Australia’s HealthCare System (Indigenous Australians and Native Americans)

Inequalities exist due to social determinants:

Within the Australian Health Care System inequalities exist due to the consequences of social determinants. In an attempt to reduce such inequalities, especially amongst indigenous populations, the importance of addressing these social determinants is emphasized. When specifically focusing on diabetes as an issue in both Indigenous Australian and American Indian communities, the determinants of geography, employment and education highly influence health levels. Within Indigenous Australian communities there are various initiatives, dependent on nurses that attempt to bridge inequalities existent between these communities and the general population. Similarly, when comparing the health issues of Indigenous Australians to the Native Indians of America, great insight can be obtained to highlight the successes and failures of the Australian Health Care System.

Indigenous Australians have a larger disparity to non-indigenous Australia:

The social determinants into which Indigenous Australians are born are directly linked to their health status. For Indigenous communities the isolation caused by their geography forms the first significant social determinant influencing their health levels. Because of their remote isolation, there is a substantial disparity in access to health services, compared to the non-indigenous population. Due to the unequal spread of funding across the entire population at Federal and State government levels, these remote communities are excluded from receiving basic access to nurses and general practitioners. In 2002, the Australian Government acknowledged the shortage of medical practitioners with 281 per 100,000 people in rural and remote communities compared to 312 per 100,000 people in more populated areas. Furthermore, as of 2001 78% of Indigenous communities were more than 50km from the nearest hospital and 50% of communities were also more than 25km from the nearest community health center. This clearly shows the inequality that exists due to the social determinant of geography and the disparity in access to basic health services.

Social determinants are the greatest deciding factor in health quality:

The societal conditions, or social determinants of health in which people live directly affect the levels of healthcare they receive. The many factors which essentially decide such social conditions include the environment into which people are born, events of early life, stresses of work and unemployment, social exclusion and support, race and ethnicity, sexual orientation and substance addiction, food, transport and the healthcare system (World Health Organisation, 2013). While these factors directly determine social conditions, the dispersal of wealth, power and resources at global, national and local levels are indirectly critical in establishing the aforementioned social conditions (World Health Organisation, 2013). For Indigenous Australians the seventeen year gap in life expectancy compared to non-Indigenous Australians dramatically emphasizes the social inequalities that lead to disparity in healthcare levels. In his August 2011 article, Michael Marmot emphasized the idea of the social gradient of health, that is, “the lower the social position [of someone] the worse their health [is].” Marmot also provided several key areas which directly apply to Indigenous Australians which determine their position on the social gradient: early childhood development; education and skills development; employment and working conditions; minimum income for healthy living and sustainability of communities (Marmot, 2011). At the 2001 National Census the average household income for Indigenous Australians was just 62% that of the average non-Indigenous household. Furthermore, the unemployment rate of Indigenous Australians at 20% in 2001 was three times higher than non-Indigenous Australians (Australian Bureau of Statistics, 2002). As Marmot outlined such factors determine one’s position on the social gradient and consequently their level of healthcare. Therefore, it is because of the social conditions, or social determinants in which people live that directly affect their level of healthcare.

Rural and remote Australians experience greater disparity in healthcare:

Within the Australian Indigenous population, and especially amongst rural and remote communities, education forms an integral way forward when addressing the health inequalities. Education is fundamental in terms of social determinants and is highly responsible in determining one’s position on the social gradient. Statistics show great disparity in levels of secondary education between Indigenous and non-Indigenous Australians. In 2008, 59% of Indigenous Australians who had year 12 education reported excellent health, compared to just 49% of those without this level of education. A greater disparity emerged within this group of indigenous Australians aged 35 and older; 43% reported excellent health compared to just 25% of those who never completed year 12. This shows that the social determinants of education is directly linked to health outcomes. Education is also critical within the health care system and amongst health care professionals. An increase in nursing education to respond to Indigenous history and culture is fundamental in reducing health inequalities between Indigenous and non-Indigenous Australians. This idea addresses cultural determinants and attempts to lessen racial barriers. It is thought that indigenous Australians consider Western health care culturally inapt and as a result are reluctant to access this form of healthcare. In the year 2000 only 30% of nursing schools had implemented studies of indigenous history, health and culture. This consequently affected indigenous Australians in a way that the majority of nurses have limited insight into the unique needs of indigenous Australians. Obviously, by providing this extra education to health care professionals, such cultural and historical appreciation can be afforded in the practice of health which consequently makes progress in reducing inequalities. According to 2007 report only 0.5% of the total number of nurses were indigenous. By promoting education of indigenous nurses to have a holistic understanding of indigenous health needs, the barriers between indigenous culture and western health care can be bridged. Education is therefore critical within both the indigenous population and amongst health care professionals in reducing health inequalities.

