Two roads for our healthcare system

[Green Left Weekly, #718, July 20, 2007]

The media hysteria over a possible Australian link to the recent British terror attacks serves to highlight a basic reality. The Australian healthcare system is critically dependent on overseas-trained doctors and it wouldn’t work without them.

Andrew Schwartz, president of the Australian Doctors Trained Overseas Association, was reported in the July 4 Melbourne Age as estimating that 40% of about 50,000 doctors practising in Australia had been trained overseas. And about 5000 overseas-trained doctors are working here on temporary 457 visas — 1200 being admitted in the past 12 months alone.

Some basic figures

Reading this short piece in the Age prompted some reflections on healthcare in Australia, a major capitalist country. I couldn't help but think of socialist Cuba, a Third World country subjected to a ruthless blockade by the United States for almost half a century. The World Health Organisation website provides some basic data.

In 2001 Australia had almost 48,000 doctors to service its 20.2 million people — a ratio of 2.47 per 1000 of population. Yet Cuba's 11.3 million people had some 67,000 doctors giving it a ratio of 5.91 — that is, one doctor per 170 people.

Furthermore, infant mortality per 1000 live births in Cuba stands at 5.0, the same as in Australia. Life expectancy for females is not so different in both countries — 84 in Australia and 79 in Cuba. Looking at hospital beds per 10,000 of population, the Australian figure is 40 compared to 49 in Cuba.

And, we might add, because Cuba is a much more egalitarian society, its health indices are much more reflective of the real situation of the whole population. By contrast, Australia’s health statistics conveniently hide the situation of so many Aboriginal communities, who constitute an internal Third World. Moreover, our general averages also cover up the reality that rich and poor in general have very different health and life prospects in class-divided capitalist Australia.

'Flooding the region with doctors'

Cuba not only has more than twice as many doctors per head of population as Australia but it also trains large numbers of students from other countries, almost all in the Third World. Established in 1999, Cuba's Latin American Medical School (ELAM) has graduated 2910 doctors and is training a further 10,222. Of these some 1600 will graduate this August. Tuition is free; the students' only obligation is to promise that when they graduate they will work in poor communities in their own countries.

In addition to ELAM, some 30,000 Cuban health professionals — 20,000 of them doctors — work in 68 poor countries around the globe.

An article in the October 28, 2006 Sydney Morning Herald reported on the growing Cuban medical presence in the Pacific. There is a tinge of hysteria here but the facts are striking.

"Cuba has been flooding some poorer parts of the region with doctors and humanitarian workers since the tsunami tragedy in Indonesia on Boxing Day, 2004. Swathes of the Pacific, from Kiribati to East Timor, are becoming dependent on Cuban medical aid, and the Cubans appear to be winning hearts and minds. Following the Java earthquake in May, teams of doctors were quickly flown to affected areas.

"Indonesia’s regional health coordinator, Ronny Rockito, said the two Cuban field hospitals and 135 workers made a bigger impact on the humanitarian crisis than the work of any other country."

An East Timor government media release on November 15 reported that 302 Cuban doctors were working throughout the impoverished country. Furthermore, 498 East Timorese were being trained in Cuba to be doctors and a further 200 were expected to join them in coming months. Australia's largesse is miserable by comparison. While its "aid" is big on training police and military and imbuing public servants with a neoliberal mindset, it has provided a mere handful of medical scholarships.


If there were the political interest and will, a rich country like Australia could easily afford a system of universal high-quality, free healthcare. And bringing our doctor/population ratio up to the Cuban level should likewise not be difficult. But the fundamental obstacle to realising such an attractive vision is the capitalist "free market" system we live under, which perversely puts the enrichment of a handful of magnates and their hangers-on ahead of the welfare of millions of ordinary people. And with neoliberalism in full ascendancy, things are getting worse, not better.

The healthcare system as a whole is inexorably being privatised. The quality and availability of healthcare is more and more dependent on the means of the patient. If you have money — no problem — but if you are poor, you wait and get what you can. It's not yet as bad as in the United States (the subject of Michael Moore's new movie Sicko) but that's the direction in which things are heading.

And for all the dedication of so many doctors, the profession as a whole is compromised by the commercial ethic. Training intakes for doctors are restricted, not by the medical needs of the population, but to avoid an "oversupply" of doctors. In addition, with university courses moving over to a fee-paying basis, few students not from rich or middle-class backgrounds are able to contemplate becoming doctors. For many, a career in medicine is seen as the pathway to a comfortable, privileged existence.

Targeting the Third World

This is the background to the crisis of healthcare in Australia. Not only is there chronic underfunding, but there are absolutely too few doctors. If we had Cuba's doctor/population ratio, we would have more than twice as many doctors as we do now — an extra 70,000! Think what could be done here and abroad with such tremendous extra resources!

In rural areas there is a permanent doctor shortage. To overcome this situation Australia (along with many other Western countries) has aggressive recruitment programs targeting doctors in other countries, especially in the Third World. A large number of the overseas-trained doctors who come to Australia work in Queensland, particularly in regional areas.

Not only does predatory western capitalism exploit the labour and resources of the Third World, more and more today it plunders its precious trained human resources. A May 2005 article on the website of the NSW Nurses Association gives a truly dramatic example:

The Philippines is exporting more nurses than it is producing, leading to a severe drop in the quality of hospital care and even forcing some hospitals to close.

Almost 90,000 nurses left the Philippines in the last 10 years, according to the National Institute of Health.

So great is the lure of a foreign nursing salary that experienced Filipino doctors are studying nursing with the aim of working abroad.

In the last four years, 3500 Filipino doctors left the country to take on nursing jobs overseas, the institute reported.

The Philippines supplies an estimated 25% of all overseas nurses worldwide.

More than half are in Saudi Arabia, 14% in the USA and 12% in the UK.

About 10% of the country's 2500 hospitals have shut down in the past three years, mainly because of the loss of doctors and nurses to jobs overseas, according to a study by the Philippine Centre for Investigative Journalism.

In 2002, 11,911 nurses chose to work abroad compared to the 4228 students who graduated as nurses.

To round out this dismal picture, it should be pointed out that the remittances of Filipinos working abroad (whether as labourers, domestics or healthcare professionals) are a major factor in the economy of the country and it could hardly survive without them.

The problems besetting the healthcare systems in First World Australia and Third World Philippines stem from the same capitalist system. The fundamental solution is the same: change the system; get rid of heartless capitalism and its neoliberal servants which put corporate profit ahead of all human needs. Then we could follow the Cuban example which, all qualifications made, is the basic alternative model of a people-centred healthcare system.