Pearls and Irritations

The pandemic has weaponised the argument that individual responsibility for one’s health is best – free from government edicts. This is pathetic.

 One June afternoon in 2013, the Dalai Lama arrived at Sydney’s Westmead Hospital to participate, with about 400 hospital and research institute staff, in a medical ethics seminar. His sense of humour was soon displayed: when he had had his gall bladder removed not long before, he explained with a chuckle, he opted for ‘medication, not meditation.’

 During the Q&A format, he emphasised the importance of each individual’s responsibility for his or her own health – but one question slowed him. Asked if doctors had a responsibility to treat people who had abused their health through smoking, drinking, and overeating, he paused: “I don’t know. You’ll need to work that out!”  But was His Holiness offering sound advice?

 During COVID’s war-like progression, generating confusion and error, a new mantra has emerged: that individual responsibility for one’s health is the way forward – free from government edicts. There is a tension between private and public responsibility. The latter is accomplished through public health regulations and changes in societal behaviour mandated, on expert medical advice, by responsible governments. It is not within the portfolio of individual responsibility.

 COVID is like a game of cricket: the government has batted for a modest first innings using public health measures. They have declared. Their responsibility is over.  After drinks in the shade, it’s up to us – the individual responsibility team – to have a go. Regrettably, our team is uneven in ability. 

 The distribution of Australian deaths reported as due to COVID up to July 31 last year by the Australian Bureau of Statistics (ABS), is uneven.

 The ABS compares the number of deaths in five equal groups or quintiles of the population ranked according to their socio-economic status. One hundred and fifty-five deaths occurred among men in the least privileged quintile – compared with 43 among the most privileged. One hundred and fifty-six deaths occurred among the least privileged women – compared with 40 among the most privileged.

 Studies of vaccination rates by Nicholas Biddle, Ben Edwards, Matthew Gray, and Kate Sollis of the Australian National University show the same strong association with socio-economic status. 

 Before concluding that these gradients are within the power of the individual to modify, we should take account of language differences, income, housing, education, employment, access to medical care and other social factors that differ markedly among the quintiles. They are not under the control of the individual.  Adult health illiteracy in Australia is running at almost 60 per cent and this weakens the ability to make individual health decisions. This cannot be remedied by individual willpower.

 Further concerns about individual responsibility relate to the treatment of Covid cases. The idea of unvaccinated patients paying for care is problematic. 

 The foundation of Medibank/Medicare was that all of us would contribute according to our incomes.  All would then be equally entitled to financial cover. It would not be risk-rated, where those with higher health risks pay more.  It would be universal. Patients with Covid ­– even the unvaccinated – are as entitled as anyone else to Medicare funding.  (The Dalai Llama could not have been expected to know much about Medicare.)

 But Medicare is not a panacea. John Deeble, one of the architects of Medibank and then Medicare, at a seminar on health equity about 25 years ago, insisted that Medicare was only about funding for care.  Nothing more or less.  It does not guarantee uniform outcomes of care, if does not overcome geographic limitations, and does not assure timeliness of care. It was not designed to resolve the inequalities in health and illness related to social and economic advantage beyond alleviating financial pressures on the sick. 

 There is understandable medical and public anger that non-Covid patients in need of timely care are being leapfrogged in hospital queues by unvaccinated Covid patients. These circumstances are indeed unacceptable. They require additional resources to cover the needs of all comers. However, this is a responsibility never fully realised anywhere, other than perhaps, Monaco, but it rests with government in Australia to do its best. Much has been done to supplement services during the pandemic, but more is needed.

 Yes, we should exercise personal responsibility to preserve our own health and that of our family as far as we can. No ethic suggests otherwise.  Beyond that we have responsibility, as citizens, to contribute to the health of all Australians, to support public health measures that keep us all safe, and to endorse government initiatives designed to strengthen the social, economic, and educational circumstances that are the real foundations of good health, with or without COVID on the prowl.

 Time for a second, higher-scoring innings from the government.