PUBLIC WEALTH,PUBLIC HEALTH,AND PRIVATE STEALTH: EXAMINING THE BLACK MARKET IN CIGARETTES IN AUSTRALIA

Taxes on tobacco provide a significant income for the Australian government — $5.1 billion in 2001. At the same time, health officials are making strenuous efforts to reduce smoking, particularly among teenagers. Some economists suggest that raising taxes on tobacco will produce more revenue while at the same time lowering smoking rates, particularly among youths who have less discretionary spending power than adults. But a by‐product of excise tax in Australia has been the emerging market in “chop‐chop,” tobacco diverted from legal channels by growers who receive considerably higher prices for a part of their yield than they can obtain from legal manufacturers. The article details this situation and suggests that only bold solutions may be able to reduce tensions in tax policies, smoking rates and the “chop‐chop” black market.     

RISK AND THE VALUE OF INFORMATION IN IRREVERSIBLE DECISIONS

The analysis of the nexus between the value of information and risk is examined for sequential decisions with different degrees of future commitment, as e.g. environmental decisions. We find that in the linear case a riskier environment in general will increase the value of information. This result will be extended in the separable case to decreasing and increasing stochastic returns to scale. An example shows the ambiguity in the general case.     

FROM TENDER CARE TO TENDERED CARE: THE CASE OF THE VICTORIAN MATERNAL AND CHILD HEALTH SERVICE

Restructuring the public sector along market principles has been a major policy development of the late twentieth century in most western countries. This paper examines the impact of recent political and administrative change on a Victorian universal primary health program, the Maternal and Child Health Service (MCHS). The first section establishes the development of the service in the years when an interventionist state provided bureaucratic support for the expansion of public health activities. In the next significant period of organisational change, the 1980s‐early 1990s, key interest groups articulated their positions in view of the administrative imperatives of corporate managerialism. Dramatic ‘marketisation ’ of the service then occurred with the impact of compulsory competitive tendering (CCT) in the mid‐1990s. The paper argues that attention to the complex processes of change shows the interplay of interest groups, discursive positions and administrative regimes, with new strategies emerging to counter the contracting state.     

ANCILLARY AND SPECIALIST HEALTH SERVICES: THE RELATIONSHIP BETWEEN INCOME,USER RATES AND EQUITY OF ACCESS

Australia's public health system currently provides substantial funding to, amongst its other objectives, ensure access to hospital, medical and pharmaceutical services by all families irrespective of income (McClelland, 1991, p. 6). However most ancillary services are not similarly subsidised and there is some evidence that income presents a barrier to the use of these services. There is also evidence that low income might also reduce access to specialist medical practitioner services which, while funded through Medicare, are less likely to be bulk billed than general practitioner services, and which therefore attract higher out-of pocket costs. In this study, the 1989–90 National Health Survey is used to examine whether there are indicators that low income reduces access to a range of ancillary services such as physiotherapy, optician services, chiropractic and dental services and to specialist medical practitioner services.     

SUPPRESSING THE VOICES OF THE SURVIVORS: SEXUAL EXPLOITATION BY HEALTH PRACTITIONERS

It has been speculated that the effects of sexual assault on victims are exacerbated by non-disclosure. It is therefore important to explore the reasons why survivors do not disclose or make formal reports. This paper looks at some of the factors that have stopped many survivors of sexual assault or exploitation by health professionals from reporting sexual assault. A sense of shame is the principal deterrent; this is coupled with other factors derived from the nature of the relationship - the inequality and trust inherent between the patient and practitioner and, in counselling contexts, possibly the added power inequity in transference. For those who do report, their experiences with complaints units, Medical Review Boards and the courts may prove to be less than satisfactory. The article looks in depth at an example of the latter, illustrating how interpretations of consent in sexual assault legislation can be particularly problematic with health practitioner perpetrators. The courts and boards may fail to understand the consent issue and delay in reporting from the point of view of survivors. Consequently, their voices will continue to be suppressed.     

