Introduction by Croakey: If the Federal Government does not take meaningful steps to reduce poverty in Australia, then the impact and value of its investment in health reform and suicide prevention will be greatly undermined.
That is a clear inference from the interim report of a Senate inquiry into the extent and nature of poverty in Australia, whose release last week was perfectly timed to influence debate around the Federal Budget.
The inquiry considered submissions from many health and medical organisations including the National Aboriginal Community Controlled Health Organisation (NACCHO) and other Aboriginal and Torres Strait Islander health organisations, cohealth, National Rural Health Alliance, Public Health Association of Australia, and the Royal Australian and New Zealand College of Psychiatrists.
The report illustrates many ways that poverty undermines physical and mental health and wellbeing, including through its impact on the determinants of health and access to healthcare.
People are missing healthcare appointments and not accessing essential medicines, unable to afford healthy foods, and experiencing chronic stress, depression, anxiety, and suicidality as a result of poverty, the report found. Children’s physical health and development is being affected, as are family relationships.
A Salvation Army spokesman told the inquiry that “the best clinical care in the world won’t make a difference if you’re sending them out to sleep in their car afterwards”.
Lifeline Australia told the inquiry that socioeconomic status has reliably been identified as a factor which impacts suicide risk. It noted that over the past decade, age-standardised suicide rates in Australia were highest for those living in the lowest socioeconomic areas.
Disappointingly, the inquiry’s terms of reference do not specifically include examination of the role of poverty in driving incarceration and contact with policing and justice systems.
In the wrap below, Croakey editor Jennifer Doggett reports on key budget asks from the Climate and Health Alliance, SNAICC, and the National Rural Health Alliance.
On Budget night, the Croakey team will be compiling analysis and reaction to the Government’s announcements – please send us your statements and comments, and on Twitter use the hashtag, #HealthBudget2023.
Action on climate and health
The Climate and Health Alliance (CAHA) submission described how climate and health issues are serious and growing. It references the recent floods which have devastated communities and caused extensive damage and warns that the shift from La Niña to El Niño weather patterns will likely see a return of very high temperatures in parts of Australia, along with risks of fire and flooding. CAHA points out that these impacts are felt very strongly by remote and rural communities, and further impede the ability of Indigenous communities to live on, and care for, Country.
CAHA argues that climate change directly impacts human health, and increases both demand for health services and the stress on the people and institutions providing those services. Therefore, action on climate and health is hugely beneficial in economic, social, environmental, and cultural terms.
In its submission, CAHA recommends that the Commonwealth Government allocate resources in this budget to enable effective and timely implementation of the Health and Climate Strategy in the 2023/24 Fiscal Year.
This includes baseline funding of $1 000 000 to establish the National Health Sustainability and Climate Unit plus additional funding for the following measures:
- National vulnerability and capacity assessment and monitoring: a triennial review of vulnerability and capacity and real time data collection
- Incorporating climate and health into the Wellbeing Framework: dedicated funding for monitoring and assessing climate and health impacts of measures evaluated through the framework.
- Supporting and enabling a “whole of government” response to the Health and Climate Strategy to develop the broader institutional infrastructure and collaborative environment at the institutional level to deliver on the strategies intentions including establishing the following advisory groups:
* a National Health and Climate Change Ministerial Forum / Committee, on climate and health and a National Committee of Health and Climate Change Ministers (or related portfolios) led by the Commonwealth, including states and territories
* a standing climate and health committee of the Australian Health Protection Principal Committee to provide advice to the Joint Climate and Health Ministerial Committee and the Australian Health Ministers’ Advisory Council.
- Supporting sustainable, resilient, low emissions healthcare via the following:
- A national healthcare decarbonisation roadmap
- An annual Ministerial health leadership roundtable on climate action
- A national and regional community of practice on climate change and health
- International action on climate and health:
- A commitment to send a delegation to all future COPS
- Join the Alliance for Transformative Action on Climate and Health
- Contingency Fund for integrating health and climate action into key portfolio areas which could support a range of activities, including the following:
- Emergency and disaster preparedness
- Education, communication and capacity building
- Research and data for a health-led recovery
- Health promotion and prevention
- Supporting healthy and resilient communities
- Thriving ecosystems.
Also see the CAHA submission to the Treasury consultation, Measuring What Matters: Developing Wellbeing Indicators for Australia.
The SNAICC pre-budget submission identifies programs and systems architecture needed to underpin self-determined action that will provide sustained, positive change in Aboriginal and Torres Strait Islander communities. Initiatives proposed progress action on priorities outlined in the current National Closing the Gap Agreement and associated implementation measures such as the Early Childhood Care and Development Sector Strengthening Plan.
