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On the new COAG Reform Council reports: “health inequality is becoming ingrained…”

Australia’s health gaps – including those between rich and poor, between Indigenous and non-Indigenous Australians, and between the major cities and everywhere else – are starkly revealed in the latest reports from the COAG Reform Council:
Healthcare 2011-12: Comparing performance across Australia
• Disability 2011-12: Comparing performance across Australia.

The health report is being formally launched at the AMA National Conference in Sydney today by Council chair John Brumby.  You can follow the AMA’s discussions via #amanatcon (it will be interesting to see how much of the chat, if any, is focused on addressing health inequalities versus professional interests).

In the post below, Mary Ann O’Loughlin, Executive Councillor and Head of the COAG Reform Council Secretariat, gives an overview of the new reports (don’t miss the informative graphs from the health report at the bottom of the post).

Beneath her article, you can read responses to the new reports from the Social Determinants of Health Alliance and the Consumers Health Forum, raising concerns about health inequalities and inequities in the healthcare system.

***

An overview of our performance in health, health care and disability services

Mary Ann O’Loughlin writes:

The COAG Reform Council’s job is to publicly report on the progress of the Commonwealth, State and Territory governments towards the goals of the COAG Reform Agenda.

The agenda covers housing, Indigenous reform, education and regulatory reform, as well as health and disability, which are the subject of this article.

The council does not offer the ‘why’ or ‘how’ of the results we report, but presents the data on whether outcomes are being met. We tell COAG and the Australian public if the Commonwealth, State and Territory governments are doing what they agreed to do.

The aim of the National Disability agreement is to ensure that people with disability achieve economic participation and social inclusion and enjoy choice, well-being and the opportunity to live as independently as possible. It also monitors whether families and carers are well supported.

In this year’s report we see that the use of specialist services by people with disability increased from 32% of the potential population to 35%.

The increase was strongest for community support services, which ensure people can live in the community and not an institutional setting.  The ACT, Tasmania and South Australia were the strongest performers on this measure, with rates above 50%.

Declining economic participation for people with disability
The report also looked at economic participation for people with disability based on the proportion of people receiving the disability support pension who also report earnings. This showed a steady decline over the past four years—from an already low rate of 9.3% in 2009 to just 8.6%.

Carers and families also face barriers to economic participation with just over half of primary carers employed, compared to more than 75% of non-carers.  More than half of primary carers also reported negative impacts on their health and wellbeing relating to the pressures of their caring role.

It will certainly be interesting to watch how the rollout of DisabilityCare affects these results.

The National Healthcare Agreement is, naturally, broader. Its aim is to ensure that all Australians, regardless of geographic location or socioeconomic status are born and remain healthy.

Remarkable progress on smoking
In this year’s report there were a number of standout results.

The rate of smoking among adults fell to 16.5%—down from 19.1% four years ago.

This continues Australia’s ‘remarkable progress’— as it has been described by the OECD— in reducing tobacco consumption in the last two decades. This is a great outcome and the result of work by successive governments at the Commonwealth, State and Territory levels.

COAG has set itself a target to reduce smoking rates to 10% by 2018 which, if achieved, will be a landmark moment in public health.

Smoking rates do, however, remain stubbornly high in rural and remote and disadvantaged areas and continued commitment is needed if governments are to get these areas on track.

This year we report new data for obesity rates and the news is not good. More than one in four Australian adults is now obese.

We know that obesity contributes to the burden of chronic disease in Australia and the management of conditions like heart disease and diabetes impacts greatly on the broader health system.

Next year the council will report new data on the prevalence of diabetes which should assist in focusing government health policy.

The report also found that 60 % of people can see a GP for an urgent appointment within four hours, but the proportion waiting for more than 24 hours has increased to nearly 1 in 4.

Some good news on preventable hospitalisations
A real positive the council has seen over four years of reporting is the fall in the rate of preventable hospitalisations each year—something you would expect to see as primary, community and preventive health care improve. The advantages of keeping people out of hospital are better outcomes for patients and more beds available to patients for whom hospital admission is essential.

As for elective surgery, wait times have increased nationally. At the mid-point of the waiting list, Queensland still comes in best at 27 days. Wait times increased in NSW, Victoria and Tasmania but have decreased in South Australia, the ACT and the Northern Territory.

Performance in emergency department waiting times has been more positive with improvements nationally and in most jurisdictions. In 2011–12, 70% of patients were seen nationally within national benchmarks for triage categories—up from 67% four years ago.

One of the objectives of the Healthcare Agreement is to support the long-term sustainability of the health system but governments are yet to define what that means.

Given that we know the system faces the pressures of an ageing population, an increasing chronic disease burden and growing consumption of health services, the council has recommended that COAG moves to bed down the measures necessary to ensure long term sustainability. Once we can measure it, the council can start monitoring it and assist governments to manage it.

• Mary Ann O’Loughlin is Executive Councillor and Head of the Secretariat, COAG Reform Council

***

SDOH Alliance: Further evidence of the urgent need to address health inequity

An alliance working for health equity in Australia says a new report from the COAG Reform Council provides further evidence of health gaps widening in this country, underlining the need for governments to follow international recommendations on how to address the social determinants of health in a way that’s relevant to the Australian context.

