Finally, perhaps some of the rhetoric about the importance of “whole-of-government” approaches in health is going to be put into action.
The recent budget announcements on mental health – with the new National Mental Health Commission to be based in the Department of Prime Minister and Cabinet – have been welcomed as a step in this direction.
Rural health leaders are also optimistic that the new national Rural Health Agency will enable high-level advocacy for rural health right across government.
But what about action on the social determinants of health?
Martin Laverty, the CEO of Catholic Health Australia, argues below that a new report from the Smith Family reinforces the need for welfare, education, and health policy to merge. But he says that a Senate inquiry may be needed to generate such a shift.
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Can a Senate inquiry come up with an action plan for a fairer distribution of health?
Martin Laverty writes:
A person’s health is strongly influenced by that person’s wealth.
A long succession of research indicates a person’s health is first influenced by their time in the womb. We know the early years of childhood define a lifetime’s health expectations. We know educational attainment, participation in the workforce, and income levels all influence people’s health outcomes.
Yet in Australia when we talk about health we immediately think of nurses, doctors, and hospitals. We don’t immediately think of vibrant childhoods, good schooling, satisfying work lives and fairness in income. We should, and that’s why welfare, education, and health policy thinking should merge.
The Smith Family recently made this same type of argument, but from their education-focused point of view.
Their report – Unequal Opportunities: Life chances for children in the lucky country (the report and press release can be downloaded here) – found higher wages and greater educational attainment are more frequently achieved by people from well off families than from poorer families.
The report finds 12.7% of children are living in jobless households, and that three-quarters of this group have been living in a household that has been jobless for two or more years.
The Smith Family report also shows a decrease in the proportion of university students coming from a low socioeconomic background, with enrolments having fallen from 16.4% in 2008 to 15.1% in 2009.
Ten years ago when I worked at The Smith Family, we grappled with research evidence showing that if we didn’t invest in early childhood experiences that kids in disadvantaged families would face challenges in completing year 12 and getting a good job. The kids we were talking about back then are now heading towards school leaving age. The new Smith Family research evidence suggests not a great deal has changed.
Catholic Health Australia research that I released last year points to a drastic consequence of the failure to invest in early childhood, schooling and social supports for disadvantaged families. Our September 2010 report – Health lies in Wealth – found a person in the lowest 20% of income earners will die on average 3 years earlier than someone in the highest 20% of income earners.
Governments in Australia need to get around to assessing Sir Michael Marmot’s health gradient strategy. He argues improving social equity through better education, income, housing, and social participation for all in the community can best address the long term health and wellbeing of the poorest in our community.
I add, for the economic rationalists that suggest lifting social equity is too hard or expensive, that to do so will also expand the capacity of the national economy.
Sir Michael’s Wold Health Organisation Commission on Social Determinants of Health outlined in 2008 a clear and simple framework for governments around the world to adopt.
We’ve asked governments in Australia at every opportunity to at least respond to this WHO proposal.
They haven’t, and that’s why we think its time for a far reaching Senate Inquiry into how the framework could be applied here in Australia to address the problems highlight in The Smith Family and Catholic Health Australia research findings.
The findings of the Smith Family report are not new – but they are timely. They reinforce that evidence that early childhood development, schooling, income levels, housing, and targeted welfare services are key to good social and health outcomes.
When we move on from the few weeks of focus on the Federal Budget, perhaps members of the Federal Parliament could spend just a few minutes considering the WHO action plan for social determinants.
Like many of us, our MPs will probably scratch their heads not knowing exactly where to start. We should start with a Senate Inquiry, tasked with developing an Australian action plan to finally tackle the social inequality as a means of addressing the social determinants of health.
• Martin Laverty is the CEO of Catholic Health Australia, the nation’s largest provider group of non-government hospitals and aged care services.
The work of Marmot (and others) is very important, but it is not perfect, and it is also not always clear how to practically implement some of the findings. Significant social inequity will always be with us, so even the most optimal application of this work will still leave serious problems to deal with.
Otherwise, yes, health needs to be a broader and better integrated concept in government policy.
The poor will be with us always! That was the justification the mediaeval church used for the wealth of the Pope and the Bishops and the Abbeys while the masses starved. That attitude by the then church led to revolutions and wars and the Protestant breakaways from Catholicism.
Marmot is quietly passionate about his work and espouses his informed views with firmness. He provides the idealism back up by his research. And what is wrong with idealism? We need more of it in our post idealistic world! He leaves the implementation to Governments and Councils because that is their job, to put in place strategies to address significant social inequities, in particular where those social inequities bring about adverse health outcomes. The beauty of Marmot is that he demonstrates to the economic rationalists that it can be done and save economies money. A Senate Enquiry on how to implement Professor Marmot (and others) ideas in Australia is a good start.
“The poor will be with us always! That was the justification the mediaeval church used for the wealth of the Pope and the Bishops and the Abbeys while the masses starved”
Are you seriously suggesting that we can eliminate all social inequity? Sorry, but that is fantasy land stuff. We can’t fix everything.