The bigger picture 

The political question of how a society organises the care of bodies is among the oldest political questions in any culture. Pre-modern medicine was practised through religious, communal, household, and apprenticeship traditions. The political conditions of who could heal, who could be healed, who paid, and who decided what counted as healing varied across cultures and centuries.

The French philosopher Michel Foucault documented in detail how the political conditions of medicine changed in the late eighteenth and nineteenth centuries with the emergence of what he called the clinic. The political authority that flowed to doctors as a profession, the political relationship between bodies and institutions that hospitals embedded, and the political practice of population health that public-health agencies developed, arrived through political settlements achieved through specific political contests about authority, knowledge, and the management of populations. Australian health systems sit inside that political settlement whether anyone names it. 

The American legal scholar Dorothy Roberts has documented in detail how the political history of medicine, particularly in relation to Black women in the United States, has involved sustained political contests about reproductive rights, body sovereignty, and who is treated as a patient versus as a problem. The analysis is a useful lens for reading how race, gender, and class shape who Australian health systems serve well and who they serve badly, even where the political contests have local rather than American specificity.

The colonial transfer

Australian medicine inherited British political settlements about health, illness, and care. The Royal College tradition, the apprentice-based training of doctors, the hierarchical political relationship between physicians and surgeons and apothecaries, and the political distinction between deserving and undeserving patients in poor-law medicine were all British political artefacts transmitted into colonial Australia. 

What that political vision excluded is part of the history. First Nations medical traditions, developed over millennia, were not recognised by colonial Australian medicine. Aboriginal healers and traditional birth attendants worked outside, parallel to, and frequently in opposition to the colonial medical settlement. The political project of suppressing First Nations medical knowledge, particularly through the political conditions of mission medicine and the active political project of removing Aboriginal women from traditional birth practices, did political work that is still doing political work in contemporary First Nations health.

The Australian medical profession, professionalising through the late nineteenth and early twentieth centuries, established political conditions for itself that excluded women, working-class men, First Nations people, and migrant practitioners trained outside British or empire institutions. The political achievement of opening medicine to women, to non-British migrants, and slowly to First Nations practitioners was the work of decades of political contest, much of it ongoing.

The welfare state and Medicare

The post-war political settlement transformed health systems globally and in Australia. The Beveridge Report in Britain, the development of Medicare in the United States, the establishment of the National Health Service in the United Kingdom, and the Australian political contests that produced Medibank and then Medicare were all political achievements, with significant operational consequences for the systems that followed.

Medicare, established in 1984 after a generation of political contest, was the product of sustained political organising by Australian Labor governments, by the Australian Council of Trade Unions, by health professional advocates, and by social movements that demanded universal access to health care as a political right. The political settlement was contested at the time by significant political actors including parts of the medical profession, parts of the opposition, and private health insurance interests. The political contest has not ended.

The political fact that Australians can access GPs, public hospitals, and significant primary health care without point-of-service payment is the legacy of decades of political organising. The political fact that the bulk-billing settlement is currently strained, that gap fees are widening, and that some Australians are increasingly unable to afford care, is also the legacy of political decisions, made and unmade across multiple political cycles.

The neoliberal turn and marketisation

From the 1980s, a different political settlement began to assert itself in health. The political idea that competition, choice, and market mechanisms could improve health outcomes was developed in policy think tanks in the United States, the United Kingdom, and Australia, and rolled out through successive reforms.

Public hospitals were corporatised in some states. Private health insurance was supported through significant federal subsidy. Primary care funding was restructured through successive Medicare reforms. The political settlement of health as a public good in continuous tension with health as a market good is the legacy of this turn, and the tension has not been resolved.

The neoliberalisation reached the workforce as well as the funding model. The political conditions of nursing, of allied health, of GPs, of specialists, and of hospital workers reflect decades of political decisions about pay, conditions, training pipelines, and workforce migration. The political conditions of feminised care work in health, including the structural undervaluing of nursing labour relative to medical labour, are political legacies, with significant consequences for who stays in the workforce and on what terms.

The reproductive and women's health political contest 

The political conversation about women's health, reproductive rights, and the medical treatment of women's bodies has been politically contested across the modern era. Australia's political contests on abortion access, contraception availability, midwifery practice, and the medical treatment of women's pain are part of a global political contest that has accelerated since the 2010s. 

The political legacy of the women's health movement, organising from the 1970s onward, produced significant achievements including the recognition of women's health as a distinct political and clinical category, the development of women's health centres and reproductive health services, and the political pressure on mainstream medicine to take women's pain and women's reproductive lives seriously. 

The political conversation about gendered medicine, about how women's symptoms are dismissed in clinical settings, about how race and class compound that dismissal, and about how the political settlement on reproductive rights is unstable, is sustained.

The present moment

AI in clinical practice, migrant health worker politics, and political backlash against rights-based health care are reshaping health now.

AI in clinical practice arrives as a contested political question. Who is liable when an AI tool produces a recommendation, who controls the data used to train clinical AI, and who profits from AI-mediated care, is being negotiated globally with significant Australian implications.

Migrant health worker politics arrives through every workforce decision. Federal migration policy, qualification recognition, and visa frameworks reach the health workforce continuously, and the political conditions of internationally trained doctors, nurses, and allied health professionals are politically contested.

The political backlash against trans-affirming care, women's health services, and Aboriginal Community Controlled Health Services is global and intensifying, and Australian health workers in those territories are politically exposed.