but it may take an unpredictable form if the public is consulted. Recent work with citizens' juries in Western Australia, by Professor Gavin Mooney and colleagues, may provide the inspiration.

They invited a cross-section of people, chosen randomly, to participate in citizens' juries and, after educating them on the dilemmas and limitations of the health system, asked them to set priorities for health. Their recommendations were groundbreaking.

Contrary to expectations, they consistently ranked high-tech and high-cost hospital care at the bottom of the list of priorities. Mental health, Aboriginal health and access to community-based health services were ranked at the top.

Citizens' preferences will vary from region to region, but in the juries conducted so far, the priorities have been clear: acute, curative care - no; preventive and chronic community-based care - yes. The public's ideas on the health system are revolutionary and form the basis of a new composition in health care. A song set to these new words would be the anthem we need to replace the clapped-out ballad we have sung for decades.

The verdict of the West Australian citizens' juries is that we need to restructure health-service funding. Most health funding is spent on curing the sick, and only a small portion is spent on preventing people from getting that way. Aside from making little sense, it is the opposite of how citizens' juries say funding should be spent.

Their suggestions would lead to far more than closing hospitals, training more doctors and employing nurse practitioners. An army of nurses, Indigenous health workers, primary care specialists, podiatrists, social workers and many other "allied health staff" would march from hospitals, hit the streets and get people moving, eating well, quitting smoking and participating in their community. Colorectal surgeons and intensive-care specialists would still be needed, of course, but would not be as sought after under the health regime the citizens' juries hope for.


Saying 'No' to new hospitals with the latest MRI machines, keyhole surgery techniques and storerooms full of flu antivirals and 'Yes' to getting healthy, is a bold choice for any community to make. If it is to succeed, the public needs to be intimately involved in reforming the system.

The Hospital Reform Group's recommendations are worthy, but not brave enough. The health system will remain in "crisis" if we continue to see hospitals as the epicentre of health and fail to give chronic disease prevention and treatment a much greater share of the funding. If we do not act, the chart-topper in 20 years' time will still be some old arrangement of Health Care in Crisis. We will all be sick and tired of singing it by then.

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First published in the Sydney Morning Herald on December 14, 2005.

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About the Authors

Stephen Leeder is professor of public health and community medicine at the University of Sydney, and co-director of the Menzies Centre for Health Policy.

Anne-Marie Boxall is a PhD student with the Australian Health Policy Institute at Sydney University.

Other articles by these Authors

All articles by Stephen Leeder
All articles by Anne-Marie Boxall

Creative Commons LicenseThis work is licensed under a Creative Commons License.

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