In reflecting upon 2022, we’ve identified ten issues that will be important for health in 2023.
Croakey’s Melissa Sweet and Alison Barrett compiled the report below, drawing upon the contributions of many authors over the past year.
1. COVID is not over
This year, more than 14,000 Australians have died from COVID and we are yet to fully understand the impact of Long COVID and repeated infections upon health and wellbeing, the workforce and the economy. The burden has not been borne equally; as Professor Stephen Duckett wrote recently, the impacts of COVID have been “more severe for the most disadvantaged”.
At a time when Australians needed clear messaging, effective policies and strong leadership to support vaccines-plus strategies, they instead heard messages that COVID is over, no worse than the flu, and all a matter of personal responsibility.
As public health physician Associate Professor Rhys Jones recently tweeted: “Public health is, by definition, a collective endeavour. It requires ‘the organised efforts of society.’ If your strategy involves relying on individuals to protect themselves, it’s not a public health strategy. It’s negligence.”
In 2022 we have learnt that it is going to take strong, determined advocacy to promote a collective and equitable approach to COVID prevention and management.
2. We can fix the housing crisis
One positive thing we learnt from COVID is that we can address homelessness when there is political will and funding commitment. States that implemented emergency housing programs housed more than 40,000 people experiencing homelessness in the first six months of the pandemic.
Sadly, we also learnt how quickly this can unravel. Pre-COVID trends have continued and the number of people experiencing homelessness in Australia has risen. By 2021-22, 91,300 Australians used specialist homelessness services – an eight percent increase in four years. Housing affordability is cited as the main cause for the increased number of people experiencing homelessness.
The housing crisis is a health nightmare for so many reasons. It has a direct impact on demand for health services and health outcomes. Remote housing concerns have gone unaddressed for decades. “Overcrowding has been highlighted repeatedly to government as a problem for over 20 years, and now we are in the midst of a COVID-19 pandemic and people need to isolate and can’t adequately and no other options are offered. We are going to see a rise in health issues and spikes in preventable diseases such as Strep A infection, trachoma, Rheumatic Heart Disease and other environmental health diseases just to mention a few,” Kimberly Aboriginal Medical Service CEO Vicki O’Donnell said in April this year.
The Aboriginal and Torres Strait Islander health sector has long advocated for secure housing as an important determinant of health. The wider health sector needs to take up the cudgels in advocating for housing as a human and health right.
3. Legal and policing systems are a major cause of harm
No government can say they weren’t warned or they didn’t know the harms caused by Australia’s justice and policing systems.
During 2022 an unending series of tragic news reports and official investigations continued to highlight the harms caused by unjust legal and policing systems – as for so many years before. Advocates across Aboriginal and Torres Strait Islander organisations and the wider legal and health sector stepped up pressure on governments to raise the age of criminality to 14 while others advocated for abolition of the prison industrial complex.
Federal Minister Dr Andrew Leigh gave a powerful speech this year illustrating the potential to save billions through reducing incarceration. He said that in 1985, the incarceration rate in Australia was 96 prisoners per 100,000 adults. In 2022, the incarceration rate was 202 prisoners per 100,000 adults. The incarceration rate has more than doubled – not because Australians are more likely to commit serious crimes, but because of how we have chosen to handle complex social challenges.
He said stricter policing, tougher sentencing, and more stringent bail laws appear to be the main drivers of behind Australia’s growing prison population. The factors that have driven the fall in crime include better community policing, immigration, rising incomes, the removal of lead from petrol and the mandatory installation of electronic immobilisers on new vehicles. This suggests that it should be possible to have an Australia with less crime and less incarceration.
If the incarceration rate had remained at its 1985 level, Australia would have saved $2.6 billion, Leigh said. To which we say: that’s a lot of dollars that could have been spent on social housing and improving income support payments.
A clear message for 2023 is how to ensure a win-win by reducing incarceration rates and enabling increased investment in communities and determinants of health such as housing and incomes, so people can live with dignity, respect and opportunities for participation.
