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Tasmania votes: ‘Joining the dots to find anything resembling a social determinants of health policy’

Yesterday Croakey previewed this Saturday’s South Australian election through a public health/social determinants of health lens, with an analysis by Professor Fran Baum of the Labor Government’s record and what the parties are saying on health.

Today Miriam Herzfeld, convenor of the Social Determinants of Health Advocacy Network of Tasmania, looks at the state of play in Tasmania, where another long-term Labor Government is expected to lose office on Saturday. She notes:

So one has to ask, given the Labor party’s reign over the past 16 years: is it time for a change? My sense is that many Tasmanians are largely singing a resounding “yes” to this question. The question however surely doesn’t end there but should be extrapolated to: “change to what?”

A fresh new government may hold great promise – but it’s disappointing to hear that the Network’s formal invitation to a broad range of  political parties in Tasmania (Labor, Liberal, Greens, Palmer United, Socialist Alliance) to publicly outline their position on the social determinants of health in the lead-up to the election attracted not one response.

UPDATE 14/3/14:

The Social Determinants of Health Advocacy Network is pleased to advise that since the publication of this article, the Labor Party and current Premier of Tasmania, Lara Giddings, has responded to our call to all candidates in the 2014 Tasmanian election to publicly outline their commitment to acting on the social determinants of health.

The reply can be found at: http://sdohan.blogspot.com.au

As we continue to join the dots in search of social determinants of health policy, we’d also like to draw attention to the Liberal’s recently announced policy, The Plan to Rebuild Essential Services. Should Tasmania be led by a Liberal Government we will look forward to seeing this plan being progressed as we will with all the other important social determinants of health related promises made by all the parties involved in Tasmania’s election campaign.

 

***

Miriam Herzfeld writes:

Tasmanians, like our neighbours in South Australia, will go to the ballet box this Saturday.

Read any local newspaper reporting on the latest polls and it would seem that all bets are on an incoming Liberal government for our state. Labor has been in power here for 16 years.

Health, as is often the case, is named up as being a key issue for many voters. The way the community often talks about health, or at least the way it is reported, is in terms of the length of waiting lists for elective surgery, the over-stretched hospital system and the need for more front-line health care services. And accordingly our major political parties respond with promises to (for example):

No surprises here perhaps.

But where does that leave people ‘like me’, who share a view that health extends beyond the walls that house the expensive equipment that might fix me up if my heart stops beating, or the five minutes I’m granted for my $75.00 consultation with a General Practitioner?

Many of us are familiar with ‘health’ as it’s defined by the 1978 Declaration of Alma Ata: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Further, the Declaration was well supported by the subsequent Jakarta Declaration in 1997 which listed the pre-requests for health including peace, shelter, education, social security, social relations, food, income, the empowerment of women, a stable eco-system, sustainable resource use, social justice, respect for human rights, and equity; and stating that, “Above all, poverty is the greatest threat to health”.

As you can see, this broader view of health and its multiple pre-requisites – including those which have a social basis – has been around for quite some time; yet when looking in my own backyard it still does not translate in any meaningful, dominating or concerted way into Tasmanian health policy. You have to look closely and join the dots to find anything that even partly resembles a social determinants of health policy approach.

During its time in power, the Labor Government oversaw the implementation of a number of relatively small initiatives that reflected a broader view of health. Very briefly, some examples of more recent projects that come to mind are A Healthy Tasmania and the now dissolved Tasmania Together initiative.

But, while these ideas have merit, none have had the longevity nor the clout to tackle the biggest health issues that this state faces: such as the significant number of Tasmanians on income support payments (roughly 30 per cent of the population) and the large number of people living below the poverty line (around a quarter of the population – depending on the measure applied:), and our associated spiralling health care costs. They are often short-term projects and add-ons, as opposed to being the main deal.

So one has to ask, given the Labor party’s reign over the past 16 years: is it time for a change? My sense is that many Tasmanians are largely singing a resounding “yes” to this question. The question however surely doesn’t end there but should be extrapolated to: “change to what?”

The Liberals have pledged a raft of policies that have the potential to impact on health – everything from education, creating job opportunities, and celebrating seniors to more support for Tasmanians with a disability. These issues are undeniably important, but again there is no over-arching commitment that brings together this plethora of disconnected health-related policy into a long-term plan that recognises our WHO definition of health and its associated pre-requisites.

Where is the health plan to reduce the inequity in health outcomes that are driven by poverty, inequality and related social determinants – and that are significantly contributing to our spiralling health care costs? Where is the health plan that recognises that lifting up the most disadvantaged people in our communities will lift up all of us?

Let me be clear that I’m not just picking on the Tasmanian Liberals; the Labor Party clearly sits in the same boat, with a scatter gun approach to health policy.

The Tasmanian Greens outline a number of important policy commitments which undoubtedly  aim at the underlying causes of poor health (even if it’s not stated) – such as empowering women and girls, investing in an inclusive ageing society, people before pokies, creating a state of preventative health and equality for all Tasmanians. However they too fall short of identifying health equity as a central goal.

When the major political parties in Tasmania (Labor, Liberal, Greens, Palmer United, Socialist Alliance) were asked (in writing) in the lead up to this weekend’s election by the Social Determinants of Health Advocacy Network of Tasmania to publicly outline their commitment to acting on the social determinants of health, there wasn’t even a whisper of response.

Where does this leave us? Maybe a little uncertain? A little disillusioned? Any Tasmanian voter would be wise to familiarise themselves with the policy platforms of all candidates/parties to at least make an informed decision. There are some small shining lights worthy of recognition and we must harness these and help them grow.

What is clear however is that there is an ongoing need to educate and advocate for health and what we – as citizens of this place – believe makes for good health policy: it is imperative that we continue to raise awareness of the need for governments to act on the root causes of poor health…

…and going by the polls maybe some fresh-faced eager politicians are just what we will get as our audience.

 

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