It’s all very well to pay lip service to health inequities, but what are their drivers and how can we address them? This is the focus of an ambitious post for Croakey from Professor Fran Baum following a slew of recent reports confirming what we already know — health is inextricably tied to wealth and social status.
What’s missing from these analyses are a consideration of the determinants of disparity, including the social, economic and political, and — more importantly — what can be done to address these drivers.
Rather than bandaid biomedical panaceas, Baum argues that reform is needed across the board, encompassing all those things that make us sick and, conversely, have the power to heal.
Fran Baum writes:
Last week the Australian Health Policy Collaboration launched their Health Tracker by socioeconomic status, which is a report card on the health of adult Australians in relation to chronic diseases, risk factors and rates of death, by quintiles of disadvantage.
The Tracker was launched at the National Press Club with much fanfare, and featured commentary by former AMA president and GP Dr Mukesh Haikerwal, and economic commentator Alan Kohler.
The data in the Tracker tells us little that is new, but does reinforce the well-known message that how healthy you are reflects how wealthy you are. It surprisingly contained no information on the health of Aboriginal and Torres Strait Islander Australians who as a group experience a well-documented health gap, with 10.5 years less life expectancy.
The more interesting question is how can society reduce the variations in health between people with different economic status?
Most of the answers offered at the National Press Club either concerned medical or behavioural solutions. Alan Kohler did note that Credit Suisse had recently reported that the richest 1% have 50.1% of the world’s wealth, up from 42.5% in 2008. But he didn’t propose how this issue might be addressed, even though it lies at the heart of health inequities.
It is now nearly ten years since the Commission on the Social Determinants of Health reported to the World Health Organisation making recommendations for national governments and international organisations.
Australia has largely ignored this Commission’s report despite a Senate Inquiry and the establishment of a Social Determinants of Health Alliance. What is clear is that chronic illness nor health inequities will not be reduced without a substantial political commitment to doing so.
The political aim is to make healthy choices the easy choices for people across the political spectrum. It is much easier to be healthy if you have access to resources and much harder if you are living on poverty line in an unhealthy environment.
I’m finalising a new book – Governing for Health (to be published by Oxford University Press, New York) — and for this I have drafted a Wellness Manifesto for use by any political party who is really committed to health and to reducing health inequities.
I share it with Croakey readers in the hope that you will help me develop it by sending in your thoughts and comments:
A Wellbeing Manifesto for the Mid-21st Century (2020-2050)
- Measure what we treasure and no longer rely on GDP as the measure of our progress. Instead, introduce a well-researched measure of wellbeing appropriate to our country
- Institute measures to reduce economic inequity including more progressive income tax and taxes on wealth and inheritance
- Regulate corporate behaviour so that transnational corporations can’t externalise costs of poor occupational health and safety, environmental degradation and unsafe and unhealthy products
- Encourage small and medium-sized businesses which show commitment to the local communities in which they operate
- Introduce a tax on high sugar and high fat foods
- Determine which assets and resources should be either nationalised or privatised based on demonstrable long term public benefit
Transparency and democratic process
- Restrict lobbying by powerful interest groups by creating a transparent register of lobbyists, and capping donations to all political parties
- Make our policy development processes as participatory as possible, and encourage groups with little economic and social power, in particular, to be meaningfully engaged
- Ensure media diversity and encourage independent journalism
- Dramatically increase investment in public early childhood education and affordable, quality childcare
- View lifelong learning as a crucial investment and make all public education free
- Reduce subsidises to private education
- Create public sector jobs to engage people at all stages of the lifecycle, and focus on job creation
- Increase income support to the unemployed to a livable level
- Ensure universal access to high quality and appropriate, publicly-funded health care, and progressively make community-controlled primary health care the backbone of our system. This system will focus on cure, rehabilitation, prevention and promotion
- Invest in the evaluation of new medical technologies to ensure they have more benefits than costs
- Eliminate subsidies to private health insurance and invest funds in the public health system
Housing, urban and rural environments
- View having a secure home as a right for all
- Create healthy urban environments which are safe, friendly to pedestrians and cyclists, and which encourage social interaction
- Invest in rural towns to increase their attractiveness as a place to live
- Institute measures to see our country dramatically reduce its carbon output and favour renewable energy
- Maintain and restore our rivers, lakes and seas and protect our lands from excessive exploitation by mining and agriculture
- Protect and treasure our biodiversity
How would you change or add to this manifesto in order to achieve health equity?
If you support the manifesto then talk to your local state and federal politicians about it. Ask them which aspects they support and which they don’t and why. I’d love to know their answers!
Professor Fran Baum is a Matthew Flinders Distinguished Professor of Public Health, and Director of the Southgate Institute of Health, Society and Equity at Flinders University.
What about including a federal target for gender equality in all levels of government and in all private and public organisations?
How about ensuring that poor and marginalised communities are able to be involved in research from prioritisation to implementation, making certain that their needs are appropriately addressed in the production of knowledge.
I suggest changing transparency and democratic process into ‘Political’ to match the first one ‘economic’, and more importantly to be explicit about the importance of politics (democratic – meaningful participation) for wellbeing.
I suggest the first item be: Democratic and meaningful participation of citizens in political processes.
One article on ‘gender’ is a must.