Show notes The 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 EPISODE Pharmacist scope of practice in Australia - Queensland’s Community Pharmacy Scope of Practice Pilot began in 2024 and was made a permanent feature of the state’s health system from 1 July 2025. Trained pharmacists can assess, treat, and prescribe for a range of acute common conditions under the Extended Practice Authority, with roughly 16 to 22 conditions covered. - Victoria’s Community Pharmacist Statewide Pilot reported a 97 per cent patient satisfaction rate and was made permanent with an $18 million investment, covering 22 conditions and offered at no cost to patients. - New South Wales, South Australia, Western Australia, and Tasmania have introduced or expanded pharmacist prescribing. Western Australia’s Enhanced Access Community Pharmacy Pilot is expected to begin service delivery by 2027. Scope is set state by state, and the Pharmacy Guild of Australia has called for the rules to be harmonised nationally. - The Productivity Commission and Queensland Government report Unleashing the Potential: An Open and Equitable Health System found that using pharmacists and other health professionals to their full scope of practice improves access to care and helps address workforce shortages, particularly in regional and rural areas. - The Australian Medical Association and the Royal Australian College of General Practitioners have opposed elements of the expansion, citing patient safety and fragmentation of care. Commentary has described the dispute as a turf war between the two professions. The professionalisation of medicine - Through the nineteenth century, medicine in the English-speaking world consolidated into a single licensed profession through registration and licensing laws, the standardisation of medical education, and control of hospitals. In Britain the Medical Act 1858 created a statutory medical register, and comparable registration regimes followed across the Australian colonies. - As the profession closed, women, who had long done much of the work of healing, were pushed to its margins. Midwifery was subordinated to a male-dominated obstetrics, and women were largely excluded from medical training for generations. Medicine and colonial power - Frantz Fanon, born in Martinique, trained as a psychiatrist and headed the Blida-Joinville psychiatric hospital in Algeria from 1953 until his resignation in 1957, during the Algerian war of independence from France. - His essay “Medicine and Colonialism,” published in A Dying Colonialism in 1959, described how colonial medicine operated as an instrument of domination, and how colonial doctors were legally required to report patients’ suspicious injuries to the authorities. Non-physician clinicians and primary health care - Mozambique, left with only a few dozen doctors after independence in 1975 and a prolonged civil war, trained a cadre of non-physician clinicians, the tecnicos de cirurgia, to perform major surgery. Studies over more than two decades found their surgical outcomes comparable to those of specialist doctors, at a fraction of the cost, with far higher retention in rural district hospitals. - The International Conference on Primary Health Care at Alma-Ata in September 1978 produced the Declaration of Alma-Ata, which set out primary health care and the goal of Health for All, giving community health workers a central role in delivering basic care. - In Australia, Ngangkari, traditional healers from the Anangu Pitjantjatjara Yankunytjatjara Lands, have been integrated into South Australian hospitals. The Northern Adelaide Local Health Network entered a partnership with the Anangu Ngangkari Tjutaku Aboriginal Corporation in 2019. The Aboriginal and Torres Strait Islander Health Practitioner is a nationally registered profession, regulated through the Aboriginal and Torres Strait Islander Health Practice Board of Australia. REFERENCES [1] Andrew Abbott, The System of Professions: An Essay on the Division of Expert Labor (Chicago: University of Chicago Press, 1988). [2] Eliot Freidson, Profession of Medicine: A Study of the Sociology of Applied Knowledge (New York: Dodd, Mead, 1970). [3] Eliot Freidson, Professional Dominance: The Social Structure of Medical Care (New York: Atherton Press, 1970); supporting source Magali Sarfatti Larson, The Rise of Professionalism: A Sociological Analysis (Berkeley: University of California Press, 1977). [4] Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982). [5] Barbara Ehrenreich and Deirdre English, Witches, Midwives, and Nurses: A History 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); originally published 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: Work Performance and Histories of Medical Doctors and Assistant Medical Officers Trained for Surgery,” BJOG: An International Journal of Obstetrics and Gynaecology 114, no. 12 (2007). [9] World Health Organization, Declaration of Alma-Ata: International Conference on Primary Health Care, Alma-Ata, 6-12 September 1978 (Geneva: World Health Organization, 1978). [10] World Health Organization, Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams; Global Recommendations and Guidelines (Geneva: World Health Organization, 2008). [11] Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council, Traditional Healers of Central Australia: Ngangkari (Broome: Magabala Books, 2013); on the registered profession, Aboriginal and Torres Strait Islander Health Practice Board of Australia, Australian Health Practitioner Regulation Agency. FURTHER READING Eliot Freidson, Professionalism: The Third Logic (2001). Freidson’s final account of professionalism as a distinct way of organising work, set against the market and the bureaucracy. Ivan Illich, Limits to Medicine: Medical Nemesis (1976). A polemic arguing that an expanding medical monopoly erodes people’s capacity to care for themselves and each other. Keith M. Macdonald, The Sociology of the Professions (1995). A survey of how sociologists have understood professions as projects of monopoly, status, and social closure. Barbara Ehrenreich and Deirdre English, For Her Own Good: Two Centuries of the Experts’ Advice to Women (1978). Traces how a male-dominated medical and scientific establishment claimed authority over women’s bodies and lives. Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (1991). On how colonial medicine in Africa classified and governed the people it claimed to treat. Charles E. Rosenberg, The Care of Strangers: The Rise of America’s Hospital System (1987). A history of how the hospital moved from a charitable refuge to the 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 listed above are real and citable. For any source intended for formal academic or professional writing, direct verification against the original publication or institutional record is recommended. bout the host Liv 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
