Government and governance, Health | Australia

9 May 2016

Poor public policies have left Australia’s health unevenly distributed, affecting millions of people’s lives. It’s a situation that could be remedied by sound research and policies, Sharon Friel and Fran Baum write.

When it comes to health, the ‘Lucky Country’ is lucky for some. Although Australia prides itself on a fair go, health is very unevenly distributed and millions of people’s lives are worsened or shortened by what experts call the social determinants of health inequity – unfair politics and economic arrangements, and poor public policies.

There is a wealth of evidence on the social determinants of health inequity, and good ideas on what should be done about it, but very few policies are being implemented to address the issues, and there is almost no evidence to explain why this is so.

Whatever your beliefs or material circumstances, the enjoyment of adequate health is vital to the pursuit of the life you value. But health is not simply an instrument to enable other social functions – our collective health is a reflection of how well our society has ensured that all Australians achieve the best health possible.

In recent years, globally, and across the political spectrum, there is recognition that widening economic and social inequities are harmful to society generally, and to health specifically. In a prosperous country like Australia, which has enjoyed 25 years of continued economic growth, is it fair that, as Andrew Leigh highlights in his book Battlers & Billionaires, the poorest 20 per cent of the population can still expect to die on average six years earlier than the richest 20 per cent, and Indigenous Australians die 11 years earlier?

Those more socially disadvantaged by income, employment status, or education are also at higher risk of depression, diabetes, heart disease and cancers.  This is not only unfair and inequitable, but also inefficient. National Centre for Social and Economic Modelling (NATSEM) evidence shows that reducing health inequities would allow annual savings of $4 billion in welfare support payments; 5.5 million fewer Medicare services would be needed each year, resulting in annual savings of $273 million; and 5.3 million fewer Pharmaceutical Benefit Scheme scripts would be filled each year, resulting in annual savings of $184.5 million each year.

More on this: A health check on funding public hospitals | Brian Owler

It does not have to be like this. It isn’t a case of poor genetics or lifestyle choices – systematic social differences create an unequal distribution of opportunity to be healthy and live longer. These health differences are avoidable, they are socially manufactured and reflect policy choices.

So what is it about society and policy choices that cause these health inequities? Not everyone has the basic material requisites that they need for a decent life, nor indeed do they have control over their lives. To redress these inequities, people need a voice in decision-making and implementation of actions that affect the conditions in which they are born, grow, live, work, and age.

Often the policy response to health inequities is focused on access to health care – this is indeed very important. However, every public policy – not just health policy – has the potential to affect human health and wellbeing. Employment, housing, social inclusion, education, income and wealth all combine to shape our health, and these policies have a powerful impact.

Reducing health inequities requires long-term, multi-disciplinary and multi-sectoral commitment.

Launched by former Prime Minister Julia Gillard in 2015, the National Health and Medical Research Council Centre of Research Excellence (CRE) in the Social Determinants of Health Equity is devoted to studying how government policies shape how healthy we are, how long we live, and how this differs depending on who we are.

The CRE recognises that health equity considerations are rarely at the forefront of policy considerations. Using agenda setting theory, it looks at factors affecting if and how health equity issues get on the political and policy agenda in four cases studies – trade; paid parental leave; the Northern Territory intervention focused on Aboriginal Australians, and primary health care. We are interested in individual, institutional and system capacity required for successful equity focused policy implementation. While drawing on intervention evaluation research, the objective is to be able to predict the longer-term impact of policy interventions where health inequity exists, and the resulting impact on health and health policy.

As Australia prepares to go to the polls, and as health is once again an election issue, it is important to note that with sound policies resulting from sound research, Australia’s health landscape could be fundamentally changed for the better. Then policies really would create a fair go for our health.

The CRE is hosting a one-day Policy Forum on May 12 at University House, ANU. For more information see here.

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Friel, S. and Baum, F. (2016). Your good health? - Policy Forum. [online] Policy Forum. Available at: