South Australians go to the polls this Saturday. Whichever party is elected, they must broaden their health agenda to address housing and other vital determinants of health, reports Alison Barrett.
*** This article was updated on 18 March to include additional comment ***
Alison Barrett writes:
Prioritising efforts and funding on social determinants of health and public health will go a long way to addressing the current critical levels of people requiring acute and/or emergency healthcare in our state.
While hospitals are vitally important to the community, improving the health and wellbeing of people in the South Australian community requires more than funding for hospitals.
Yet the election campaign from both major parties would have us believe that hospital funding is the most important health issue. The recent deaths of two people linked by the Ambulance Employees Association to delayed responses of ambulances has also ensured the focus remains on hospitals.
Ross Womersley, Chief Executive Officer of South Australian Council of Social Service (SACOSS), told Croakey that addressing ambulance ramping requires broad-ranging responses.
“Ramping of ambulances at our public hospitals has been very much in the spotlight recently, and reflects the focus that goes straight to the tertiary end of the system – our hospitals,” he said.
“But this is really just one part of a much broader issue. You won’t stop ramping until we have the right health promotion information, systems and resourcing to tackle illness prevention, and understand and address health inequalities, to ensure that people can protect their own health and reduce the need for hospitalisation.”
The current Liberal Government has been in power since 2018 after sixteen years of a Labor Government. South Australia has similar health outcomes to the rest of Australia, particularly in relation to life expectancy at birth, cancer survival and pregnancy outcomes.
However, disparities exist between regional and urban health outcomes, and for Aboriginal and Torres Strait Islander people, who account for 2.4 percent of the population. One-quarter of the state’s population live outside of the capital city, Adelaide.
While at times criticised for taking an over-cautious approach to COVID-19, the Liberal Government with Chief Health Officer Professor Nicola Spurrier and Police Commissioner Grant Stevens had arguably managed the response quite well up until the end of 2021.
South Australia remained mostly free of COVID-19 until the borders reopened on 23 November 2021 around the same time as the Omicron variant was identified in Australia.
Since then, as with much of the rest of the country, the state has been marred by elective surgery cancellations, disruptions to business and schools and a significant increase in COVID-19 cases and deaths.
Affordable, available housing needed
Many groups have identified housing as a critical health concern. Scott Wilson, CEO of the Aboriginal Drug and Alcohol Council (SA) (ADAC), told Croakey that improving access to affordable housing would go a long way in improving people’s outcomes after they are discharged from rehabilitation.
“When clients come to our rehab, from day one until they leave 12 weeks later, that’s the issue, to try and get them into some sort of either short-term or long-term accommodation, because we know that if, once they leave and they are homeless, then more than likely, they may relapse pretty soon after that,” he said.
“And that’s a problem. There is no housing available. And so really, to a certain extent, you know, are we just not setting people up to fail in the first place? One of the things that we would all like to see in the election is commitment on public housing.”
Reiterating the importance of housing as a vital determinant of health, the Mental Health Coalition of South Australia (MHCSA) is asking the next government to improve access to sustainable housing. This will help reduce the average length of hospital stay and avoidable presentations to emergency departments.
The SACOSS report card says more is needed by both Labor and Liberal to effectively address the housing and rental affordability crisis.
With the occurrence of more frequent climate disasters, it is critical that safe and affordable housing is available for everyone.
South Australians for Climate Action are calling for continued bipartisan leadership on climate policies with specific priorities including transition to 100 percent renewable electricity by 2030, innovative and smart land use, protection of biodiversity and greenhouse gas neutrality of business and agriculture.
See the signatories to this statement here.
Raise the age
While it is promising to hear support from both Labor and Liberal for the Uluru Statement from the Heart and an introduction of an Aboriginal voice to parliament, and the unanimous vote in 2021 to ban spit hoods in SA, more is required to improve the health and wellbeing of Aboriginal and Torres Strait Islander people in South Australia.
Raising the age of criminal responsibility from ten to at least 14 years will reduce the disproportionate rate of Aboriginal and Torres Strait Islander youth in jail and improve their growth and development.
Raising the age is “a really easy policy decision” that would lower the incarceration rate for Aboriginal children overnight, Wilson told Croakey.
He also said that having prevention programs and support in place for children was important.
Reconciliation SA has called for the next South Australian Government to work with the “broader community to prioritise action towards a reconciled state”. Their full election policy platform can be read here.
Mary Brushe, researcher at Telethon Kids Institute, PhD Candidate and Advocacy Coordinator of SA’s branch of PHAA, would like to see reduced inequalities and inequities within the SA community, especially for Aboriginal and Torres Strait Islander people. She calls for increased investment in Aboriginal Community Controlled Health Services and a reorientation of the health system to focus on prevention.
“Finally, an increase in universal screening from 0-5 years so that no child is left behind and every South Australian family is provided the information and support required for their child’s health and development,” Brushe told Croakey.
Invest in primary healthcare
The Aboriginal Health Council of SA Ltd (AHCSA) calls for the incoming government to take action on the following priorities to improve the health and wellbeing of Aboriginal and Torres Strait Islander people:
- More secure, reliable funding streams to deliver critical services without arduous hoop-jumping, such as longer term and higher level agreements
- Greater consultative approach with stronger collaboration between government agencies, such as SA Health and AHCSA with regard to workforce planning and strategy development – in a real and meaningful way, not just tokenistic, and not them stepping over our heads as they have been
- Greater understanding and appreciation for the complex role of an Allied Health Professional (AHP) within the health sector and strategies for integrating the role across broader government agencies. For example, allied health roles can work within government departments based on their health and/or clinical expertise so why are AHPs limited to standing in a clinic?