Many projects have been put in place to try and bridge disparities:

In an attempt lessen the health disparity between Indigenous and non-Indigenous Australians in terms of cultural differences, the Yapunyah Project educates nurses in Indigenous history and culture. The Yapunyah Project, designed by the Queensland University of Technology attempts to educate nursing students with emphasis on cultural beliefs and highlights traditional life ways of Indigenous Australians and integrates this knowledge with the practice of health care. A pre-project questionnaire found that just 51% of nursing students understood the concept of culture and its inextricable link to indigenous identity. The project found significant changes in nursing students’ attitudes and understanding of indigenous history and culture. As a result this led to a significant degradation in health inequalities between Indigenous and non-Indigenous Australians when in the care of these nursing students. The Yapunyah project provides a clear example of the benefits of addressing the social determinants of race and education on cultural awareness which consequently reduces the inequalities of health.

Similarly to Indigenous Australians, the Native American Indian population suffers similar health inequalities when compared to the non-indigenous American population. Education within this ethnic group highlights the inequality compared to the non-indigenous populace. In 1992 just 6% of American Indians had a university degree compared to 23% of the white population. According to Marmot (YEAR!) who argues that one’s position on the social gradient, is directly linked to their level of health, American Indians have substantially poorer health than the white population.

The inequalities that exist within the Australian Health Care System are the consequences of the social determinants of health which are incredibly important when attempting to reduce these inequalities. Education is an integral determinant in healthcare in both the Indigenous Australian and American Indian communities. In an attempt to reduce inequalities, the Yapunyah Project provides education to both nurses and indigenous peoples, improving their position on the social gradient and consequently their level of healthcare.


Inequalities of Modern Healthcare

Modern medicine is increasingly influenced by economic interests:

Originally providing a social critique on the capitalist economic structure of the mid-nineteenth century, today Marxist critique mirrors developing trends within modern medicine and the healthcare system.The Marxist model explains an evolving definition of health, as medicine becomes shaped by corporate interests in a highly capitalist society. The movement of healthcare from a local public service to being driven by the intentions of large corporations encourages a social division and inequality between classes.

According to basic Marxist philosophy, healthcare originally facilitated profit-making of other industries by reducing illness that affected productivity. In this capacity the motivations for providing healthcare become blurred with economic prosperity. Originally, as 19th century Harvard University president Charles Elliot wrote, “the objective of research in medicine is to prevent industrial losses due to sickness and untimely death”. The impact that capitalism had on medicine was profound in transforming a profession based on caring for the ill to one driven by economic interests. This significantly altered the definition of health to reflect the motivations of healthcare to support other industries to sustain their profits.

Work Environments are closely linked to health status:

The Marxist perspective furthermore claims that health is closely related to work environments such that unequal social structure should be considered more important to health issues than individual frailty or weakness. While this was largely evident during the rise of capitalism and the industrial revolution, such models reflect modern trends and the impact on health due to class division that modern capitalism causes. In the United Kingdom between 1991 and 1993 the incidence rate of lung cancer was almost five times greater in the unskilled population compared to the professional workforce. As the Marxist perspective explains, capitalism blurred the lines between providing healthcare and maintaining profit so that healthcare becomes related to one’s work environment and therefore social class.

Technology has increased medical capital and with that economic interests dominate:

The rapid evolution of medical knowledge and technology has led to a significant increase in medical capital, obscuring the motivations of administrators in providing healthcare to make profit. From the earliest days of healthcare, physicians could do little more than provide comfort for suffering patients. With little medical infrastructure, small public hospitals which serviced the poor, and charity supported private hospitals provided relatively indiscriminative medical care. Marxist theory explains that with insignificant amounts of money being spent on healthcare at the turn of the century, the business of medicine was not economically lucrative. Because of the lack of infrastructure and investment in medicine, healthcare, although relatively poor at this stage was not socially divisive.

