In Marriage equality and greyhounds (10 August) I explain why, in my view, there need not be a plebiscite on marriage equality. And in the piece entitled Of mandates and furphies (12 July) I try to explain my irritation at the way our Parliamentary leaders talk about their “mandate” as if those who voted for them explicitly agree with every element of the package their Party took to the election.
My view is that, having won an election, the victor only has one mandate and that is to form government. It still needs to explain, justify and promote specific proposals for change to everyone, rather than taking those things as read and taking the people for granted.
If there is a plebiscite, it is to be hoped – most earnestly – that the process in which we engage is characterised by respect, generosity of spirit and good will, so that Australia’s social cohesion is further enhanced.
One of the issues that will arise is how individual Members and Senators should act once the people of their electorates and State/Territory have had their say. Should they be bound by the majority view of their electorate, in the case of members of the House of Representatives, or by the majority view of their jurisdiction in the case of Senators? Should they be bound by the majority national view? Or should they only be bound by their own individual opinion even if it is contrary to that of the majority of their electors?
Those parliamentarians who choose the last of these three courses might be thought of as using ‘the Bristol defence’, created by Edmund Burke (1729-1797), the man who brought us the T-shirt we have all seen on the streets:
“The only thing necessary for the triumph of evil is for good men to do nothing.”
This and several other of the recorded quotations from the speeches and writings of Edmund Burke (1729-1797) are so familiar as to seem more like aphorisms than quotations from actual statements made by a real person. Added together, they read today like a Manual for Effective Advocacy on Good Causes.
Nobody made a greater mistake than he who did nothing because he could do only a little.
Those who don’t know history are destined to repeat it.
When bad men combine, the good must associate; else they will fall one by one, an unpitied sacrifice in a contemptible struggle.
Our patience will achieve more than our force.
We must all obey the great law of change. It is the most powerful law of nature.
The arrogance of age must submit to be taught by youth.
Frugality is founded on the principal that all riches have limits.
It is not what a lawyer tells me I may do; but what humanity, reason, and justice tell me I ought to do.
There is but one law for all, namely that law which governs all law, the law of our Creator, the law of humanity, justice, equity – the law of nature and of nations.
It is interesting to speculate about how a man capable of such generous and humane statements would view the issues involved in the debate about marriage equality. I would like to think that he would be driven to support marriage equality by one of the three reasons normally given to explain his scepticism about democracy. This can be seen in the context of another of his quotable quotes:
In a democracy, the majority of the citizens is capable of exercising the most cruel oppressions upon the minority.
Specifically he feared that democracy would create a tyranny over unpopular minorities, who would therefore need the protection of the upper classes. It might be said that this has been the position faced by those with a personal stake in seeking marriage equality in Australia.
For the sake of completeness, let us record the other two reasons behind Burke’s lack of trust in democracy. The first was his belief that good government requires a degree of intelligence and breadth of knowledge of the sort that occurred rarely among the common people. (Our current-day leaders frequently remind us about how smart we are as the mugs who elect them.) The second was his fear that “the passions of the common people could be aroused by demagogues, leading to the potential loss of cherished traditions and established religion, and to violence and the confiscation of property”.
It is not surprising that after more than two centuries these reservations seem very dated. However it is worth reminding ourselves that Edmund Burke had a clear understanding of what, these days, would be called the national interest and in this regard was well ahead of his time
Because of its relevance, let’s consider more of the Bristol story and, to enjoy the beauty of the language, let much of it be done in Edmund Burke’s original words.
In 1774, Edmund Burke was elected the Member of Parliament for Bristol, at the time England’s second city – a seat for which there was a real electoral contest.
In May 1778, his constituents – citizens of a great trading city – urged Burke to oppose free trade with Ireland. He resisted, saying:
“If, from this conduct, I shall forfeit their suffrages at an ensuing election, it will stand on record an example to future representatives of the Commons of England, that one man at least had dared to resist the desires of his constituents when his judgment assured him they were wrong”.
This shouldn’t have come as a surprise to the Electors of Bristol. Burke’s thoughts on the matter had been spelled out in his speech to them on 3 November 1774, just after they had elected him!
“Certainly, Gentlemen, it ought to be the happiness and glory of a representative to live in the strictest union, the closest correspondence, and the most unreserved communication with his constituents. Their wishes ought to have great weight with him; their opinions high respect; their business unremitted attention. It is his duty to sacrifice his repose, his pleasure, his satisfactions, to theirs, – and above all, ever, and in all cases, to prefer their interest to his own.
But his unbiased opinion, his mature judgement, his enlightened conscience, he ought not to sacrifice to you, to any man, or to any set of men living. These he does not derive from your pleasure, – no, nor from the law and the Constitution. They are a trust from Providence, for the abuse of which he is deeply answerable. Your representative owes you, not his industry only, but his judgment; and he betrays instead of serving you if he sacrifices it to your opinion.”
“Parliament is not a congress of ambassadors from different and hostile interests; which interests each must maintain, as an agent and advocate, against other agents and advocates; but parliament is a deliberative assembly of one nation, with one interest, that of the whole; where, not local purposes, not local prejudices ought to guide, but the general good, resulting from the general reason of the whole. You choose a member indeed; but when you have chosen him, he is not a member of Bristol, but he is a member of parliament.”
His support for this and other causes that were not popular with the gentlemen of Bristol led to Burke losing his seat in 1780. For the rest of his parliamentary career he represented Malton, a pocket borough under the patronage of the Marquess of Rockingham, leader of the Whig faction.
Current Australian parliamentarians wishing to adopt ‘the Bristol position’ should consider what has changed since 1778 in the relationship between parliamentarians and the people.
And they might also want to consider just one more of the T-shirts designed by Edmund Burke:
“Nothing turns out to be so oppressive as feeble government.”
It’s a big ‘thankyou’ to Anne Cahill Lambert for sharing her holiday snaps and thoughts with those of us who have chosen to follow her on Facebook.
It is a case study in the conversion of a Luddite to an understanding and appreciation of what Facebook is and does.
And it is a demonstration of the joy and potential of vicarious pleasure.
Being informed about the holiday that Anne and Rod have enjoyed over the past 60 days has connected and touched me many times and at a number of levels. It is clear that there are degrees of vicarious pleasure – hot, warm, cool – determined by the extent to which the active person’s observation of a particular place or event reflects or matches the experience of the other – the passive person experiencing things through another.
So, for instance, I gained some limited (or neutral) vicarious pleasure from the pictures and descriptions of my daughter’s trip to Machu Picchu. But having never been there myself, my enjoyment of what I saw through her eyes was limited – more cerebral than emotional.
Anne and Rod, on the other hand, have been to and reported on places with which I have a strong connection. Some of what they have observed and said has reminded me of things that were once dear to me and that had to be left behind as a part of becoming Australian: historic streetscapes, stone walls, green fields and castles.
When Anne was CEO of the Women’s and Children’s Hospitals Association, we shared a tenancy in a building owned by what was then the Australian Hospitals Association. Times were tough: Anne had one half of the broom cupboard, I had the other. It was a close relationship. We were both herding cats, had similar political approaches and fed off each other’s strengths and weaknesses.
Anne then contracted ‘an incurable lung disease’ – which of course she eventually beat, after a huge amount of effort, energy and determination. Her strength of purpose was always an inspiration, whether in her personal travails, as an advocate for oxygen and organ donation, or as a gun for hire on health consumer issues. On winter weekends I sometimes call in on them for a beer after my hockey at Lyneham.
We are close.
