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Should you have to be wealthy to be healthy?

Indigenous health and the impact of disadvantage upon health are among the issues high on the agenda of the Public Health Association of Australia’s annual conference, which kicks off in Adelaide today.

Meanwhile, a new report also aims to put the spotlight on the social determinants of health. It was undertaken by the researchers from the National Centre for Social and Economic Modelling and commissioned by Catholic Health Australia.

Martin Laverty, CEO of Catholic Health Australia, reports:

Economists divide Australia into five income groups. A new national report released today finds people in the lowest of these income groups live 3.1 years less than those in the highest income group.

Health Lies in Wealth, researched and written by the National Centre for Social and Economic Modelling (NATSEM) for Catholic Health Australia, finds 65 per cent of people in low income groups have long term health problems, compared to only 15 per cent in high income groups. The report also finds obesity rates are three times as high in low income families as they are in high income families.

And these outcomes, the report finds, have more to do with education level, stability of housing and employment, and the size of your social and familial network, than they have to do with access to health services.

For the duration of the Rudd Government, health reform focused mostly on hospital beds. There are 84,000 hospital beds in Australia – roughly one for every 266 people. Catholic health services operate about 9,000 of these beds.

The Rudd Government made changes to hospital financing to better position State and Territory Governments to meet the cost of public hospital services into the future. For this the Government deserves credit.

But health reform in the last term of government was somewhat limited. It prioritised treating people once they were in the system, rather than keeping people out of hospital in the first place. It all but ignored the social determinants of health.  Now the new parliamentary Briefing Book of key issues for the 43rd parliament has ignored them as well.

Health reform needs more than hospital beds. Catholic Health Australia, the voice of 75 not-for-profit hospitals across the nation, is deeply interested in the working of hospital beds. But we’re more motivated to keep people healthy and out of hospitals altogether.

Health reform requires action in three distinct areas, only part of which concerns hospitals.

The first step of reform is to strengthen the responsive or reactive components of health care. Hospitals need to be funded to cope with demand. There need to be enough doctors and nurses to treat patients. Universal access to medical and pharmaceutical treatment is required.

The second step of policy reform is to ensure community commitment to preventive health. There is growing awareness of the need for physical activity, healthy diets, combined with tobacco and alcohol control. The policy focus on preventive programs could be better, but again governments are at least aware of the need for more action.

The third, and most ignored, component of health reform is action on the social determinants of health.

Social determinants are the building blocks of good health. The determinants are such things as the experience of an unborn child in the womb. If an unborn child is exposed to undue stress, trauma, or substance abuse, it is possible that child’s long term health will be adversely impacted.

Other social determinants include early childhood development, primary and secondary schooling, and the level of education a person completes.

A United States study reveals non-completion of high school is a greater risk factor than biological factors for development of many diseases. Another US study found the level of a person’s formal education better predicted cardiovascular death than random assignment to an active drug during a three year clinical trial.

Income levels, job status, housing, and whether a person lives in a metropolitan, regional or remote setting are all social determinants of health.

Put together, a person’s education, access to income, and access to housing greatly impacts a person’s health status to the point that on national average, those in the lowest socioeconomic group will die 3.1 years earlier than those in the highest socioeconomic group.

There is nothing new about the social determinants of health. In 1998, the American College of Physicians said job classification, as a measure of socioeconomic status, better predicted cardiovascular death than cholesterol level, blood pressure, and smoking combined.

In 2008, the World Health Organisation (WHO) developed a framework for countries like Australia to take action on the social determinants of health.

The WHO was rightly critical of the low life expectancy for indigenous Australians. The WHO framework has not been adopted in Australia, but at least the ‘Closing the Gap’ initiative is taking action on indigenous health.

If early childhood development, schooling, income levels, housing, and welfare services are so important to health outcomes, how can we integrate them into the health reform agenda this new hung (and regionally focused) federal parliament will be asked to implement?

As new Local Hospital and Primary Health Care networks are established around the country, they must be tasked to report and act on the social determinants of health. The most disadvantaged areas of Australia, many of which are in regional and remote locations, will need extra resources for social service interventions.

Action on the social determinants of health does not mean less focus on hospital policy, or less focus on preventive health. Instead it requires broader recognition that if we only worry about a person’s health at the time when they present at a doctor’s surgery, for many Australians we will be too late to improve their eventual health outcome.

The report, Health Lies in Wealth, is available at www.cha.org.au/policy

Comments 7

  1. Jenny Haines says:

    The social determinants of health have long been understood as the factors that need to be addressed if we are to reduce rates of physical and mental health and hospital and health service admissions. Australia, as usual, lags behind other countries overseas in understanding the importance of the social determinants of health and putting in place programs that address needs. What the author of this article is calling for is not only a progressive approach to the planning of health services but most importantly the commitment of real money to addressing real needs. What a revolution in health services that would be.

  2. Jenny Haines says:

    The previous posting should say “reduce rates of physical and mental ill health.” Oops!

  3. Gavin Mooney says:

    Martin Laverty is right to keep on and on and on about the SDH. For example the proposed PHCOs need to be seen as Primary Care Organisations for Health (PCHOs) and currently, as set out, they are not.
    Also the different roads to economic growth and good population health need to be thought about. They matter as Amartya Sen* indicates in his comparison between growth mediated and support-led progress. The former: ‘works through fast economic growth and its success depends on the growth process being wide-based and economically broad … and also on the utilization of the enhanced economic prosperity to expand the relevant social services, including health care, education and social security. In contrast … the ‘support-led’ process does not operate through fast economic growth but works through a programme of skilful social support of health care, education, and other relevant social arrangements.’ Sen quotes the examples of ‘the experiences of economies such as Sri Lanka, pre-reform China, Costa Rica, or the Indian state of Kerala, which have had very rapid reductions in mortality rates and enhancement of living conditions, without much economic growth.’

    With global warming there are enormous risks (including clearly to health) in pursuing any economic growth. So redistribution is the name of the game but linked to Sen’s ‘other relevant social arrangements’.

    We need a minister for health and not as now a minister for health services. But first we really need to get the governments to recognise the need for a really broad health policy. Let’s hope this report succeeds in that.

    *Sen A (2001) Economic progress and health. In Poverty Inequality and Health. Eds. D Leon and G Walt. Oxford: Oxford University Press.

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Croakey Conference News Service 2013 – 2019
2013 conferences
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Closing the Credibility Gap 2013
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Racism and children/youth health symposium 2014
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Population Health Congress 2015
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