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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

whither health reform? « Previous | |Next »
October 6, 2009

Is the Rudd Government serious about health reform? By health reform I mean the need for increased investment in primary care. That’s the key to improving health outcomes, access and equity. All the pictures on TV and the press have been about Rudd, Roxon and Elliot having consultations with health professionals in public hospitals. The message is that health equals hospitals.

Isn't that reduction what is supposedly being reformed? Do we interpret the meaning of these carefully prepared images as the Rudd Government is "in the process of retreat from any serious health reform? That health reform becomes the equivalent of sorting out the hospitals?

That is how I am reading the signs. This is what appears to be the case. I am prepared to concede that it may not be--that Rudd and Co will not promise heaps--a revolution ---then deliver very little.

The responses to the promised reforms to primary health care have been interesting. For instance the Institute of Public Affairs (IPA, has argued that the National Preventative Health Taskforce’s report is more or less a grab for more bureaucratic power, and a grab for more tax by government, in that the Taskforce’s report advocates widespread government interference and control over individual choices by the nanny state.

According to the IPA the Preventative Health Taskforce's report argues that people get fat because they eat too much and don't exercise enough. The taskforce's solution -- the government needs to make sure people eat less and exercise more. It is a government shove on how average Australians should live their lives:

the taskforce recommends imposing heavy sin taxes that will increase the price of food, alcohol and cigarettes. But these tax increases are unlikely to have any additional effect on existing taxes, advertising bans and horrific warning labels about the consequences of smoking. They are likely to act as a regressive imposition on the least well-to-do in our community. The only beneficiary is likely to be government coffers. Increasing taxes as a deterrent has a poor record of success.

Australians can make rational, informed decisions and still smoke, eat fast food and binge-drink beyond the technical standard of three glasses of booze without destroying our health, as long as we are encouraged to take responsibility for our lives and should accept the consequences. However, the government is removing choice from individuals and is creating a society where experts determine how we live our lives.

The debate takes place because few in public health think that an exclusive focus on individual food choice or personal responsibility is sufficient to combat the obesity epidemic, any more than it was to combat the epidemic of tobacco-related disease. It is akin to smoking, which was once seen as an individual choice and has has become a major public health issue with a high degree of regulation. Obesity is a political issue as well as a health issue. It is political because the debate is whether the government has a limited role or that it has a significant one.

Supporters of the first view insist that overweight and obesity result from daily lifestyle choices. They believe adults should not only make positive choices for themselves, but also supervise their children in terms of nutrition and physical activity. They feel the government’s role is to provide health information and facilitate behavior changes through the support for education, research, and community-based interventions.

Proponents of a more active government role argue that overweight and obesity result from a complex interplay of behavioral, environmental, and genetic factors, and that the government needs to undertake broad policy initiatives ranging from regulating the food environment and prescribing physical activity and nutrition for children, to supporting urban planning for increased physical activity through transportation and public safety provisions.

The public health approach focuses on population rather than on the individual and it is highlights the power of the food lobby defending its interests, as Big Tobacco did with cigarettes when faced with evidence of tabacco as an addictive carcinogen. The problem of obesity has moved beyond an issue of individual choice to become a societal problem that requires public policy change

| Posted by Gary Sauer-Thompson at 3:12 PM | | Comments (4)


Politically speaking, Rudd doesn't have to do anything about anything right now and won't for a while to come. While the opposition are hogging all the attention for themselves over the ETS, and now Dutton has effectively abandoned his post in search of a safe seat, nobody is going to notice the absence of the health revolution or the education revolution or the intervention revolution or anything else.

The trouble is that the national government and even state governments are singularly ill-suited to participate meaningfully in primary health care, which requires lots and lots of different small community-based facilities rather than the massive regional centres exemplified by teaching hospitals.

We are paying the price for an awful constitutional structure where local government is frequently a joke and usually incapable of being entrusted with something like a health care program. But if it can't be done by autonomous community-based institutions it's unlikely ever to be done well at all.

I read somewhere--here--- that the health benefits of losing weight are largely imaginary; that we are using "health" to advance our class bias in favor of thin people, particularly thin women. We're in the midst of a moral panic over fat, which has transformed the heavier than average into folk devils, to whom all sorts of social ills are ascribed.

If fat people are the problem, then the solution is to get rid of them, by making them thin people.In this culture fatness is a metaphor for poverty, lack of self-control, and other stuff that freaks out the new Puritans all across the ideological spectrum, which is why the war on fat is so ferocious.

"eat well and be active" is a form of governing bodies at a distance by shaping the freedom of citizens by moral prescription about how to live well so that individuals exercise responsibility for disciplining their fat bodies. It is self-management for healthy lifestyles.