As many of you will know, the Senate Standing Committee on Community Affairs is currently conducting an inquiry into Australia’s domestic response to the World Health Organization’s (WHO) Commission on Social Determinants of Health report “Closing the gap within a generation”
The Committee is seeking submissions from stakeholders (the closing date is 4 October but the Secretariat has informed Croakey that there is some flexibility with this date and they will accept late submissions – so don’t panic if you haven’t finished yours yet!).
See here for more information on the Inquiry, including terms of reference and how to make a submission.
Five submissions are already posted on the site and all are well worth a read – for those who don’t have the time to read the entire submissions (although none of them are overly long) Croakey has picked some ‘stand out’ excerpts:
Sharon Friel, Professor of Health Equity at the ANU was head of the scientific secretariat for the WHO commission that produced the report into social determinants so clearly knows the issues inside out. Interestingly her submission makes a number of positive statements about current health reform initiatives “The national rollout of Medicare Locals with a prevention mandate is encouraging and they have proactively sought input [from me and others] on how best to take a social determinant of health approach to population health and health equity” and makes some useful suggestions about data collection and application “We need national level measurable indicators for the social determinants – employment, health care use, education etc – and be able to connect them to socially stratified health outcome data. The excellent work undertaken for the social atlas of Australia could be extended to give fine grain local level health inequities. Finally we need a mechanism where a health, and health equity lens is systematically applied to key non-health policies and programs and the impact of these policies on health and health equity routinely assessed.” She also calls for “an explicit policy framework around the societal level factors that affect health and health equity.”
Kate Carnell, CEO of beyondblue, describes how the Government’s implementation of some mental health programs, such as Kids Matter, are taking a social determinants approach to health. She argues for the implementation of a ‘Health in all policies’ approach at a federal level similar to that taken by the South Australian Government.
The Gippsland Women’s Health Service argues that “A key social determinant of health is gender and this must be reflected in Australia’s response to Closing the Gap.” They also argue for a ‘health in all policies’ approach driven by “a Social Determinants of Health Centre of Excellence, or similar body, to be responsible for the implementation, monitoring and evaluation of efforts to address the social determinants of health”.
The Hume Whittlesea Primary Care Partnership (HWPCP) is a voluntary alliance comprising of 30 primary care agencies operating in the local government areas (LGA’s) of Hume and Whittlesea. Its submission describes the challenges of implementing a social determinants approach to primary care in the current environment – making the point strongly that there are already “a multitude of highly credible policies, programs and service providers seeking to redress social determinants as well as others such as homelessness, gender based violence, age, physical and mental disabilities etc. These may be initiated and/or co-ordinated through Local, State or Federal authorities or many different community based agencies. Various endeavours are also being undertaken to enhance environmental conditions including urban planning, transport and economic development. Again, these typically involve a multitude of government and non-government players and their corollary policies, programs, statutory frameworks etc. None have both the expressed mandate and funded capacity to be the central/lead coordinating body with the necessary cross-sectoral authority to influence.”
They also provide a memorable example of the challenges of inter-sectoral action in this area “In practical terms this leads to scenarios where the actions of different stakeholders can be at cross purposes. For example, within Hume, a “Jobs and Skills Joint Taskforce” has been established to improve the rates of local jobs for local people and ensure that those seeking work have skills and attributes matched to the needs of employers. It includes representatives of local businesses, education providers, labour market training programs as well as local and federal economic development initiatives. The Taskforce is however endeavouring to progress in an environment where, on one hand the Commonwealth Government has recently selected the area as a site its new intensive employment support programs for vulnerable families while at the same time, the State government has made significant reductions to the TAFE budget which means that staff and courses at the local institute will be significantly cut.”
The Doctors’ Reform Society discusses the role of fee-for-service as a barrier to health equity and discusses the philosophical underpinnings of health inequality:
“The inequitable distribution of power, money, and resources is not just about income and the tax system however. The increasing emphasis on individualism must be considered if we are to address inequities. Individualism is required to encourage innovation and excellence but the potential price is the decline of community, of a sense of belonging, of links to others which are critical to healthy lives. In the absence of those connections in a competitive environment, materialism thrives and lives become increasingly empty. We see the effects in our consulting rooms, patients desperate for an explanation for their complaints which are so often the result of ‘burning the candle at both ends’, keeping up with the pack, or simply being left behind. Whether these issues are the result of the promotion of the individualist ideology of neoliberalism and the materialism with which it is often associated, or the result of the perception of loss of control over life events due to relative income inequality is debatable ie is this a chicken and egg scenario, but to ignore this part of the problem of inequity and ill health is to hide one’s head in the sand. This aspect of the issue is not one which is addressed in the CSDH report.”
DRS concludes by recommending “At the political level…a Health Equity in All Policies approach as has been taken by the South Australian Government. Crucial to the success of such an initiative is support at the highest level of government. Without the leadership from the Prime Minister, the approach will be as weak as many environmental impact assessments.”