Responding to the Healthcare 2011–12: Comparing performance across Australia report, the Social Determinants of Health Alliance renewed its call for Parliament to adopt the World Health Organisation’s Closing the gap in a generation report and for the social determinants of health to be considered across all policy areas.

The Social Determinants of Health Alliance (SDOHA), representing more than 45 health, social service and public policy organisations, was launched in February. Its members believe it is well and truly time for action on health inequity in a nation that aspires to give everyone a “fair go”.

“The findings from COAG’s report are shocking. How many more of these reports do we have to wait for – as health gaps widen further and further – before we take action on the social determinants of health?” SDOHA spokesman Michael Moore asked.

“The report shows that people from the most disadvantaged areas are more likely to be overweight or obese, and smoke. Those living outside major cities are also more likely to be overweight or obese, and smoke than those living in major cities. This is a country that prides itself on giving everyone a ‘fair go’, but it’s clear from these finding that we’re a long way from actually being fair.”

SDOHA spokesman Martin Laverty said “the report also shows that when it comes to accessing elective surgery, people living in the most disadvantaged areas wait longer for elective surgery and the gap is widening. Similarly, while waiting times are improving for patients in major cities, they are getting worse for patients in remote areas.”

COAG Reform Council chair John Brumby said in his letter to Prime Minister Julia Gillard that Australians “continue to experience health inequalities based on who they are, how much they earn and where they live. We do not see consistently strong performance across all states and territories in key areas of hospital care and continue to find that there are health inequalities for Indigenous Australians”.

Professor Sharon Friel, a health equity professor at Australian National University and one of the lead advisors to the WHO’s Commission on the Social Determinants of Health, said this report reinforces the need to act on the recommendations of the Senate Inquiry report.

“Senators from across the three major parties worked diligently to produce a report that offered thoughtful recommendations on important first steps in addressing health inequity in this country,” she said. “As we see another report today laying bare the extent of the challenges, the Alliance is hopeful this will remind governments around the country of the urgent need to implement those recommendations, which will support economic, social and health policy goals.”

***

Consumers Health Forum: We have a two-tier health system

“The COAG Reform Council has today reported a widening disparity between income groups in accessing public hospital surgery, highlighting the emergence of a two-tiered health system in Australia,” says Carol Bennett, the CEO of the Consumers Health Forum.

“CHF finds it deeply troubling that the most disadvantaged patients in Australia usually face a 44 per cent longer wait for recommended surgery than those in well-off areas. This access gap has worsened in recent years. Those in disadvantaged areas now wait a median 13 days longer than the 29 days wait for those from better-off suburbs.

“Health inequality is becoming ingrained in the operations of our public hospitals. How long you wait for care is determined not just by your health needs, but also your income level. Universal healthcare is now clearly on the ropes.”

Ms Bennett was responding to the publication today of the COAG Reform Council’s report into healthcare performance prepared for the Council of Australian Governments.

“The plight of many thousands of patients, disabled and in pain, waiting for hip replacements and other elective procedures, raises questions about whether taxpayers are getting any return on the major increases in funding provided to public hospitals. Claims that health insurance growth would ease the pressure on public wards are also in doubt. Elective surgery waiting times have risen from a median 34 days to 36 days in the past five years.

“Waiting times of 24 hours or longer for an urgent appointment with a GP, are also up by 12 per cent last year on the previous year.

“Indigenous infant death rates at 7.4 deaths per 1000 births still remain nearly double the rate of that for other Australians — a shameful figure in a prosperous country like Australia.

“We are also failing to win the fight against obesity with 63 per cent of people overweight or obese in 2011-12, up two percentage points on 2007-08.

Ms Bennett also highlighted some of the bright spots in Australia’s health performance revealed in the report, which she said “are a credit to the quality of care that is available. The 16 per cent fall in heart attacks between 2007 and 2010 is a remarkable achievement, even though the fall for indigenous people was less than half that.

“Other achievements have included the 14.9 per cent decline in the rate of potentially preventable hospitalisations for chronic conditions, and the meeting of a national benchmark for hospital acquired infections”.

***

Graphs from COAG’s health report 

Adult smoking rate 2011-12 varies between states, territories

***

The geographic distribution of risk factors 2011-12

***

Distribution of risk factors by SES area

***

Trends in adults at long-term risk from alcohol consumption

***

Encouraging trends in potentially preventable hospitalisations

***

The health gap and potentially preventable hospitalisations

***

Changes in life expectancy: by gender and jurisdiction

 

Comments 3

  1. Liz Callaghan says:

    “Let’s talk about health inequity, not just waiting lists”.

    While people around the country continue to focus on waiting lists in any discussion of health care in Australia, Catholic Health Australia says this morning’s report from the COAG Reform Council reveals – once again – the great injustice of health inequity continues to grow in this country.

