Despite deceitful government spin a report reveals alarming health inequality in Australia

by Peter Brokensha

In March 2005, Health Minister Tony Abbot released a government funded report ‘Health Inequalities in Australia: Mortality‘ with the claim ‘The report shows that the differences in the "all causes" death rates between the least and the most disadvantaged groups have narrowed. ‘The narrowing of the gap in health outcomes between lower and higher socio economic groups testifies to the quality of Australia’s health system.’

This is a blatant misuse of the report’s findings. The report compares inequalities in 1985–87 to 1998–2000 and as one would expect the advances in medicine since 1985–1987 have improved health across all sectors of the community but the difference in mortality rates from all causes between the least disadvantaged group and the most disadvantaged group over that period has increased for both males and females. As the report points out ’for all age groups, males and females in the most disadvantaged areas had significantly higher all-cause death rates and if all groups in the community experienced the same death rate as the least socio economically disadvantaged areas more than 23,000 deaths could have been avoided in 1998–2000.

[In a 2003 paper, Agnes Walker of the National Centre for Epidemiology and Population Health, Australian National University, provided a more alarming result:‘If a policy was implemented which resulted in the lifting of the health status of all Australians to that of the most affluent 20% in the population, then close to one million fewer Australians are estimated to be disabled, over 180,000 life years could be saved, health care costs would be around A$3 billion lower and the government could save close to A$1 billion on disability pension costs.‘]

For specific causes of death in 1998–2000, the most disadvantaged experienced markedly higher mortality rates for: Sudden Infant Death Syndrome (SIDS); conditions arising from the perinatal period; congenital malformations, deformations, and chromosomal abnormalities in newborn babies; accidents and injury; suicide; cancers; diseases of the respiratory, digestive and circulatory systems in the aged (65 years and over); and diabetes mellitus in the aged. The report also found that blue-collar workers, compared to those employed in managerial, administrative and professional areas, ‘experienced significantly higher death rates for all causes and for most specific causes’. The gap was especially marked for deaths due to lung cancer; behavioural disorders resulting from psychoactive substance use; circulatory, respiratory and digestive diseases; accidents and injury; and suicide.

In a November 2004 article, Professor Peter Curson* further outlines the extent of health inequalities, their multiple causes and a suggestion on how the problem could be tackled. ‘During the last 50 years the health of all Australians has improved markedly. Deaths from infectious disease have largely been brought under control, public health campaigns have produced some behavioural and life-style changes, and a reasonably fair and equitable health care system put in place. In international health terms, Australia now ranks highly, with life expectancy and mortality rates among the best in the world.

Despite this, stark health inequalities continue to persist in our society and one wonders how we can sit back complacently when we know that a male Aboriginal can expect to live more than 20 years less than his European counterpart; that Aboriginal infant mortality is at least three times the rate of other Australians; that residents on Sydney’s North Shore can expect to live 3-5 years longer than residents in the Far West of NSW; that death rates for a variety of causes increase progressively with increasing geographical remoteness; and, that significant socio-economic differentials in health and health behaviour continue to persist. But these are not the only disturbing health inequalities to mark 21st century Australia. Our workplaces, for example, are not the safe places we often assume them to be. Today, approximately 2,700 Australians die as a result of injuries or diseases acquired in the course of their employment. This is more than are currently killed on Australian roads. In addition, a further 650,000 suffer from a non-fatal injury or illness acquired at work.

...approximately 2,700 Australians die as a result of injuries or diseases acquired in the course of their employment...

About one in five adults and one in eight children continue to smoke and there are disturbing income differentials in oral health. Such inequalities are striking, and in a wealthy country like Australia, totally unacceptable. Further, they question Australia’s commitment to an equal, free and healthy society.

So what is the solution? Do we shrug our shoulders and say that this health experience is pretty much on a par for all ageing developed countries and that some degree of health inequality will always be a characteristic of a society that allows freedom of choice? Do we argue that such inequalities are outside our control and can simply be attributed to biologic or genetic differences between individuals. Or do we acknowledge that such health disparities are unjust and avoidable and demean our status as a developed nation?

...health inequality is very much a value-laden ethical issue, and depending upon one’s stance, not all health inequalities might be considered unjust or unfair...

One of the basic problems that confronts us is that health inequality is very much a value-laden ethical issue, and depending upon one’s stance, not all health inequalities might be considered unjust or unfair. Some inequalities arise because particular individuals and groups suffer poor health as a result of societal and environmental forces outside their control: For example - overt discrimination, institutionalised neglect, limited access to education, low income and or exposure to environmental or work-based health risks. By comparison, other health inequalities may arise as a result of personal choice - people choosing to engage in risky activities that they are largely free to adopt. Given this, perhaps we need to develop a coherent ethical health policy that defines which health inequalities are unjust and should be addressed.

Recently, the Swedish Government has gone down this road and produced a framework for addressing health inequalities that is largely based on the assumption that health contributes to the basic capabilities that allow people to live the lives they want, and that inequalities in rights, liberties, freedoms, opportunities, income and education are fair and acceptable only if they do not come at a cost to the worse off groups in our society.

What we really need is for Australian governments to follow such a line and develop ethical health inequalities policies that clearly define inequalities that are unjust and unfair and advance policies for redressing such inequities.’

* Professor Peter Curson is Professorial Fellow in Medical Geography and Director Health Studies Program at Macquarie University.