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, B?gin, Houweling, & Taylor, 2009).
Social determinants of health either enable or disable members of the society to access quality and affordable healthcare (Baum, B?gin, 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 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 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 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 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 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 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 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.
Australian Institute of Health and Welfare 2011, Medical Labour Force 2009
Australian Government; Department of Health (2017). Health's Gender Equality and Flexibility
Blueprint 2017-20 Available from
Australian Institute of Health and Welfare (2016). Australia’s health 2016; How does Australia's
health system work? Available from
Australian Review of Public Affairs (2011).What is it about women doctors? Available from
Australian Government; Closing the Gap (2013) National Aboriginal and Torres Strait Islander
Health Plan 2013–2023. Available from
Australian Indigenous HealthInfoNet (2017). Summary of Aboriginal and Torres Strait Islander
health status, 2016 Perth, WA: Australian Indigenous HealthInfoNet Available from
Burton, C. W. (2016). The Health Needs of Young Women: Applying a feminist philosophical
lens to nursing science and practice. ANS. Advances in nursing science, 39(2), 108.
Burton, R. (2015). Beyond inequality: Acknowledging the complexity of social determinants
of health. Social Science & Medicine, 147, 121-125.
Baum, F. E., B?gin, M., Houweling, T. A., & Taylor, S. (2009). Changes not for the fainthearted:
reorienting health care systems toward health equity through action on the social determinants of health. American journal of public health, 99(11), 1967-1974.
Barrow, M., McKimm, J., & Gasquoine, S. (2011). The policy and the practice: early-career
doctors and nurses as leaders and followers in the delivery of healthcare. Advances in health sciences education, 16(1), 17-29.
Cockerham, W. C., & Scambler, G. (2010). Medical sociology and sociological theory. The new
Blackwell companion to medical sociology, 3-26.
Feo, R., & Kitson, A. (2016). Promoting patient-centered fundamental care in acute healthcare
systems. International journal of nursing studies, 57, 1-11.
Fewster-Thuente, L., & Velsor-Friedrich, B. (2008). Interdisciplinary collaboration for
healthcare professionals. Nursing administration quarterly, 32(1), 40-48.
Gaboury, I., Bujold, M., Boon, H., & Moher, D. (2009). Interprofessional collaboration within
Canadian integrative healthcare clinics: Key components. Social Science & Medicine, 69(5), 707-715.
Germov, J. (2005). Theorizing health: major theoretical perspectives in health sociology. J.
Germov (3rd Ed.), Second Opinion: An Introduction to Health Sociology, publisher/…28-50.
Haralambos, M., & Holborn, M. (2008). Sociology: Themes and perspectives. HarperCollins
Kuhlmann, E., & Saks, M. (Eds.) (2008). Rethinking professional governance: International
directions in healthcare. Policy Press.
Kippist, L., & Fitzgerald, A. (2009). Organizational professional conflict and hybrid clinician
managers: the effects of dual roles in Australian healthcare organizations. Journal of Health Organization and Management, 23(6), 642-655.
Kuhlmann, E. (2009). From women's health to gender mainstreaming and back again: Linking
feminist agendas and new governance in healthcare. Current Sociology, 57(2), 135-154.
Liberatore, M. J., & Nydick, R. L. (2008). The analytic hierarchy process in medical and health
care decision making: A literature review. European Journal of Operational Research, 189(1), 194-207.
Marmot, M., Friel, S., Bell, R., Houweling, T. A., Taylor, S., & Commission on Social
Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. The lancet, 372(9650), 1661-1669.
Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of
health inequalities: theory, evidence, and policy implications. Journal of health and social behavior, 51(1_suppl), S28-S40.
Pedwell, C., & Whitehead, A. (2012). Affecting feminism: Questions of feeling in feminist
theory. Feminist Theory, 13(2), 115-129.
Paradies, Y., Harris, R., & Anderson, I. (2008). The impact of racism on Indigenous health in
Australia and Aotearoa: Towards a research agenda. Cooperative Research Centre for Aboriginal Health
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and
adolescents: a systematic review. Social science & medicine, 90, 24-31.
Short, S. E., & Mollborn, S. (2015). Social determinants and health behaviors: conceptual frames
and empirical advances. Current opinion in psychology, 5, 78-84.
Stanton, P., Young, S., Bartram, T., & Leggat, S. G. (2010). Singing the same song: translating
HRM messages across management hierarchies in Australian hospitals. The International Journal of Human Resource Management, 21(4), 567-581.
Timmermans, S., & Haas, S. (2008). Towards a sociology of disease. Sociology of health &
illness, 30(5), 659-676.
Willis, K. F., & Elmer, S. L. (2007). Society, culture and health-an introduction to sociology for
nurses. Oxford University Press.