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If Australia took any notice of the Marmot Review…

Following on from previous posts about the Marmot Review, below is a piece I wrote for the Crikey bulletin today, which asks: Why is Australia dragging the chain on health inequalities?

I hope it prompts a rash of health equity advocates to come out of the closet and engage with Croakey, and public debate more broadly!


If Australian policy makers acted on a landmark report aimed at tackling inequalities in health that was released in the UK yesterday, this is what would happen:

• Federal, state and local governments would evaluate all policies and programs (not only the health ones) according to whether they increase or reduce health inequalities

• Paid parental leave would be available for the first year after baby’s arrival, and flexible employment arrangements thereafter

• Good quality childcare would be available and affordable for all, including for some parents who are not working

• Efforts to improve education outcomes would focus less on schools, and more on supporting parents and communities to help children’s development

• There would be a major shake-up of health spending in favour of early childhood support and development programs, and public and preventive health generally

• Economic growth would not be the most important measure of our country’s success, and the fair distribution of health, well-being and sustainability would be important social goals.

The report, Fairer Society, Healthy Lives, sets out the rationale, evidence base and strategies for tackling health inequalities, and was commissioned by the British Government in response to the 2008 report of the WHO’s Commission on the Social Determinants of Health.

It is also known as the Marmot Review, as it was produced by a group chaired by Professor Sir Michael Marmot, who also chaired the WHO’s Commission.

The report argues that reducing health inequalities is a matter of fairness and social justice, with many people dying prematurely because of societal inequalities that contribute to poor health and earlier deaths.

As well, it says that reducing health inequalities will have economic benefits in reducing losses from illness associated with health inequalities, which contribute to productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.

It’s interesting that the debate about health equity has advanced so far in England, with high-level government endorsement for the report. It’s also worth noting that this is England’s second major review into inequalities.

In Australia, by contrast, concerns about health inequalities are barely evident in our health reform discussions, which tend to remain focused on professional turf wars, hospitals, and surgery waiting lists. Behind the scenes, we may be doing some good work but you’d never know it from the headlines.

I’ve been wondering about this lately, why is the country that has historically prided itself on “the fair go” so unenthused about the fact that children born in one suburb are so much more likely to suffer poor health and to die younger than children born in a wealthier suburb?

Should we blame the media for our lack of concern? This recent study found that Canadian media outlets don’t have much time for stories about health inequalities, and I’d be surprised if things were any different here. Perhaps journalists could be asking questions about health equity much more than they do, and not only of health ministers. The American Association of Health Care Journalists has gone so far as highlighting ways its members can make stories about health inequalities interesting to a broader audience.

Should we blame academia? Australia suffers from a dearth of active public advocates for health equity. We have some international leaders in the field, such as Professor Fran Baum, but more could be done to develop our capacity. The Marmot review also identified the “modest” evidence base relevant to public health interventions to reduce health inequalities. In 2005 it was estimated that of the research published on public health, only 0.5% of articles were related to interventions, with most research describing inequalities rather than providing evidence on how to reduce them.

Should we blame professional organisations? These are motivated by the interests of members, who’ve traditionally gravitated to well-heeled areas of practice, whether the leafy suburbs or procedural medicine. I was stunned to learn recently that Marmot will soon take over as president of the British Medical Association. Somehow, I just can’t imagine a Marmot-style figure at the helm of the AMA, can you? But what a difference it could make.

Should we blame politicians? Tackling health inequalities requires strong leadership, the Marmot Review notes. Health ministers are meeting today, and a health equity expert at the University of NSW, Ben Harris-Roxas, would like to see them consider setting targets for reducing health inequalities. “A high profile inter-governmental review might help them,” he wrote at Croakey earlier today.

But politicians tend to take their lead from the public and opinion polls.

So it comes back to us. It will be interesting to see how much, if at all, Australia engages with this report. It hasn’t made much of a dent in the headlines, yet. It deserves to.

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#CRANAplus2016
#IAMRA2016
#LowitjaConf2016