Anne just had time before she and Rod left for their holiday to impart the best bits of Retirement 101 in which she lectures, gratis, to anyone who will listen. I have tried to put her lessons into action.
Between 28 June and 24 August Anne posted to Facebook about their holiday 55 times. These posts included 473 photos, 82 of which (17.3 per cent) feature Rod. Only 6 of the 473 (1.3 per cent) include Anne herself. That’s a poor example of the gender agenda.
The earliest highlights include a photo of what Anne describes as “high tech border protection” near Helsinki: a naive and forlorn looking sign standing on a grassy rise with an arrow pointing to ‘Passport control’.
On 4 July there was a photo of both Rod and Anne, with Big Ben in the background, in which Anne is wearing a Gift of Life hat. (She never lets a chance go by!)
Another memorable shot has Mahatma Gandhi watching – with strong approval, surely – a small demonstration close to the Houses of Parliament.
Anne succeeds in embedding her record of where she and Rod are at a particular moment into notable events elsewhere, as with the picture (from a TV) of Andy Murray in the fifth set against Tsonga, “while Wales is playing Portugal in the European cup”.
Manchester’s architecture surprises her, including the impressive facades of Carlton House and the Corn Exchange, and the walkways between the Town Hall and council offices which, to me, look a little like the Bridge of Sighs! “It’s breathtaking looking at buildings that were built hundreds of years before my own city”.
From Manchester, where Alpha worked in a music specialist school just a block from the Cathedral, they go to Edinburgh, where Anne takes stunning shots of and from the castle. Some connections: brother Peter went to university in Edinburgh; Pella and I went to The Fringe Festival; Jonathan and Katrina now live there; Parri passes through with tour groups.
The photographic record Anne takes on board the Royal Yacht Britannia is impressive, with its gorgeous sitting room. From there they went to Greyfriars Bobby at 34 Candlemaker Row, for Rod to continue “eating pies around the UK”.
In York they come across Dame Judi Dench walk. Yes: she was born near York.
Moving south they visit Bob at the Wold Gliding Club, who winters at Benalla. Anne sums up the complexities of the enclosure movement and hundreds of years of the English countryside: “I love the use of hedges to divide paddocks”.
On 16 July: “When you think an old building can’t be any better or worse than you’ve seen elsewhere, then visit Cambridge.” Connection: The uni graduations they interrupted there were only a few days later than the ones in which Scott took part. While in Cambridge Anne and Rod busy themselves “looking for Inspector Morse, DS Lewis and avoiding murder”.
Next evening they saw the Corrs in London at Kew Gardens in London. Tad and I saw the Corrs at the National Folk Festival years ago when they were just starting out.
One of the strongest coincidences is the fact that, in Paris, Anne and Rod came across Le Jardin du Luxembourg (23 July). Our family have stayed several times in a cousin’s unit just across the Boulevard Saint-Michele from the gardens. We all have fond memories of Le Jardin.
The last stage of the Tour de France hit the Champs-Elysées on Sunday 24 July. Were Anne and Rod secretly watching before they set off for Spain?
Rod features heavily in the reports and pictures from San Sebastián between 26 July and 8 August. He represents Australia in the world unicycling championships, and proves to be the 19th fastest (50+ male) in the 800 metres, with a time of 3 minutes 31.9 seconds. He also competes in the hockey and, in the wet, in the 10 km race. Number 301, Rod Lambert “comes home with a wet sail, shirt and shorts”, notes his doting supporter. Connection: Pella spent time in San Sebastián last year.
Then – what a day! – the two of them celebrate their 29th wedding anniversary, still in San Sebastian. There’s a lovely selfie of Anne and Rod – with red wine.
En route back to England Anne is reminded of some of the world’s current realities. “We saw the refugee camp in Calais. Overwhelmingly sad.”
From London they fly to Dublin. More green fields and hedges welcome them. In a pub in Kinsale they catch an ad hoc performance of The Band Played Waltzing Matilda, just a few days after the Pacific Boy Choir show the piece off as their Australian speciality when they perform it during their visit to Canberra.
Back in England, near Windsor on 22 August, we see (at last) a nice portrait of Anne and Rod together. They pass through scenic Bourton-on-the-Water on the way to Cardiff, resist feeding the feckin’ ducks, as requested, and in Cardiff they see the Welsh National Assembly.
Soon they will be back in their refurbished, well-appointed pied–à–terre in Canberra. Anne will want to worry about the Hawks’ form. But we all know that hers will be immaculate. Thank you so much Anne!
This piece was written by gg and published by Croakey during Anti-Poverty Week 2016. It was edited for Croakey by Marie McInerney. Thanks to Marie and Melissa Sweet for the work they do on Croakey and for permission to publish the piece in www.aggravations.org
For people living in rural and remote areas to have a real chance of equal health and equivalent access to health services, more focus is needed from the Federal Government on the urgent need for economic change in those areas.
People in rural communities want to see explicit and meaningful recognition in government programs of their own characteristics and challenges. There are positive signs, including the new Building Better Regions Fund.
The income challenge to good health
Some of the social determinants of health are stronger or better in country areas than in Australia’s capital cities. These include the greater connectedness of people with each other, resulting in a valuable sense of community. There is also easier access to the natural world, a disposition to be independent – and less time spent in traffic jams.
Unfortunately, however, most of the weightier social determinants of wellbeing are tilted against people in rural and remote areas. Most importantly, these include years of completed education[1] and access to work and income.
In 2010-11, wage and salary earners outside Australia’s capital cities earned only 85 per cent of the amount their capital city counterparts earned. The percentage of employed people earning $15,600 or less was 15 per cent higher outside capital cities, while the percentage of employed people earning $78,000 or more was 26 per cent lower.
In 2011-12 the median gross household income in the cities across Australia was 1.37 times higher than for the ‘balance of state’. People in rural and remote areas also experience higher rates of unemployment
These significant income challenges have been exacerbated as the nation’s mining sector has moved from a growth-and-capital-development to a production-only phase. The slowdown in employment opportunities in that sector has naturally been felt most strongly in rural and remote regions.
The government recognises the urgent need to diversify Australia’s economy through the development and growth of newer industries. Much of the focus has been on the loss of manufacturing jobs, the majority of which are in the capital cities and major regional centres. This is perhaps the reason why there seems to have been little focus on the urgency of the need for economic change in rural and remote areas.
This situation will have to change if people in rural and remote areas are to have a real chance of equal health and equivalent access to health services as those in the cities.
A good sign
The Governor General’s speech, given to the opening session of each new Parliament, is supposed to set the agenda for the duly elected government. It is a statement of intentions, formulated by the new administration and delivered by the Queen’s representative.
For people concerned with the wellbeing of Australia’s rural, regional and remote people, it was encouraging to hear Sir Peter Cosgrove include the following in his formal speech:
Regional communities
Cities are crucial, but there are almost eight million Australians living in rural, regional and remote communities. Our regional communities generate 67 per cent of Australia’s export earnings and have untapped growth potential.
My government will tap into that potential with the $200 million Regional Jobs and Investment Package.
The package will support regional communities to invest in and diversify their economies, create new business and innovation opportunities, and help boost jobs in regional areas.
The new Building Better Regions Fund will also provide continued support to regional projects.
The Prime Minister’s emphasis
The Prime Minister has made it clear that an important part of his government’s agenda is to diversify the economy, including through the development and expansion of industries not tied to the export of mineral resources. In working on this agenda the Prime Minister is aided by Assistant Minister for Cities and Digital Transformation Angus Taylor – ironically the member for Parkes, consisting of large parts of southern inland New South Wales – and Minister for Urban Infrastructure Paul Fletcher, the Member for Bradfield, an electorate of just 101 square kilometres.
