Introduction by Croakey: If voters at the upcoming Western Australian election are concerned with protecting and improving the health of current and future generations, they should demand that politicians focus less on healthcare services, and far more on the wider determinants of health.
That’s according Dr George Crisp, a GP in Perth, who puts forward a five-point wishlist for the WA election below – much of which is also relevant for the upcoming federal election.
“The painful realisation for those of us who work in healthcare, once we understand what is happening in our environment, is that if we fail to protect these underlying determinants of health, particularly the planet’s ecosystems and climate system, then all our efforts within healthcare will be in vain,” he writes.
George Crisp writes:
It’s that time of the electoral cycle again: political parties engaging in point scoring and promises aimed at fixing various deficiencies in health services.
As a GP and health advocate, I find it rather uninspiring, and I doubt we’ll see anymeaningful improvement in actual health outcomes.
Worse still, this is a distraction from very real and escalating health problems – crises – that we are facing. Our politicians could improve health in our communities if there was political will.
Here are five ambitious but possible wishes.
1. Prioritise prevention: Increase spending on prevention to five percent of the health budget (as previously agreed by WA Labor!). It’s both far more effective and economic to address the upstream causes of ill health rather than try to manage illness once it’s established.
2. Implement Health in All Policy (HiAP) across government. If we include health-thinking in assessment, planning and decision making we can prevent adverse health costs and take advantage of ‘co-benefits’. It’s not new, South Australia has tried this.
3. Mental health taskforce: to understand the causes of the increasing prevalence and burden of ill health and how to modify the causes and improve management.
4. Address climate change. We need to implement adaptation measures to increase resilience of health and essential services and disaster preparedness as well as set near term emissions targets.
5. Nature positive laws. Our wellbeing, health and ultimately survival are dependent on ecosystems. We must take an active approach in preserving and promoting biodiversity and nature.
Cross-sectoral action needed
First, for context, when politicians say ‘health’, they’re invariably talk about ‘healthcare’ (and mostly acute frontline services).
Our ‘health service’ is primarily an ‘illness service’ with illness-centred thinking – managing established (and non-curable) illnesses.
Less than two percent of the ‘health’ budget is directed to preventive services, most of which is targeted on a few areas, for example, tobacco, alcohol, skin cancer prevention.
WA Labor previously agreed to lift funding of prevention to five percent by 2030, but there’s been no obvious progress so far.
The big gains we’ve made in health outcomes over the last two centuries are not down to high-tech or modern healthcare, they’re from measures implemented at the population rather than individual level – for example, clean water, safe food, occupational safety, regulation of pollution, infection control etc.
Reversing the escalating rates of non-communicable diseases, like heart disease, asthma, Type 2 diabetes, dementia, and early onset cancers, can’t be achieved through individualised and expensive treatments, but through addressing upstream determinants of health.
Addressing these conditions lies outside of the domain of the health department and health portfolio. It will take cross-sectoral policy and funding.
Implementing a Health in All Policy (HiAP) approach to break down siloed thinking and decision making can avoid adverse health impacts (particularly when combined with Health Risk Assessments) and take advantage of health “co-benefits”.
For example, accounting for the mental and physical health benefits from active and public transport and the negative health costs of inactivity, stress and congestion from car commuting. Or, including the health cost from air pollution in electricity generation.
We are in the midst of a mental health epidemic. Particularly for our younger patients, where prevalence has increased by nearly 50 percent in just 15 years. Our services are barely coping now and it’s really difficult to see how we will deal with this in healthcare and society more broadly.
We are still thinking in terms of reactive responses. But, as with other health problems, we need to start looking for the ‘causes of the causes’ of this problem. Why are so many people suffering mental health problems now?
It’s clearly a multifactorial and complex problem that may involve educational and social pressures, social media, isolation, increasing societal inequality, unhealthy diets, reduced physical activity, exposure to environmental toxics and existential threats, in particular climate anxiety.
We need a broader look at the determinants of mental ill health and how we can modify them and prevent this worsening generational suffering.
Climate matters
Signs of climate breakdown are now evident around the world.
Our health is being impacted through exposure to extreme events, changing patterns of infectious diseases and broader economic and environmental changes. The speed of these changes has exceeded projections as have their health consequences.
We did not understand how susceptible we are to higher temperatures or how devastating exposure extreme events can be on our mental health. Children in particular have been shown to be far more vulnerable to these climate mediated events with higher observed rates of psychological illness following bushfires, floods and severe storms.
We are seeing more young people in our clinics with climate anxiety affecting in response to this unaddressed existential threat.
Vital infrastructure is being compromised. Insurance premiums are rising rapidly, causing financial stress and insecurity. Infectious diseases are increasing and spreading to new areas.
We urgently need to build more resilient infrastructure, plan and prepare for disasters, especially in critical areas like health services to manage the now unavoidable climate-related impacts.
We also need to reduce emissions (globally) and set near term (2030) emissions reduction targets as our part in avoiding unmanageable consequences that will occur with current policies.
And our media and politicians need to start telling the truth about climate change. They have been briefed by scientists and by doctors. Without mitigation and adaption, health outcomes will deteriorate and our health and other essential services will not cope, there is really no excuse for obfuscation.
Protect nature
We rely on a wide range of essential “ecosystem services” provided by nature. From clean freshwater, air, pollination of crops, soil formation, nutrient recycling, medicines and materials, we do not pay for them, and they are not captured by GDP, but without them we literally have no economy.
Nature is critical for health in our cities, in reducing heat and improving air quality. Green spaces and trees have a restorative effect, reducing stress, blood pressure and mood.
Children who grow up farthest away from green spaces in cities have been shown to have up to 50 percent higher rates of a wide range of mental health disorders when compared to those live closest, regardless of other factors.
The State Government has just approved the continuing clearing of what remains of our jarrah forest for aluminum mining, while the pristine Scott’s reef on the Kimberley coast, a critical habitat for many migratory and endangered species including whales, is under threat from Woodside’s Browse gas development.
Nature positive laws had been introduced to Federal Parliament and were intended to improve environmental protection and restore integrity and trust around environmental laws, and would go some way to curtail the ongoing destruction of our natural capital.
But these laws have recently been shelved after lobbying from our state Premier.
The thing about our health (both mental and physical) and environment is that it is all connected; you can’t be healthy if your environment is sick.
It is why I became involved in environmental health advocacy over two decades ago.
The painful realisation for those of us who work in healthcare, once we understand what is happening in our environment, is that if we fail to protect these underlying determinants of health, particularly the planet’s ecosystems and climate system, then all our efforts within healthcare will be in vain.
See Croakey’s coverage of the WA election and health
