In an uncertain world, at least one thing is quite certain. When it comes to Federal Budget time, we will hear plenty about the “winners” and “losers”.
While helpful for headline writers, this is a simplistic and unhelpful framing for addressing the many complex challenges that we face, especially during pandemic and planetary health crises.
What if we examined the budget papers through a different lens – such as whether their measures as a whole will contribute to better health for all over time?
Some timely suggestions for alternative budget discussions come from a 40-page collection of articles, published this week by The Medical Journal of Australia as a supplement and sponsored by VicHealth, titled ‘Australia in 2030: what is our path to health for all?’.
In an accompanying MJA editorial summarising the collection, VicHealth CEO Dr Sandro Demaio suggests we need to reframe our discussions about health, to “lift our gaze and focus more broadly on protecting all life (not just human life) and achieving intergenerational planetary health equity (rather than a narrower focus on human health equity)”.
He argues that the pandemic has created an opportunity for “bold action and systemic change”, and that the foundations for action — evidence, frameworks, precedents in other sectors, international case studies — are already in place.
“There is nothing holding us back and no excuses for complacency, inaction or practice not informed by evidence or based on principles of equity and sustainability,” Demaio writes.
However, he acknowledges that current governance arrangements are a barrier.
“Fundamental changes in the way we govern our lives and what is valued by society are required, including participatory governance to ensure an engaged civil society,” he writes.
The collection itself also highlights many challenges, with one in eight Australians, including one in six children, living in poverty and unable to afford necessities such as healthy food, clothing, education and healthcare.
Demaio also calls for evolution of the health sector and public health workforce so it is better placed to address the challenges facing the world.
“Investment in the workforce is essential, and existing health promotion frameworks need revising to support the shifts and guide subsequent action to build back better, fairer and greener,” he writes.
Below are some of the suggestions made in the seven chapters, each were authored by multiple academics (see the contents list here). Croakey has grouped these suggestions thematically, noting some overlap between the various authors’ recommendations.
- A federal Independent Commission Against Corruption, and stricter rules on potential conflicts of interest around lobbying politicians, donations to political parties and funding of research.
- Measures to prevent the revolving door of personnel between industry and governance, the protection of whistle blowers and the public disclosure of lobbying activities and donations.
- A whole-of-government approach that prioritises health equity, with a national health equity strategy guiding the actions of all government departments.
- To ensure cross-sectoral collaboration, an integrated governance framework, formalisation of shared accountability and responsibility, and creation of shared priorities, reporting mechanisms and organisational behaviours and norms.
- Governance structures designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples.
- Policy development processes mandated to involve meaningful consultation with citizens and people directly affected by the proposed policy change.
- Strengthening of public sector capacities and functions. No more outsourcing policy advice to international accounting firms and privatising social services delivery. The Commonwealth Government leads this by expanding the Australian Public Service, especially its social, health and environmental policy functions.
- An end to the stipulation that non-government organisations that receive government funding are not allowed to advocate on social and environmental issues, thus freeing them from what had effectively been a gag order.
Aboriginal and Torres Strait Islander peoples’ health
- A treaty with Aboriginal and Torres Strait Islander people so First Nations people have a central voice in all policy processes at every level.
- Embedding a cultural determinants of health approach into policy for Aboriginal and Torres Strait Islander people with flexible implementation to enable responses tailored to individual communities.
- Policies and programs to address the trauma of dispossession, paternalism and racism that has been inflicted on Aboriginal and Torres Strait Islander peoples.
- Aboriginal and Torres Strait Islander leadership across all policies that affect Aboriginal and Torres Strait Islander people.
- Governments resource Aboriginal and Torres Strait Islander people and organisations to effectively develop and implement cultural determinants of health programs that meet the needs of their communities.
- Acceptance of the Uluru Statement from the Heart.
Health in all policies
- A broader suite of measures than Gross Domestic Product to determine how well Australia is doing.
