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In Australia, health inequalities are caused by a cumber of reasons including social structure and historical division of the society. In Australia, of all the health and health-related issues before the inequality in health is the most politically potent. There is more and more evidence linking a growth in social and in economic inequalities, in the world’s most advanced economies, with increasing inequalities in health. The main differences in health policies exist between aboriginal and urban populations.
In Australia, health inequalities are caused by class location and employment. Low class people are deprived a chance to receive the same health-related services and products as middle and high class citizens. Few Australians believe that their own or their neighbor’s life chances should be reliant on unmodified market forces Indeed it would be difficult to find a majority to support the view that the chances of living a long and healthy life should be allowed to directly map the distribution of incomes or of wealth. More difficult still, should public policies be thought capable of equalizing the chances of living a long and healthy life? Making the distribution of good health more equal than the shares of income going to rich and poor is generally perceived as a good thing and as a job for government (Germov 2002). Nevertheless many Australians (along with their political leaders) also appear to accept, judging by their voting behavior (and campaign strategies), that the distribution of income and of wealth should be — can only be — driven by market forces. Health policies and social policies contingent on explicit and substantial income redistribution, beyond anything that already occurs, are often viewed as unrealistic. Nevertheless those social scientists, who have the most detailed knowledge and greatest interest in health inequalities, continue to produce arguments and provide convincing evidence to show that social and economic inequalities are the strongest and most pervasive influences on the markedly different patterns of morbidity and mortality being experienced by richer and poorer Australians (Eagar et al 2002).
In Australia, aboriginal populations are deprived a chance to access medical institutions and receive quality healthcare. If health is considered to be a universal good, which citizens are entitled to expect their political leaders to pursue with vision and vigor, political leaders — who are in a position to go beyond articulating the general goal of improving the public health — must expect to be called upon to involve themselves in nearly every branch of government (Germov 2002). Political decision makers have good reason to suspect that if they accept a greater role for government, in ameliorating inequalities in health, that it will often be shown — by the magicians with whom they work, epidemiologists and academic health specialists — that their initiatives have failed to take sufficient account of the wider inequalities said to give rise to poorer health and shorter life expectancy in the first place (Lewis 2003).
In Australia, direct assaults on economic inequality are highly contentious and raise politically intractable issues for the state. Social classes may be co-operators but they are also competitors. And it is not just health specialists who claim that social and economic issues are bound together. Economic policy advisors frequently make the same point and often with a different end in mind (Lewis 2003). The development of policy in any one area has become increasingly difficult to divorce from any other. Bean and his colleagues, writing about Australian integration argue that: even though the case for harmonization of social policies has grown stronger, the ability to concert policy developments has weakened. It is the interconnectedness of health inequality with social exclusion and economic inequality and economic growth that accounts for its political potency and for the considerable difficulties that the government encounters as soon as they begin the search for social and economic policies to contain or reduce inequalities. The search for policies capable of reconciling member state’s social and economic goals with those of Australia is likely to prove a difficult and frustrating one. Those differences were assessed to have a profound impact on health. And the differences were said to be capable of being modified, in a great many ways, by public policies. If material differences were reduced it was suggested that it was reasonable to expect inequalities in health to be reduced (Eagar et al 2002).
In Australia, the reference to both upstream and downstream policies and the distinction made between them has considerable significance for low social classes. Upstream policies have a general effect on inequalities and opportunities and are intended to influence social structure and development early in life. Downstream policies are targeted at particular health threats and at those whose health is already thought to have been damaged or about to be damaged. The cost of basic foodstuffs claims a high proportion of poorer household’s incomes. Access to good nutrition is a key factor in good health and particularly significant to poorer households containing children and members with a history of poor health.
In Australia, there is the need for government to explore the relationship between the quality of work, the working environment and the health of the poorest citizens, takes us well into policy-making territory. Unemployment increases the chances of becoming ill and of dying prematurely and also increases the risks of ill-health being experienced by immediate family members, including children. However the most sophisticated theoretical approaches to health inequalities — based on elaborate comparisons of health and social inequalities in the world’s most advanced economies — suggest that governments that are unwilling or unable to countenance extensive income and wealth transfers and substantial changes in the organization and regulation of employment will be unable to reduce inequalities in health (O’Connor-Fleming, 2002). Differences in living standards between populations are not as important, in explaining differences in expectation of life, as differences in living standards within societies. Most of the citizens of a poorer region have the prospect of a longer life than do citizens of a richer country where social and economic divisions are much greater (Germov 2002).
In sum, having demonstrated the close relationship between social and economic inequalities and inequalities in health, in the most objective manner that they could manage, the report’s authors concluded that public policy makers had access to a vast policy armory, upon which they could draw in order to reduce inequalities in health. The message seemed clear: the fruitfulness of the socio-economic model should serve as an inspiration to policy-makers. It should also serve as a warning; no single public policy strategy, to combat social inequalities in health, would suffice. Effective interventions would need to be broadly based and concern with health inequalities would need to shape the whole of economic and social policy. This was a job for the whole of government, not just the national healthcare.
Eagar, K., Grant, P., Lin, V. (2002). Health Planning: Australian Perspectives. Allen & Unwin Academic.
Germov,J.(Ed). (2002). Second Opinion: An Introduction to Health Sociology. Melbourne:Oxford University Press.
Lewis, M. J. (2003). People’s Health: Public Health in Australia, 1788-1950 [Part of two volume set] (Contributions in Medical Studies). Praeger Publishers.
O’Connor-Fleming, M. (2002). Health Promotion: Principles and Practice in the Australian Context. Allen & Unwin Academic.