Hierarchy and Power: Australian Health Care System

This essay discusses the hierarchy and power in the Australian healthcare system using sociological theories of health such as conflict theory and feminism theory. It also contrasts these theories from the biomedical approach to health care.

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Hierarchy and Power: Australian Health Care System
The Australian healthcare system like any other across the globe is extensively
characterized by hierarchy and power with different stakeholders advancing different viewpoints
on what should be the ideal situation (Stanton, Young, Bartram, & Leggat, 2010). Hierarchy and
power in healthcare systems are witnessed both at the healthcare facility setting and at the
society level. At the healthcare setting, different healthcare stakeholders including healthcare
practitioners, healthcare facility administration, patients, and families manifest their power and
authority which by extension create hierarchies (Kippist, & Fitzgerald, 2009). At the social
scene, social determinants of health such as equitable resources distribution, adequate housing,
access to safe drinking water, employment, poverty, and sociocultural orientations explain the
emergence of hierarchical power relationships amongst different individuals and sections of the
society (Baum, Bégin, Houweling, & Taylor, 2009).
Social determinants of health either enable or disable members of the society to access
quality and affordable healthcare (Baum, Bégin, Houweling, & Taylor, 2009). According to
Cockerham and Scambler (2010), the presence of hierarchies and power in health care systems
has the potential of either impacting the system positively or negatively. Against this
background, this essay will utilize three sociological theories of health; conflict theory and
feminism theory to demonstrate how intrinsic hierarchy and power are in the Australian
healthcare system as well as how this may impact healthcare practitioners in the delivery of
quality and safe healthcare. Moreover, these sociological theories will be contrasted from the
biomedical approach to health care which does not incorporate sociological perspective in

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healthcare. The “structure-agency” concept will be employed to extrapolate the relevance of
these theories in healthcare sociological discourse.
First, a comprehensive understanding of the current the hierarchical arrangement of the
Australian healthcare is critical in the extrapolation of power hierarchies in healthcare systems
from a sociological discourse. The Australian healthcare system constitutes a complex and
multifaceted web of both public and private healthcare providers with different participants and
supporting mechanisms coming at play. The system follows a hierarchical power system with its
apex comprising of the Council of Australian Governments (COAG) which is the
intergovernmental decision-making body for system’s policies, programs, funding, and
regulation. Stakeholders forming the COAG constitute healthcare ministers drawn from the
federal, state and territorial governments of Australian. The federal government is keen on
universal public health through availing funds universal public health insurance scheme
including Medicare. State and territorial governments take the responsibility of actual delivery of
healthcare to Australians through the management of various Australian health care facilities.
Local governments provide localized community-based health services [Australian Institute of
Health and Welfare, 2016].
All levels of Australian government (federal, state and territory, and local) are inherently
involved in funding the system’s services. Moreover, other players such private health insurers
and non-governmental organizations also contribute to funding the system. A variety of
healthcare facilities both public and private such as hospitals, pharmacies, and clinics as well as
healthcare professionals such as medical practitioners and nurses are by and large involved to see
the adequate delivery of health care services to Australian residents. Both primary and secondary
healthcare services are offered across all Australian health care facilities and the primary model

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of care is of a biomedical approach. Hospitals provide physical medical or surgical care to
patients with different healthcare needs on a referral basis between primary and secondary
healthcare services [Australian Institute of Health and Welfare, 2016].
Health and healthcare as provided by the Australian healthcare system are sociological
concerns and therefore hierarchies and power are bound to come into play in healthcare delivery.
Wills and Elmer (2011) define sociology as the study of social life and its multifaceted
interrelationships. Haralambos and Holborn (2008) posit that sociology utilizes sociological
theories to explain how individuals and communities shape societies. Using these sociological
theories, sociologists can determine the existence of social inequalities in societies that
contribute to hierarchy and power imbalances and subsequently using the same to suggest ways
and means of solving social inequalities. The sociological theories can improve the ‘healthcare
providers’ approach to general health care by being more competent and fair in their healthcare
delivery besides shunning hierarchy and power intrigues from the society level (Cockerham, &
Scambler, 2010).
Sociologists employ the “structure-agency” concept to understand sociological
discourses. Structuralism perspective analyzes and describes the social influences emanating
from institutions in society. On the other hand, the agency component posits that individuals
possess authority and power to influence their own lives. Sociological theories of health are
founded on either the structure or agency side of the concept or the combination of the two
(Germov, 2015). Short & Mollborn (2015) assert that both the structure and agency elements
provide a significant platform for debating sociological discourses and advance a comprehensive
and complete picture of what health entails. A comprehensive sociological approach to health

