BLOG 2: The need of a constantly expanding market... Privatising Aged Care
BLOG 2: The need of a constantly expanding market... Privatising Aged Care
Another way in which capitalism threatens our health is through its endemic dynamic of commodification. Cook (2004) defines this neatly as the process by which services, relationships and other social entities become objects (commodities) that can be bought and sold in a market (Marx 1976). Commodifying tendencies emphasise the pursuit of profit maximisation. Naturally, under capitalism healthcare becomes a business and health services commodities.
There is perhaps nothing startling in this. Marx and Engels proclaimed in their 1848 Communist Manifesto: The need of a constantly expanding market for its products chases the bourgeoisie [capitalist class] over the entire surface of the globe. What is surprising for some though is the speed and extent that neoliberalism has rolled back over a century of resistance, and commodified areas of life previously thought of as non-profit, philanthropic, low-return, government provided or subsidised. This now incorporates many hospitals and now aged care.
It should be said that prior to neoliberalism was no Golden Age for the elderly, despite Australia being a leader in introducing the aged pensions in 1908, enabling the elderly working-class to age and possibly die at home rather than in asylums (Norton, 2020). A cash incentive was added by the Menzies Government in 1963 for private providers to take on the bed-ridden pensioners but profit margins were modest. Nevertheless, it meant Australia had more people in nursing homes (25% of residents) by 1972, compared to any other country, without a medical reason to be there (Norton, 2020). At this point nursing homes still had strict regulations about staff to patient ratios and requirements to provide professional nursing staff. Their workforces were also highly unionised.
In 1997, a major shift towards privatised aged care was inaugurated by the Howard Governments Aged Care Act 1997 and as Russell (2018) argues, much of the current crisis in aged care can be traced to this. The Act abolished the regulatory requirement for nursing homes to spend a specified percentage of their income on direct care, which included qualified nurses, opening the door to rampant privatisation. With these costs abolished, private equity firms, new foreign investors, and superannuation and property real estate investment trusts entered the residential aged care market (Russell, 2018) looking for profitable returns. The usual justifications of efficiencies were used and patients became customers but when markets went down, so did the quality in care, facilities and staff wages, which remain amongst the lowest of any workforce in Australia. This did not stop the owners maintaining huge profits and luxury lifestyles, while their residents might be left lying in excrement, with untended wounds, awful food, over-prescription of sedation and inadequate care (Topsfield, 2021).
Investors were happy with all these changes, however, as can be seen in the photo below of Tony and Stacey Antonopoulos, who co-own half the Heritage Nursing Home chain and appear to be in good health. They live a very different lifestyle from the aged care residents in their homes. They claim they have poured enormous amounts into their nursing home investment. Yet the Health Services Union President said that Heritage Care had outsourced its cleaning and catering services in its NSW homes in 2020 and cut the hours in their Heritage Botany kitchen by 20 per cent that year. At the same time, the Antonopouloss and fellow owners are lobbying the Government for more funding for the sector claiming they don(Bachelard, 2021).
Despite 18 major Government inquiries since 1997, the situation remains in a deadly mess, as was highlighted by the death-toll when the COVID 19 pandemic entered nursing homes (the site of one third of all COVID deaths in Australia) (Topsfield, 2021).
WHAT TO DO?
There is no simple solution to any of the problems involved when capitalism adversely affects our health. Given that a socialist revolution is unlikely in the short term, those of us aware of the problem of health inequities and privatised health care need to vigorously campaign for reforms at both the community and social policy (legislative) levels. Firstly, the issue of funding must be addressed and here we might look at fixing the tax evasion of many corporations, including those involved in the provision of healthcare and nursing homes. Secondly, we need to raise the wage levels for workers in health and aged-care to attract and maintain trained staff, including professional healthcare staff. Thirdly, these industries need to be subject to far greater regulation in regarding quality of care, food standards, staff treatment and training. Somehow the message needs to be projected that the money in these areas is for healthcare workers, carers and patients; not rentier corporate vultures. In terms of health advocacy campaigns, we need more inequality exposing campaigns that highlight the real life costs of capitalism in the health sector and what a better system might look like.
REFERENCES AND FURTHER RESOURCES
AIHW (Australian Institute of Health and Welfare) (2020) Australia's Health 2020. Australias Health Data Insights. Australian Government.
