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    Dr Mary Wyatt

    The Australasian Faculty of Occupational and Environmental Medicine (AFOEM), part of the Royal Australasian College of Physicians, has been working to raise awareness of work as a social determinant of health. AFEOM has recently released a position statement “Realising the health benefits of work” (

    Being out of work for more than six months has a health risk equivalent to that of smoking ten packs of cigarettes per day. After six months out of work, the suicide rate in young men is increased forty times. For longer term worklessness, the general suicide rate is increased six times.

    It’s an issue not well understood by health practitioners and the community. Whether someone remains at work or returns to work is heavily influenced by attitudes, policy approaches, and the advice given by their family, doctors and other treating practitioners.

    Many systems in Australia fail to address work and health outcomes. Workers’ compensation systems often focus on financial outcomes at the expense of the well being of the claimant. Empowering GPs to inform patients of the problems of staying off work, and supporting inclusive employment practices are key steps if the health benefits of work are to be made available to more Australians. Providing employment is a key approach in reducing health inequities, particularly for indigenous Australians.

    Can Australian doctors do more to tackle health inequities? We are in a position to do so and can make a major contribution if we do.

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    Of course Australian doctors could be doing more to tackle health inequalities. Part of the inequalities we see happen when people cross the door into a doctors office or into a hospital. For example, why are Aboriginal people with heart disease treated differently after the walk in the doors of the hospital?
    (See: )

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    There are terrible health conditions in poor countries. There are terrible health conditions in Australia, a rich country. These affect the most vulnerable and neglected Australians; a majority of indigenous people (perhaps 70,000) and all the seriously mentally ill (schizophrenia, bipolar 1, severe affective disorders, about 550,000). All these people have a life expectancy which is twenty five years lower than average, fifty-five years instead of eighty years, mainly because of medical andpsychosocial conditions which all governments have learned to ignore.
    Regarding the seriously mentally ill (SMI)…the rate follows global rates of these brain diseases, 2,500 per 100,000. The Mental health Council of Australia (MHCA) believes that only 35% receive specialist or hospital care as needed. It also estimates 50,000
    SMI are homeless. Since deinstitutionalization, when thousands of SMI were left without accommodation, the SMI have been been re-houseds in prisons, streets, graves and urns.
    The suicide rate, 2008, is said by the World Health Organization to be 21.1 per 100,000, the highest ever. The SMI carry 13-14% of the burden of disease and generally receive 6-7% of the health budget. The Rudd 2010 health budget gave them 2%.
    Where is the Royal Australian College of Psychiatrists this year? Where has it successfully hidden in the past 20 years as the treatment, services and accommodation needed by the seriously mentally ill to stay alive and as well as possible have exponentially declined?


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