What opportunities has the pandemic created for enabling health equity to become a focus for mainstream policy?
Melissa Sweet writes:
Discussions about the social determinants of health and health equity so often end up sounding like unappetising mouthfuls of jargon. However, the pandemic is bringing into sharp focus the real-world importance of these concepts.
The need to address housing and income insecurity as critical determinants of health assumes a new urgency when it becomes blindingly obvious that failure to do so creates ideal conditions for the coronavirus to flourish.
Everyone’s health is potentially at risk if people can’t afford to stay home from work when they are sick, or do not have a home where they can self-isolate, or if they have poor health literacy, or if they are on the wrong side of the digital divide and unable to access critical health information or supplies.
An otherwise somewhat abstract concept, that inequality is bad for everyone, suddenly becomes much more tangible and meaningful.
Likewise, the pandemic has presented an opportunity for the potentially transformative concept of health in all policies – around in research and policy circles for yonks, but yet to really permeate mainstream public consciousness – to gain some wider traction.
A series of #HealthReimagined webinars recently convened by VicHealth – and reported by the Croakey Conference News Service – generated wide-ranging discussions about bringing health considerations into policies affecting workplaces, the food supply, urban planning, and social and economic wellbeing.
Complementing these discussions is a new report from the Menzies Centre for Health Governance at the Australian National University, investigating the likely impacts on health equity of 156 policy measures introduced by Federal and State/Territory Governments in response to the pandemic.
As one of the report’s authors, Professor Sharon Friel, wrote recently at Croakey, previewing its launch:
COVID-19 highlights the critical need to address the social determinants of health inequities – the conditions in which we are born, grow, live, work, and age, and which are shaped by structural drivers of power, money, and resources. These factors are very much influenced by public policy well beyond the health sector.”
The report offers these key messages:
- The pandemic shines a spotlight on social and health inequities, and will exacerbate widening inequities in life expectancy, premature death, non-communicable diseases and mental health if progressive, long-term multi-sectoral action is not taken.
- The wide-ranging and rapid policy responses to COVID-19 at Federal and State/Territory levels are impressive and to be commended, showing that if there is political will, action can happen.
- The 156 specific policy measures introduced by Federal and State/Territory Govts can be grouped under eight key social determinants of health equity (as per the table above).
- Positive measures affecting employment, household income and standard of living could go a long way to keeping people well and reducing health inequities. Governments must, however, not return to conditions that will keep people in poverty (and read more on this from Greg Jericho in a timely analysis at The Guardian).
- To prevent an accumulation of disadvantage and health inequities throughout the life course, the temporary supports for childcare should continue and enable access to free childcare for, at the very least, socially disadvantaged households.
- None of the housing-related measures address the medium- and long-term housing precariousness that is prevalent in Australia. Unless this is fixed, social and health inequities will continue to widen. Investment in social housing could help address the gap in housing, job creation and income growth, and reduce homelessness.
- Policy measures introduced to support aged care, disability services, the arts and family violence are very helpful in the short term. But the pandemic shows the need for sustained, adequate funding to these sectors and organisations.
- COVID-19 has initiated an enormous intergenerational transfer of debt, and the health consequences will be felt for decades, possibly generations. Austerity cannot be the policy response going forward. Action on the structural drivers of health inequity is essential.
- Without action on climate change, health inequities will be exacerbated. Good social policy is good climate adaptation policy, and good for health.
- ‘Bouncing back better’ from COVID-19 could see a healthier, more equitable and sustainable Australia if political leaders choose to use this unfortunate event to drive positive societal change rather than pushing deregulation in social, health and environment sectors in order to ‘kickstart the economy’.
The dominant political paradigm, whereby concern for the economy is often privileged over concerns for the wellbeing of communities, families and people, was highlighted as a critical barrier for efforts to address health inequities going forward.
But it may also be an opportunity. Sharon Friel suggested that a strategy for getting health equity onto the agenda of the Prime Minister, Cabinet and the COVID Commission is “show them it’s good for the economy, there is a phenomenal return on investment”.
But to shift the debate, she said the dominant narrative of “the economy” cannot continue.
“The economy is simply a means to an end, not the end in itself,” she said. “We must privilege talking about people and communities, and the conditions that enable everyone to live with dignity and good health.”
Both Friel and VicHealth’s CEO Dr Sandro Demaio stressed the importance of building coalitions beyond “our usual bedfellows” and of using language that engages across sectors.
There may also be useful leads from reflecting on issues not covered in the report, such as media policy.
Given the importance of the media landscape in shaping policy discussions and outcomes, some analysis of related pandemic policy initiatives and their implications for under-served communities would be useful.
Associate Professor Kristy Hess at Deakin University has provided some useful critique in this article at The Conversation, ‘The government’s regional media bailout doesn’t go far enough — here are reforms we really need’.
Croakey’s recent submission to an Australian Competition and Consumer Commission (ACCC) consultation with big implications for the media sector also draws links between media policy and health equity.
Of course, we are delighted the researchers thought to engage the Croakey Conference News Service for the launch. An additional strategy for such reports might be to include an extra chapter, reviewing the literature on best-practice in communications about concepts such as health equity, the social determinants of health and health in all policies.
Truth is, we all need all the help we can get in doing a better job of engaging the wider public, and thus politicians and policy makers with these issues, especially during these times of disruption, which bring both opportunity and threat.
On Twitter, 170 accounts participated in the #Govern4Health discussions over the past week, sending 535 tweets and generating more than five million Twitter impressions, according to Symplur analytics. Read the Twitter transcript here.
*** Note: the headline on this article was changed after publication.
Previously it said: “To govern for health: transform the conversation” ***
Bookmark this link for the #Govern4Health coverage.