Some practical steps that health services and health policy makers can take to address health inequities will be explored at a summit in Sydney tomorrow, which journalist and medical student Amy Coopes is covering for the Croakey Conference News Service.
Amy Coopes writes:
As the gulf in life expectancy and quality grows between society’s richest and poorest, is it enough for the health system to cry “social determinants” without examining its own role in perpetuating disparities?
This will be the focus of a timely summit at UNSW’s Centre for Primary Health Care and Equity (CPHCE) tomorrow, titled The Role of the Health System in Reducing Health Inequity. It comes at a time of intense political and public focus on health policy as part of #healthelection16 discussions.
Bringing together local and global experts, the CPHCE forum will explore the idea that the health system is, in and of itself, a social determinant of health, and has the power to effect change, not only at the lobbying or policy level, but from within.
“Traditionally, people have thought that inequity is caused by social things like employment, education, with little that the health system could do,” explained CPHCE Associate Professor (Health Equity) Elizabeth Harris.
“But there’s new research coming out which is showing that about 20 percent of it is to do with accessing good health care, and another 30 percent of it is behavioural risk factors – things like smoking.
“That’s 50 percent of the difference coming from things that the health system has quite a lot of control over, or a mandate to do something about.”
Her point is illustrated by the image below.
The forum will examine how practitioners and policymakers in the health sector contribute to a growing social gradient in health by falling short on access issues – including location, appropriateness and affordability of services and health literacy.
This gradient means that while life expectancy and quality increases, the chasm grows between haves and have-nots, as indicated by the images below.
Keynote speakers will include Professor Don Nutbeam, Tony Blair’s head of public health from 2000-2003 and something of a global guru on health literacy and health promotion (most recently publishing a feasibility study on adult education and health literacy/inequalities in Australia).
Sarah Simpson, author of a landmark WHO paper on socially-determined health inequities Putting Our Own House in Order, will speak about her research in Europe on integrating equity into health systems.
Simpson’s report calls on the health sector to look to its own backyard when it comes to equity, and ask whether it is providing appropriate, accessible services that ameliorate and remedy health disadvantages due to poverty, poor living conditions and unemployment.
Putting the windfall of reducing avoidable health disparities by just 10 percent at more than 100 billion euros, Putting Our Own House in Order explores success stories in Europe, including a homeless health initiative in Austria, TB control within Romania’s Roma community and health promotion among Spain’s Navarre ethic minorities.
At the forum, two programmes from the Sydney Local Health District – Hospital in the Home and Can Get Health Canterbury – will share their experiences, and Harris hopes they will form the first in a series of local case studies on ways health providers are working to overcome systemic inequities.
Looking at things like location and cost of services, opening hours, and linguistic and cultural diversity of staff were all small but essential steps to improving access and literacy, Harris said.
Robust data on who was accessing health services and who was missing out, equity-focused planning, and funding structures that rewarded connected, quality care and integrated services rather than activity alone were also vital.
Within health workplaces themselves, employing and offering opportunities to Aboriginal and Torres Strait Islander people, workers with a mental or physical disability or those of a culturally and linguistically diverse background was important and meaningful, said Harris.
Other steps to consider could include ‘localism’ strategies like ordering supplies from local companies to generate jobs and income; partnering with local schools and institutions on skill and capacity building; and including patients and staff in governance and ownership.
“The health system can directly influence 50 percent of the determinants of life expectancy and quality of life, and the health system itself has an important role in addressing health inequity and is itself a social determinant of health,” said Harris.
With the Australian election less than a week away, it was timely to acknowledge how growing income disparity was influencing the nation’s health, she added.
“Life expectancy is improving for everyone but the gradient is becoming steeper, and one of the things that it’s important to recognise is that we’re all there somewhere, each of us is on that gradient, we’re all losing life or gaining life related to socioeconomic status,” she said.
“It’s not just the rich and the poor, every one of us has got an interest in having an equal society because that would make our health or our life expectancy or disability-free years more equal.”
Download the summit program here.