Cost of social health agenda

COME the revolution: we’ll all be healthy. Mind you a few could die on the way, but what the heck, the important thing is the cause. The cause is the “social determinants of health”, and you are funding it.

The World Health Organisation has convinced many governments worldwide that “social determinants of health are the genesis of many health problems”.

In a submission to a Senate committee earlier this year, established to respond to the WHO report, an enthusiast explained: “Take as an example two people growing up in different communities. One is from the north shore of Sydney, who has educational opportunities, is encouraged by his or her parents, has adequate food and has parents who are not alcoholics.

“Compare that person to the extreme case of somebody growing up in the community of Yuendumu, just out of Alice Springs, where there are not the educational opportunities and encouragement.”

In a stunning insight, our enthusiast concludes “their health outcomes would be very different”.

Health, it appears is not about addressing individual choices any more. Poor dumb fatties are powerless, and only social engineers, posing as the medical profession, can solve this one. Except, of course, they cannot.

Disappointingly, a Senate committee regurgitated the social determinants mantra and recommended that “the government adopt the WHO report and commit to addressing the social determinants of health”.

Charities and government organisations made submissions, hoping to score more public money for their dreams of egalitarianism in health. Indeed, a whole new stream of health promotion (harm prevention) charities, heavily government-funded, live for these reinventions of old problems.

One “recent Australian study” found that by following the WHO prescription:

500,000 Australians could avoid suffering a chronic illness;

170,000 extra Australians could enter the workforce, generating $8 billion in extra earnings;

Annual savings of $4bn in welfare support payments could be made;

60,000 fewer people would need to be admitted to hospital annually, resulting in savings of $2.3bn in hospital expenditure.

People are not pets. Turning residents of Yuendumu into residents of the north shore is not as simple as shifting house or shifting people. These savings are no more realisable from this prescription than they are from scores of other programs that have been addressing the same problems for generations.

Health is a frustrating issue. Every Australian can visit a doctor for free. Having patients turn up is the problem.

Every doctor can advise a patient to change his or her behaviour – “get off your fat bum, stop eating crap, and lay off the grog” – to minimise the risk of disease. Having patients listen is the problem.

While too many Australians are heading for an early death, it does not follow that it is determined by their social surrounds, or that the solution is to change surrounds.

Devout determinists warn that good health is not a simple matter of changing lifestyle. No, life has to be made better in all regards – a marriage, a house, a job, an education, and better transport. What prescription does the GP write? How does the health industry add one iota of useful knowledge about family stability, or the housing market, or the labour market, or schooling?

There have been perhaps three revolutions in health that have contributed mightily to the health of Australians. Medical research, typified by Howard Florey, pharmacologist and pathologist who shared the Nobel Prize in Physiology and Medicine in 1945: engineering, which delivered clean water and sewerage. In Australia, it was stimulated by the definition of ownership of water and rights to water use under the model established by Alfred Deakin’s Victorian Irrigation Act of 1886.

And in sewage treatment, there were many, but a typical candidate was George Stayton, an engineer with the sewerage branch of the Roads and Bridges Department in Sydney who helped develop a sewage farm in 1882. And, access to medicine was further stimulated by universal insurance, with the introduction in 1975 of Medibank, ushered in by the Whitlam government.

Far more modestly, under the Fraser government, came the amiable cartoon character Norm and “Life. Be In It”, which was an example of governments telling people how to live. But social deterministas are playing a much bigger game than lifestyle.

They suggest “early intervention”. In other words, changing people, as if they have no free will. This is the revolution that the revolutions in Russia and China failed to achieve: to make people into those they are not: to stop choices that people make, given their surrounds, their failings and foibles.

Health Minister Peter Dutton should close the door to these lobbyists. A lot of people will die waiting for the social determinants of health revolution to bear fruit. Save your health budget for something useful, no doctor and no patient would notice its absence.