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The Impact of Structured Social Inequalities on Public Health. Printable Version PRINTABLE VERSION
by Marcus Bingemann, Australia May 5, 2002
Health   Opinions
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Since World War II, the health of all Australians has improved with advancements in medicine and changes in individual behaviour. However, the gap between people who have poorer health and those who do not continues to increase due to factors beyond the control of the individual or the formal health system. Between 1983 and 1995, the percentage of people in the lower two income quintiles who suffered more serious illnesses than people in the upper three quintiles increased from 30% to 45% [Walker 2001: pg6]. This poses serious health management issues which are in dire need of resolution.

Health is a multi-factorial subject. Thus a holistic approach that recognises and includes the physical, mental, social, ecological, cultural and spiritual aspects must be applied to management practices. One way in which this can be achieved is by looking at strategies which aim to reduce the structured social inequalities which create health inequities. This encompasses questions of poverty, social isolation and exclusion, education and training, living standards and environments, work and unemployment, access to health services, stress, addiction, nutrition and food, and indigenous infant mortality rates. Moreover, these strategies look at ways of abolishing the social, economic and political boundaries which limit people’s choices and opportunities.

This paper will identify some of the key health inequalities (access, life expectancy, smoking etc) suffered in the Western Sydney area by examining the structured social inequalities (class, gender, policy, ethnicity, education) which create them.Despite claims of Australia being a classless society, socioeconomic status is a key determining factor in the health and well being of its citizens. Depending upon where you are placed in the social hierarchy, access to health care and opportunities to improve your health status differs markedly.

One of the major health inequalities suffered by Sydney’s lower socioeconomic groups - particularly those in the west and southwest - is inequitable access to health care services. This is largely due to lower levels of unemployment, housing and income but locational disadvantage, isolation and exclusion also play a role.

In Auburn and Fairfield, where unemployment rates are up to 16% and median weekly income range between $590 and $650, access to health services are not always accessible [GEOS111 2000: pg20]. This can be shown in the NSW Health Surveys for 1997 and 1998 where up to 10% of people in the Western Sydney (WSHSA) and South Western Sydney Health Service (SWSHSA) Areas expressed difficulties getting health care [NSW Health 2000: access]. In comparison, only 5.7% of people from the Northern Sydney Health Area - which includes both Manly and Ku-ring-gai – reported complications getting health care [NSW Health 2000: access]. Both these places have unemployment rates much lower than 5% and their median weekly income exceeds $900.
NOTE: The figures for “difficulty getting health care” are representative of the LGAs relevant health area, not the individual LGA. So the figures for Manly and Ku-ring-gai are those of the Northern Sydney Area Health Service and the figures for Auburn and Fairfield are those of the Western Sydney Area Health Service and the South Western Sydney Area Health Service respectively. Nonetheless, it still shows the differentials in access by place. The data was collected from NSW Health Surveys and GEOS111 Study guide.

Using this data, we can assume that areas of higher socioeconomic status also have better access to health care services. People who are generally better off financially, have more health care options such as private cover. Additionally, those who can afford private health care are four to seven times more likely to undergo cardiac procedures such as heart bypass surgery than those in the public system [Walkom 2000]. This issue is of particular significance to Sydney’s west as Circulatory disease is one of the major causes of death.
In an ironic kind of sense, the recent collapse of the United Medical Protection Fund (UMP) will mean that people in the higher socioeconomic groups will endure the same pressures as their lower counterparts experience on a regular basis. UMP covers around 90% of the doctors in NSW. Without this safety net, doctors in the private sector will refuse to carry out operations which are not life threatening. Ultimately, this means that those who would normally seek surgery from private health care will now be forced to wait on public lists. Unfortunately, but realistically however, this outcome will only increase the pressures of those lesser off as the demand for public health services will escalate. Coupling this with lack of government funding for public hospitals and the billions of dollars being diverted to prop up the costly private health insurance system, it is easy to speculate some of the problems which could potentially surface.

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Marcus Bingemann

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