Below, Fiona Armstrong, Executive Director of the Climate and Health Alliance, offers some wide-ranging suggestions for improvement.
Fiona Armstrong writes:
The draft is a significant improvement in acknowledging environmental health and environmental determinants of health (compared with earlier iterations).
It is disappointing that the statistics included from Mitchell Institute Health Tracker clearly do not consider these determinants; they should also be including the Lancet Countdown and MJA Countdown analysis on climate and health.
The social determinants mentioned should include access to and quality of education (not just preschool)!? and meaningful work – a strong determinant of mental health (not just avoiding poor/unfair working conditions).
Regarding the structural determinants, there should also be included urban planning. Poor planning, especially on urban fringe and in poor quality flammable apartments, is a serious health threat.
Protective actions to avert racism go beyond access to culturally safe care; for Aboriginal and Torres Strait Islander people, it also entails recognition of sovereignty, connection to Country, recognition and valuing of Indigenous ways of knowing.
Universal basic income is another important protective measure in terms of healthcare costs.
Every portfolio must contribute
Commercial determinants should include recognition of media ownership and limits to media diversity as a risk factor particularly when it comes to misinformation and disinformation – a real and present danger to individual and population health and wellbeing (for example, vaccine hesitancy).
Leadership governance and funding; if prevention is everyone’s business, as the paper suggests, then there needs to be more than ‘ring fenced funding’ – there needs to be funding for prevention in every portfolio.
And therefore we need an embedded approach to health and wellbeing in ALL policies implemented as an enduring structural change, so funding flows from many different sources for prevention (should arise from every government program).
Prevention in healthcare – needs a MUCH strong emphasis on avoiding over prescribing and over servicing as a prevention measure, as well as a much greater investment in the health promotion workforce.
Partnerships with community should include funding for community organisations so they have capacity to engage with and guide policy and funding decisions.
Beyond lip service
Health literacy requires investment, not just lip service. This has been talked about FOREVER but never properly funded.
This MUST be built on the evidence of behaviour change, and be a significant investment over a sustained period – a huge investment for a healthier, more engaged, more literate population with a greater sense of agency and responsibility when it comes to health and wellbeing.
Research and evaluation is critical; the latter is often overlooked and underinvested in. The notion of bringing researchers together with policy-makers, practitioners, and consumers and community members is a good one, but it must be done regularly and as an ongoing initiative – creating a national and every growing community of practice around prevention, conducted face to face where possible but supported by digital infrastructure.
Monitoring and surveillance is important but we must be monitoring the right indicators, and these must be more than crude measures of incidence of specific illnesses.
Let’s make prevention as broad as this strategy is beginning to promise, and monitor, and act in response, accordingly
Preparedness (one of “seven enablers to mobilise a prevention system”) is obviously critical. Our shortcomings in Australia in relation to this have been when we don’t respond to evidence – for example, on climate change, commercial determinants, racism, under-investing in primary/community care and prevention.
The focus areas in the draft strategy are STILL downstream! I had hoped for more from this document, as this will almost certainly prevail as the priorities and if so, the opportunity for prevention will be completely missed.
Also, waiting nine to ten years to develop the proposed national environmental health strategy (currently in draft strategy for achievement by 2030) is far too long to wait to act on what is a current, escalating threat, which risks massive ecosystem and societal collapse in the latter part of this century.
Scientists warn this threat can only be averted in the next decade, beyond which there is a risk of passing irreversible tipping points in Earth systems, beyond which the “speed, severity, extent, timing and permanence” of the impacts of global warming may not be able to be reversed.