In a major speech in April the Prime Minister said that “smart cities” would be the engine room of innovation and growth in Australia’s new economy. The aim is to provide jobs closer to people’s homes, more affordable housing, better transport connections and healthy environments.
Regional cities are included in the rhetoric relating to ‘Smart cities’ and Townsville is to be the first to be recognised in a ‘City Deal’ under the Smart Cities Plan. But Townsville has a population of 180,000 and the majority of Australia’s rural, regional and remote people live in places far smaller.
The Government also promotes cities as ‘living laboratories’ for its National Innovation and Science Agenda, including the work of the Digital Transformation Office.
Hopefully the Prime Minister will not forget that the need for economic diversification is arguably stronger in rural than city areas. It is after all in those areas that the bulk of mining and minerals activity occurs.
This underlines the critical role to be played by Senator Fiona Nash in her capacity as Minister for Local Government and Territories, Regional Communications and Regional Development. She will be expected to demonstrate that the Turnbull Government does have a specific agenda of support for rural and remote industries and their people.
The Regional Jobs and Building Better Regions approaches
In this endeavour Senator Nash has two programs from which the agenda can be launched. Both were mentioned in the Governor General’s speech.
The nine regions eligible for the Regional Jobs and Investment Package are all non-metropolitan and have been selected because they have been affected by the slowdown in mining, falling commodity prices and changes to the manufacturing sector – but also have potential for growth.
This emphasis is good. But of course there is just $20-30 million for each of the nine selected regions, to be spent on business innovation grants, local infrastructure projects, and skills and training programs.
The Government’s plans for the Building Better Regions Fund (BBRF) also provide an encouraging signal.
The BBRF is to replace the National Stronger Regions Fund (NSRF). Successful applications to the third and final round of the NSRF have recently been announced, and from the list it is clear that NSRF was primarily for non-metro activity. Only about 15 per cent of the $126 million allocated in that round went to metropolitan areas, including grants to Hurstville and St George in Sydney, Wollongong, South Perth and the Blue Mountains.
But the fact that metropolitan proposals will not be eligible for support under BBRF suggests that the special circumstances and needs of rural and remote areas will be recognised by the Government.
The BBRF will focus exclusively on areas outside the major capital cities. The majority of its funds will still be focused on infrastructure, but there will also be a community investment stream. This will provide an opportunity for small community groups and volunteer organisations to access funding where they can’t contribute matching money themselves. This community stream will help build local leadership and community projects which have previously been ineligible.
Project proposals will compete against other projects of similar size: small projects against small projects, medium against medium, and major infrastructure projects against major infrastructure projects.
These are positive signs. To become meaningful there must be no reduction in the funds available to BBRF relative to the National Stronger Regions Fund it will replace. About $630 million was available through three rounds of the NSRF. And the people of rural areas will be looking for examples of such positive discrimination in other policy areas. They crave some explicit and meaningful recognition of the particular characteristics and relative challenges facing rural people in the communities in which they are fortunate enough to live.
Anti-Poverty Week, 16-22 October
There is another opportunity for all of us to focus on the rural aspects of deprivation in Anti-Poverty Week. It’s a special Week in which all Australians are encouraged to organise or take part in an activity aiming to highlight or overcome issues of poverty and hardship here in Australia or overseas.
It was established in Australia as an expansion of the UN’s annual International Anti-Poverty Day on October 17.
The Principal National Sponsors of Anti-Poverty Week for 2016 are the Brotherhood of St Laurence, the Australian Red Cross, the St Vincent DePaul Society and the University of New South Wales. Much of the Week’s momentum comes from Julian Disney and Jill Lang, Founder and National Coordinator respectively of Anti-Poverty Week.
To get involved in an activity for Anti-Poverty Week in your area, go to http://www.antipovertyweek.org.au/ [1] In 2013 over 75% of children in metropolitan areas completed year 12, compared with just under 70% of children in provincial and remote areas, and only 40% of children in Very remote areas. This and most of the other statistics in this piece are from the NRHA’s wonderful Little Book of Rural Health Numbers.
mandate, noun: 2: the authority to carry out a policy, regarded as given by the electorate to a party or candidate that wins an election.
With the election over, we now move to consideration of the often tetchy issue of who has a mandate to do what, with what and to whom.
The mandate theory of democratic governance has it that a government has both the right and the responsibility to enact the proposals to which it committed in the preceding election campaign. And presumably it’s a winner-takes-all situation in which the margin of an electoral victory has no implication for the mandate supposedly earned.
There are a number of issues with this and a number of ways in which talk of ‘a mandate’ can overreach.
First, it might be interpreted in such a way as to discourage or preclude a new government from changing its mind on something promised during the campaign. The belief that politicians and, in particular, Prime Ministers should never ever change their mind is one of the silliest and most damaging characteristics of government in Australia.
We are familiar with the situation in which, when there is change in the Party occupying the Treasury benches, the new government argues that because it was not in possession of the full details of the financial situation inherited it is unable to meet all the commitments it made. This is an entirely reasonable position to take, with the only possible criticism being that, in the national interest, there ought to be more transparency about the nation’s true financial situation at any given time.
For instance, right here and now, if the Coalition is guided by the apparent widespread opposition to the freezing of Medicare rebates and decides to end the freeze earlier than 1 July 2018, will it be accused of reneging on its mandate? Can it use the mandate argument as a reason for not unfreezing it early?
A reasonable interpretation of the mandate theory is that the Party or Parties that won the election have a general mandate to govern. It is annoying and illogical for a new government to claim a mandate for a swag of specific issues as if, when people cast their vote, they were aware of and supported every single commitment in a particular Party’s platform.
In Government that Party should still engage with the public in explaining and justifying the need for and the fairness of particular new policy proposals, whose existence and details may have remained completely unknown to individuals when they cast their vote.
A third issue relating to a mandate is the relationship between the House of Representatives and the Senate. The Government can claim a mandate on the basis of winning the majority of seats in the Lower House. But the Senate and its individual members can claim a mandate to review – particularly on behalf of the less populous jurisdictions – given the voters’ decision not to give the Government control of the Senate.
This situation is tailor-made for fractiousness and opposition – two features of our system of government we are currently being asked to forego in order to ensure no further deterioration in the nation’s economic future.
And have a care for the position of the Leader of an Opposition after an election. He or she has no mandate from the public but it would be passing strange for someone in their position to provide nothing but support for the Government until the time when the next election is called. The Westminster system relies on there being an Opposition at all times, not just for the duration of an election campaign. Its duty is to provide alternative ways and means of doing government business.
Reference to a global mandate cannot reasonably be used as the rationale for limiting debate and criticism of specific proposals.
Finally, political parties and those who comment on them cannot have it all ways where electoral success or failure is concerned. Either seats are won and lost on the basis of local issues and the qualities of local candidates; or people vote on the basis of the full set of national policies enunciated in a particular Party’s electoral platform; or people are swayed by perceptions of the individuals who lead the major parties.
Of course the reality is that it’s a mix of all three of these things.
This mix and the complexity involved in individuals’ voting decisions should be considered by people using ‘the mandate argument’ as justification for particular policy proposals.
gg
12 July 2016
Aphorism. Meaning: incredulous assertion that one single part of an entity actually has a value greater than has been ascribed to the whole entity and, therefore, that the person making such a valuation must be kidding.
A household or farm clearing sale is an open invitation for everyone who’s always wondered how their neighbour lived – God Rest Their Soul – to check the reality against their prejudicial thinking on the matter.
