These were some of the questions emerging from last weekend’s South Australian election, where electors voted Labor out of government after 16 years at the helm, and installed a new Liberal Government headed by Premier Steven Marshall.
Prior to the election, President of the Public Health Association of Australia SA Branch, Kate Kameniar, wrote for Croakey about efforts by the #HealthySA campaign by a consortium of public health and social service organisations to remind parties that health is about much more than hospitals and other services.
Croakey thanks her for this followup, looking at what Marshall’s government might now mean for a #HealthySA.
While there are question marks over details and funding, the PHAA says there is much to welcome in the public health space, including the promise to create a discrete Chief Public Health Officer, separate from that of the Chief Medical Officer, which was one of the consortium’s three priority strategies.
Kate Kameniar writes:
South Australians took to the polls last weekend and watched with bated breath as the count rolled in on Saturday night revealing a new Liberal Government.
Leading up to the election the Public Health Association of Australia SA Branch, together with a consortium of health and social service organisations called for all parties to prioritise public health, health promotion and disease prevention. These key areas have suffered significantly due to public spending cuts over the past five years, leaving SA with a reduced capacity to address population health concerns.
Priorities for South Australia
Health is more than hospitals and medical services. It is created in our communities, where we work live and play. Our policies and community structures, through their design, can either positively or negatively shape the health and wellbeing of our community in the long term.
With less than 2 per cent of the total Australian health budget spent on preventive strategies, the prevalence of chronic disease on the rise and growing levels of inequity, it is vital that governments invest in long term strategies to address the social determinants of health. The consortium wants to see investment in evidence-based goals, strategies and actions that work across sectors to improve community health outcomes, in particular for those groups disproportionately experiencing increased burden.
Priority populations, such as people on low incomes, people with disabilities and Aboriginal and Torres Strait Islander people often experience higher levels of poor health than other groups. Strategies and resources must focus beyond the hospital and health services systems to address housing, income, education, access to healthy food, green space and other services that impact the health and wellbeing of South Australians.
How well do the new Liberal Government’s policies shape up?
The Liberal Government released Better Prevention – A healthy South Australia in 2017. While the detail still needs to be developed, the policy provides a good overarching platform. The policy recognises that “good health is a foundation for South Australians to reach their full potential and live with dignity”, acknowledging that effective prevention requires “dedicated, long term action.” It states that the new Liberal Government will commit to “investing in prevention and re-balancing health funding” through five key strategic levers:
- individual and community action
- education screening and vaccination
- research, monitoring and evaluation
- public health regulation
- leadership and coordination.
A discrete Chief Public Health Officer
The plan details a variety of strategies, including creating a discrete Chief Public Health Officer, separate from that of the Chief Medical Officer. This was one of the SA Public Health Consortium’s three priority strategies.
A discrete Chief Public Health Officer with demonstrated expertise, experience and qualifications in public health practice, health promotion and policy development has the potential to focus on working collaboratively both within SA Health and externally with other community groups to build the state’s capacity as a leader in public health and prevention strategies.
Finding someone with the right expertise will be paramount to ensure they have the capacity to oversee and evaluate outcomes of a state-wide public health, community health promotion and disease prevention strategies and the administration and adequate resourcing of the Public Health Act 2011.
The establishment of Wellbeing SA is one of the policy’s key commitments to build a prevention focussed team within SA Health, including a health promotion branch with dedicated expertise and focus on public health, health promotion and disease prevention.
South Australia is already recognised internationally for its efforts in cross-departmental collaboration to address the social determinants of health.
If implemented well, Wellbeing SA could further mature this evidence-based approach to policy design, improve the critical cross-departmental expertise in prevention and become a leader in this space.
An important consideration will be to engage beyond the government sector to the non-government community services sector and other special interest groups representing priority groups experiencing overall lower health outcomes, such as those in the SA Public Health Consortium.
The Consortium priorities included, through a Connected Health for All strategy, two positions located in non-Government organisations to build the skills and capacity of the NGO sector to better engage in public health planning. Embracing these networks will allow the state to leverage the collective expertise of organisations that are in touch with local community needs and best-practice evidence.
The Healthy Communities Program seeks to improve health outcomes in the regions through preventive initiatives focused on increasing physical activity and access to affordable healthy food, decreasing smoking and alcohol consumption, and improving health literacy. This includes the Healthy Towns challenge where towns can apply for $50,000 for health and wellbeing projects.
A further commitment to regional health is $20 million over 4 years to develop and implement a rural health workforce.
It will be particularly important to include development of public health and health promotion expertise in the regions to ensure that there is adequate capacity in councils to not only engage in the new Healthy Communities program, but to better leverage the Public Health Plans under the Public Health Act 2011. To date there has been limited ongoing central support for councils to design and implement these plans.
The Liberal Government has identified treatment as a key element in dealing with drug use across the State.
While the focus is specifically on amphetamines (ice) it is important that treatment programs be supported to deal with misuse of all drugs including alcohol and pharmaceuticals.
Investment in prevention is also important, particularly at an environmental level through addressing the social determinants of drug use.
The Better Prevention Plan acknowledges the importance of public health regulation, particularly in relation to healthy food environments. The plan lacks a clear strategy as to what this would look like in practice.
Recommendations from a South Australian Citizen’s jury could be readily implemented; support councils to implement their public health plans around healthy food access, make health a consideration for new planning applications such as zoning to prevent new unhealthy food outlets close to schools, and audit and enforce existing nutritional guidelines in food outlets in public institutions including schools and hospitals.
Further commitments include measuring and reporting on health and wellbeing, evaluating the success of primary health prevention campaigns, funding research that reflects community need and reporting to Parliament each year on Preventive health activity.
All valuable strategies, however as yet, no funding commitment has been identified. It is recommended that an additional 10 per cent of the total funding for public health initiative be allocated to proper evaluation.
In a response to the SACOSS Election Report Card, the party also agreed in principle to develop increased networks within South Australia to facilitate better partnerships to engage other sectors in the delivery of public health, health promotion and disease prevention initiatives. Adequate resourcing will be vital to ensure the success of these strategies.
Furthermore, the party acknowledged the importance of comprehensive primary health care and was open to further discussion in this space, as well as prioritising mental health by developing and funding a Mental Health Services Plan within the first 12-months after the election, as well as maintaining the SA Mental Health Commissioner role and $15 million for specialised programs.
The Public Health Association of Australia SA Branch and our consortium partners, the Australian Health Promotion Association of Australia SA Branch, the South Australian Council of Social Service, the People’s Health Movement and the Anti-Poverty Network, have high hopes for new directions in the public health space.
We would be pleased to work with state MPs to provide guidance, expertise and recommendations on public health practice, equity, social determinants, health promotion and disease prevention.
As always, we will continue to provide input and feedback on policy directions and advocate for evidence-based public health practice and improved community health outcomes in SA.