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States of health: health and illness in Australia (3rd edn)
J. George and A. Davis
ISBN: 0-582810-14-0 1998 Addison Wesley Longman
Thea van de Mortel
Associate Lecturer, School of Nursing and Health Care Practices, Southern Cross University, Lismore NSW
This text is a 'must read' for anyone working as a health professional. George and Davis (the latter died prior to publication) engage in a lively discussion of the factors that impact on health and illness in Australia. They look at the organisation of society, patterns of health and illness, and the development of the current medical model and health care system from an historical perspective, and compare the situation in Australia to that seen in other industrialised countries.
The overall premise of the text is that the degree of health or illness experienced by groups within the population as a whole is influenced by social factors such as poverty/wealth, employment and marital status, cultural background and beliefs, and the extent of social networks and supports. During the process of dissecting the current health system and medical approach, the authors offer some eye-opening information on entrenched biases in the health system, which affect both access to health care and the ability of some marginalised groups (including women!) to influence health policy.
Chapters 1 and 2 examine the relationship between social structure and health/illness, and discuss some of the factors that have impacted on rates of illness from an historical perspective. While I have no argument with one of their premises - that many of the improvements in morbidity and mortality that occurred over the last couple of hundred years were related more to improvements in diet and sanitation than to advances in medicine - I think the approach in this section is at times a bit simplistic and overlooks some of the evidence that conflicts with their viewpoint.
To illustrate this point, the suggestion that post-operative survival in the 1800s owed more to better living standards and increased host resistance than newly introduced antiseptic techniques completely ignores the well-documented dramatic declines in mortality obtained by doctors such as Semmelweis who introduced antiseptic procedures into the labour ward. Similarly, the statement that vaccination had little to offer public health as disease rates were declining prior to the introduction of vaccines, disregards more recent sources of information on the efficacy of vaccines such as changes to patterns of Haemophilus influenzae infections in children in Australia following the relatively recent introduction of Hib vaccination. There are also well-documented increases in rates of particular infectious illnesses following the withdrawal of vaccination programs in several countries.
The way in which age, class and ethnicity influence morbidity and mortality in the Australian population is the topic of Chapter 3, while Chapter examines how the current health system has evolved and makes comparisons between our health system and those of other countries. Chapters 5 and 6 discuss the development of the biomedical model of disease from ancient times to the present day and the tensions that have arisen in the health system, respectively. These tensions have occurred as a result of conflicts between the need to rationalise services and contain costs, the desire of doctors to use high-tech, expensive solutions, and the wish of private companies to profit from the vast health-care market.
Chapter 7 examines the development of nursing and its move to professional status, debunking a few common myths about Florence Nightingale along the way. Chapter 8 looks at some of the social factors that influence whether or not an individual consults a doctor, and examines the interactions between doctor and patient. In the following chapter, the authors discuss the difficulties which have arisen for groups such as the chronically ill, the aged and the disabled due to the pressures of economic rationalism, and a shift in focus from chronic to acute illness in the current medical system. This chapter also includes a section on occupational health and safety which reveals frightening statistics on the number of work related injuries, illnesses and deaths per year, and discusses some of the difficulties involved when companies manufacturing a particular product fund the research which is used to set the standards for worker exposure to that product. Its amazing how few politicians and corporate moguls appear to understand the term 'conflict of interest'.
The provision of inadequate or inappropriate services to various groups such as women, the Aboriginal community, the terminally ill, and persons infected with Human Immunodeficiency virus is the topic of discussion in Chapters 10 and 11. The authors draw attention to the disempowerment experienced by these groups due to differences in race, gender and sexuality, and due to the paternalistic approach of many doctors towards their patients. In the final chapter, the authors outline some of the tensions that have arisen due to the ever-increasing costs of health care, and identify some possible solutions to the problem such as directing funds away from curative medicine towards preventative medicine.
Overall, this text is a very interesting read, and excellent value for money. Be warned that it offers an overview of factors affecting health and illness in Australia, rather than a very detailed argument. However, the text is well-referenced, and further recommended reading is suggested at the end of each chapter for those who wish to follow up some point of interest. Highly recommended.
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