4. Strong political and public support for the Uluru Statement
In 2022, Australian voters elected a Government strongly committed to the Uluru Statement from the Heart. In his first public statements after the election victory, Anthony Albanese – as he did throughout the campaign – stressed his support.
Aboriginal and Torres Strait Islander health organisations have spoken strongly for the Uluru Statement and a constitutionally enshrined Voice to Parliament, recognising the fundamental importance of self-determination for health and wellbeing.
The Uluru Statement from the Heart was recognised with the 2021-22 Sydney Peace Foundation prize “for bringing together Australia’s First Nations Peoples around a clear and comprehensive agenda; for healing and peace within our Nation and delivering self-determination for Aboriginal and Torres Strait Islander peoples, that enables Australia to move into the future united and confident.”
The final Guardian Essential poll for 2022 found 63 percent of respondents (down two percent since August) backed an alteration to Australia’s constitution enshrining a First Nations consultative body, with 35 percent (up two percent) in opposition. The 2022 Australian Reconciliation Barometer found that 72 percent of the general community support a treaty (53 percent in 2020, 47 percent in 2018).
In 2023, the health sector will have important opportunities to contribute to a national conversation of profound importance for health and wellbeing. A challenge will be to address queries and concerns without fuelling misinformation and disinformation.
5. Misinformation and disinformation are killers
Australia (and the world) needs to do a better job of systematically addressing misinformation and disinformation. The COVID pandemic has brought into focus the dangers of misinformation and disinformation. But the concerns range far wider. There are terrible consequences from the online spread of hate, conspiracy theories, disinformation and misinformation.
As Professor Peter Hotez said in this video circulated by the World Health Organization, anti-vaccine activism is expanding across the world, is “a killing force”, and has become a political movement linked to far-right extremism. “We need political solutions to address this,” he urges.
Efforts to address misinformation and disinformation must move far beyond the promotion of health and digital literacy, to incorporate regulation of digital platforms, bearing in mind that these companies also have wider impacts on public health, through harmful marketing practices and surveillance. Prior to the G20 Summit in Bali, the UN Secretary-General António Guterres called for leadership to address the public health threat of disinformation spread by Big Tech.
Part of the solution is support for public interest journalism. As the WHO brief on COVID-19 infodemic management notes, journalists and professional fact checkers are important players in efforts to combat misinformation and disinformation. As the Twitter imbroglio has shown, the global news and information system is broken.
6. Australians voted for climate action, but what about climate justice?
The Federal election outcome suggests strong public support for climate action. But what about climate justice?
This is not a term we hear often from politicians, in public discourse or even in the health and medical literature. This concept has multiple layers and recognises the potential for climate mitigation and adaptation efforts to exacerbate existing inequities.
As Jesuit Social Services researchers recently wrote, addressing the social determinants of health – including income, gender inequality, employment, food security, housing, urban planning and design and environmental conditions – is critical to just and equitable responses to climate change.
Climate justice also means addressing the climate crisis as an outcome of colonisation. As Amba-Rose Atkinson recently wrote, we cannot solve the climate crisis from the same worldview from which it emerged; she stressed that First Nations voices and solutions should be heard at all times and at every level of society.
As climate action gathers pace in 2023, including across the health system, it will be a challenge to ensure climate justice is driving the narrative.
7. Health and aged care reform is STILL desperately needed
In 2022, as health and aged care systems faced extreme pressure, the imperatives for reform of outdated systems and models became ever stronger.
When systems are stressed and the workforce is depleted and exhausted, there may be reduced capacity to engage with and support the change management processes that real reform requires. Strong leadership will be required, from government as well as the professions and services.
To ensure changes address rather than exacerbate the inverse care law – whereby health services tend to be most available to the well off and least available to those with the greatest need – it will be important to centre the voices and expertise of those with a real commitment to addressing health inequities. The loud voices of self-interest must be put to the sidelines.