Capt Gordon George Gregory’s clearing sale at Fordgate Farm was in 1958. Capt Gregory, his wife Flora and their four children had moved to Fordgate from Little Broughton farm, near the Taunton racecourse, in 1946. Gordon’s sightless brother Richard remained at Broughton and could regularly be seen, without reciprocation, milking his cows. On at least one occasion Uncle Dick was found tending the tiles on top of the cowshed roof, and he was said to plant out potatoes in the field in what, to people with sight, was clearly the middle of the night.
For the Gregory boys, Fordgate was a second home, enjoyed in the periods between their 12-weekly stints at Taunton School. It was the base from which Capt Gregory used to travel to the five racecourses at which the ‘system’ which governed his betting on horses apparently worked best. They were Doncaster, Newbury, Alexandra Palace (‘Ally-Pally’), Kempton Park and Goodwood.
Four of these five are relatively close to each other in the south east of England, and Capt Gregory made use of the Southern railway line, joining at Templecombe, between Sherborne and Wincanton, and on the Exeter to London (Waterloo) line.
He and some of his friends sometimes drove, and David recalls going to Goodwood races in a small Standard belonging to one of his racing friends, “who drove and overtook like a maniac”.
There was, incidentally, nothing maniacal about Capt Gregory’s wagering. His system has been referred to, and Peter remembers him as a very disciplined gambler: “sometimes he would travel miles to a racecourse but if the ‘runes’ weren’t right he would not have a single bet”.
Getting from Fordgate to Doncaster was quite a different challenge. This was in the period before motorways had been laid across large swathes of the English countryside. One can only imagine the time and energy it would have taken in his friend’s Standard or in his own Wolseley 4/44 (number plate RFC 5) to drive from Fordgate to Doncaster and, given his propensity while hurtling along to inspect the livestock in fields adjacent to the road, the number of near misses there might have been.
His nearest Mrs, Flora, would stay at home with the Aga cooker, in the large rambling house – several of its rooms unused – comfortable in the knowledge that she was in the bosom of the team of farm workers whose loyalty, by birthright, was to the farm and its proprietor.
I loved Fordgate very dearly and determined to buy it once my fortune had been made. (That hasn’t happened, but the fact that an anagram of its letters is one of my computer passwords attests to the importance of its memory! Another ongoing connection for me is the batting practice on the lawn at Fordgate, with Granny bowling to me underarm, the few remaining fruits of which are now ‘enjoyed’ by the Queanbeyan Razorbacks fifth grade team.)
There must have been many days’ preparation for the clearing sale. When it arrived every item which I had ever seen at any spot around the farm, together with many I had never seen at all, was arranged in separate piles in serried ranks like the regular droppings of some gigantic Beast of the Industrial Revolution. Each little pile was accompanied by a stick in the ground with a number which corresponded to the roneo’d listing of the day’s munificence.
The larger items, such as tractors (some of which were capable of independent motion), ploughs, discs and balers were at one end of the roneo’d sequence, with smaller piles of hand tools of known and mysterious function towards the other. I don’t recall if it was so but I imagine pride of place might have been taken by The Potato Harvester, a device of such huge scope and stature that – when laid up for the non-potato harvesting seasons – provided endless metallic channels and cubbyholes for small boys to play in.
Capt Gregory was an inveterate attender of auctions and the clearing sales of other farmers, and hopelessly incapable of keeping his hands in his pocket when in full view of an auctioneer with a difficult job to do. Thus it was that he used to come home with trailerloads of ‘things’ which were unloaded at some vacant and unsuspecting spot around the farm, there to be ignored until it was time for 1958 and the clearing sale.
I have a distinct memory of one such load arriving one day, with expectations on the part of the driver and – who knows? – perhaps on its own account (but not on Flora’s) that it might one day again amount to something of value. At first sight – and even more so at second and third – it appeared to be a load comprised of striplings of semi-rotten softwood mixed randomly and inextricably with wire and chicken netting. It was not, our father assured us, firewood as we suspected, but a useful and commodious chicken house needing only to be reassembled.
Capt Gregory’s four boys all inherited a gene which gave them a predisposition for creating one-liners which captured the essence of memorable family events (such as running out of petrol; having one of the boys fall out of the car on a bend; skiing uncontrollably; and trying to find new homes for piles of immature industrial archaeology) and then quoting it to undeserved gales of laughter by other members of the family as well as by the teller himself.
Anthony (‘Greg’ to everyone in Australia) gave few words to the sale in the detailed description he wrote of his life from birth to 1970, but nevertheless captured its essence and the one-liner that became associated with it:
It was the ex-US army Dodge that had sat in the bottom yard for 10 years, un-driven and unloved, that made the most impact. It must have been towed by a tractor to take its place in the orderly rows of sundries on offer.
“What am I offered?” came the auctioneer’s usual cry.
” Ten pounds'” came a genuine offer.
“Ten pounds!?” replied the auctioneer in disbelief. Then, striking the vehicle close to the ground with his shooting
-stick: “Look at the tyres: they’re worth more than that on their own!!”
Other family sayings of note included “They know me in the office”, (about petrol in the tank) “There’s enough for another twenty miles”, and “That ‘No Entry’ sign doesn’t mean us”. David has a clear memory of arriving at Cardiff Arms Park for a rugby match against England for which Capt Gregory had no tickets. After he went to ‘the office’ he and David found themselves high up at the end of the old stadium with a fantastic view down the pitch – ideal for appreciating Bleddyn Williams’ jink.
In his book Greg records the fact that his best friend Pete Raw was also permitted to be away from school for the clearing sale, which may have been part of his – Pete’s – inspiration to become a successful auctioneer himself.
Dusk fell over Fordgate. Many of the piles were loaded onto trucks and trailers and pondered away to new homes. And the Home Field – every field in this glorious 300 acres of Somerset had its own name – returned to normal duties. Fordgate Farm from the canal
Not sold that day were the bee hives. A bees’ nest in an elm tree just across the drive from the front lawn had been transferred to a hive, with more hives added to the collection when swarms provided the opportunity. It may be that the last vehicle to leave Fordgate Farm was RFC 5 with a trailer in tow containing the bee hives.
Nobody had thought to close the hives overnight, so when it came time to relocate them they were simply covered with hessian bags and loaded onto the trailer. Capt GG Gregory set off up the lane to North Petherton followed by a mass of bees confronted, like him and his family, with the challenge of a new home address.
Thinks: I’ve been on my right side for quite a while now; it may be time to roll over?
Push knees and feet down to move from foetal to straight position. Hope for no resultant cramp in calf or foot. Begin turning left knee towards the ceiling, followed by right knee. Slowly twist hips and backside. Position right elbow and forearm to take the weight of the trunk, push down hard, using the weight of the head to assist in reaching position in which one is lying on one’s back. Pause for breath. Re-position left knee and leg so that they may fold underneath during the next stage of the turn. Position right forearm and palm of right hand in such a way as to exert maximum force, readying right hand to reach out and pull on edge of mattress mid-way through the turn. Ready; steady: heave. Use weight of head to assist the manoeuvre. Pause for breath. Use right hand to check distance of trunk and legs from the side of the bed. If necessary, push back towards middle of bed to ensure there is little risk of falling put. Push down on the left forearm and hand and on right-hand to adopt semi-sitting position. Force backside a few inches towards the foot of the bed so that, when lying, one’s left shoulder is in the best position vis-a-vis the pillow. At the same time, adjust night shirt so that, when lying down again, it is not crinkled underneath the left side of one’s waist. Using right hand and forearm, allow the trunk to descend slowly from semi-sitting to lying position; test relationship of shoulder and pillow. If further adjustment is needed, repeat three previous manoeuvres. If satisfactory, pull or move left knee towards head, followed by right knee, to adopt foetal position. Adjust and re-adjust relative stance of left and right knees and feet to maximise immediate comfort. Sense precise angle of head and neck and adjust in order to minimise stiffness.
