An Analysis of Hierarchy and Power in the Australian Healthcare System

This essay examines the pervasive influence of hierarchy and power within the Australian healthcare system. It begins by introducing key sociological concepts and perspectives, including the functionalist, conflict, and symbolic interactionist models, alongside the biomedical model of health. The essay then defines hierarchy and power, exploring relevant theories such as social dominance theory, Karl Marx's theory of socialism, and Weber's social power theory. These concepts are then applied to the Australian context, highlighting disparities in healthcare access and outcomes across different communities, particularly the Indigenous population. The essay discusses the roles of various stakeholders, including political parties, government bodies, and private sectors. It concludes by emphasizing how hierarchy and power contribute to inequalities in healthcare, affecting factors such as access to services, geographical location, and socioeconomic status, and the impact on various groups within Australia. The essay highlights specific examples such as the impact on tobacco use and smoking policies.

“Hierarchy and power are intrinsic to the current health care system in
Australia”
INTRODUCTION
Hierarchy and power are two concepts which greatly affect various fields across almost all
countries. In this particular discussion, we will take Australian health care system into
consideration. Further, to have a clear understanding of the same, we will discuss few key
concepts of sociology and its perspectives, biomedical model of health, discussion about our
two key concepts namely hierarchy and power, there definition and theories related to same
and at the end how they are inherent in Australia’s present health care system and how they
are reasons of disparities amongst different communities across Australia and a concluding
note at the end.
EXPLANATION OF SOCIOLOGY AND THE ROLE OF
PERSPECTIVES
Sociology, contrary to psychology which is a study of individuals conduct and intellect, is the
methodical study of society and groups and how an individual’s conduct depends on which
society and group he or she is associated with. It comprises of forms of societal associations,
communal interface, and ethnicity. This study hugely helps health practitioners globally in
determining the health conditions affecting people in different locations. Thereby, helps in
the determination of the correct course of treatment. There are several social factors including
religion, race, gender, education etc that majorly affects the health of an individual. The
sociology of health and illness determines the relationship between health and these societal
factors. It has been proved by sociologists that position of an individual in the society, racial
belief and other communal factors considerably impact the growth of diseases (Crossman,
2017). There has been a constant advancement in technology and economy, changes in
insurance, which largely affects the health care facility available to an individual.
There are diverse approaches to sociological analysis which are commonly referred as
perspectives. Firstly, the functionalist model perceives that for the society to perform
proficiently, it is necessary to have good health and efficient health care as indicated by
Talcott Parsons (Libraries, 2015). It emphasizes on the “sick role”. It further highlights that a

sick person disrupts the performance of society as a whole, as he is unable to execute his
responsibility as a member of the society (Lumen, 2014). Also, lack of proper health care
worsens society’s functioning. Individuals to be regarded as sick should have the will to
recover; their sickness should be well established by a medical practitioner and he should not
be responsible for his own ill condition. This approach perceives hierarchical relationship
between the sick person and medical practitioner. However, the said perspective was
condemned on various grounds. Secondly, the conflict theory highlights the disparity
between health quality and medical care services. There have been disparities in the society
as far as race, customs, sex and social groups are concerned. Probability of individuals with
pitiable conditions to fall sick is more and with poor medical services, it further worsens their
condition. It also accentuates evaluation of efforts by medical practitioner to have dominance
over their practice and of considering numerous society issues such as over eating problem as
health issue. Further, the symbolic interactionist model underlines both health and sickness
are socially built. It highlights that health conditions are clearly explicated as sick or healthy
by the society at large. The approach also focuses on the interface between ill people and
medical practitioner clearing that the medical practitioner exhibit their power of curative
understanding by using composite medicinal language which are difficult for the common
men to understand and usually they have to wait for practitioner to turn up. However, like
other perspectives, this approach has also been criticized as certain severe medical issues still
subsists despite of whether it is considered so by the general public or not.
BIOMEDICAL MODEL OF HEALTH
There have been several models of illness and health. However, biomedical model is the most
popular and governing model of health of the 20th century (Wade & Halligan, 2004). Also
referred as biomechanical model, the said model methodically evaluates health and explains
that disease occur from causal aberration inside the individuals body. It considers health as
without the presence of any disease. It exclusively highlights the biological causes in
assessing a particular disease. In this model, an ill person is perceived as a body which is sick
and is managed, investigated and medicated by the medical practitioners solely with their
rationality and extrinsic evaluations (Smith, 2017). Hence, practitioners of health with proper
understanding are obligated to cure the sick person in a background with existence of suitable

