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Could Australian doctors be doing more to tackle health inequities?

At the Public Health Association conference in Adelaide this week, Professor Fran Baum from Flinders University presented this broad overview of the international evidence on the relationships between sustainability and equity in health.

Her presentation showed that:

• global health inequalities are profound. For example, while 92 per cent of girls born in Australia between 2000-5 can expect to survive to 65 and beyond, only 37 per cent of boys born in Nigeria and Kenya can expect to do so.

• health inequalities are worsening internationally. The life expectancy for men in low income countries fell from 62 years in 1997 to 56 years in 2006. In rural Cambodia, only 8 per cent of the population had adequate access to water and sanitation in 2004.

• health is not only about wealth but is also about how it is distributed. More equal societies tend to be healthier. For example, children’s wellbeing is better and levels of trust are higher in more equal rich countries, while the more unequal rich countries have longer working hours and a higher prevalence of mental illness.

This slide comparing Costa Rica and US is a corker; it shows that better health and happiness is not all about more money, or even more spending on health services.

costarica
The evidence that Baum presented was compelling, but the question lingering afterwards was: what can be done?

Public health consultant Rebecca Gordon has been investigating whether Australia’s medical powerbrokers have been doing enough to advance action on the social determinants of health and health equity.

Rebecca Gordon writes:

In June this year, the Royal College of Physicians in England released a policy statement “How doctors can close the gap: Tackling the social determinants of health”.

The RCP points out that many doctors have not paid enough attention to health promotion, preventing ill health and reducing health inequalities, and unequal access to care. As some of the most trusted professionals in society, doctors at all levels can join forces to advocate for health equality. Doctors can advocate on a personal, community or national level.

The statement includes recommendations and suggestions for actions across the health sector.

These range from considering the impact of day-to-day practice on health inequalities to advocating policies and programmes that could benefit the physical and mental health of socially disadvantaged groups and also result in reductions in greenhouse gas emissions.

In Australia, colleges and professional organisations have made government submissions and public statements on issues such as health reform, Indigenous health, mental health, refugee health and climate change. Individual doctors have spoken up on the same issues.

Mental health professionals have been active in advocating for change in mental health care and to address factors which influence the development and course of mental disorders including social inclusion, early intervention and community versus hospital based care.

It’s clear that these advocates are on the same message but efforts have been hampered by a lack of unified action.

This month Andrew Pesce has been in the media discussing the AMA Indigenous Report Card and has called on government to use the health reform process to focus more on social disadvantage.

But taking the RCP approach as opposed to lobbying government, how can the health profession as a whole and as individuals take effective action on influencing the social determinants of health? How can doctors tackle social inequality both in day-to-day practice and as a profession?

Some professional organisations have policies on social determinants or related issues such as alcohol. But these lean heavily towards the traditional focus of the Colleges and the AMA on influencing government. While taking a position is important, these policies lack concrete recommendations for action by their individual members.

The RCP proposes a shift towards unified action supporting a shared goal at all levels, personal, community and national. They also emphasise working with other sectors.

A quick search of three Australian professional organisations’ web sites turned up the following:

• The Royal Australasian College of Physicians 2005 policy statement “Inequity and Health.  A call to action.  Addressing Health and Socioeconomic Inequality in Australia”.

• The Royal Australian College of General Practitioners  has policies related to enhancing equity and access, including statements on Aboriginal health, access to general practice services, and healthcare for refugees and asylum seekers

• The AMA position statement on Social Determinants and Prevention of Health Inequities (2007).

The Royal Australian and New Zeland College of Psychiatrists whose members work in a key area of social disadvantage has no specific policy on social determinants but do have position statements on asylum seekers.

Doctors, highly trusted and respected by their patients and society, are in the unique position of being able to influence the health of individuals directly while advocating for broader social change.

The colleges and professional organisations representing doctors can advance this process by providing an evidence-based action plan to promote health and prevent illness emphasising actions that address social determinants of health.

Clearly there is a lot more that could be done, but at least the RCP has made a start.

• Rebecca Gordon is a consultant with RaggAhmed

***

Meanwhile, Fran Baum told the PHAA conference that the most important book she ever read is Syvlia Nobel Tesh’s 1988 “Hidden Arguments: political ideology and disease prevention policy”.

“Everybody in public health should read that book,” she said.

Just passing on the recommendation…

Comments 3

  1. Dr Mary Wyatt says:

    The Australasian Faculty of Occupational and Environmental Medicine (AFOEM), part of the Royal Australasian College of Physicians, has been working to raise awareness of work as a social determinant of health. AFEOM has recently released a position statement “Realising the health benefits of work” (http://afom.racp.edu.au/page/media-and-news/realising-the-health-benefits-of-work).

    Being out of work for more than six months has a health risk equivalent to that of smoking ten packs of cigarettes per day. After six months out of work, the suicide rate in young men is increased forty times. For longer term worklessness, the general suicide rate is increased six times.

    It’s an issue not well understood by health practitioners and the community. Whether someone remains at work or returns to work is heavily influenced by attitudes, policy approaches, and the advice given by their family, doctors and other treating practitioners.

    Many systems in Australia fail to address work and health outcomes. Workers’ compensation systems often focus on financial outcomes at the expense of the well being of the claimant. Empowering GPs to inform patients of the problems of staying off work, and supporting inclusive employment practices are key steps if the health benefits of work are to be made available to more Australians. Providing employment is a key approach in reducing health inequities, particularly for indigenous Australians.

    Can Australian doctors do more to tackle health inequities? We are in a position to do so and can make a major contribution if we do.

  2. Alice68 says:

    Of course Australian doctors could be doing more to tackle health inequalities. Part of the inequalities we see happen when people cross the door into a doctors office or into a hospital. For example, why are Aboriginal people with heart disease treated differently after the walk in the doors of the hospital?
    (See: http://www.aihw.gov.au/publications/index.cfm/title/10364 )

  3. carol93 says:

    There are terrible health conditions in poor countries. There are terrible health conditions in Australia, a rich country. These affect the most vulnerable and neglected Australians; a majority of indigenous people (perhaps 70,000) and all the seriously mentally ill (schizophrenia, bipolar 1, severe affective disorders, about 550,000). All these people have a life expectancy which is twenty five years lower than average, fifty-five years instead of eighty years, mainly because of medical andpsychosocial conditions which all governments have learned to ignore.
    Regarding the seriously mentally ill (SMI)…the rate follows global rates of these brain diseases, 2,500 per 100,000. The Mental health Council of Australia (MHCA) believes that only 35% receive specialist or hospital care as needed. It also estimates 50,000
    SMI are homeless. Since deinstitutionalization, when thousands of SMI were left without accommodation, the SMI have been been re-houseds in prisons, streets, graves and urns.
    The suicide rate, 2008, is said by the World Health Organization to be 21.1 per 100,000, the highest ever. The SMI carry 13-14% of the burden of disease and generally receive 6-7% of the health budget. The Rudd 2010 health budget gave them 2%.
    Where is the Royal Australian College of Psychiatrists this year? Where has it successfully hidden in the past 20 years as the treatment, services and accommodation needed by the seriously mentally ill to stay alive and as well as possible have exponentially declined?

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#UnmetNeedsinPublicHealth
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Health in All Policies
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Media Doctor Australia
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017