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The Health of Nations: Towards a new political economy

In Team America – World Police, the rollicking spoof of the War on Terror by the creators of South Park, the Tim Robbins character explains the evils of capitalism: “The corporations finance Team America, and then Team America goes out... and the corporations sit there in their... in their corporation buildings, and... and, and see, they're all corporation-y... and they make money”. This came to mind while reading The Health of Nations: Towards a new political economy, by Gavin Mooney.

03 Dec 2012

The Health of Nations: Towards a new political economy, Zed Books, RRP$34.95, pp328, ISBN 9781780320595

By Gavin Mooney

Reviewed by Adrian Rollins

In Team America – World Police, the rollicking spoof of the War on Terror by the creators of South Park, the Tim Robbins character explains the evils of capitalism: “The corporations finance Team America, and then Team America goes out... and the corporations sit there in their... in their corporation buildings, and... and, and see, they're all corporation-y... and they make money”.

This came to mind while reading The Health of Nations: Towards a new political economy, by Gavin Mooney.

In the book Professor Mooney, who has carved out a 40-year career as a health economist, poses important questions about why there is so much sickness and death in the world, and why gaping inequalities in health persist, despite huge advances in medical treatments and technology, and the enormous sums being spent on health care.

But the answer he provides is, just like that from the Tim Robbins character, disappointingly facile.

Professor Mooney lays the blame for the world’s ills on “neoliberalism”, by which he means a political and economic outlook that prizes free markets and trade, strong property rights, individual freedom and minimal government interference.

In health, he argues, this has led to a focus on medicine and individual care rather than the underlying social determinants of health, such as poverty, inequality, housing, education and transport.

From Mooney’s viewpoint doctors are, at best, unwittingly complicit in a system that puts a premium on the health of the rich and damns the rest to benign neglect or worse.

There is nothing subtle about his argument.

The health system is run by, and for, the well-off: pharmaceutical companies shower doctors with money to convince them to prescribe their products, and doctors “willingly connive” with the rich and powerful to devote most health resources to looking after them. As an example of this, he argues, you do not have to look much further than the resources thrown at the battle against obesity compared with that devoted to tackling developing world health problems.

“The power in health care currently rests all too much with the medical profession and the pharmaceutical industry, and all too little with the citizenry,” Mooney writes.

The problem is, there is little in the way of evidence provided to back up his assertions.

In a passage that fairly quakes with indignation, Mooney excoriates the medical profession for being “in the pockets” of Big Pharma.

For him, it is axiomatic that doctors who receive any sort of funding or assistance from pharmaceutical companies will suspend any capacity for independent thought and simply do their bidding.

Mooney adopts a similarly simplistic view of the migration of health workers from places like Africa and Asia to developed countries.

“The West does not care that, with the freeing up of markets under neoliberal globalisation, by ‘stealing’ doctors and nurses from poor countries, they are creating very serious workforce shortages in these countries…This is an example of the selfishness of the neoliberal West,” he writes.

The solution commonly proposed to this ‘problem’ is to somehow bond doctors and nurses to their home countries.

As development expert Michael Clemens points out, this is a view that essentially treats heath workers as objects, rather than intelligent human beings who should have freedom to choose where they work.

Clemens says there is little evidence to suggest that somehow making doctors and nurses from developing countries stay at home does much to improve health care.

For example, a South African study found that many health workers who could not emigrate simply dropped out of the profession altogether.

Mooney’s ‘solution’ to the ills of health care is to convene citizens’ juries to set the principles and priorities for health services, based on information provided by a group of experts.

But who selects the citizen jurors, and the experts who advise them? And what happens if a jury is irrevocably split?

Like other propositions and assertions made by Mooney, the idea seems to be only partially formed and tested.

The Health of Nations appears to be a heart-felt testament to the failures of the current health care system and what needs to be done to improve it.

But its disappointingly thin analysis renders the diagnosis – and the prescribed treatment – far from compelling.

Adrian Rollins is Editor, Australian Medicine


Published: 03 Dec 2012