Australia’s national health system is two-tiered with first, (apparent) universal access to a public system called Medicare (funded by taxes) and second a private system (funded by individuals and their private health insurer). As a health consumer and citizen in a high income country I have benefited from the public system and will continue to do so as citizenship status privileges me over non-citizens for whom accessing health care can be highly problematic.
The Australian health care system includes community-controlled Indigenous health services which are used by many Indigenous Australians. These services deliver locally and coordinate through a national coalition, and also advocate about key issues in Indigenous health. For example, Indigenous Australians experience health issues not often seen in high-income countries, from leprosy, to trachoma, rheumatic fever and otitis media. There is also a major gap between the health of Indigenous Australians and the mainstream population.
Australia’s universal access to health care while benefiting me greatly as a citizen has problematic areas and is not perfect in guaranteeing access. For example, rural, remote and regional communities experience problems accessing the public health system. There are health consumer groups that represent and advocate rural health issues - I was an active member while living in rural Australia but resigned when I moved to a metropolitan area. Other major gaps in accessing health care includes people with disabilities (there is currently a robust Royal Commission investigating and exposing appalling inequities in care for people with disabilities) and the aged (likewise, both national and regional Royal Commissions have helped Australians articulate gross inequities in our health system). There are other groups which are marginalised or alienated from our universal health system, and also under-addressed health issues. For example, dental health is privatised (with a very very small public dental system which is difficult to access), and many allied health services (such as physiotherapy) are privatised and difficult to access for people on low incomes or living in remote areas.
Australia’s health system is highly regulated and monitored, rich with data some of which is available in open and public access through (for example) the Australian Bureau of Statistics and the Australian Institute of Health and Welfare, as well as national government websites. The Australian health care system appears to make quality an explicit issue which is under constant scrutiny and development and which offers opportunities for consumer engagement. As a health activist I have frequently engaged with ongoing reviews of national quality standards – for example, I am a panel member of Australian Health Panel and later this week I will contribute to a structured questionnaire coordinated through the Consumers Health Forum which will allow me to comment on one of eight quality standards - standard 2, Partnering with Consumers. In the past year or so I have contributed (as a citizen and health activist) to the review of and development of other standards - there are eight national service standards. I can do this as a concerned individual directly participating online with structured design features eg a questionnaire: but I have also done this work in concert with my regional health consumers group (The Health Consumers Council of Western Australia, and when living in New South Wales and South Australia, with similar health consumer groups). Participating in regional health consumer groups allows me to enter into rich dialogue and learning with other health consumers and to encourage each other to speak boldly back to powerful interests, to empower our individual effort as well as to act collectively. Likewise, I have been able to contribute to the national reviews through special interest groups such as those found in rural health.
Australia has rich and long history of larrakins and trouble makers, and health consumers can access a wide range of advocacy groups, either geographically based or issue based or profession based, if we wish to become active and engaged health citizens. Some but not all are funded through a variety of mechanisms such as donations and government grants). This consumer activism is an important feature of the Australian health system, and of our national, regional and local culture(s). I have entered this advocacy culture to participate in national, state (regional) and local institutions. I have also participated in special issue groups and professional associations about health issues. For example, in rural health, climate health and women’s health (Australia has a horrendous shadow pandemic - the tragedy of domestic violence), and in professional associations in sociology, public health and health promotion. I offer this personal experience as a reveal of how health advocacy plays a part in the Australian universal health care system - in summary it happens through national, regionnal (state and territories, but also local government) and local institutions (such as my local women’s health centre) but also through special interest groups such as rural health or health justice centres and professional associations such as the Australian Public Health Association and Australian Health Promotions Association as well as unions which have a special program serving international health called APHEDA-Union Aid Abroad. Health consumers - health advocates and the fewer of us who call ourselves health activists - are a vital force in Australian health research (where we often collaborate with health researchers) and in Australian health service review and service delivery. We experience many frustrations and setbacks but I have been inspired by fellow citizens who continue to stand up to vested interests, bureaucracies and technocrats, and advocate doggedly and with courage and with love for our mutual humanity both nationally and globally.
Dr Ann Lawless,
Perth, Western Australia, Australia.
HIFA profile: Ann Lawless is a sociologist and patient representative, currently based in Australia. She has worked in a community health centre as a health worker, has taught health issues at university level including Indigenous health; and has an active and long term interest in health advocacy. She is a member of the HIFA-WHO working group on Learning for quality health services.
Email: lawlesszest AT yahoo.com