Close eyes. Smile inwardly. Hope for sleep.
Result: The Western Bulldogs beat the Sydney Swans by 89 points (13-11) to 67 (10-7).
Fact: Sting provided the pre-game entertainment – but did not sing Fields of Gold.
History: On 15 May 2013 the Melbourne Age newspaper published an article by Bob Murphy, Western Bulldogs AFL player, entitled The dream that never dies. It began:
The Boston Red Sox baseball franchise in the Major League of America is a famous source of both fascination and inspiration for sport lovers all over the world.
Thrust into prominence in the early 20th century through the heroics of a champion team and Babe Ruth’s charismatic talent, the Red Sox were the hottest ticket around. Inexplicably, they then traded ‘the Babe’ to the New York Yankees, where he won even more championships and established the Yankees as the powerhouse franchise in the world. They remain so to this day and the ‘curse of the great Bambino’ was born.
Between 1918 and 2004 the Red Sox didn’t win a single pennant, despite coming painfully close a few times. That all changed when, 0-3 down in the best-of-seven American League Championships Series (against the Yankees, of course), the Red Sox fought their way back to claim the title, rid themselves of the curse and etch their names into sporting folklore for ever.
ESPN made a documentary on this incredible story simply titled Four Days In October. About four weeks ago I sat down to watch it, and it nearly ripped me in half.
In the final stages of the game, with victory a mere formality, the documentary-makers were able to capture the emotions of the Red Sox players and fans. Generation upon generation of broken hearts came together to cry, to cheer, to hold one another close and live in the world of their dreams.
As I sat watching I couldn’t help but draw the obvious comparisons to me and my Bulldogs.
Fact: On Sunday 2 October 2016, ABC television’s Offsiders began with Gerard Whateley declaring: “It’s a concept so big, in circumstances so far-fetched, as to feel like the stuff of make-believe.”
He referred to a stanza of Bob Murphy’s article: “Generation upon generation of broken hearts came together to cry, to cheer, to hold one another close, and live in the world of their dreams.” The discussion on Offsiders was joined by Caroline Wilson, Roy Masters and Waleed Aly.
Judgement: Gerard said it was “a quest that will be recounted from here until football eternity” – – “just about the best thing you’ve ever seen at the footy”. Caroline agreed: “We’ve seen a woman ride the Melbourne Cup winner, we saw Cathy Freeman at the Sydney Olympics. It was one of those days – one of the greatest afternoons, certainly in Australian football history, and one of the biggest days in Australian sport. It has allowed everyone now to think that they can do something like this.”
Things had conspired against the Western Bulldogs Football Club. The administration of the AFL had tried to merge them, relocate them, and at one stage cut off the club’s funds.
According to Waleed Aly the Bulldogs had had to trade success for survival for so long – selling great players in order to stay afloat financially. Roy Masters – vastly experienced in Australia’s sports sector and a delightful wordsmith – said he had been fascinated by the physical difference between the two teams in the final. Whereas so much of the preparation of football teams these days is based on science, metrics and method, this had been “just a desperate physical struggle – humans v computers. – – You could see the enterprise, enthusiasm and fitness of the Bulldogs and you could see the physical degeneration of the Swans.”
Folklore: The signature moment of the day happened on the podium when Bulldogs coach Luke Beveridge called for his injured captain, Bob Murphy, sometime Age correspondent, and put the medal around his neck – – a moment that “instantly became part of Australian sporting folklore”.
Caroline Wilson noted that most of the 99,981 people present had stayed for the presentations. “The Swans and their fans had been reduced to a bit player by the last 5-10 minutes, and yet everybody stayed – even those who were mourning needed to see this.”
Achievement awards:
Tom Boyd for provig his critics wrong.
Liam Picken, whose father Billy played in four losing grand finals for Collingwood.
Jason Johannisen won the Norm Smith Medal for ‘Best on Ground’.
Josh Kennedy, in a losing side, played (in the second) “one of the great Grand Final quarters”.
Dale Morris, including for a tackle on Buddy Franklin that led to a Bulldogs goal, and who was under an injury cloud during the finals series.
Club Chairman Peter Gordon, Luke Beveridge and Bob Murphy for building and operating a winning human culture.
Gerard Whateley, for consistently providing terrific sports journalism.
Villain: the goal that was overturned unilaterally by someone upstairs using “the appalling intervention of flawed technology” (Gerard). However, as Roy pointed out, the conceit of technology was trumped “when humanity came back – with the Bulldogs kicking the next goal straight afterwards”.
The Swans: Must be more shattered than two years ago (when they were trounced by Hawthorn). “It will be a long way to come back; it’s a game they thought they should have won.”
Wrapping up: “This year, every final was won by the less experienced team – we may never see this again.”
In anticipation of the ARL Grand Final in Sydney, Gerard said: “If you believe in symmetry, if you believe in omens, then the fates have tipped the way of the Sharks.”
So the porch light can now be turned off. Harold isn’t coming home – but the Sharks are.
No-one in their right mind would disagree with the proposition that it is better to prevent illness than to manage it. Why, then, is there not a stronger and more pervasive demand from the public for governments to shape their investment in health to match this commonsense approach?
Part of the answer lies in the language used – the imprecise and varied ways in which the prevention of illness is described and considered.
For there to be a consensus on the matter, there needs to be clarity and shared understanding about what is entailed. Language is important if agreement is to be reached and expressed by both those directly involved in the health sector and other members of the public.
It does not help to have discussions built haphazardly around terms as loose and diverse as ‘illness prevention’, ‘health promotion’, ‘preventive’ or ‘preventative health’, ‘public health’, ‘preventive medicine’, ‘preventable illness’ or (most nonsensically of all) ‘health prevention’.
So the first thing that could be done to increase support for the cause would be for everyone who writes and speaks about it to be more careful with the terms used.
From a semantic point of view, ‘health promotion’ and ‘illness prevention’ seem to be synonymous. It’s a zero sum game: the more health, the less illness. This should be the focus of efforts in the sector.
(I propose a plebiscite on which of the two terms is preferable. Its result would be binding on everyone who works, thinks, talks and writes on the matter.)
Both health promotion and illness prevention are processes through which people are enabled to increase control over, and to improve, their health. The terms encompass a wide range of social and environmental interventions by governments and other agencies, as well as individual behaviours and their modification.
‘Preventive medicine’ is a useful term, but professionally narrow. It means work by medical practitioners at the individual, community or population level to protect, promote and maintain health and wellbeing by preventing disease, disability and death.
‘Public health’ and ‘population health’ really have no place in this particular lexicon. ‘Health promotion’ and ‘illness prevention’ are high order (or collective) terms for a wide range of actions with the same purpose: to keep people healthy. In contrast, ‘public health’ and ‘population health’ are methods or approaches, within the health domain, through which interventions can be effected. The former means the health of the population as a whole, especially as monitored, regulated and promoted by the state. The latter is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.
This piece is not about to dignify, through discussion, the terms ‘preventive health’, or worse still, ‘health prevention’.
The relationship between these entities can be illustrated through both their accurate and inaccurate usage.