8. Commercial determinants
The need to broaden action on the commercial determinants of health beyond the traditional culprits – such as the tobacco, alcohol and food and beverages industries – became even more evident this year.
The harmful influence of the fossil fuels industries and other powerful corporations, such as gambling interests, Big Media and Big Tech, need to be addressed as public health priorities.
Again, systems approaches are needed given the interconnections between these industries and their impacts. For example, unhealthy food systems are contributing to the climate crisis.
(Read the journal article, ‘Big Food and Drink sponsorship of conferences and speakers: A case study of one multinational company’s influence over knowledge dissemination and professional engagement’.)
Young people and their futures are particularly at risk from the power and political influence of these corporations.
While Health and Aged Care Minister Mark Butler has shown willingness to take on tobacco and vaping, across the board the political commitment to addressing the CDOH is very patchy and limited, underscoring the importance of wider electoral reform to curtail the influence of big corporates as well as other public health strategies.
Another commercial determinant we do not talk about enough is the arms industry. As the events in Ukraine have so tragically shown us, peace is a foundational determinant of health.
9. Health in All policies, it’s (past) time for structural change
The World Health Organization has been recommending Health in All Policies approaches for decades.
With some limited exceptions (looking at you, South Australia), Australia is very far from enacting health in all policies. You only have to look at Robodebt, cruelly low income support payments, subsidies for fossil fuels, inequitable taxation regimes), unhealthy urban planning…and the list goes on.
With a Federal Government now committed to implementing a Wellbeing Budget and a national centre for disease prevention and control, this could be a timely opportunity for recommending structural changes to drive a Health in All Policies agenda. Or even better, Health Equity in All Policies.
Given that health ministers seem to have too much on their plates dealing with health policy and that current structures do not authorise them to intervene in other portfolios, do we need Cabinet Ministers (federal and state/territory) with the authority and responsibility to bring a health and health equity lens to all policies?
The Voice to Parliament may also be an opportunity for structural change to bring a health equity lens to policy development.
10. Lived experience matters
Transformational changes across many areas are needed to safeguard our future health and wellbeing, and it is critical that people with lived experience of structural disadvantage are leading change efforts.
For example, people with lived experience of colonisation, racism, discrimination, poverty, ageism, climate disruption, digital exclusion, and life in rural and remote areas have valuable expertise to contribute to design and delivery of policies and services.
As the world faces multiple public health crises, it grows ever more important to disrupt existing power structures and processes that do not privilege the expertise and needs of those communities and individuals who are at greatest risk.
In a recent BMJ article, public policy analyst Pauline Castres argues that climate change is one of the single biggest threats to the disability community, and yet disabled people have long been ignored and forgotten in climate activism and policy.
“If we are to create a just transition to a greener economy that is fair to everyone and tackle the underlying problems that have caused and driven climate change, we need to put disabled people – a diverse, resourceful, and knowledgeable group of people – at the heart of the climate movement,” Castres writes.
“Designing and implementing scalable solutions to tackle climate change – while also empowering and engaging people, especially the most marginalised, to hold policy makers to account – will require collaboration, creativity, collective resilience, and resourcefulness. And disabled people are experts at these.”
These observations are relevant across many contexts, including climate justice, mental healthcare, and Long COVID.
And finally…
Importantly, what we learnt from 2022 is that all of these issues are interlinked.
Homelessness and housing insecurity contribute to incarceration rates, as well as exacerbating multiple health and social issues, including COVID. Climate justice is impacted by commercial and social determinants of health, and requires responses informed by the expertise of lived experience. Tackling the power of the commercial determinants in private health and aged care will also assist reform efforts. Embedding health in all policies approaches could prevent much illness and suffering. And so on.
Our challenge to readers (and also for our work at Croakey) is: how to work with the requisite sense of urgency, while advocating for just change on so many fronts, and sustaining communities, vital services and workforces?
Let’s keep trying to figure this out when we’re back on deck in 2023…
Note from editor: the headline for this article was updated on 9 January, 2023
