Fairer Australia Campaign Public Meeting

Professor Ian Webster AO

Former Director of Population Health in S/W Sydney Area Health Service

I came to South West Sydney to deal with public health and to practice community medicine and to deal with the complex issues of substance abuse, mental illness and physical illness.

We tried to create an environment in which young doctors and other professionals would to be trained - not solely focussed inside hospitals but on the needs of the vast growing and diverse population of that area.

I know the hospitals in the newspapers - Liverpool, Campbelltown and Camden.
I know the problems they deal with and above all I know the people do the best they can to treat the sick and injured and to promote the public's health.
Much of my medical experience has been in public hospitals and in providing medical services for homeless people in Inner Sydney.

When I moved to Liverpool the experience was almost physical, palpable, as I met families, young families, women who could not afford the smart clothes of the rest of Sydney (they had none of the accessories that others wear), with their children, coping with the exigencies of substance abuse and many other problems.

Poverty
In every way these are impoverished lives.
I could describe the epidemiology of this in great detail, but I will only have time to give you some glimpses of that.

So many people of the Western areas (South Western areas) experience poverty in the real way that Amartya Sen, Nobel Prize winning economist, described it.

In the way this famous economist speaks - poverty is the lack of "substantive freedoms - the capabilities to choose a life one has reason to value. " And, as "deprivation of basic capabilities rather than merely as lowness of incomes, which is the standard criterion for the identification of poverty"... "..the approach concentrates on deprivations that are intrinsically important (unlike low income, which is only instrumentally significant).

Poverty in this sense is an oppression from which we should aim to liberate our people.
In a similar way disease and disability oppresses people and limits their freedoms.

For many who come to work in Western and South West Sydney - in medicine and health - our view of what and why we do this is linked with our views of social justice and equity.

Our motivation can best be described in this statement about the purpose of medicine; the purpose of the health system overall.

Evidence of poverty in Western and South Western Sydney
Disease and disability and poverty are the end-points of common pathways. This figure shows that in South West Sydney according to this index that the vast majority of suburbs (postcodes) are poor in the lower levels of this index (SEIFA) whereas in Northern and Eastern Sydney the pattern is exactly the opposite.

This is significant in two respects:
First, disease and disability and injury will be higher and there will be more problems presenting to the health system. Second, it means that all services including health services will be low and stretched in their response to social and health needs.

Communities which lack capacity and capability have high rates of health problems; individuals who lack capabilities - and especially when socially segregated - experience higher rates of disease; and in their turn serious illnesses and diseases and disabilities create problems in communities as the needs for 'welfare' and other resources rise.

Then, their turn health problems are both magnified and new ones created. This figure shows that in the sense of feel well, those with higher socio economic status are more likely to do so compared with those who have low income.

This is a subjective measure, and underestimates the magnitude of differences that really exist. (It is remarkable how people adapt to their level of physical or mental impairments.)

What this means to me is that the solutions, at least for the best part, require - locality, community-based and regional solutions. Not grand plans from on high.

But there is harder evidence.This figure shows death rates which indirectly indicate the incidence and prevalence of disease that are higher in Western and South Western Sydney than areas of Sydney where the population is better off, and of course where there are more services and they are better resourced.

Inadequate health resources
While newspapers and politicians look for scapegoats, and the health system becomes pervaded by fear and mistrust, it is clear that in these outer areas, the staff in health work under great pressure and are poorly supported. Not one of them would not they feel that they could and should have done more!
The professions themselves are to blame as well; their members prefer not to work in areas such as Liverpool and Campbelltown and areas in Western Sydney and Wentworth.

It is remarkable that Campbelltown Hospital, should have to recruit radiologists from South Africa, and emergency physicians from other the US and the UK. In one year Macarthur area had only 10 registrars while St Vincent's Hospital in the inner city had 61.

The loads of work and the demands are just as high, and en masse greater, as in inner city hospitals yet the medical staffing available levels are massively less.These discrepancies are to be found in other health services in western and south western areas of Sydney.

Not only is the capacity to provide services constrained, but also the populations are growing rapidly, and the burden of disease and injury is high.

What is needed!
A fairer health system, a better distributed health system, one that reaches out and engages - through community services, primary health care and general practitioners - to where people live and work and have their being.

The answer does not lie in pristine stainless steel hospitals, for all their importance, as they should be seen as resources to reach out from and from which the travails of the community can be understood.
This requires leadership, passion and a real belief in that "other" person and those "other" people!