“The fluoridation of drinking water is a public health measure through which people’s (oral) health is promoted and (oral) illness prevented.”
“Ante-natal care is a population health measure (for pregnant women and their partners) through which their health and that of their babies can be promoted.”
In his address at the National Press Club on 17 August, Michael Gannon, President of the Australian Medical Association, said that people can be kept well and out of hospital “by greater investment upstream in public health prevention”.
And after a summary of Australia’s world-leading work on reducing the rates of smoking, Dr Gannon said: “We are a world leader in this area of health prevention”
Such slips of the cursor are not helpful to public understanding or support.
Given the more precise use of terms suggested, what can be said about Australia’s position on the matter?
The Australian Institute of Health and Welfare has reported that, in 2011-12, 1.7 per cent of total health expenditure went to public health activities, which included prevention, protection, and promotion. And according to the Prevention 1st Alliance that was active during the Federal Election Campaign, this proportion has been falling.
The Australian National Preventive Health Agency was abolished in the 2014-15 Budget, as well as the National Partnership Agreement on Preventive Health. Savings of $368 million over four years were transferred to the Medical Research Future Fund.
These cuts jeopardised initiatives such as community healthy lifestyle programs like the Heart Foundation’s walking groups and the Diabetes Council’s BEAT IT program; Healthy Children, which provided funding to states and territories to run physical activity and healthy eating programs for children in schools, early childhood centres and preschools; and Healthy Workers, which funded workplace programs on healthy eating, physical activity, smoking cessation and reducing harmful levels of alcohol consumption.
It is not clear what leadership and other resources are now being invested in these and similar endeavours by the Department of Health.
Australia’s 1.7 per cent on health promotion compares with New Zealand’s 6.4 per cent and Canada’s 5.9 per cent.
The OECD estimates that about half of all premature deaths are attributable to preventable behaviours, such as tobacco smoking and excessive alcohol consumption. Type 2 diabetes and cardiovascular diseases are also largely preventable, as are many forms of cancer.
The failure to invest adequately in health promotion is part of the reason for continued increases in the prevalence of obesity. Australia faces the prospect that the current generation aged 60-plus will have a higher average life expectancy than their children.
Being high order terms, health promotion and illness prevention activities take place in multiple settings, and through a range of policies: educational, social, economic, cultural, housing, environmental, transport etc.
Place is an important determinant of the prevalence of the health risk factors through which health promotion and illness prevention operate. One of the main ways in which health promotion is effected is through behaviour change. This means that the design and operation of health promotion interventions have to account for differences in the dynamics of behavioural change between groups of people in particular places, demographic groups, health condition groups, and economic or social circumstances.
A greater proportion of people in rural and remote areas are daily smokers than is the case for those in metropolitan areas. The extent to which this is due to the lower success rate of quit-smoking campaigns, as distinct from other causes, is unclear. But it is a very serious matter where the prevalence of poor health is concerned. And however important a contributor they are, there needs to be a better understanding of the effectiveness of health promotion campaigns in rural areas relating to the use of tobacco.
As can be seen, there is a great deal to be considered where health promotion is concerned.
The work should be informed by clear and consistent use of terms. This will help the public to appreciate the importance of insisting that more is invested.
And governments can be made accountable for their action and inaction on the best way to reshape the overall system so that it can be more concerned with health than with illness.
Editor: Dr Ruth Armstrong. Author: Gordon Gregory on August 17, 2016. In Croakey longreads.
In his post last week at Croakey, Gordon Gregory flagged the tremendous opportunities open to the Hon Dr David Gillespie, MP, in his new role as Assistant Minister for Rural Health – an area in which leadership and support is sorely needed.
In a longer article below Gregory, who recently retired after 23 years of heading up the NRHA, expands on this concept with an even dozen agenda items for the Minister, including a helpful guide to his key collaborators for success: his fellow ministers, along with those work and live in rural Australia. Gordon Gregory writes:
In an earlier article, I discussed the potential roles of the new Assistant Minister for Rural Health, Dr David Gillespie, in expanding the Rural Generalist Pathway and developing the role of the Commissioner for Rural Health.
But if his work in this portfolio is to improve significantly the health of rural and remote-living Australians, the Minister’s agenda needs to be much fuller. Here I outline twelve further items for consideration.
1. The Minister for Rural Health should lead a whole-of-government approach to rural health
As a health practitioner from a non-metropolitan region, David Gillespie is well qualified to understand the realities of health and health services in rural and remote areas.
He will have been a close observer of the well-known health service deficits borne by rural people, including the relatively poor access to health professionals, particularly those in more specialised disciplines. He will also be aware of the logistical and financial access difficulties that long distances create for consumers.
He will understand the increased prevalence of health risk factors in rural areas, such as smoking, excessive drinking, food insecurity and insufficient physical activity.
Other predisposing factors relating to poorer health will also be well-known to Dr Gillespie: the overall situation in which rural people have lower incomes, fewer years of completed education, and higher rates of deprivation, including unemployment, disability and poverty.
Alongside this, the Minister will be aware of the advantages of rural life, such as an often enhanced sense of community, which provides the basis for teamwork and collaboration between and among health and other professionals. These less tangible benefits of rural life are evidenced in reports of greater overall ‘happiness’ revealed by rural people in surveys on the issue. (See, for example, the University of Melbourne’s Household, Income and Labour Dynamics Survey (HILDA), 2015.)
The purpose of my very brief reiteration of what might be called ‘the rural syndrome’ is to emphasise the potential value of Dr Gillespie working with and through his Ministerial colleagues to secure a more-joined-up approach to rural health challenges. Some of the best investments in improved rural health would come from close and ongoing liaison – and collaborative action – between portfolios responsible for all of the social determinants.
This collaborative action would see the Minister for Rural Health working closely with colleagues in several other portfolios: Nigel Scullion (Minister for Indigenous Affairs); Michaelia Cash (in her capacity as Minister for Women); Fiona Nash (now Minister for Regional Development and Regional Communications); his portfolio colleague Ken Wyatt (Assistant Minister for Health and Aged Care); Jane Prentice (relating to disability services); Zed Seselja (multicultural affairs); and Karen Andrews (in relation to her responsibility for vocational education and skills).
Building bridges for a joined-up approach
2. The health of Aboriginal and Torres Strait Islander peoples
Everyone understands that Closing the Gap in health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians requires improvements in the social and cultural determinants of health and wellbeing – which lie outside the health sector.
So perhaps the greatest contribution David Gillespie can make to improved Indigenous health in rural and remote areas will come from collaborating closely with Indigenous Affairs Minister, Nigel Scullion, to ensure that the information on issues relating to Aboriginal and Torres Strait Islander health provided to both Ministers, and to Cabinet, comprehends the need for different approaches to Indigenous people’s wellbeing in city, regional, rural and remote areas.
Where Indigenous health is concerned, as with so much else, there are different priorities and circumstances in different settings. Once public servants in their respective agencies see their Ministers in close collaboration, day-to-day cooperation at agency level will more readily follow.
Dr Gillespie will need his senior Minister’s support for such inter-departmental work – support which Health Minister Sussan Ley, given her close understanding of rural areas, will presumably provide.
An example of a proposal on which Ministers Gillespie and Scullion could act is eye health among Aboriginal and Torres Strait Islander people. Over 90 per cent of vision loss in Aboriginal communities is preventable or treatable, and a federally funded subsidised spectacle scheme for rural and remote areas (including for their Aboriginal and Torres Strait Islander people) would have positive social and economic returns.
3. Action is needed on rural mental health – and the report from the Mental Health Commission has described some of the best bets.
