Five years after the Social Determinants of Health Alliance was formed with the aim of reducing health inequities, questions are being raised about its future, ahead of its annual general meeting on 9 November.
Lyn Morgain, the Chief Executive of cohealth, which is a member organisation of the Alliance, hopes to hear from Croakey contributors, readers and others about your suggestions for the future of advocacy around health equity.
Lyn Morgain writes:
As we watch the political parties begin to shape up their pitches for the forthcoming Federal election, so too is it time for those of us who advocate for a more equitable health system to consider our priorities and strategies.
There is nothing in the current political environment to suggest that history won’t repeat itself, suggesting that the extent of the debate about national health policy will likely be limited to headlines regarding hospitals and Medicare.
As many of us know, however, there is so much more to achieving better health outcomes for the country – the question is how to ensure that those other considerations form part of our national policy debate.
The Social Determinants of Health Alliance (SDoHA) was established in 2013 to promote implementation of the five recommendations of the Senate Inquiry into Australia’s domestic response to the WHO’s Closing the Gap in a Generation Report, a report which – at its simplest – sought the recalibration of health policy to acknowledge the powerful influence that issues of power, resources and money have on the health of a population.
Five years on, those recommendations remain simply that, and there is scant recognition of equity issues in Australian health policy overall. The need for the implementation of the WHO Report’s recommendations hasn’t diminished, however.
Beyond one-size-fits-all approaches
As previous SDOHA Chair Michael Moore AO observed in response to data released by the Australian Health Policy Collaboration:
Every year chronic disease is claiming the lives of thousands of Australians under 75 in lower socio-economic groups at an alarming rate – however, this is not adequately accounted for in our national health policy and programs. Instead of prioritising our most vulnerable, we are applying one-size-fits-all health policies.”
Indeed, recent work undertaken by the Commonwealth Fund has highlighted that while Australia has a high quality health care system – second best amongst those it ranked – we perform very poorly on issues of equity, coming fifth last amongst our peers.
This effectively means those with the poorest health status are the least well served by the system overall. This produces unacceptable inequity in health outcomes, caused and perpetuated by a failure to address that which drives ill health, and to take into account the lived experience and structural factors which impact the lives of those who require care.
Notwithstanding this ongoing demonstrable need, and valiant effort from advocates, SDoHA has struggled over the time since the report was released to gain traction in policy debates.
There remains significant resistance at the political level to move beyond the “hospitals and Medicare” narrative of the shape and form of health care. With much of the debate driven by powerful stakeholders and vested established interests, policy scarcely references issues such as prevention, the determinants of poor health and the clear link between inequality and illness.
The Alliance has also been hampered by the continued pressure on many of our supporting organisations, limiting its capacity for effective engagement and communication.
Time for a plan
With the Federal election approaching, it is necessary therefore for us to take the opportunity of the forthcoming AGM on the 9th of November to discuss these issues and formulate a plan for next steps.
Without a renewed commitment, SdoHA’s future is in question. We need to hear from our sector colleagues and fellow activists to understand what you think is needed and what you may be able to contribute.
We believe there remains a pressing need and clear case for advocacy on matters of equity in health, and want to hear from others how this might best be achieved.
We welcome input from Croakey readers and contributors via email to SDoHA@aracy.org.au, and look forward to crafting an energetic approach to the future together.
• Lyn Morgain is the Chief Executive of cohealth – one of Australia’s largest community health services and a member organisation of the Social Determinants of Health Alliance.