Dr Stefania Siedlecky AM graduated in medicine in 1943 and is a former Senior Advisor in Family Planning and Women's Health in the Commonwealth Department of Health.
The past 50 years in Australia and Great Britain has seen increasing recognition of the importance of public health and the role of governments in healthcare. This has formed the basis of change in our health systems.
This article includes excerpts from original pieces identifying the two different approaches to essentially the same public health goal. These are the philosophy of those arguing that health is the concern of the whole community; and the philosophy, promoted by the Australian Medical Association and the Liberal Party, that health is an individual responsibility with the government's role being to support the private health system and provide only for those who cannot otherwise afford to pay. These two philosophies still underpin arguments about Medicare and private health insurance.
Aneurin Bevan: In Place of Fear, 1952
Aneurin Bevan was the Minister for Health in Great Britain responsible for introducing the National Health Service (NHS). In 1952 in his book "In Place of Fear" (A Free Health Service, Chapter 5 of In Place of Fear London: Heinemann), he described the philosophy behind the introduction of the NHS. The following excerpts have a contemporary ring:
"The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is health. That is true both for curative and preventive medicine. The preventive health services of modern society fight the battle over a wider front and therefore less dramatically than is the case with personal medicine." (p73)
"Yet the victories won by preventive medicine are much the most important for mankind. This is so not only because it is obviously preferable to prevent suffering than to alleviate it. Preventive medicine, which is merely another way of saying health by collective action, builds up a system of social habits which constitute an indispensable part of what we mean by civilisation. In this sphere values that are in essence Socialist, challenge and win victory after victory against the assertions and practice of the Competitive Society." (p73)
"When we consider the great discoveries in medicine that have revolutionised surgery and the treatment of disease, the same pattern appears. They were made by dedicated men and women whose work was inspired by values that have nothing to do with the rapacious bustle of the Stock Exchange: Pasteur, Simpson, Jenner, Lister, Semmelweiss, Fleming, Domagk, Roentgen - the list is endless. Few of these would have considered themselves Socialists, but they can hardly be considered representative of the Competitive Society." (p74)
"The same story is now being unfolded in the field of curative medicine. Here individual and collective action are joined in a series of competitive battles. The collective principle asserts that the resources of medical skill and the apparatus of healing shall be placed at the disposal of the patient, without charge, when he or she needs them; that medical treatment and care should be a communal responsibility; that they should be made available to rich and poor alike in accordance with medical need and by no other criteria. It claims that financial anxiety in time of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty. It insists that no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means." (p75)
"Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide. But private charity and endowment, although inescapably essential at one time, cannot meet the cost of all this. If the job is to be done, the State must accept responsibility." (p75)
Unfortunately, the full text of this article is not currently available online and we do not have the resources to email copies on request. Follow this link to find Australian libraries where New Doctor is available. If you wish, you can purchase back issues of New Doctor for $5.00 (at the time of writing, March 2000). Contact Carol at the DRS national office to order copies or for more information.
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