Given the high burden of mental illness (including suicide) in rural and remote areas and the shortage of specialised mental health workers, greater flexibility is needed in existing funding streams, enabling localised solutions for local needs and contexts.
In its report, the Mental Health Commission proposed the establishment of 12 regions across Australia as the first step in the introduction of comprehensive, whole-of-community approaches to suicide prevention.
It is very welcome that the first two of these trial sites are in North Queensland and WA’s Kimberley region, recognising the over-representation of suicide rates in remote and Indigenous communities such as the Kimberley, where the age-adjusted rate of suicide is more than six times the national average.
The North Queensland site is to give special attention to defence force personnel. If other sites are to have a specific population focus, one to be considered might be child and adolescent mental health. The shortage of specialists means that screening and early intervention for mental health conditions among children in rural areas often does not happen.
A whole-of-government approach to child and adolescent mental health will help to ensure that the evolving National Disability Insurance Scheme deals appropriately with children with complex psychosocial needs.
4. Supporting the work of Primary Health Networks (PHNs) that include large rural and remote areas
To be effective, PHNs with rural and remote populations and large geographic areas have to work differently from their metropolitan counterparts. They face a number of extra challenges but, on the positive side, they can demonstrate the practicability and effectiveness of working collaboratively across disability and aged care services, acute and primary care, preventive health, education and Indigenous affairs.
Another positive thing for rural and remote PHNs is that non-traditional organisational partnerships and innovative measures like funds pooling are more likely to be permitted and workable than in urban contexts.
The relationship between PHNs in rural areas, and hospitals, Multi-Purpose Services and Aboriginal Community Controlled Health Services can reflect the natural ‘closeness’ or visibility of agencies in rural communities and the fact that many of the same professionals are involved across multiple settings.
The work that Dr Gillespie can lead could help demonstrate the value of PHNs as the new architecture for co-ordinated primary care.
www.alexstemmer.com
5. Optimising the benefits for rural people of ‘Consumer Directed Care’ in the aged and disability sectors
Both the aged care and the disability care sectors are emerging from transformations driven by the principles of Consumer Directed Care (CDC). Some developments have not been clear to all parties, resulting in uncertainty on the ground, especially in areas where information is less readily available.
This time of considerable flux provides an opportunity to ensure that policies and programs for aged and disability care are joined up – as they need to be in rural areas – rather than separate entities, and that close practical relationships are also developed with the National Disability Insurance Scheme (NDIS).
Collaboration in workforce recruitment, retention and support has the capacity to increase the number of funded positions for health staff. This can increase the availability of allied health professionals, essential contributors to the NDIS.
6. Rural and remote health research
Many people in the rural and remote health sector believe that research in their areas of interest receives nothing like its fair share. For example, Lesley Barclay and others have calculated that research undertaken on rural health and by people in rural areas accounts for less than 5 per cent of the total funded by NHMRC.
This raises the issue of the relative effectiveness of good research of a national nature which includes consideration of rural and remote issues, as distinct from good research on rural and remote issues, undertaken by rural people, and undertaken in rural and remote areas.
As Minister for Rural Health, David Gillespie will have a natural interest in the means by which evidence relating to rural and remote health becomes available. The national context for this is quite alarming. Funding for research on several fronts has suffered. The timing of these cuts could not be worse, as the greatest need for evidence arises when new money is scarce, and choices have to be made about which service systems and approaches work best.
Without data, it is impossible to evaluate progress towards targets or know the effectiveness of various programs. The national data agencies do valuable work and undertake a pleasing amount of analysis comparing results by remoteness. This is a resource which the Minister needs to protect. (The Minister is providing the opening address to the 5th Rural and Remote Health Scientific Symposium in Canberra, 6-7 September 2016.)
7. Connectivity in hard-to-service areas – and its importance for health services
Given their National Party affiliations, there will be a particularly close working relationship between Fiona Nash in her role as Regional Communications Minister and David Gillespie as Rural Health Minister. This could potentially be valuable for people living in rural and remote areas, as fast, reliable and affordable digital access is an urgent and essential priority for business, schooling, professional training and recreational purposes – as well as for services such as telehealth.
It is to be hoped that the Turnbull Government will map out a remote digital inclusion framework and telecommunications strategy to ensure that remote and rural Australians can effectively participate in the global digital economy. For too long, various national telecommunications infrastructure initiatives have focused on the 95 per cent of the population who are, at least in a technical sense, relatively easy to service.
Minister Gillespie will ideally be involved with Fiona Nash’s work on regional communications, not merely as an observer but as someone whose portfolio interests will inform progress. Dr Gillespie should commission the Department of Health to undertake a review of how telehealth programs can be extended and improved.
8. Food (in)security
The National Rural Health Alliance (NRHA) has recently completed a study of food security, funded by the Rural Industries Research and Development Corporation (RIRDC) (publication forthcoming through RIRDC and the NRHA). It is alarming to know that in a nation as wealthy as Australia, and one which is a net exporter of food, there are people who experience food security from time to time and some, indeed, who regularly cannot access the food they need for a healthy diet.
It is to be hoped that Dr Gillespie will consider acting on the major proposal in the forthcoming RIRDC/NRHA report. This is that coordinated action to address food security nationally should begin with the development of a National Food Security Strategy. It would consider every aspect of food production, distribution, pricing, storage and preparation – all of which pose particular challenges in more remote areas.
9. The rural and remote health workforce
A significant proportion of the resources of the Department of Health is devoted to health workforce issues. The gold medal in these considerations goes to the medical workforce, with nursing interests winning silver and allied health bronze.
There can be no argument with the proposition that the Australian Department of Health has a particular interest in and responsibility for medical matters. However, as Dr Gillespie will understand, providing effective rural health care depends on all members of the health professional team. As Minister for Rural Health he can play a leading role in ensuring that nursing, dental and allied health interests are appropriately considered in the Department’s work.
One specific matter for his early attention should be the question of rural and remote health scholarships. The Government decided some time ago to recast these. It is critical that these scholarships remain in place, whatever changes are effected to their management or administration.
The role of the Rural Health Commissioner, discussed in an earlier piece for Croakey, will be a critical adjunct to the Minister’s leadership on broad-based health workforce issues.
10. Medicare and more remote areas
The recent election campaign provided compelling evidence of the central role played in Australia’s health system by Medicare. It has such immense political cachet that no one seems to be brave enough to remind governments that, however good it is, Medicare is only useful to those people who can and do visit a doctor. Dr Gillespie might commission his Department to update the size of the rural Medicare deficit, estimated to be $2.1 billion in 2006-07.
Despite the fact that, in aggregate, Australia is almost certainly over-doctored, there are still some people who cannot access a doctor, either through geography or financial means. Dr Gillespie will probably be astonished (but nevertheless convinced!) that data from different sources on just how much ‘doctoring’ is done in rural and remote areas are so varied that the actual situation is still not clear.
It is also to be hoped that the Medicare Benefits Schedule (MBS) Review Taskforce has come up with some good ideas for their Ministers to consider about how access to Medicare funded services in rural and remote areas can be expanded.
11. Child health
The Caring for Country Kids Conference was held in Alice Springs in April 2016. Given the appalling treatment of certain young people in the Northern Territory that has become clearly known since then, one of the outcomes from that Conference now assumes quite a different character.
The organisations that convened the Conference, the NRHA and Children’s Healthcare Australasia (CHA), agreed “to progress both individually and jointly with the aim of raising the profile of child health care in Australia and dramatically improving our national capacity to understand what needs to be done and to act on it”.