Towards the middle part of the twentieth century an acceleration in medical knowledge and technology saw a rapid increase in medical capital:

By the early 1980s 6.3% of GDP was being spent on healthcare at a cost of $10.8 billion. In Australia today, this has grown to over 9% with over $120 billion being injected into healthcare. With an increasing amount of finance within the medical industry Marxist theory explains that a once charitable and service orientated profession is now shaped by an entrepreneurial mentality. Medical administrators and corporate directors gain unchallenged power which they use to exploit the medical market for further profit. In this situation healthcare becomes a socially divisive service, even in an Australian setting where the public system is not discriminative to who is provided with healthcare, however, healthcare quality still varies amongst social classes. Wealthier citizens who can afford private healthcare have greater control of hospital and doctor choice and have minimal waiting times for elective surgeries. Furthermore, however, there is an argument that with massive amounts of profit flowing to medical practitioners and hospitals, a growing patient distrust has emerged since doctors are now tainted by capitalism and money. While the quality of healthcare may be related to social class, the significant increase in medical capital has seen the definition of health, change universally among social classes to reflect the emerging capitalistic motivations for providing healthcare.

A Medical-Industrial Complex exists between the state and medical industry:

The Marxist model contributes significantly to the explanation of a developing Medical-Industrial Complex where an intricate interplay between governments and the medical industry has a profound effect on the distribution of healthcare. In Australia and similarly in all capitalist countries, both the private and public systems contribute to establishing an entrepreneurial approach to providing healthcare since the state funds in part both systems. All medical equipment and pharmaceuticals are bought by the state from large medical supply and pharmaceutical corporations, therefore contributing to the super profits of these companies. With ever growing profits brings greater power to such corporations who in turn use such to exploit the medical system to gain monopolistic control over this market sector and thus minimizing competition.

Taking patents on all newly developed technologies or drugs eliminates competition and establishes a market monopoly for that product:

This currently occurs through the research and production of drugs to the point that pharmaceutical companies have abandoned the manufacture of certain essential drugs on the basis that they’re not profitable. The American Society of Health Pharmacists (ASHP) reports a critical shortage of a drug called Fluorouracil which treats a variety of cancers.The ASHP attributes this to the fact that manufacturers have simply ceased its production due to its lack of profitability. Drug companies would rather focus their investment on, for example blood pressure drugs which a patient would need to take on a daily basis.

Political motives become increasingly self-interested with a growing medical economy:

With patients forced to spend substantial amounts of money on additional treatments a socially divisive element is introduced where their ability to afford such is determined by their social position. In Australia both state and federal governments have politicized medicine and the healthcare system in return for short term political gain, subsequently altering the medical landscape. With overwhelming and increasing investment in treatment, rather than prevention of illness, governments are able to maintain short term satisfaction with voters. Governments are hardly prepared to make sizable investment in preventative programs which the effects, if even noticed at all, would arise well after their term in government. Since lower social classes experience the greatest susceptibility to disease and illness the lack of preventative measures furthermore makes this a socially divisive issue. A medical – industrial complex contributes significantly to the degradation of the idea of health, as motivations alter.

Consequently, the idea of a medical-industrial complex where the state contributes to the monopolistic tendencies of medical companies exemplifies the Marxist claim that just because medicine is organized as a national system of healthcare it is not necessarily free from capitalist influence.

The effects of capitalism are profound on how we define health and contributes significantly to the evolving motivations for practicing medicine:

In our highly commercialized society medicine has become yet another commodity exploited by large corporations for profit. Because of the economically lucrative nature of medicine, providing healthcare has become a socially divisive yet fundamental need. With increasing medical capital and a developing Medical-Industrial Complex, Marxist theory provides a critique on the exploitative nature of capitalism and its effects on the evolving motivations for providing healthcare for profit.




