The politics of pharmacies

Show notesThe story in this episode is composite, drawn from real events. The identifying details have been changed to protect privacy, but the situations and the political contexts are real. The real-world events the story draws on, full citations, and further reading are below.REAL-WORLD EVENTS REFERENCED IN THIS EPISODEPharmacist scope of practice in Australia- Queensland’s Community Pharmacy Scope of Practice Pilot began in 2024 and wasmade a permanent feature of the state’s health system from 1 July 2025.Trained pharmacists can assess, treat, and prescribe for a range of acutecommon conditions under the Extended Practice Authority, with roughly 16 to22 conditions covered.- Victoria’s Community Pharmacist Statewide Pilot reported a 97 per centpatient satisfaction rate and was made permanent with an $18 millioninvestment, covering 22 conditions and offered at no cost to patients.- New South Wales, South Australia, Western Australia, and Tasmania haveintroduced or expanded pharmacist prescribing. Western Australia’s EnhancedAccess Community Pharmacy Pilot is expected to begin service delivery by2027. Scope is set state by state, and the Pharmacy Guild of Australia hascalled for the rules to be harmonised nationally.- The Productivity Commission and Queensland Government report Unleashing thePotential: An Open and Equitable Health System found that using pharmacistsand other health professionals to their full scope of practice improvesaccess to care and helps address workforce shortages, particularly inregional and rural areas.- The Australian Medical Association and the Royal Australian College ofGeneral Practitioners have opposed elements of the expansion, citing patientsafety and fragmentation of care. Commentary has described the dispute as aturf war between the two professions.The professionalisation of medicine- Through the nineteenth century, medicine in the English-speaking worldconsolidated into a single licensed profession through registration andlicensing laws, the standardisation of medical education, and control ofhospitals. In Britain the Medical Act 1858 created a statutory medicalregister, and comparable registration regimes followed across the Australiancolonies.- As the profession closed, women, who had long done much of the work ofhealing, were pushed to its margins. Midwifery was subordinated to amale-dominated obstetrics, and women were largely excluded from medicaltraining for generations.Medicine and colonial power- Frantz Fanon, born in Martinique, trained as a psychiatrist and headed theBlida-Joinville psychiatric hospital in Algeria from 1953 until hisresignation in 1957, during the Algerian war of independence from France.- His essay “Medicine and Colonialism,” published in A Dying Colonialism in1959, described how colonial medicine operated as an instrument ofdomination, and how colonial doctors were legally required to reportpatients’ suspicious injuries to the authorities.Non-physician clinicians and primary health care- Mozambique, left with only a few dozen doctors after independence in 1975 anda prolonged civil war, trained a cadre of non-physician clinicians, thetecnicos de cirurgia, to perform major surgery. Studies over more than twodecades found their surgical outcomes comparable to those of specialistdoctors, at a fraction of the cost, with far higher retention in ruraldistrict hospitals.- The International Conference on Primary Health Care at Alma-Ata in September1978 produced the Declaration of Alma-Ata, which set out primary health careand the goal of Health for All, giving community health workers a centralrole in delivering basic care.- In Australia, Ngangkari, traditional healers from the Anangu PitjantjatjaraYankunytjatjara Lands, have been integrated into South Australian hospitals.The Northern Adelaide Local Health Network entered a partnership with theAnangu Ngangkari Tjutaku Aboriginal Corporation in 2019. The Aboriginal andTorres Strait Islander Health Practitioner is a nationally registeredprofession, regulated through the Aboriginal and Torres Strait IslanderHealth Practice Board of Australia.REFERENCES[1] Andrew Abbott, The System of Professions: An Essay on the Division ofExpert Labor (Chicago: University of Chicago Press, 1988).[2] Eliot Freidson, Profession of Medicine: A Study of the Sociology of AppliedKnowledge (New York: Dodd, Mead, 1970).[3] Eliot Freidson, Professional Dominance: The Social Structure of MedicalCare (New York: Atherton Press, 1970); supporting source Magali SarfattiLarson, The Rise of Professionalism: A Sociological Analysis (Berkeley:University of California Press, 1977).[4] Paul Starr, The Social Transformation of American Medicine (New York: BasicBooks, 1982).[5] Barbara Ehrenreich and Deirdre English, Witches, Midwives, and Nurses: AHistory of Women Healers (Old Westbury, New York: Feminist Press, 1973);supporting source Anne Witz, Professions and Patriarchy (London: Routledge,1992).[6] Frantz Fanon, “Medicine and Colonialism,” in A Dying Colonialism,translated by Haakon Chevalier (New York: Grove Press, 1965); originallypublished as L’An V de la revolution algerienne (Paris: Francois Maspero,1959).[7] David Arnold, ed., Imperial Medicine and Indigenous Societies (Manchester:Manchester University Press, 1988).[8] C. Pereira, A. Cumbi, R. Malalane, F. Vaz, C. McCord, A. Bacci, and S.Bergstrom, “Meeting the Need for Emergency Obstetric Care in Mozambique: WorkPerformance and Histories of Medical Doctors and Assistant Medical OfficersTrained for Surgery,” BJOG: An International Journal of Obstetrics andGynaecology 114, no. 12 (2007).[9] World Health Organization, Declaration of Alma-Ata: InternationalConference on Primary Health Care, Alma-Ata, 6-12 September 1978 (Geneva: WorldHealth Organization, 1978).[10] World Health Organization, Task Shifting: Rational Redistribution of Tasksamong Health Workforce Teams; Global Recommendations and Guidelines (Geneva:World Health Organization, 2008).[11] Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council, TraditionalHealers of Central Australia: Ngangkari (Broome: Magabala Books, 2013); on theregistered profession, Aboriginal and Torres Strait Islander Health PracticeBoard of Australia, Australian Health Practitioner Regulation Agency.FURTHER READINGEliot Freidson, Professionalism: The Third Logic (2001). Freidson’s finalaccount of professionalism as a distinct way of organising work, set againstthe market and the bureaucracy.Ivan Illich, Limits to Medicine: Medical Nemesis (1976). A polemic arguing thatan expanding medical monopoly erodes people’s capacity to care for themselvesand each other.Keith M. Macdonald, The Sociology of the Professions (1995). A survey of howsociologists have understood professions as projects of monopoly, status, andsocial closure.Barbara Ehrenreich and Deirdre English, For Her Own Good: Two Centuries of theExperts’ Advice to Women (1978). Traces how a male-dominated medical andscientific establishment claimed authority over women’s bodies and lives.Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (1991). Onhow colonial medicine in Africa classified and governed the people it claimedto treat.Charles E. Rosenberg, The Care of Strangers: The Rise of America’s HospitalSystem (1987). A history of how the hospital moved from a charitable refuge tothe institutional centre of professional medicine.Frantz Fanon, A Dying Colonialism (1959). The essay “Medicine and Colonialism”sets out how medicine became part of the machinery of colonial rule.All works, organisations, scholars, legislation, and historical events listedabove are real and citable. For any source intended for formal academic orprofessional writing, direct verification against the original publication orinstitutional record is recommended.bout the hostLiv Roe is a civic and political adviser based in Melbourne. She works with businesses, organisations, and individuals on the political and civic context of their work. Book a consultation at livroe.org. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit civicsandcommerce.substack.com