Will the poor be better off when the Greenies' Dorky Doc Dick makes drugs free for all ?Beyond sin taxes and the law lies personal choiceGary Johns Brisbane THE AUSTRALIAN MAY 18, 2016 12:00AM
The poor in Australia are so poor that they can eat, drink, and smoke themselves to death. Indeed, they seem pretty good at it because they are one and a half times more likely to suffer disease from those causes than those who are better off.Last week, the Australian Institute of Health and Welfare released its report, Australian Burden of Disease Study: impact and causes of illness and deaths in Australia 2011. Burden of disease combines measures of the impact of dying early and living with illness. The report suggests 30 per cent of the burden of disease in Australia is preventable because "modifiable risk factors" cause it.
An example of a modifiable risk factor is "high body mass" — fat. It could lead to heart disease, diabetes and more. A great many modifiable risks are "behavioural". They are very familiar and include grog, smokes, drugs, unsafe sex, physical inactivity, childhood sexual abuse, domestic violence, and a diet low in vegetables.
All of these factors are heavily class based. The researchers also say that, "if the poor were as healthy as the rich they would be 21 per cent better off." The message in the report, although drowning in gobbledygook, is quite simple. If you change the way you live, or with whom you live, you will live longer.
The researchers say that "disparity" in health outcomes is caused by "reduced access" to health services and resources, and "risky behaviours". Short of making the poor rich, how can the disparity be removed?
The fact that the wealthy can be kept alive by buying better health services does not explain why the poor, who have access to perfectly good health services, die younger. Bulk-billing GPs tell their patients every day to lose weight, eat vegetables, give up the smokes, give up grog, and to exercise. It is not "reduced access" that results in the poor dying younger or being less well.
All Australians are able to learn from highly qualified medical practitioners how to live healthier lives. Whether they listen is another thing altogether. Indeed, governments know that many do not listen, so they give them a real hard nudge.
Of the behavioural factors, and putting to one side unsafe sex, sin products such as grog and smokes (including gambling, which is highly related to others) are heavily taxed, vegetables are not, and the others are illegal.
In effect, the tax and the legal system distinguish between two classes of poor: the deserving and the undeserving.
The deserving poor do not have to pay sin taxes or fall foul of the law. To a great extent, through sin taxes and legal penalties, the undeserving poor pay for their sins, but little else.
Much of the federal election is encapsulated in this tale of class and health.
The welfare state cannot modify the class system sufficiently for the poor to catch up. The differences in health (and life chances) between the poor and the rest are unlikely ever to be abolished.
The welfare state provides adequate access to health services, and it tries to modify behaviour by taxation and the law. To some extent this works. In other respects, it makes lives more difficult.
Duncan Storrar, Q&A’s "national hero", is the architect of his downfall. He receives benefits regardless of whether he deserves it. As a nation, we have shown great forbearance.
My sense, in this campaign, is that forbearance is wearing thin. This is a huge danger for Bill Shorten and the Labor Party on two grounds. The ideology that welfare can abolish differences is threadbare. The money backing the threadbare ideology has gone. Labor has spent the future. There is no more chance that the welfare state can abolish the class system, sufficient to have the poor live as well as the rich, than Bill Shorten has of becoming prime minister.
To paraphrase Amy Wax (Race, Wrongs and Remedies: Group Justice in the 21st Century), no one knows how to ensure that others make good health choices or do not engage in risky behaviour. More broadly, "We do not know how to make someone obey the law, study hard, develop useful skills, be courteous, speak and write well, work steadily, marry and stay married, be a devoted husband and father, and refrain from bearing children they cannot or will not care for."
The problems of the unhealthy poor will not be found in great social programs run out of Canberra. What remains is a salutary series of questions, with few answers, and the bill.
http://www.theaustralian.com.au/opinion/columnists/gary-johns/beyond-sin-taxes-a...