In my travels to remote Aboriginal communities I have found there is much to learn from our Indigenous friends and colleagues about primary health care. They instinctively understand what Western health professionals and policy makers have had to learn – that “health” is much more than the absence of disease or infirmity. Their holistic approach is consistent with the principles espoused in the Declaration of Alma Ata (1978) and the Ottawa Charter (1986), which acknowledged the right of all citizens to realise their aspirations and achieve a state of complete physical, mental, social, emotional, spiritual and environmental wellbeing, and the responsibilities of governments to provide the fundamental investment in the social infrastructure of the nation to enable health for all.
Primary health care acknowledges that the basic prerequisites for the wellbeing of individuals and communities include not only equal access to essential health services, but also to transport, education, employment, income and social status, social support, adequate housing and nutrition, stable eco-systems and a sustainable environment. These are the indicators that broadly determine quality of life.
The community services industry is now implementing a Consumer Directed Care model of service in accordance with the Commonwealth Department of Health and Ageing’s policy directions. The model is consistent with the global primary health care agenda, embracing a holistic perspective of wellbeing that acknowledges individual aspirations, and encapsulating the primary health care principles of inclusion, participation and empowerment.
However,
analysis of political priorities at federal and state levels finds economic
policies directed towards reducing national/state debt through reduced
expenditure, and encouraging the development of new industries to improve growth
in GDP. This presents contradictory policy pressures when the true environmental
impact of some of these developments, like coal seam gas exploration, is unknown.
In the pursuit of such economic goals, community wellbeing may well be
sacrificed.
One
of the weaknesses of the economic rationalist approach to planning is that
market forces neglect to sufficiently factor in production outputs that
threaten the wellbeing of communities. There is a need for balance between
productivity, population health and sustainable environments.
Primary
health care offers policy makers an alternative framework for integrated
planning at a macro level. It requires a paradigm shift from a medical,
illness-based model of “health” directed primarily toward individuals, to a
social, population health model directed towards community wellbeing. The
health of a population is as much a product of the opportunities and control
people have over their own lives and environments as it is of the medical
services they receive.
If
our quality of life is to be maintained, it is qualitative growth that needs to
drive the economic prosperity agenda.
Politicians
and policy makers are urged to remember the most basic requirement for healthy
communities is access to clean air and water. Independent scientific research
has yet to prove that toxic emissions from coal seam gas exploration cause no
damage to essential water tables or to the atmosphere. The short-term economic
benefits of this “clean energy” option may amass serious health and social
deficits in the long term, impacting on generations to come.
As a
first step in implementing a primary health care planning framework for
community wellbeing and population health, perhaps politicians taking their
oath of office could echo the medicos’ pledge: “First, do no harm”.