A serious threat to humanity – the rise of Antibiotic Resistance and the ‘superbug’

The evolution of bacteria is outpacing our ability to research new antibioticsThe single greatest threat to the world’s health care over the coming decade is the rise of the ‘super-bug’:

These are resistant bacteria which are able to withstand antimicrobial medicines including antibiotics, antifungals, antivirals and antimalarials

“Some bacteria are now so resistant that they are virtually untreatable with any of the currently available drugs. If we do not take action to address this threat, humankind will be on the brink of a post antibiotic era, where untreatable and fatal infections become increasingly common” – Simon Prasad and Phillippa Smith, Australian Office of the Chief Scientist.

The Antibiotic era begins: Most people would be at least remotely aware of Alexander Flemming’s discovery of penicillin in 1928 as an antibacterial agent. Although the antimicrobial effects of mold had been known for some time, Flemming’s discovery eventually led to penicillin’s mass production as an antibiotic medicine by the 1940s.

As the name suggests, antibiotics work to kill or destroy bacteria which invades our body. If bacteria infect our body and begin to reproduce, their cumulative effects on our body manifest as symptoms, making us ‘sick’. Although our immune system works overtime to fight off the infection it actually adds to many of the symptoms such as inflammation and makes us feel even sicker. Antibiotics are necessary to kill bacteria and help an immune system in overdrive. Different antibiotic drugs act on certain bacteria in different ways. Certain drugs may inhibit bacteria from converting glucose to energy or may prevent bacteria from building its cell walls. When antibiotics are at work the bacteria will die instead of reproducing. The problem with antibiotic resistant bacteria is that when our body is infected there is no means by which we can rid ourselves of the infection and their reproduction continues uninterrupted to a fatal point.

The over prescription and use of antibiotics has promoted the evolution of resistant bacteria

How do bacteria become resistant to antibiotics?

Bacterial evolution, which has always occurred, is the means by which bacteria may develop resistance to antibiotic drugs. While this is not new, nor is it surprising since all organisms evolve over time, the concern is the pace at which evolutionary changes are occurring. Bacteria may become resistant by receiving genes from already resistant bacteria or may achieve resistance through spontaneous mutations of DNA sequences during reproduction. If this mutation provides a favorable outcome for survival then it is passed on through reproduction to its offspring. The genetic changes that may occur include bacteria forming the ability to:

  • produce chemicals that destroy antibiotics
  • to build protein machinery to pump antibiotics out of the cell
  • make the cell impenetrable by antibiotics
  • modify its appearance so that it is unrecognisable to antibiotics

Staphylococcus Aureus, commonly known as Golden Staph is constantly giving rise to newer forms of the disease which are antibiotic resistant

The misuse of antibiotics prevalent in today’s society is largely responsible for the rising resistance:

Many practitioners prescribe antibiotics for viral infections such as the common cold which provides no physiological benefit except promote the evolution of bacteria. Viruses are non-living particles of genetic material and cannot be killed by antibiotics. Immunizations are essential to protect against many viruses including influenza. With up to date immunizations our immune system can generally fight off viral infections.

Quite alarmingly, a study conducted in 2003 found that 99% of antibiotic prescriptions at a specific hospital’s emergency room where not necessary. While this on some level may be excused due to the nature and necessity for quick medicine in emergency rooms, the over prescription of antibiotics by general practitioners is creating an environment where bacterial evolution is resulting in antibiotic resistance.

The alarming decrease in research for new antibiotics is a critical issue in the rise of antibiotic resistance:

The lucrative nature of drugs other than antibiotics has caused a shift in commitments to other research areas. Some cancer drugs can be sold at as much as $20,000 a course while antibiotics are sold at no more than $20 a course. The commercialisation of healthcare has a seen a dramatic shift in commitments where many companies have completely abandoned their research into antibiotics.

Many antimicrobial products including hand sanitizers, bathroom and household cleaners, soaps, mouthwash, toothpaste and garbage bags also contribute significantly to the rise of an antibacterial resistant era. Most of these bacteria that these products kill are generally good bacteria essentially to building stronger immune systems and maintaining good intestinal function. The tag that these products carry as being antimicrobial is nothing more than an expert advertising ploy to alarm mothers of the health of their children. These products are no more effective at preventing infection within the home than good personal and household hygiene with ordinary soap, warm water and plain detergents.

According to the Director-General of the World Health Organization, Dr Margaret Chan, “a post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”