CALCULATING THE TRUE COST OF PRIVATE SCHOOL EDUCATION: BASED ON A SURVEY OF SOUTH AUSTRALIAN SCHOOL FEES

The cost of a child's education should not be a mystery to consumers, yet little has been published about the true costs, and it is no simple task for parents to calculate. This paper seeks to fill a gap in the research literature that exists in relation to informing parents and educationalists alike as to the true cost of private school education. The term cost is used in the economic sense as encompassing not only the price paid for the product (school fees) but also the opportunity cost to the family in terms of what they forego in order to finance private schooling. Identifying opportunity cost is a useful means of assessing the impact of factors, other than financial, that are influential in determining whether or not private education is purchased. From a survey of South Australian private schools, we have been able to provide a detailed account of the price variations between the fees charged, as well as identifying a variety of additional ancillary charges. Based on the survey figures, we have projected the amount of money that needs to be taken out of the family budget in order to pay for a child's private schooling. At the time the survey was conducted the cost of private school education across three strata, on average, ranged from $13,400 to $42,246. We calculated that incremental family pretax incomes of between $20,303 and $64,009 would be required to fund this education. The amounts represent an opportunity cost to a family whereby money could be put to alternative uses such as home renovation, an overseas holiday, or a buffer against unexpected life events. We conclude that the outlay is substantial for many families and that greater transparency of all costs is needed for families to make informed financial plans to accommodate the overall cost of education for their children.     

SOURCES OF INFORMATION ABOUT HIV/AIDS AND PERCEIVED RISK OF INFECTION AMONG HETEROSEXUAL YOUNG ADULTS: 1989 AND 1994

This paper reports a study of sources of information about HIV/AIDS and trust of the sources among heterosexuals in 1989 (113 females and 91 males) and 1994 (185 females and 66 males). We also examined whether perceived personal risk of HIV infection was predicted by sources of information about HIV/AIDS, trust of the sources, how informed about AIDS people believed they were, and perceived risk of infection to others, as well as whether there was a relationship between perceived personal risk and safe sex behaviour. Participants received most of their information about AIDS/HIV from magazines, newspapers, and television, but placed most trust on sources such as doctors and HIV/AIDS organisations. Perceived personal risk was influenced most by perceived risk to friends and to people with the same sexual practices. In the 1994 sample, perceived personal risk was correlated with the amount of condom use among participants with sexual experience. These results indicate ther has been relative stability across a five-year period. They also point to the continuing discrepancy among young heterosexuals between the most-used and most-trusted sources of information, as well as to the importance of peer influence on perceptions of personal risk of HIV infection.     

VICTIMS OF CRIME AND LAW AND ORDER IDEOLOGY: A CRITICAL ANALYSIS

This article will argue that conservative forces in the community have used the renewed concern for crime victims in order to further their own political positions, rather than to genuinely advance crime victims' interests. These forces, commonly referred to as the ‘law-and-order’ lobby, include right wing politicians, the police and some sections of the media. The ideology which informs their approach will be critically examined, as well as the most important specific policies relating to crime victims deriving from this ideology.     

THE POWER OF NORMALISATION: FOUCAULDIAN PERSPECTIVES ON CONTEMPORARY AUSTRALIAN HEALTH CARE PRACTICES

Foucault's analysis provides social and political insights into the way that contemporary health care practices in Australia have been, and are being, constructed. His notion of discourse provides a useful starting point to analyse the taken-for-granted nature of reality that is so hegemonic in many health care practices. An analysis of discourse reveals the panoptic tendencies inherent in the Australian health care system. The notion of panopticism calls into question some very fundamental assumptions about the relationship between power, knowledge and truth. At the core of such panopticism are disciplinary techniques which promote normalisation. The examinations carried out by health care professionals, the case notes that are subsequently developed, along with an associated proliferation of diagnostic tests and procedures resulting in the production of the docile body, are symptomatic of the process designed to restore normalisation.     

AN ANALYSIS OF THE DEBATE ON INTERGENERATIONAL EQUITY AND FISCAL SUSTAINABILITY IN AUSTRALIA

The authorities in a number of advanced countries have produced intergenerational reports that seek to determine the fiscal sustainability of current policy parameters. The Australian government will publish its Intergenerational Report in May 2002. This paper attempts to place these reports in analytical perspective. We examine the notion of intergenerational equity, the conceptual basis for generational accounting, Australian efforts at constructing generational accounts, and then review the intergenerational reports of several other countries. The paper concludes with a brief synoptic discussion of various policies that can help Australian governments achieve intergenerational balance in future.     

POWER AND ADDICTION: THE MAKING OF THE MODERN ADDICT

This article provides a genealogical analysis of the ‘discovery’ of the modern phenomenon of addiction. It considers how the emergence of a bio-politics of the population in the industrialising West facilitated the invention of addiction and supported an argument for the regulation of opiate use. As a result of regulation, particular patterns of opiate use became increasingly visible. In response the medical profession, in the late nineteenth century, through the use of power-knowledge strategies transformed opiate use from a diverse set of social valuations to a unified pathology associated with madness, or unreason. This constitution of addiction as a negative category has been developed and appropriated by other discourses to provide the foundation for disciplinary interventions directed towards the regulation of undesirable patterns of consumption.