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It is time to think more broadly about security than the narrow military concept about which there is endless debate. Security for individuals and communities does not depend on a nuclear powered and nuclear armed submarine. We are humans and human security is about many things including health, and it is health which our organisation, the Doctors Reform Society, has focused on for the last 50 years.

Specifically regarding health, there are two key principles we support.

Firstly, there is no cost access to timely, culturally appropriate health services (including dentistry and mental health) for everyone.

Secondly there is the requirement that individuals and communities have the capacity to make optimal use of that access. For that to happen, people need to feel a sense of control over their lives. For that to happen, the social determinants of health, the conditions in which we work, live, and play, must be optimized.

These two principles are intertwined. One without the other embeds insecurity. Indeed, a sense of control over one’s life and those around is perhaps another way of saying Human Security, at least for the individual.

People who are sick and cannot afford or cannot access appropriate health care feel insecure. Fixing that issue is not hard if there is political will. In Australia that does not currently exist. In the Whitlam era there were visionaries who believed in equitable access. There are few such people now in positions of political power. The rise of neoliberalism sees a country as a market and every government use of funds as a cost. Our society is firstly a community or should be. Market forces are useful in some sectors, but health care is not a market. If we see our society as a community, funding health care is an investment. Healthy individuals can contribute to the society. Failing to help unhealthy people (because of perceived cost) is the real drain on the community and the economy, with the most acute affects felt by families and individuals.

The funding model needs to be radically altered. Public hospitals provide excellent health care to anyone, so long as they can wait long enough. It is a political decision to make public patients wait while private ones jump the queue and seek private care, heavily funded by taxes. Getting access to health care in the community is completely different. It is a hodgepodge of up-front fees, caps, gaps and disease specific funding plans. Out of pocket costs are frequently unaffordable, and the distribution of doctors compared to need is appalling. A new way of funding would be to have salaried doctors everywhere. Doctors survive in public hospitals on salaries. Why not salaried health care providers across the country? That requires firstly a major consideration of the principles of Human Security, as well as political will in order to make such a big change.

But providing that access and affordability is just the first step in ensuring a feeling of security, a feeling of control over one’s life. Access is not enough. Countries which have much more equitable access to health care than we do (on equitable access we rate 9^th out of 10 OECD countries, just ahead of the USA), don’t necessarily have good health outcomes.

The reason: social determinants of health, the conditions in which we live, work, and play. This was beautifully illustrated in a study of English public servants in the 1980s. Despite a secure job in the same sector, and equitable access to health care through the NHS, mortality and morbidity from almost every cause followed a gradient. At the top, people felt in control, secure, and well able to make best use of the access and advice they were given, using the NHS. At the bottom, on a basic wage people felt insecure, not feeling able to make best use of what was available. And the middle-income earners were in the middle, in terms of health outcomes and sense of control. It is a gradient.

Providing that sense of control over one’s life, that security, requires addressing poverty, educational opportunities, secure housing, protection from violence, effects of climate change and many other social factors which impact different people’s lives. And when we talk about poverty, the evidence in richer countries is that it is relative poverty that counts. Thus, an entry level English public servant in the 1980s would not be seen as poor, but perceptions count when one is talking about security and control. The rich can do anything. The relatively poor base grade public servants cannot, they know it, they feel it, and they suffer, especially in a society with marked inequality.

In 1969 in his policy speech Gough Whitlam announced that “we propose a universal health scheme, based on the needs and means of families”. We would now say individuals rather than families. But he also said “We are all diminished as citizens when any of us are poor. Poverty is a national waste”.

Now our leaders of both major political parties are happy to leave the unemployed living below the poverty line, along with many others with poor paying jobs and rents which reduce their disposable incomes to poverty levels. Health goes out the door. Dental health never got in the door. Security is impossible.

We would like to see our policy makers taking responsibility for ensuring Human Security. To do that we need from them

1. the recognition that access to adequate health care is a basic human right.
2. a commitment to equity i.e. the opportunity for everyone to achieve their optimal capacity in life without impinging on others’ opportunities.

Only then might we see a move to recognition of Human Security rather than an obsession with geopolitical and military security.