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14 May 2019

BY PROFESSOR STEPHEN LEEDER, EMERITIS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY

You will not have been able to escape hearing a lot about the ‘economy’ as you listen to what our major political contestants have to say in the run up to the May election. But there are other versions of ‘economy’ beside the dollar and cent variety.

For example, the term ‘political economy’ captures the rich context in which our financial economy operates and concerns more than financial accounting and management. ‘Political Economy’, according to the University of Sydney Web page, ‘focuses on the links between the economy, society and political interests.’ It encompasses ‘pressing economic issues in the contemporary world, including inequality and economic development, economic crisis and change, and the conflict between economic growth and environmental sustainability’.

Now in the world of political competition for your vote when contestants use phrases such as ‘jobs and growth’ to define their philosophy and intentions, you might not expect to hear much about the political economy because of its complexity. And that is a pity.

But let’s look at health as an election issue. Appropriately, there is concern about access to health care where and when it is needed. The adequate support of Medicare for this purpose is not in question. Efforts to defray the out-of-pocket costs of care, including cancer, are welcome and consistent with the spirit of Medicare in which financial barriers to access to care are removed. Patching up of holes in the fabric of healthcare financing are encouraging. 

But deeper problems exist that fall within the economic basket. These relate to the nature of the disease challenges that we face and what we might do to reduce their occurrence.

Yes, we need to support strongly the medical care arrangements for patients for whom prevention is no longer an option, if it ever was. Dementia is currently in this category. But more generally, especially in relation to heart disease and stroke, we know enough to do better by way of prevention.

I am not writing here about attempts at prevention that leave it to the individual to adopt behaviours that are health promoting but frequently impossible for them. Rather, I am thinking of changes in the environment, the economic arrangements relating to labour, the big-business agenda, globalisation and trade and their impact on how we live our lives. 

Trade arrangements that make cheap rubbish food attractive, urban development that takes no account of the effects of open space deprivation, education systems that favour – without compensation – the wealthy all affect our health. They are elements of the political economy.

Let’s take an example. Coronary heart disease remains a scourge. We now have an armamentarium of drugs, devices, scans, and surgical interventions of proven effectiveness. This requires a good chunk of national treasure to support. Good use of money.

But many studies have shown that the steady progress in reducing deaths from heart attack in prosperous countries (now at least 50 per cent less than at their peaks in the 1950s) are due to a combination of medical care and prevention. However, when you calculate the years of life saved by prevention and care, it turns out that prevention has, proportionally, a much higher yield because the lives saved are those of younger people who have longer to live.

The point about prevention of heart disease is that it requires political action. Without government support tobacco control would not have happened in Australia, and without that heart disease would be a far worse problem than it is today. The traditions of government intervention in pursuit of prevention were established in the first half of the last century, including clean water and immunisation.

What other things could be done in the political economy today to improve health? We hear nothing about new or amplified approaches to abate small particle air pollution (diesel is a major contributor). In this case there is nothing for the individual to do but there is a lot for government and business.

Similarly, with the amounts of added salt and sugar and trans fats in our food, the political nature of the economic decisions that sustain these hazards suggests that political action is needed to remedy these intoxications. We have seen this approach with road trauma where political action has reduced fatalities and serious injury through vehicle design regulation, safer roads and stricter policing of speed, inattention, alcohol and drugs.

We need not confine our thinking about the economy to jobs and growth. Those of us with careers that commit us to seek health gain for our patients and the community should urge our leaders to consider ways their political influence could make for a healthier future.

 

 

 


Published: 14 May 2019