medicinal equipments. Doctors hold a dominant position in the said model and greatest
probable cure for the patient in a medically equipped environment is the major benefit of this
model. However, health is recognized as the condition of being bodily, emotionally and
communally robust and not simply the dearth of disease by the World Health Organization.
This particular model is well established in today’s modern communities. However, there are
certain disadvantages of the said model. It does not take into consideration social aspects
such as standard of living and the financial system as a whole. There are several other factors
other than biological that are responsible for an illness in individuals such as hierarchy and
power that majorly affects a person’s health in today’s world.
HEIRARCHY AND POWER –DISCUSSION, THEORIES AND
EVIDENCE RELATED TO BOTH CONCEPTS
Hierarchy is defined as the categorization of collection of individuals in accordance with their
financial, societal and professional position in the society. Individuals are divided on the
basis of race, religion, class, ethnicity and many more factors which in turn have great impact
on the health and services provided to individuals in these distinct categories. Firstly, we will
discuss social dominance theory which was developed by Sidanius and Pratto in the year
1999. The theory describes the source of societal hierarchies and how these classifications
boost certain groups and adversely affect people in particular groups (Moss, 2016).
According to this theory, there are dominant and subordinate groups and there exists
inequality in both these groups. There are three different arrangement of hierarchy in all
developed economies on the basis of age, gender and subjective reasons such as ethnic group,
race, rank, belief and faith. There are five key determinants of this theory. To start with,
governing groups possess dominance over other minor groups. Also societal background
greatly impacts these groups. It is more prevalent in males than females and is affected by
traits of people and socialization happenings. We further discuss Karl max’s theory of
socialism which classifies individuals in society into three groups namely upper, middle and
lower class (Heirarchystructure, 2017). Normally known as the Marxist Social Hierarchy, the
said theory explains that the wealthiest individuals owning land belongs to upper class,
individuals who work for upper class and sells their talent in return of money comprises of
middle class. Lastly, less earning group with no property comprised the lower class. There

have been discrepancies amongst all these groups as far as health and health care services are
concerned.
Weber described power as the capacity of a person or collection of people to accomplish their
objective despite of opposition from other groups who attempts to avert them from achieving
the same (Cook, 2013). In Weber’s social power theory, power takes two forms of being
authoritative and the other one is through force. Further, lawful authority is of three kind
namely charismatic authorities wherein a person possesses such authority owing to appealing
qualities, traditional authority wherein power is possessed owing to custom and is conceded
on inheritance grounds and lastly regal-legal authority wherein the authority is given owing
to certain set of regulations and the individual is empowered with authority through a
procedure. Moving forward, there are three models of power which describes communal and
opinionated power. Firstly, as per the pluralist model, power is dispersed amid numerous
groups and there are two groups namely insider group who has more dominance such as
worker, agricultural and practiced groups and the outside groups such as grassroots activists
and political action committees. This model particularly brings out the political aspect of
power in society and relates to functionalist perspective that we discussed above. Secondly,
in elite models, power in democratic economies such as Australia is linked with wealth. C.
Wright Mills power elite theory is the most popular one in which the government, military
and well established business holds a dominant position in leading society for their own self
concerns and ignores the concerns of others. Lastly, Marxist approach of power describes that
there is restricted amount of power which can be exercised by few people at a single point in
time. As per him, there are two classes- ruling and working class, wherein the latter is
subjugated by the former in capitalism.
Hence, all the theories related to these concepts namely hierarchy and power proves that they
affect health and health care system of every economy.
AUSTRALIAN HEALTH CARE SYSTEM
Australia has a diverse culture. There are different groups with differences in race, culture,
ethnicity, education and language. There is a significant inequality between several groups as
far as health and health care services are concerned. Medicinal profession holds a governing

