Tuesday, 28 June 2016

The need for justice and rights in Australia’s health policy debate

Image via iStock
by Dr Russell Solomon

As a developed country, Australia provides the resources and facilities to ensure that the majority of the population are able to access adequate health care. Generally, other socio-economic determinants of health and wellbeing are also being met in terms of the basics: nutrition, clean drinking water, sanitation and a relatively pollution free environment.

While the health care of the general population is addressed, particularly through Medicare’s bulk billing and a world class hospital system, this is done without any reference to the right to health as found in the UN’s International Covenant on Economic, Social and Cultural Rights which Australia has signed.

There are, in fact, significant gaps when considering the country’s adherence to the UN’s right to health principles of accessibility, availability, acceptability and non-discrimination.

Australia does not have a constitutional guarantee of the right to health nor a federal bill of rights.
The extensive federal and state laws providing for health services are focused on the services that are provided to certain categories of citizens, if not the population as a whole.

They are not framed as rights highlighting the primacy of equality and dignity of patients but as services that can be removed at the will of parliament.

During the current federal election campaign, the Liberal-National Coalition parties and the Labor party are busy arguing about the current freeze on the GP’s Medicare rebate and making various health spending promises to certain parts of the Australian electorate, usually with respect to hospitals or other facilities.

When not in election mode, their principal political focus is, however, around the cost of health care - with each side blaming the other when in government for inefficiencies and waste.

Their debate has been focused more on economic indicators than an improvement in health outcomes, despite the fact that health expenditure at AUD$154.6 billion in 2013-14, was only 9.8 per cent of gross domestic product (GDP) and represented relatively slow expenditure growth.

The Coalition and Labor parties have, in the main, supported the importation of neoliberal ideas into health law and policy when in government as revealed through the increasing privatisation of aspects of the public health system.

Privatisation effectively commodifies health and examples largely supported by both sides of politics include a 30 per cent health insurance taxation rebate, the growth of private hospitals and the cross-subsidisation from the public to the private health system.

Private health insurance enables patients to jump the queue ahead of public patients and access ‘private’ surgeons practising in public hospitals.

The non-discrimination principle is undermined by the private insurance companies’ pre-existing and often restrictive risk conditions, as well as recent attempts by some to encourage certain GP clinics to privilege access to particular health insurance members.

There has also been recent growth in the financial barriers to some specialist services, in terms of out of pocket expenses, as well as the reduction in the level of subsidisation for some pharmaceuticals.

Recent international free trade agreements threaten to place intellectual property rights over patented medicines ahead of Australians’ access to essential medicines.

Australians in rural and remote communities often find adequate health care inaccessible while asylum seekers in offshore detention continue to suffer both physically and mentally through inadequate medical facilities.

Australia’s provision of health care for its indigenous people has fallen below the international standards in terms of almost all the right to health principles, evidenced by an alarming health gap between indigenous and non-indigenous Australians as revealed through a number of chronic ailments and diminished life expectancy (still well over 10 years less for the indigenous population).

While Australians generally see their continued access to a high standard of health care as a matter of ‘fairness’, this vague sentiment does not address accessibility problems (economic or geographical) and the increasing commodification and privatisation of the provision of health care.

For there to be justice in terms of the accessibility to and availability of health care, the national health policy debate needs to go beyond quarrels over the cost and include an awareness of the individual’s right to health and governments’ responsibilities, at both the federal and state levels.

The health of the nation is too important to be framed in terms of the current market-led politics. Where economic arguments can be important and be used to enhance Australia’s adherence to its international right to health obligations is in addressing the longer term economic costs associated with undermining public health care.

Dr Russell Solomon teaches the Master of Justice and Criminology at RMIT University. Russell is passionate about human rights. Russell has teaching interests in human rights and welfare law, advocacy and public policy making. He has published in political economy and human rights. 

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