ACTU (Australian Council of Trade Unions), (2019) Inequality in Australia: An Economic, Social & Political Disaster. https://www.actu.org.au/media/1385450/actu_inequality_briefing.pdf
ACOSS & UNSW. (2020). Inequality in Australia 2020: Part 2: Whos Affected and Why? Australian Council of Social Services, in partnership with the University of New South Wales. https://povertyandinequality.acoss.org.au/wp-content/uploads/2020/12/Inequality-in-Australia-2020-Part-2-Who-is-affected-and-why_FINAL.pdf
Bachelard, P. (2021) Golden age over for Maserati-driving aged care moguls, says nursing home CEO. The Sydney Morning Herald. https://www.smh.com.au/national/golden-age-over-for-maserati-driving-aged-care-moguls-says-nursing-home-ceo-20200803-p55i4b.html?fbclid=IwAR3-pPmIl4tD3kTNTP4jz0_CIZ2arAyd6omdLKRF53RVyPXZPzouQt4F4pA
Cai, L., ((2009) Be Wealthy to Stay Healthy: An Analysis of Older Australians using the HILDA Survey. Journal of Sociology. 45. Pp. 55-79. https://doi.org/10.1177/1440783308099986
Cook, C. (2004) Who Care About Marx, Weber and Durkheim?: Social theory and the changing face of medicine. Health Sociology Review. 13 (1): 87-96 https://www.tandfonline.com/doi/abs/10.5172/hesr.13.1.87
Credit Suisse. (2017) Global Wealth Report. global-wealth-report-2017-en.pdf
Dorling, D. (2015) The Mother of Underlying Causes Economic Ranking and Health. Social Science & Medicine. 128. pp. 327 330. https://doi.org/10.1016/j.socscimed.2015.01.008
Freudenberg, N. (2021). Why do we Ignore Capitalism when we Examine the Health Crises of our Time? British Medical Journal Blogs - The BMJ Opinion. (6th March) https://blogs.bmj.com/bmj/2021/05/06/why-do-we-ignore-capitalism-when-we-examine-the-health-crises-of-our-time/
Germov, J. (2018) Second Opinion: An Introduction to Health Sociology. Sixth Edition. Oxford University Press. Oxford.
Kondo, N., Sembajwe, G., Kawachi, I., van Dam, R., Subramanian, S. and Yamagata, Z. (2010). Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. British Medical Journal. 2010; 341 doi: https://doi.org/10.1136/bmj.c5590
Leigh A, 2013 Battlers and Billionaires: The story of inequality in Australia, Redback, Melbourne.
Norton, E. (2020) The Disaster of Australias Privatised Aged Care. Red Flag. (Thursday 10th September). https://redflag.org.au/node/7368Nowatzki, N.R., (2012). Wealth Inequality and Health: a Political Economy Perspective. International Journal of Health Services. 42 (3), 403e424. http://www.ncbi.nlm.nih.gov/pubmed/22993961.
Pickett, K., and Wilkinson, R., (2015). Income Inequality and Health: a causal review.
Social Science & Medicine. 128, pp. 316-326. https://doi.org/10.1016/j.socscimed.2014.12.031
Oxfam, (2022) Inequality Kills: The unparalleled action needed to combat unprecedented inequality in the wake of COVID-19. Annual Inequality Report. Oxfam International. Oxford.
https://oxfamilibrary.openrepository.com/bitstream/handle/10546/621341/bp-inequality-kills-170122-en.pdf
Russell, S. (2018) The Aged Care Crisis can be traced back to Howards Aged Care Act. We need a new Act. The Guardian. 20th April. https://www.theguardian.com/commentisfree/2018/apr/20/the-new-aged-care-watchdog-is-like-shifting-the-deckchairs-on-the-titanic
Sell, S. and Williams, O., (2020) Health Under Capitalism: a global political economy of structural pathogenesis, Review of International Political Economy, 27:1, 1-25, DOI: 10.1080/09692290.2019.1659842 Topsfield, J. (2021)24 Years, 18 Inquiries: Can we face the truth of aged care? The Sydney Morning Herald. March 1st. https://www.smh.com.au/politics/federal/24-years-18-inquiries-can-we-face-the-truth-of-aged-care-20210225-p575qs.html
Vaidhyanathan, S. (2020) The economy v our lives? It's a false choice and a deeply stupid one. The Guardian. (March 26th) https://www.theguardian.com/commentisfree/2020/mar/26/coronavirus-us-economy-health-lives-trump
Wilkinson, R., Pickett, K.E., (2006). Income inequality and population health: a
review and explanation of the evidence. Social Science & Medicine. 62 (7), 1768-1784. https://doi.org/10.1016/j.socscimed.2005.08.036
Wilkinson, R., Pickett, K.E., (2010). The Spirit Level: Why Equality is Better for Everyone. Harmondsworth. UK. Penguin.
WHO (1948). World Health Organisation Constitution. https://www.who.int/about/governance/constitution
WID (World Inequality Database). (c.2019) World Inequality Database https://wid.world/country/australia/
Whats wrong with good old vaginal delivery?
