A time for courage

Despite the growing threat to our health posed by climate change, wealth inequality, and poor working conditions, there remains a void in national policy to address the problem. Policymakers must act now or Australians will suffer, Sharon Friel writes.

In 2015, I wrote a piece for Policy Forum highlighting that Australia is almost fatally sick due to the underlying social and economic conditions that cause poor health.

Commonly referred to as the social determinants of health and health inequities, this connection between society-level factors and individual human health means that most public policy – not just health policy – has the potential to affect human health and its inequitable social distribution.

Has anything changed since 2015? Yes. Political and policy attention to the social determinants of health equity has gotten worse, not better. Not only has there been little relevant policy action, there has been an even greater focus on the biomedical and individual, rather than the social or economic determinants of health.

An analysis of 266 health policies showed that whilst the rhetoric of the social determinants of health abounds in governments’ health policies, its implementation reveals a continued preference for medical care and individualised behaviour-change strategies. While these things do matter for health, they are completely insufficient to keep people well and, importantly, prevent poor health outcomes.

This is happening at a time when many peoples’ daily living conditions have deteriorated or improved very little, exposing them to physical and mental health risks. For example, the income of Australian working and middle class households has not grown as much or as quickly as those who already have very high incomes.

More on this: Time to break a sweat over health and climate policy

Widening income inequality reduces trust, self-worth, sympathy, and a sense of community within societies. It gives rise to feelings of social exclusion, insecurity, and stress.

The labour market is an important source of household income, and it has changed significantly in Australia, with a growth in precarious employment arrangements such as temporary work, part-time work, informal work, and piece work characterising recent years.

These labour market changes affect peoples’ working conditions, with increasingly less job control, financial and other types of security, work hour flexibility, and access to paid family leave. There have been significant job losses too.

The Australian car manufacturing industry closed in 2017, bringing to an end 70 years of vehicle assembly as General Motors Holden, Ford, and Toyota ceased large-scale production. This resulted in highly visible redundancies amongst the vehicle producers, and a more profound, but less noticeable, loss of employment within the supply chain.

The health of people who experience redundancy and job precariousness is affected through the loss of control over their lives that they will experience – this is a recognised stressor for increasing risk of coronary heart disease by 50 per cent and for poor mental health.

More on this: When health policy is ill

In addition to these socio-economic risks to their health, Australians face a very real and significant health danger from climate change. Human activity is the primary cause of the changes in the earth’s climate conditions since the 18th century that jeopardises its capacity to sustain life.

Humanity has produced and consumed vast quantities of fossil fuels, and destroyed numerous animal habitats and species. Humans have used up almost half of the world’s land surface to feed ourselves, while simultaneously concentrating large populations of people into concrete jungles. The attendant disruption to the Earth system is profound and an accumulation of carbon dioxide in the atmosphere is warming the planet.

The CSIRO has recently reiterated that climate change and the environment is one of six major challenges facing the nation. Australia’s climate has warmed by just over one degree Celsius since 1910, leading to an increase in the frequency of extreme heat events.

Sea levels are rising around Australia, increasing the risk of inundation. The oceans around Australia are acidifying. There has been a decline of around 11 per cent in April to October rainfall in the southeast of Australia since the late 1990s. Rainfall has increased across parts of northern Australia since the 1970s, and there has been a long‑term increase in extreme fire weather, and in the length of the fire season, across large parts of Australia.

The recent Medical Journal of Australia and Lancet countdown on health and climate change report found that Australia is very vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives.

While the disruption caused by climate change to life-supporting environmental systems will affect everyone, it will have the greatest – and generally earliest – impact on the poorest and most disadvantaged populations.

This will compound existing social and health inequities within Australia. While there has been state and local government level action on climate change, there continues to be no engagement on climate change or climate change and health in the Australian Parliament.

Currently, precious little policy action is being taken to address the social, economic and environmental determinants of health and health inequities, but Australia must act to prevent catastrophic climate change and redress egregious health inequities, and it must be now. This requires a shared vision, a willingness to engage with unusual bedfellows to build coalitions of influence, courageous political leadership, and, frankly, political struggle.