Will the Federal Government’s new Measuring What Matters: Australia’s First Wellbeing Framework help to transform policy, debate and investment, and lead to greater health equity?
Many commentators believe it’s an important first step towards creating meaningful change, but much more work is needed, writes Jennifer Doggett.
Jennifer Doggett writes:
Australia’s First Wellbeing Framework is a deliberate effort to put people and progress, fairness and opportunity at the very core of the Government’s thinking about the economy, according to Treasurer Jim Chalmers.
The statement was flagged in the Government’s first budget in October 2022 and follows a two-stage consultation process involving 165 submissions from individuals and groups.
Other countries, including New Zealand, Finland and the UK, have taken similar approaches to their budgets, in response to concerns about their narrow focus on expenditure and deficits, which can obscure broader problems affecting quality of life, such as climate change, health, housing and community connectedness.
Indicators
The Framework uses 50 different indicators to measures well-being, including how safe Australians feel, how much time people have for recreation, their job satisfaction, air quality and trust in institutions.
It reports that 20 of these indicators saw improvement over the past decade, seven were stable, 12 deteriorated and others had mixed trends.
A “healthy society” is one of the key areas addressed in the framework, defined as one “in which people feel well, are in good physical and mental health, can access services when needed, and have the information they require to take action and improve their health”.
The following five indicators are being used to measure Australia’s performance in this area:
- Access to care and support services
- Access to health services
- Life expectancy
- Mental health
- Prevalence of chronic conditions.
Sitting under these indicators are a range of measures including life expectancy, proportion of people who experienced high or very high levels of psychological distress, proportion of people with one or more selected chronic health conditions and assessments of healthcare access and quality.
Access to healthcare is measured by the proportion of people who at least once delayed or did not seek care from a GP or specialist when needed due to cost, and the proportion of people waiting longer than they felt acceptable for an appointment with a GP.
Other opportunities
The statement specifies that it should be read in conjunction with other current government policies and initiatives aimed at improving Australians’ mental and physical health.
These include:
- Establishing the Australian Centre for Disease Control in response to health emergencies and other public health challenges
- National Aboriginal and Torres Strait Islander Health Plan 2021–2031
- Closing the Gap Social and Emotional Wellbeing Policy Partnership
- Developing the Gayaa Dhuwi (Proud Spirit) Declaration Implementation Plan
- National Preventive Health Strategy 2021–2030
- Refreshed National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Social and Emotional Wellbeing.
The Statement also coincides with an opportunity for Croakey readers to provide their feedback on the draft National Consumer Engagement Strategy for Health and Wellbeing commissioned by the Department of Health and Aged Care.
The Strategy is among the immediate priorities for action under the National Preventive Health Strategy 2021-2030.
The draft Strategy is open for public review and consultation on the Department’s consultation hub for 6 weeks, closing 11:59pm on 4 September 2023.
Professor Rosemary Calder, of Victoria University, and Leanne Wells, formerly CEO of the Consumers Health Forum of Australia, were Project Co-Directors for development of the Strategy, and said it provides a practical resource for policy makers and those involved in preventive health programs such as NGOs, local government, health foundations and Primary Health Networks.
The draft Strategy was designed in consultation with consumers, policymakers, community organisations with health and communications experts.
It will equip people with knowledge, frameworks and skills to engage effectively and purposefully with consumers and communities in the design and development of preventive health policies and programs.
“If we are to make inroads to the important indicators of health and wellbeing in the Treasurer’s Statement, the principles and practices included in the draft Strategy will be invaluable to everyone involved in the work to do so,” Calder said.
Indigenous knowledge
The Treasurer’s Statement recognises that the concept of wellbeing held by First Nations people differs from that of non-Indigenous Australians and includes a strong focus on “preserving and maintaining culture, which directly affects mental, physical and spiritual health”.
It states that this is “anchored in ways of knowing and being that have existed and continued for tens of thousands of years, shared through complex kinship systems, and passed down through systems of law, lore, ceremony, and song”.
“Because of this, the whole of population indicators outlined in this Framework are not an accurate measure of First Nations wellbeing as they are limited in their ability to represent these intrinsic cultural differences or acknowledge the past practices that have had detrimental impacts,” says the Statement.
It notes that the Statement can supplement the National Agreement on Closing the Gap metrics and add to the work already being undertaken through the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing (2017–2023).
Specific indicators used to measure the wellbeing of Aboriginal and Torres Strait Islander Australians include: the number of First Nations people who speak a First Nations language at home; and the proportion of First Nations people who recognise an area as their homelands or traditional country
What about value-based healthcare?
Kylie Woolcock, Chief Executive Officer of the Australian Healthcare and Hospitals Association (AHHA), told Croakey that the Statement signals support at the highest level for a cultural shift towards outcome-focused, value-based health care (VBHC).
“It gives permission to government, departments, organisations, teams and individuals to prioritise outcomes that matter to people and communities. We welcome this,” she said.