    “The report Healthcare 2011–12: Comparing performance across Australia found its way into today’s newspapers with the usual fascination with waiting list times leading the story,” Catholic Health Australia CEO Martin Laverty said. “It is important that people receive health care in a timely fashion, but it would be great if people around the country were as interested in the reality that people living in different parts of Australia, or from different cultural or socioeconomic backgrounds, are seeing their health suffer. In fact, it’s those most disadvantaged Australians who are further impacted as they are left to languish on the longest waiting lists.

    “The Senate Inquiry report recommending a path forward for action on the social determinants of health was issued 65 days ago. It is sitting on politicians’ desks gathering dust, rather than being followed.”

    Mr Laverty said COAG Reform Council chair John Brumby quite succinctly summed up the current disparity facing the country.

    In a letter to the Prime Minister Julia Gillard, Mr Brumby said Australians “continue to experience health inequalities based on who they are, how much they earn and where they live. We do not see consistently strong performance across all states and territories in key areas of hospital care and continue to find that there are health inequalities for Indigenous Australians”.

    Said Mr Laverty: “We hold out hope – albeit not great hope – that this might be the report that flips the switch in the minds of our politicians and makes them realise that they can’t ignore the overwhelming evidence forever.”

    Among findings in today’s report were:
    • smoking rates increased with socioeconomic disadvantage inside and outside major cities;
    • whether an adult is likely to engage in behaviours that affect health outcomes varies depending on where they live;
    • two out of three adults outside a major city were overweight or obese across all areas of socioeconomic disadvantage. In major cities, around two-thirds of adults in the most disadvantaged areas were overweight or obese;
    • Those in the least disadvantaged areas were more likely to drink alcohol at levels that put them at risk of long-term harm;
    • People living in the most socioeconomically disadvantaged areas were more than twice as likely to experience very high levels of psychological distress.
    • The rate of potentially preventable hospitalisations for chronic conditions is highest for the most disadvantaged areas.

    “This is hardly the first report to present these stark realities, and we fear it won’t be the last. It certainly won’t be the last if governments – particularly the Commonwealth – don’t take this issue seriously,” Mr Laverty said.

    “The social determinants agenda should be one that transcends politics, with something in it that should appeal to all of the major parties. In an election year, we’ll be asking hard questions of Labor, the Coalitions and the Greens, seeking their solution to unacceptable levels of health inequity.”

  2. Margo says:

    It is tempting, and relatively easy, to talk about inequalities and inequities in health with reference to factors such as geographic location and socioeconomic status. However, there are other important social determinants which play important roles, both individually and in combination with other influences. Gender and occupation would be the ones which spring immediately to mind as having significant impacts on health-related attitudes, beliefs and behaviour (and noting that the national women’s and male health policies seem to exist primarily in name only).
    This is not to deny that many of the options which impact on health outcomes are limited by easily-measurable factors such as where we live and SES. However, commercial marketers have long understood that what defines us in terms of behavioural determinants are not necessarily the crude factors such as age, education, or SES but are things like identity, goals, risk acceptance, and aspirational values. Being able to tap into these, by understanding what people want from their lives and what they (rather than the ‘health lobby’) see as problems, is what influences decisions. There is tremendous merit in addressing the classic SoDH, but I am not persuaded that Australia’s health problems, such as those related to smoking, alcohol abuse and obesity, would disappear if everyone had a tertiary education, a nice house, and a $200 000 annual salary.

  3. kwarner says:

    Karen Warner posting on behalf of AML Alliance CEO, Claire Austin

    The COAG report, Healthcare 2011-12: Comparing performance across Australia confirms the investment that needs to be channelled into the primary health care sector through Medicare Locals if further improvements are to be realised in the health outcomes of all Australians.
    The report, which showed a 7.3% reduction in potentially preventable hospital admissions over the past four years, highlights the purpose of Medicare Locals, Australia’s primary health care organisations, which are working now to keep people well and out of hospital.
    Hospital care is the most expensive care to deliver in this country and most people with chronic diseases and complex conditions should be, and will be, increasingly managed through frontline team-based care at the community level through Medicare Locals.
    It is unacceptable that the proportion of people who felt they waited an ‘unacceptable time’ to see a GP increased to 27.4% from 17.8% over a four year period.
    Improvements in after hours care and access to GPs is happening now with Medicare Locals working systematically in 61 catchment areas to identify where there are gaps in after hours services and where services need to be adjusted to meet local community needs.
    With Australia’s ageing population and the increasing proportion of adults who are either overweight (35%) or obese (28%), the acute care sector cannot be expected to cope with this onslaught of increasing chronic disease, in terms of patient numbers and cost to the system.
    Medicare Locals have been set up to take this load away from the hospital sector to effectively free it up for the acute care episodes that need intensive treatment.
    Managing the treatments, care plans and prevention programs for chronic diseases like diabetes, heart disease, smoking cessation programs and asthma for example, are better dealt with through coordinating organisations like Medicare Locals.
    AML Alliance, the peak primary health care body for the 61 Medicare Locals, is working to strengthen and support its members to deliver the integrated care at the frontline, locally.

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