- With regard to funding, a deeper understanding on the complexities of higher education (VET/University) for Aboriginal and Torres Strait Islander people (i.e. racist education systems) and the therefore necessary additional resources and dollars required to support engagement, progression and completion
- Holistic support approaches to training, workforce and education with a focus on resourcing sufficient roles to provide this support, understanding the necessity of this support being available and provided by an Aboriginal organisation and people.
With reference to the Closing the Gap priority area reforms, particularly priority reform two – ‘Building the Community-Controlled Sector’, Shane Mohor, CEO of AHCSA told Croakey: “The main issue is that funding for Aboriginal programs should be initially provided to Aboriginal Community Controlled Organisations. This is across all sectors not only health. There is a lack of accountability and transparency around how Aboriginal health dollars are expended by State and Commonwealth governments.”
AHCSA is also investing significant time in to priority area four – ‘Shared Access to Data and information at a Regional level’.
“We are working on systems which will provide the infrastructure to enable data sharing to occur, in a way which respects and enhances Aboriginal data sovereignty,” Mohor said.
Three specific program areas AHCSA are currently focused on attracting additional resources for are social and emotional wellbeing, eye health and chronic disease management.
While ADAC is funded by the Federal Government, Wilson also noted it was challenging securing ongoing funding and human resources for their service due to the cyclical nature of short-term government commitments and grant-funding.
ADAC provides vital primary healthcare, including meals and first-aid, in addition to drug and alcohol support for Indigenous and non-Indigenous people in South Australia. The service helps prevent people requiring hospitalisation, Wilson says.
Mark Burdack, CEO of Rural and Remote Medical Services (based in NSW), emphasised the importance of addressing primary healthcare, particularly in rural communities. “There is actually a very compelling case for the States and the Territories to invest in primary care, because they’re the doctors that you need to run hospitals in those locations because they’re not full surgical hospitals.”
“But all the industry players, all the universities and all the governments have to get together and go, ‘We’re going to put patients first, not our own interests. How do we make that happen?’ And that’s the big challenge for whoever gets government in South Australia, whoever gets government at a Federal level,” Burdack told Croakey.
Health promotion and public health workforce
COVID-19 has highlighted the importance of having a sustainable public health workforce to not only support current pandemic efforts, but ongoing disease prevention and health promotion.
SA’s Public Health Consortium, consisting of SACOSS and SA branches of Public Health Association of Australia (PHAA) and Australian Health Promotion Association (AHPA), have called for the incoming government to increase investment in public health, prevention and promotion.
AHPA SA Branch’s President Dr Stefania Velardo told Croakey: “South Australia continues to face increasing demand on the healthcare system alongside widening health inequities. While the pandemic remains an important priority, our system remains unbalanced with insufficient investment in disease prevention and action on the determinants of health. This comes at significant personal, social, and economic costs. This system is unsustainable and bursting at the seams. We need to see it shift towards public health and health promotion so that all South Australians can flourish.”
Professor Jacqueline Bowden, PHAA SA Branch’s President, told Croakey: “PHAA SA’s key priority is to ensure that prevention is adequately resourced in South Australia. There is so much more that could be done to prevent South Australians becoming unwell in the first place and unnecessarily entering our health system – causing stress on families and costing more in the longer term. We would like political parties to commit to spending five percent of total health expenditure on prevention, which would bring SA in line with international best practice. To ensure this funding is spent where it is needed the most, South Australia also needs better reporting and monitoring of health inequities across key priority groups. Finally, we need to make healthy choices the easy choices and create health promoting environments through strategies such as the Rite Bite program, banning unhealthy food and drink advertising on government property and making our very cheap alcohol products, less easy to obtain.”
Vice-President of AHPA’s SA Branch, Gabrielle Fisher said: “It has been almost ten years since the McCann Review of non-hospital services decimated the local health promotion workforce. Therefore, I would like to see the newly-elected government build the capacity of our workforce into the future and beyond COVID-19, in a system where five percent of health expenditure goes towards disease prevention and health promotion. Public health workforce development has been identified as one of the best forms of insurance governments could take out for the future.”
Measuring political parties’ priorities
Emphasising an urgent need for the next State Government to address broader social issues, key advocates for social, mental and public health have measured the commitments of SA’s political parties against key health election priorities.
South Australia’s Public Health Consortium released their election scorecard today, showing The Greens and SA-Best’s commitments to supporting public and preventative health measures.
SACOSS published an additional election report card in response to their ‘Cover the Basics’ policy platform, that had a specific focus on fundamental requirements for health, such as affordable housing and safe drinking water.
Not all South Australians have access to safe drinking water, and this particularly impacts people living in regional and remote communities. The Liberal Government has made progress during their current term in securing drinking water in remote communities that has previously been unsafe to drink.
The MHCSA has compiled the State’s four main political party’s mental health policies here.
In conclusion, investing funding and effort in Aboriginal community controlled health services, a public health workforce, disease prevention, primary healthcare and fundamental needs such as housing will enable the South Australian population to have a healthier future.
Calls to action from Twitter
Read: SA seniors pressure politicians about ageism, housing and healthy ageing.
See Croakey’s previous coverage of the 2022 South Australian election.