Woolcock added that in its current state, the Statement is high-level and intentionally so, as it states that this is to ensure it is accessible and meaningful to as many people as possible.
However, she argues that the utility of the Statement to support a move towards VBHC in policy-making and healthcare delivery will require commitment and investment to both enable outcome measurement and support flexibility in the design of solutions that improve outcomes, rather than counting inputs and inactivity.
AHHA’s submission to the consultation process highlights that “measuring what matters” is already being explored and practised in the Australian health system, and there is a significant amount of knowledge and expertise that should be collated and leveraged.
Woolcock says the organisation believes that the Statement can play a powerful role in aligning the understandings and indicators used currently to measure outcomes that matter, avoiding duplication and promoting efficiencies. This should include a nationally consistent approach to inform improvements at all levels of the system and open the door to developing wellbeing indicators, benchmarks and targets at a national, state and territory, regional and local level.
“Bottom-up workforce and consumer engagement is needed to make the Wellbeing Statement fit-for-purpose and generate the buy-in needed to cement the cultural shift the Government has signalled they are leading,” Woolcock said.
Climate change matters
The Climate and Health Alliance (CAHA) welcomed the Statement’s release, but said that much more needs to be done to tackle climate change, “the biggest health challenge of the 21st century” according to the World Health Organization.
“It is clear that the prosperity of a nation goes far beyond traditional economic measures like GDP. We are pleased to see the Commonwealth taking a whole-of-government, wellbeing approach to how it measures success of policy for current and future generations,” said Roland Sapsford, CAHA CEO.
However, he said the Statement was not doing enough to address the impacts of climate change on health.
“Nowhere does the Statement recognise climate change as the biggest health burden of the 21st century. Health underpins every aspect of wellbeing, from the ability to work and contribute to community and family life, to individual and cultural wellbeing,” he said.
Sapsford said that CAHA supported the inclusion of the National Climate Risk Assessment and a National Adaptation Plan as important aspects of resilience planning but felt that other aspects of global environmental change needed to be prioritised in the next iteration of the Statement.
He urged the Government to undertake a national conversation that enables all Australians to be a part of the evolution of the Statement, including strong engagement with First Nations Elders and communities.
A spokesperson from the Public Health Association of Australia (PHAA) told Croakey that PHAA hopes that the government acts on the final version of Measuring What Matters so that its full potential is realised and not ignored.
“We are pleased that the Government has expanded its health-related measures in recent months, based on feedback from the community. Any final report will need to be backed by indicators which are more frequent that five-yearly data from the ABS. PHAA looks forward to tracking the progress of the framework,” the spokesperson said.
Recognising rural Australia
The National Rural Health Alliance welcomed the initiative, and said it is looking forward to the next iteration, noting that it is early days in the Government’s attempt to outline a framework to improve wellbeing outcomes.
Alliance CEO Susi Tegen stressed the contribution that rural Australia has made to the Australian economy and society, including steering Australia through financial crises and the COVID-19 pandemic, through providing two-thirds of Australia’s exports, almost 90 percent of the food Australians eat, 50 percent of Australia’s tourism income and one-third of Australia’s GDP.
Despite this contribution, Tegen argued that current funding models favour and support urban centres or those who outreach to rural, rather than funding rural centres, with outreach to urban if needed. She said that this does not build local capacity, economy and sends a message that rural is not able to deliver as well as the city, which is not accurate.
To highlight and measure the health and wellbeing of rural Australians, the NRHA supports the addition of a National Rural Health Strategy under one of the 50 indicators in the Wellbeing Framework.
“There currently isn’t a strategy, and without it, we are not be able to measure improvement against the recent findings that rural, remote and regional Australia currently has a $6.55 billion under-spend per annum in healthcare. A strategy will allow Australia to measure rural Australia’s progress towards health status, access and equity, and also redistribute the underspend to these regions.”
Tegen said the NRHA is looking forward to working with the Treasurer, Prime Minister and MPs to benchmark against 50 different indicators, including the National Rural Health Strategy.
“This will help Australia better understand how rural Australia contributes and is faring as we pursue a more healthy, secure, sustainable, cohesive, prosperous and above all, equitable Australia. We need to ensure that we make equitable adjustments to policy, funding and strategies to improve the status quo. Australia has a social contract to do so,” she said.
Root causes
Political economist and founder of the Wellbeing Economic Alliance, Dr Katherine Trebeck, commented via Twitter that the Statement isn’t a “wellbeing budget”, saying that this would require the measures to be used to frame and direct spending and taxes.
She supported the Statement’s overall themes, in particular its inclusion of well-paid and secure jobs as a measure rather than broad employment statistics, but added that these need to be rooted in what Australians say matters to them.
During a webinar today, ‘Building a wellbeing economy: the what, the how, and the who’, hosted by ANU with researcher Megan Arthur and Professor Sharon Friel, Trebeck stressed the importance of getting to the root causes of poor health and wellbeing, rather than just addressing the symptoms.