A series of recommendations was generated from the Caring for Country Kids conference which, between them, could become the centrepieces of a strategic plan for child health in Australia. They include the formation of a coalition of child and youth health and wellbeing expert bodies to drive national investment in the early years as the most evidence-based way of improving child, youth and wider community health.
Other important elements of such a strategic plan should include a focus on child and adolescent mental health within the National Mental Health Plan; and a platform to bring together data collected in different agencies to analyse and report on child and youth health and wellbeing, including issues relating to family violence, self-harm and suicide.
12. Support from the National Rural Health Alliance
Across this broad agenda Dr Gillespie can call on support and advice from the National Rural Health Alliance (NRHA). The NRHA’s ongoing challenge is to be active in all these areas, giving it the unique capacity to represent the complexity, the inter-relationships, and the social and economic determinants which are the reality of rural and remote health and wellbeing.
There are many different voices in Australia’s rural and remote health sector and the NRHA’s purpose is to bring them together in order to strengthen the general case for governments to prioritise improvements in rural and remote health and health services.
Working on such a broad agenda is always difficult and it is sometimes tempting – oh for a simple life! – for the NRHA to focus on a small number of issues at the expense of the whole. This is a temptation the NRHA must resist.
The detailed research and evidence can be provided by its member bodies (currently numbering 38) or by mainstream rural research bodies. But the NRHA is the only body charged with the task of representing the shared interests of all those professions and other organisations that serve the people of rural and remote Australia.
An industrious approach to this work will see detailed understandings from research undertaken by its member bodies on issues of importance to them, being combined with the breadth of understanding of the whole organisation – and especially its consumers. This will enable the NRHA to support David Gillespie effectively in what is intrinsically challenging work.
*Gordon Gregory is the recently retired CEO of the National Rural Health Alliance. Follow him on twitter @gnfg.
Published in gg’s blogg on 22 July 2016
The Australian Government’s hands-off approach to the loss of manufacturing industries fails to account for the fact that structural change is a cause of increased income inequality. Its approach to industry support will have to be one of the early considerations of the Turnbull Government, encouraged by the Nick Xenophon team and others who are described in some quarters as nothing more than a fresh wave of populist and protectionist upper-house crossbenchers.
Reliable agencies as diverse and independent as the Reserve Bank of Australia (RBA), the Productivity Commission (PC) and the Australian Council of Social Service (ACOSS) have published data showing that inequality in the distribution of income and assets in Australia is increasing.
The RBA demonstrates that this has less to do with household characteristics (age, years of completed education, family status) than with what it calls ‘income shocks’, such as being laid off and being unemployed for a long period.
The link between increased income inequality and structural change in the economy is one that seems to have gone largely unnoticed.
The post to this blogg of 22 July 2016 (Structural change in the Australian economy) argued that the standard response of both sides of politics to structural change in the economy has, for many years, been ‘Let the market rule’. What drives the market is an industry’s unsubsidised current and future cost of production – in Australia compared with overseas, or in Adelaide compared with Brisbane – and the price its products can command. If an industry fails on these counts it is unsustainable and is likely to be written off by government.
A more complete analysis of the effects of not supporting an existing industry in Australia would include consideration of where (and how soon) employees laid off could expect to find work, and the impact on the national distribution of income of the ‘shock’ displaced workers will experience.
This more complete analysis of industrial closures is being sought by Nick Xenophon and his team, as well as a number of others. This has been described in the press as ”a fresh wave of populist and protectionist upper-house crossbenchers”.
National analysis of the pros and cons of industry subsidies should include an understanding of the dynamics of employment and unemployment. We need to know what proportion of those who are unemployed were laid off from a declining industry, the proportion laid off from an industry that is still employing workers, and the proportion who have never had a job. The best policy prescriptions for each of these groups may be quite distinct.
In the case of the first group, some sort of industry intervention to maintain existing jobs would do the trick. In the case of the third, the question is how the government can encourage the establishment and growth of industries and firms that can provide work for people who may have been out of the workforce for a number of years and for those who have never had meaningful paid employment.
South Australia is fertile ground for some sort of intervention in the free market for industrial change. (See the Opinion piece in The Drum, 22 June 2016, by Greg Jericho.) It has had the lowest employment growth of any State since the 2013 election and only Tasmania has a lower percentage of its adults in employment. South Australia’s employment-to-population ratio of 57.6 per cent is below the national average of 61.1 per cent. It also has the lowest percentage of full-time workers and is more dependent on manufacturing than other States. While the manufacturing industry employs 7.5 per cent of all workers across Australia, in South Australia it is 9.1 per cent.
And it’s not just in Australia that the free market tide might be turning. A more interventionist or protectionist stance has been proposed for the United States by Bernie Sanders, who won support for the view that the benefits of free-trade agreements are not shared by everyone.
(Incidentally, the Productivity Commissions itself has found few benefits of Australia’s current free-trade agreements. Apart from anything else, the economic models used to evaluate Free Trade Agreements tend to exaggerate the benefits, ignore many of the costs and assume away unemployment effects.)
The Turnbull Government has recognised the seriousness of South Australia’s employment situation by using government procurement preference as the basis for its decision on submarine manufacture.
The Productivity Commission (PC) has suggested that the decision to build $50 billion worth of submarines in South Australia represents the greatest industry subsidy in Australia for many decades. It is estimated that choosing manufacture by a French company, but based in Adelaide, and with a preference for Australian steel, adds around 30 per cent to the total cost. The result is an extra cost of some $11 billion.
Treasurer Scott Morrison has said that the Government’s defence industry plan is a key component of supporting the transition of the Australian economy. He says the submarine builds will directly secure over 3,600 jobs as well as thousands more through the supply chain.
The PC reports that in 2014-15 Australian taxpayers and importers in effect paid $15.1 billion in total assistance to help manufacturers cope with global competition. This was comprised of $7.8 billion from tariffs on goods imported into Australia; $4.2 billion in direct budget outlays for things such as research and development; and $3.1 billion in direct tax concessions to industry.
Compared with these annual figures, an estimated one-off cost of around $11 billion for the submarines is relatively modest. Ian McCauley has pointed out that we pay almost that amount every year to subsidise the private health insurance (PHI) industry. That is $6.4 billion in direct budgetary outlays and about $4.1 billion in revenue forgone, because the PHI rebate is not subject to income tax and because those with high incomes who hold PHI are exempt from the Medicare Levy Surcharge.
The transformation of industry is clearly seen in motor vehicle manufacture. Ford has in effect stopped making cars in Australia and Holden and Toyota will go by 2017. This will result in the loss of up to 200,000 jobs, many of them in South Australia. This will add to the number of Australians who, despite record economic growth, are on the margins. To do nothing risks bequeathing to our children a society in which they have fewer chances than we had – one in which life opportunities are determined by postcode or family background.
The Productivity Commission is clear about three key areas for work to avoid such a situation: the importance of children’s early years in shaping their life chances; the fundamental importance of education in shaping the trajectory of young people’s lives into the future; and the importance of jobs as a pathway out of poverty for many people of working age.
Compared with the manufacturing of motor vehicles and submarines, New South Wales’ greyhound industry has been subject to quite a different prescription for structural change. More on that later.
In the meantime, let’s agree that there are strong but poorly quantified links between industry policy and inequality, and show that we care enough about the latter to consider industry policy with a heart.
This piece is several things.
Result: The Western Bulldogs beat the Sydney Swans by 89 points (13-11) to 67 (10-7).
Gordon Gregory writes:
Building bridges for a joined-up approach
