Professor Carla Treloar, Director of CSRH and graduate of the University of Newcastle (UON), was invited to give the occasional address at the graduating ceremony of the Faculty of Health and Medicine, UON in late September this year.
Professor Treloar, who was awarded the Alumni Medal for Professional Excellence by UON in July this year, reflected on her early studies and career.
Read the full occasional address below.
Professor Carla Treloar: Chancellor, Vice Chancellor, Members of the Council, staff of the University, families and friends of graduates, and mostly importantly, graduates.
On my first day as an undergraduate at this university, I was 18 and straight from school. I met a fellow, a mature aged student who became a good friend. But on that first day, when I told him where I came from, what school I had been to, he exclaimed, "I didn’t think anyone who came from there ever went to university."
An amusing anecdote perhaps, given that all these years later and I have not yet left university.
This was my very first experience of structural inequality – that postcode can set the agenda for a life.
Well my life didn’t run according to the typical script of an undesirable postcode. I was a smart kid. But my personal qualities are only a very small part of the story – a story which is shaped by systems and people that can create opportunity where none may have existed. I could not have attended this university without government benefits to support me. Those benefits were made possible because others before me thought it important to give everyone the opportunity for education, regardless of capacity to pay. Those are headline, big policy issues. My life is shaped by so many others, people who have power to shape the everyday: my high school teachers who implanted the expectation of a university degree and showed me how to get there; my parents who instilled in me the idea that girls can do whatever they want; my friends that were supportive of big dreams – even if none of us quite knew how to make them real.
But what does that have to do with you – about to embark on a career in health – maybe working directly with people in clinical care, maybe in education, in research, in community development? Or all of these?
That postcode lottery invades every part of the health system and as part of the health system, you need your eyes to be open to ways in which that system is set up to work against your goals and the needs of the people it is supposed to serve.
To illustrate – I will fast forward from that first day as an undergraduate to last November. I was sitting on a plane travelling to a conference. I did have my phone set to flight mode but up popped a reminder that I was due at an appointment with a specialist in 15 minutes. With another 45 minutes on the flight, there was nothing I could do but watch the minutes tick by, knowing that I had become one of those “did not attend” statistics. That I had wasted very valuable time in a specialist’s calendar – an appointment that takes months of waiting.
I missed that appointment, even though it was for my son (I’m highly invested in his care), even though I have the resources of an electronic calendar, a phone with credit, good family relationships oriented around the priority of my son’s care, I know how to get to the hospital and can afford the outrageous car parking fees. Even though I speak the same language as the specialist, and I have the education to understand the issues in my son’s diagnosis and treatment. Even with all these resources, I missed that appointment. I just forgot.
But with my presentation, my language, my approach – I could call the specialist’s office as soon as I landed – apologise and organise to reschedule at the specialist’s private rooms with just 2 months delay. My son’s care was not compromised because I could afford and had the resources to search out alternatives.
My son requires numerous of these appointments – sometimes up to 20 or 25 appointments and procedures every year – with a range of specialists involved. I have remarked very often – how does someone – without the resources that I and my family have at our disposal – how do others manage to coordinate care across specialist systems, where data is not shared and where the individual becomes the holder of the corporate memory of when things have happened and what the results were and what needs to happen next and when. How do others do it?
Isn’t this a system perfectly designed to exclude, or give lesser care, to those who can’t manage what I can (almost) manage to do with all the supports that I have available to draw upon? And who are those with lesser resources? At a population level, those with lesser resources are also more likely to suffer ill-health. Does the organisation of our health system sustain or contribute to these patterns of inequality?
And so what can you, new graduates, do about this? What role can you play in lessening the unequal outcomes that our systems can produce?
I’m sure that many of you were trained in interactional skills, how to have conversations with people. What I’m suggesting is that these conversations or interactions need to pay attention to those factors which impact a person’s life long before and long after they come into contact with you. Whether that is their postcode or their race or gender or education opportunities or their income – all of these will impact on your ability to do your job to facilitate better outcomes.
You can’t change generations of structural inequality or social injustice but by understanding that the people in front of you are shaped by these histories, you can work to ensure that the people you are in contact with are best prepared to cope with navigating this messy and complex beast of a health system. Keep learning about the world around you and what shapes it. Keep thinking about how you can make a difference. Listen, with humility, to the worlds and experiences of the people you see. Challenge where things don’t make sense and where life is made more difficult for people with the least resources. That’s the role you can play: to advocate and work for “health for all”.