“The trick will be to use these measures to give permission to look upstream and ask ‘why?’ where outcomes are inadequate and then work to take action at the root causes. Too much government money is spent downstream repair and reaction and this is of course celebrated in GDP terms,” she said.
Trebeck also supported a role for an independent commissioner, along the lines of the Welsh Future Generations Commissioner, saying that this would really help drive the necessary changes through “supporting, cajoling, encouraging, calling out when necessary.”
Other themes addressed in the webinar included the potential for the Statement to draw political and policy attention to the way economics impacts health through a range of actors and institutions, policies, commercial activities, and norms that incentivise a consumptogenic system reliant on fossil fuels which drives both inequality and climate change.
Unfair criticism
The Opposition was quick to criticise the Framework for relying on old data but according to Dr John Hawkins and Associate Professor Jacki Schirmer, both from the University of Canberra, this criticism is unfair given that the Government used the most recent data available from the Australian Bureau of Statistics.
Hawkins and Schirmer argue that the document should be acknowledged as a significant and positive step in the right direction by Australia’s Treasury, in keeping with international best practice.
They also say that the measures being used need improvement, both in terms of regularity and how much they capture differences masked by national averages
“Averages can mask significant inequalities. As Paul Krugman put it, if Elon Musk walks into a bar, then the average person there becomes a billionaire,” they wrote in The Conversation.
The only way to fix this is to provide the resources needed to collect more detailed information more often. This should include ensuring a sample of the many groups known to be at higher risk of low wellbeing but often under-represented in national data collections, for example Aboriginal and Torres Strait Islander people and those living in regional communities.
Paradigm shift needed
Research economist and Centre for Policy Development Wellbeing Initiative Director, Warwick Smith, welcomed the Statement as a “substantial, sensible and urgent step towards a fair, sustainable national economy that works for people, communities and the environment.”
But he also warned that turning the Statement into meaningful action won’t be easy.
“While the metrics…will be useful for tracking progress and sparking action aimed at reversing negative trends and building on successes, international examples tell us it’s hard to use a Statement built from 50 different metrics to work out what to do. It can turn compliance into a box-ticking exercise, when what’s really needed is a paradigm shift,” he said.
Smith argues that success will require “the support and vigilance of the Australian people. Australians, and the Government will need to be willing to experiment and sometimes fail.”
He offers the example of Wales having three attempts at developing a wellbeing Statement before it landed on the Wellbeing of Future Generations Act, which requires public bodies to use sustainable development as guiding principle and to work to achieve seven goals that reflect the values and aspirations of the Welsh people.
Next steps
The Government has not outlined how the Statement is going to be used to inform policy and budget decisions but Treasurer Jim Chalmers has stated that it was “the first step of an iterative process” and that the Government would “continue to consult and refine the Statement based on ongoing and welcome feedback”.
If the Government is looking for ideas to strengthen its next iteration. it could revisit some of the outstanding recommendations (below) from health groups and experts provided through the consultation process on the Statement.
Community health organisation cohealth urged the Government to include a more diverse range of health indicators to reflect broad determinants of health and wellbeing, specifically recommending that measures of poverty, wealth inequality, deprivation, cultural safety and digital inclusion be adopted.
PHAA also recommended a much more extensive list of indicators to measure health and wellbeing in its submission than was adopted by the Framework, including a strong focus on health literacy.
The George Institute recommended the increased use of data to reflect diversity in indicators likely to impact men, women and non-binary people differently.
For example, it suggests collecting gender-based data on indicators on feeling safe, hours worked and having a say in government. It also suggested the inclusion of indicators on access to public transport and housing affordability.
A group of academics from the Menzies Centre for Health Governance, including Dr Ashley Schram, Professor Sharon Friel, Dr Amy Carrad and Dr Belinda Townsend, argued for greater attention to be paid to the structural determinants of health, such as power and privilege, in order to achieve systemic change.
They supported moving away from individualised and biomedical conceptions of wellbeing towards a focus on equity of wellbeing and called for the Wellbeing Statement and indicators of wellbeing to be aligned with Australia’s existing commitment to the Sustainable Development Goals.
Learning curve
Academics Dr James Guthrie and Ian McAuley stressed the steep learning curve facing public servants on policies and the wellbeing framework.
They highlighted the importance of developing a shared understanding across the government about the meaning of societal wellbeing and how different wellbeing outcomes interrelate.
“Policymakers must understand the system rather than its parts and focus on the root causes of crises rather than firefighting the symptoms of a broken system. Moreover, as improving well-being is ultimately a whole-of-society affair, it calls on governments to reconnect with the people they serve,” they wrote.
From Twitter
Previously at Croakey
- Wellbeing budgets are not the soft underbelly of public policy: Leanne Wells
- Calling all “frustrated champions” – Australia’s future needs you, now
- See Croakey’s archive of articles on wellbeing budgets.
