Next year marks four decades since promulgation of the seminal Declaration of Alma Ata, which declared health — complete physical, mental and social wellbeing — to be a fundamental human right requiring government action across a range of policy areas.
Alma Ata laid the foundations for what are now widely championed as the social determinants of health; the economic and social conditions underpinning the wellbeing of individuals, communities and nations.
Without action on the social determinants, the so-called 'causes of the causes', health policy — and indeed health expenditure — can be a little like that joke about the cyclopean orthopod who, when confronted with a patient suffering fatal internal bleeding, is interested only in fixing their broken leg.
So it is with the 2017-18 Federal Budget. Touted as a signal moment for health, and a principled exercise in fairness by Treasurer Scott Morrison, the budget promises much but delivers little.
Budgets are by necessity a political exercise, and this one was heavy on rhetoric venerating universal health care and a détente with doctors following Labor's damaging 'Mediscare' election campaign and unpopular missteps by the previous government on copayments, diagnostic tests and the Medicare rebate freeze.
The former never managed to limp its way through the Senate, but the latter two measures were prominently wound back last Tuesday night under the guise of a new era of cooperation with Australia's doctors and pharmacists.
These so-called 'landmark compacts' acknowledge that the government must rebuild trust with the health sector, but also demand the RACGP and AMA crackdown on after-hours services, promote the rollout of the controversial opt-out My Health Record and support government surveillance of and challenges to Medicare billing.
How these memoranda were agreed and under what terms are unclear, and the lack of transparency does little to dispel the notion that these negotiations were brokered by a self-interested elite.
"They have kicked the can down the road on prevention, primary care and Indigenous health, deferring them as priorities for a so-called 'third wave' of health reform. This is not only poor public health policy, it puts the cart before the horse in economic terms."
Olive branch or fig leaf?
There are two big-ticket olive branches being spruiked by the government in health — the thaw of the MBS indexation freeze and establishment of a Medicare Guarantee Fund to secure the long-term future of universal health and access to medicines through the Pharmaceutical Benefits Scheme.
The first was heavily lobbied for by doctors