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combines individuals’ healthcare requirements along with the society’s ideologies and
institutions as well as examining the impact on social inequalities.
In sharp contrast to this healthcare sociological discourse, the biomedical theory gives
emphasis to healthcare facets that advance diagnosis from an objective and physical viewpoint.
Following the Cartesian philosophy, the biomedical model detaches the soul, mind, and spirit
from the body and views the body as an object that needs treatment whenever its dysfunctions
(Timmermans, & Haas, 2008). To this end, the model does not incline to either the structural or
agency side of the "structure-agency" sociological discourse. This simply means distancing
social aspects from patients’ illness (Feo & Kitson, 2016). Though instrumental in contributing
immensely to clinical research, biomedical limitation remains its assumption that the mind and
the body are separate and therefore no social aspects can be tagged along with healthcare
delivery. As such biomedical theory posits no hierarchical and power concerns in healthcare in
contrast to sociological theories.
The conflict theory has been one of the most instrumental sociological theories in
explaining the impacts and implications of hierarchical and power struggles in the society as well
as at the healthcare systems. Conflict theory advocates for a just and fair society in which no
power inequalities can bar anyone from freely reaching out to quality and affordable healthcare
(Phelan, Link, & Tehranifar, 2010). Reiss (2013) asserts that conflict theory is premised on Karl
Marx’s proposition that all people deserve fairness in the access of fundamental social
determinants of health such as adequate housing; decent employment; quality food and safe
drinking water; and equitable wealth distribution. Inequitable possession and/or access to social
determinants of health amongst society individuals and groups creates social hierarchies and

HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 5
power imbalances at the society level that by extension enable or disable people to access
quality, safe and affordable healthcare (Marmot, Friel, Bell, Houweling, Taylor, 2008).
In the Australian healthcare context, a good example in which conflict theory's
condemnation of the impacts and implications of social hierarchies and power is the historical
denial of the equitable access to fundamental determinants of health by the Aboriginal and
Torres Strait Islander People. Paradies, Harris, and Anderson (2008) observe that for a long time,
indigenous Australians have been discriminated upon and have been labeled as disadvantaged in
the Australian society hierarchies partly due to their poor socioeconomic standing as well as their
indigenous sociocultural orientation. These social determinants of health by extension
disadvantages Aboriginal and Torres Strait Islander People to equitable access quality, safe and
affordable health care [Australian Indigenous HealthInfoNet, 2017].
Conflict theory in the healthcare sociological discourse calls for the elimination of power
and hierarchies that can hinder any member of the society from accessing quality healthcare
services. As such, due to socioeconomic inequalities that have created unfair society hierarchies
and power relationships between indigenous and non-indigenous Australians and which by
extension hinder indigenous people to effectively access quality health care in the Australian
healthcare system, the Australian government have instituted the “closing the gap initiative”
[Australian Government; Closing the Gap, 2013]. This initiative is aimed at eliminating all the
negative social determinants of health that create these inequalities. In doing, the Australian
government aims to effectively stabilize life expectancies of all Australians by making healthcare
services accessible to all regardless of the socioeconomic status of all Australians.
Feminism theory’s discourse in healthcare sociology espouses the perspectives of conflict
theory but from a gender viewpoint. The feminist theory asserts that healthcare hierarchies and

HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 6
powers surrounding patriarchal and capitalist frameworks are supposed to be minimized if not
completely eradicated. As such the feminist theory also espouses both the structural and agency
viewpoints of sociological discourse (Pedwell & Whitehead, 2012). For a long time, women
have been discriminated upon and have been viewed as weaker against their men counterparts
both at the society level as well as at the healthcare practitioner level (Burton, 2016). At the
society level, women have been seen as being inadequate, and incompetent to take up medical
courses because they are perceived as weaker than their men counterparts in tackling complex
patient treatment procedures (Kuhlmann, 2009).
At the healthcare system, feminists argue that workplace gender inequalities significantly
draw from the patriarchal and the capitalistic hierarchy systems of the society to exert power and
control over female practitioners (Burton, 2015). By aligning with the social determinants of
health viewpoint, the feminist theory endeavors to improve the social environment to favor the
flourishing of women both in medical practice as well as at the community level. As opposed to
the tenets of the biomedical model, the feminist and the conflict theory demand healthcare
practitioners to research more whenever women seek healthcare services in order to establish
whether she is a victim of domestic power hierarchies.
According to Australian Review of Public Affairs (2011) women have really struggled to
be recognized as competent health care practitioners in the Australian healthcare system both
when seeking enrollment into the profession at the medical school as well as right into practice.
Medicine have for a long time been labeled as male's profession. For instance, the University of
Melbourne graduated its first female doctors Clara Stone and Margaret Whyte, in 1891 and it
was until the 1980s and 1990s that significant numbers of women entering the medical field were
recorded. Moreover, according to the Australian Institute of Health and Welfare (2011) although

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women make up to 25% of surgical trainees only 10% actually become practicing surgeons.
Medical female students are likely to get delayed in finishing their medical studies due to gender
to hindrances of gender roles. However, the Australian government department of health has
come up with a Health’s Gender Equality & Flexibility Blueprint 2017-20 meant to eliminate the
challenges and inequalities that create power hierarchies that disable women to fully exploit their
potential in the medical field. Amongst its objectives in achieving this goal include advancing
supportive and enabling workplace cultures that embrace the specific needs of women;
promoting flexible work arrangements that respect women' dual gender roles; and promoting
gender equality in healthcare system's employment and leadership [Australian Government;
Department of Health, 2017].
Since the inception of modern medicine, there has been a great tussle for power,
dominion, and control for medical procedures amongst different healthcare practitioners
(Fewster-Thuente, & Velsor-Friedrich, 2008). Junior medical staffs are in most cases intimidated
by senior medical staff based on their professional level in the medical field as well as on the
basis of gender (Gaboury, Bujold, Boon, & Moher, 2009). To this end, senior male healthcare
practitioners perceive themselves as the custodians of power and authority (Barrow, McKimm, &
Gasquoine, 2011). Actually, women in healthcare practice have been forced to contend from the
receiving side in this tight power tussle against social ills such as discrimination, bullying,
segregation, and intimidation (Liberatore, & Nydick, 2008).
Hierarchies and power are bound to impact healthcare practitioners’ patient treatment and
management outcomes either positively or negatively. If well-articulated and applied in practice,
the two can advance positive health outcomes of patients as well as ensuring the smooth running
of healthcare facilities (Kuhlmann & Saks, 2008). In instances where power and authority are

HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 8
sort and utilized for selfish endeavors, then patient health outcomes will always be compromised.
Healthcare practitioners can, however, use sociological theories to engage in sociological
discourses to come up with the optimal solutions in different healthcare scenarios. For instance,
the conflict theory posits a significance perspective in the administration of healthcare to
different members of the society.
According to the theory, irrespective of the socioeconomic status of the members of the
society, healthcare practitioners ought to treat patients that seek their services with fairness.
Indeed, healthcare practitioners ought to be in the frontline in smothering all sorts of negative
social determinants of health. In support of the conflict theory, the feminist theory calls upon
healthcare practitioners to shun hierarchical powers that disadvantage the thriving of women in
the healthcare industry. Female healthcare practitioners ought to be treated as the equals of their
male healthcare practitioners’ counterparts and must be seen as capable to deliver health care to
patients on the premise of their capabilities and not what their gender is.
Arguably, the Australian Health Care system like any other system is bound to continue
experiencing major hierarchical power tussles across its diverse and multifaceted stakeholders
because inherent factors instigating power, control, and dominance are still underlying in the
system. However, hierarchical power and authority controls ought to be exercised with the goal
of expediting the outcomes of healthcare delivery for the benefits of patients and their families
(Liberatore, & Nydick, 2008). In doing so, relevant healthcare sociological perspectives must be
sought to provide policy guidance where necessary. The “structure-agency” model provides a
formidable platform over which healthcare practitioners can debate hierarchy and power in
healthcare and the sociological perspectives of the same and by extension assisting them to make
critical decisions on how best to advance healthcare to their patients.

HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 9
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