- Health is considered in all land use and transport planning and policy.
- Human rights are enshrined in legislation.
- Introduction of progressive taxation policy, including taxation in Australia for multinational companies.
- A systematic crackdown on tax evasion and an increase of the top marginal rates to those of the 1950s (around 70 percent).
- Climate change and green technologies and labour conditions, especially in the care economy, are key tenets of trade and investment policy
- The health consequences of trade agreements are addressed.
- A redesign of cities and towns to foster healthy, sustainable lifestyles.
- Stronger, mandatory standards for how corporations make, market and sell unhealthy products and services.
- Protecting and encouraging a strong, diverse and independent media.
- Australian-owned media companies receive generous tax breaks, especially if they enabled the production of both national and local news and debate.
- Citizen journalism is encouraged as part of the process of strengthening civil society.
- Laws ban any one company from owning more than 30 percent of media.
- A New Deal for Education agreement is signed with the states and territories, covering early childhood education through to universities, ensuring that schools and universities are governed much more democratically, with staff and students having a strong voice and local communities more welcome on campuses.
- Rapid decarbonisation of the economy.
- The Climate Emergency Response Initiative is established with a governance council and a new federal department supporting programs such as a Green Youth Corp to restore degraded areas of country, guided by Traditional Owners.
- Measures to address the inequitable distribution of risk and vulnerability to climate change.
- Upgrading of housing, green space and community infrastructure in vulnerable communities; stronger controls over where and how new homes are built; community programs that build social capital in risk-prone areas, in preparation for future emergencies; and targeted financial assistance following natural disasters.
- The Green Social Housing Economic Stimulus Package provides 30,000 social housing units, and introduces participatory governance for housing tenants.
- Increasing access to green infrastructure and designing homes to enhance thermal comfort.
- Building regulations that improve indoor temperature comfort and air quality, and transport infrastructure and planning regulations that create walkable, localised neighbourhoods, which are less reliant on fossil fuel-based transport.
- Invest in infrastructure consistent with the implementation of the 20-minute Neighbourhood, including upgrading and building more social and affordable housing; investing in world-class digital infrastructure to foster connectivity and productivity; prioritising cycling and urban greening on transport corridors; and building pedestrian and cycling infrastructure.
- Health systems shift focus to comprehensive primary health care, prevention and promotion.
- Community-governed community health centres provide individual care as well as group programs and community health promotion. They help reduce the excess burden of disease in rural, remote and outer suburban areas.
- The national Healthy Communities Initiative funds libraries, neighbourhood houses and community centres in low socioeconomic areas to develop new programs to encourage people of all ages to be healthy.
Back to reality
Clearly, we are a very long way from achieving such a vision, and Budget night (11 May) will no doubt remind us of some of the reasons why.
As well, many of these suggestions are beyond the remit of government, and also pose considerable challenges to the health sector itself, especially the public health sector, to work differently.
One chapter, titled ‘Health promotion in the Anthropocene: the ecological determinants of health’, says that health promotion practice has been slow to incorporate the ecological determinants of health. The authors say:
The next decade requires us to engage directly in advocating for climate action and disinvestment from fossil fuels while rapidly preparing the health promotion sector for planetary health thinking and action.
This is the critical decade for action — lives depend on it.”
Another chapter, titled ‘Disrupting the commercial determinants of health’, also addresses workforce issues:
Finally, there is a need to train and support a multidisciplinary public health workforce with expertise in areas like law, economics, corporate finance, political science and community organising to strengthen our capacity to hold powerful corporations to account for their role in promoting NCDs [non communicable diseases].”
Please join the Croakey team in sharing news about the Budget’s health impacts on Twitter and other channels using the hashtag, #Budget2021Health.
The tweets below are from today’s launch of the supplement in Melbourne, with another event planned for Adelaide next week.
See previous Croakey articles on this year’s Federal Budget.
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