May 10, 2021 Born by Caesarean Section Photo: Transforming Maternity Care Collaborative
are we putting australian mothers and babies at unneccesary risk?
I had my first child nearly twenty-two years ago in Randwick, Sydney. I was fortunate to have had access to a progressive antenatal class during my pregnancy. Some of the women in the class shared their experiences of their previous births in a hospital setting. These stories horrified me and offered a potent reminder of how the patriarchy was still in charge of decision making when it came to women's bodies. The majority of the women felt disempowered or traumatised by their birthing experiences.
I was determined to empower myself with a birthing plan that involved a midwife and an obstetrician in a shared care situation. I wanted to deliver my daughter without medical intervention in a birthing centre, and I clearly stated my intentions. I was just over thirty, so my pregnancy was regarded as a 'geriatric pregnancy.' The expectation was that I would end up with a C-section upstairs in the hospital ward to 'manage the risks' associated with my age.
Image: National Library of Medicine
The medicalisation of childbirth in the mid-nineteen century
My daughter was in the posterior position when it came time to give birth. The midwives at the birthing centre at the Royal Women's Hospital were increasingly nervous as, despite my contractions, my cervix was not dilating. As the hours progressed and with each shift, a new midwife came into my room to suggest that I move upstairs to the ward to be 'monitored' by a doctor. I was pressured to go upstairs for intravenous oxytocin to speed up my contractions or threatened that my waters would be pierced with a metal rod. I refused to go upstairs I knew that once the medical intervention commenced it could easily lead to a so-called 'emergency'C-section. Luckily for me, with time, the baby repositioned herself into the anterior position, and I delivered her naturally after two days.
After my experience, I wondered why there was so little attention given to women's birthing experiences in Australia. During the process of writing this, however, I discovered a large-scale research study conducted very recently by the University of Western Sydney. The study Australian Birth Experience Study, has already attracted 4800 birthing stories and confirms that at least one in three women were traumatised by their birthing experiences (Tuohy, 2021).
Theres also a highly successful podcast Australian Birthing Stories created by Sophie Walker in the last few years that delves into the topic of womens birthing experiences. The podcast, which has had at least 7.5 million downloads, talks of the classic cascade of interventions, which eventually leads to what Walker describes as unnecess-caesareans (Tuohy, 2021).
Medical intervention in the form of a C-section is so rife that the WHO has declared it a caesarean epidemic, especially in first world high-income countries like Australia (WHO, 2021). Here, more than one in three women have a C-section and that number is growing at an alarming rate (Visser et al.,2018). Also, once you have had one caesarean, chances are you will continue to have the procedure with subsequent births (TMCC, 2021).
WHO: "...not all the caesarean sections carried out at the moment are needed for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and her baby (WHO, 2021).
Add to this a recent Australian healthcare report, which showed that a whopping half of C-sections were performed before 39 weeks without any medical reason whatsoever (ACSQH, 2021), which can put a baby's life at risk.
The Federation of International Gynecologists and Obstetricianshas released a statement that women must be "properly informed" of the risks before consenting to C-sections (Visser et al., 2018).
Ladies, when it comes to giving birth, make sure you are informed about the risks and the options before you agree to a C-section and aim for quality
woman-centred-care (WHO, 2021) if you can when delivering your child.
0298450Forceps. Image: National Library of Medicine
114300-3200400
Caesarean Section: A brief History
References:
Tuohy, W. (2021). Sophie had gold standard births, but many women want to talk about birth trauma. The Sydney Morning Herald. https://www.smh.com.au/national/sophie-had-gold-standard-births-but-many-women-want-to-talk-about-birth-trauma-20210423-p57lye.htmlVisser, G.H.A, Ayres-de-Campos, D., Barnea, E.R, et al. (2018). FIGO position paper: How to stop the caesarean section epidemic.The Lancet, 392(10155), 1286-1287.
Transforming Maternity Care Collaborative. (2021). Caesareans Are Just Another Way of Giving Birth Right? https://www.transformingmaternity.org.au/2021/05/caesareans-are-just-another-way-of-giving-birth-right/Australian Commission on Safety and Quality in Healthcare. (2021). High rates of early C-section are putting Australian babies at unnecessary risk. https://www.safetyandquality.gov.au/about-us/latest-news/media-releases/high-rates-early-caesarean-sections-are-putting-australian-babies-unnecessary-riskAustralian Commission on Safety and Quality in Healthcare. (2021). Early Planned Births.The Fourth Australian Atlas on Healthcare Variation. https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/early-planned-birthsWorld Health Organisation. (2021). Caesarean section rates continue to rise, amid growing inequalities in access. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access#:~:text=According%20to%20new%20research%20from,21%25)%20of%20all%20childbirths