position in the Australian health care system. Even today, most of the doctors in pastoral
Australia works individually and are not working publically owing to such dominance. There
should be impartiality in providing health care services throughout Australia as per the
Australian Health Care Agreement (Kenny, 2014). Conversely, huge disparities exist between
distinct groups. Diverse political parties who hold highest position in hierarchy as discussed
in above theory, prevalent in Australia have diverse views and enforce powers when it comes
to medical services. There is not always clarity in relevant position of the Common Wealth,
the state and territory government who are responsible for funding and ruling of health care
in Australia. Medicare which is a nationalized plan for ensuring liberated and low cost
medical services is the accountability of the Commonwealth. Major funding is the
Commonwealth responsibility. However, other related activities of managing and regulation
of services is state and territory responsibility. Private sector also accounts for significant
position by taking care of around one third of total medical expenses. Also, nonprofit
organizations accounts for important position by taking care of old age services.
Further, various groups especially the Indigenous community in Australia is still facing
inequalities because of hierarchy and power. Pitiable housing infrastructure, lack of
employment, lack of awareness, racial discrimination, gender biasness, difference in beliefs
and values all these socio economic factors accounts for poor health of this community as
compared to others. There have been proofs that people living in lower rural areas are badly
impacted with diseases than those residing in metropolitan areas. Poor access to health
services is also a cause of deteriorating health in different communities. Hence, it is proved
that hierarchy and power plays vital role in Australian health care system. Customs and
geographical location, environmental factors, access to medical services greatly affects health
of individuals. As explained in above theories that authority and power resides in few groups
and the higher management, t clearly applies in Australia’s health care system as all decisions
regarding funding, regulation is taken by high political class with their own interests in mind
and hence, proof is the inequality between young and aged, men and women and various
other groups. There are few women politicians in Australia which proves our point.
Moreover, Indigenous males face higher death and morbidity rates as compared to other
males. Suicidal deaths in young males are common. Young Australians are faced with
household brutality, ignorance, child paucity and addiction to tobacco as a result of hierarchy
and power.

We can further discuss the role of hierarchy and power in relation to tobacco use and
smoking policy implemented in Australia. Tobacco has been the principal cause of deaths and
hospitalization in Australia. Tobacco smoking has been considered as the major reason
behind poorer health and cause of several persistent ailments amongst Indigenous people with
around 12% of the whole lumber of ailment and accounting for around one fifth of total
deaths (Purcell, 2015).Smoking rates are higher in people suffering from mental illness, who
are unemployed, who live in underprivileged locations, Indigenous people and amongst
prisoners. This information clearly shows that people who belong to lower class are highly
impacted with the tobacco use and in turn the most impacted ones when it comes to suffering
from diseases related to same. Although continuous steps has been taken by the Australian
government including the federal, state and territory government in reducing the use of
tobacco by banning smoking in flights, development of National Tobacco Strategy, banning
smoking in enclosed public areas, smoke free dining laws in Victoria and communications
campaign. Still there is inequality as far as tobacco control efforts are concerned amongst
different groups on the basis of socio economic factors, cultural and political factors which is
clear from the fact that people resides in lower rural areas in Victoria accounts for 17.5% and
people residing in higher metropolitan areas accounts for 11.1% of normal smoking rates.
Smoking amongst prisoners despite of efforts has increased over a period of time. However,
the current trend and efforts with regards to taxation has proved to have a positive impact on
overall reduction in tobacco use and should be followed to reduce disparities amongst various
groups.
OVERALL CRITICAL DEPTH
From the above discussion we conclude, hierarchy and power have a major role in Australian
health care system. There are inequalities amongst various groups on the basis of race,
culture, ethnicity, employment, political in Australia which we have clearly highlighted.
Medical dominance is prevalent. Hierarchy and power greatly affects and impacts people’s
health which is evident from the facts discussed above. Because of these two, diverse
communities including Indigenous, aged people, males and females, mentally disabled people
etc suffer greatly in terms of health as well as in other fields.

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