In the context of Closing the Gap, early childhood development and care has been recognised as an area in which positive change has potential to impact a range of Closing the Gap targets and create positive structural change. This submission proposes investments to increase the affordability and accessibility of quality early childhood education and care (ECEC) and a national program of preventive services to support vulnerable families and reverse the trend of increasing numbers of children in out-of-home care. Closing the Gap prioritises shared decision-making between Aboriginal and Torres Strait Islander people and Governments.
SNAICC has been working with governments to implement these provisions through the Safe and Supported: National Framework for Protecting Australia’s Children 2021-31, including establishing shared decision- making in the governance, implementation and specific actions under the Framework. The submission calls for full funding to support Safe and Supported, to give effect to shared decision-making and for government to follow through on commitments in the Framework.
Specific measures proposed in the submission are:
- Abolish the childcare activity test: Introduce an alternative needs-based funding stream for Aboriginal and Torres Strait Islander ECEC services, which supports service viability and continued capacity to offer unique, integrated and community focussed child development supports to children and families.
- Provide a minimum entitlement of 30 hours 95 percent subsidised access per week to Early Childhood Education and Care for all Aboriginal and Torres Strait Islander children as an ongoing measure to Close the Gap in ECEC attendance and Australian Early Development Census outcomes.
- Fully resource Safe and Supported: the National Framework for Protecting Australia’s Children 2021-2031
- Create a new national program for Aboriginal and Torres Strait Islander-led prevention and early support
- Establish a National Commissioner for Aboriginal and Torres Strait Islander Children and Young People
- Invest in the viability and membership engagement capacity of SNAICC as Peak body, and national voice for Aboriginal and Torres Strait Islander children.
Multidisciplinary rural health services
The National Rural Health Alliance (the Alliance) is calling for an investment in multidisciplinary health services in rural areas.
Its submission argues that despite the enormous contribution made by rural Australia to the general prosperity, resilience and wellbeing of the whole country, people living in rural Australia have poorer access to health services than other Australians, with the number of health professionals (including nurses and midwives, allied health practitioners, general practitioners, medical specialists and other health providers) decreasing as geographic isolation increases.
Per capita, rural areas have up to 50 percent fewer health providers than major cities. As a result, Australians living in rural areas have, on average, shorter lives, higher levels of disease and injury and poorer access to and use of health services, compared with people living in metropolitan areas.
The Alliance urged the Government to correct the problems of market failure associated with healthcare access for rural Australian communities and support local blended solutions to be developed, where they receive equitable access to healthcare.
This could be achieved via the following three specific proposals:
- Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS): An indicative budget of $16,577,376 per site for five years (of which Medicare offset is calculated at $5,000,000 over five years), based on a population of 3,000 people.
- The inter-site governance support, process and outcome evaluation of the PRIM-HS sites across Australia: $3,565,000 (of which Department of Health and Aged Care staff costings are $600,000) over four years.
- Commitment to a National Rural Health Strategy and Implementation Plan: $3,200,000 (of which Department of Health and Aged Care staff costings are $1,300,000) over four years.
The above proposals should be supported by an additional enabling recommendation:
- To support improved analysis, reporting and publication – across the spectrum – of measures related to health outcomes, health services and health workforce by geographical classification, in particular reporting on health expenditure in rural Australia.
NRHA CEO Susanne Tegen told Croakey that the NRHA has been working with several communities and entities which are desperate to have Government support for a local approach to their healthcare needs of their communities. “These communities require flexibility to decide what and how services are delivered according to the gap between need and what exists,” she said.
Tegan argued that Medicare was never supposed to be a doctor’s payment, but rather a public health subsidy for the patient, and that rural communities no longer wish to be set up to fail because they are told bulk billing will solve all.
She said that multi-disciplinary approaches add to the access and sustainability of health services in rural areas, in particular via the PRIM-HS model which is different in every one of the communities and entities the Alliance has worked with.
Tegan pointed out that the current political landscape, with a Labor federal government and majority Labor states, provides the opportunity to address fragmentation and cost-shifting across jurisdictional boundaries to take the pressure off rural communities who pay for their healthcare “not once through taxes, twice through fundraising, but three times through their rates.”
A sugar-sweetened beverage tax
The submission from the Australian Medical Association (AMA) is calling for implementation of the National Preventive Health Strategy 2021–2030, including the commitment to allocate five percent of health expenditure to prevention activities in the life of the strategy.
Its submission argues that investing in preventive health helps mitigate the onset of chronic illness, affords people longer and healthier lives, and reduces pressure on the health system. “Prevention must become a foundation of healthcare planning and design,” the submission says.
Some of the specific proposals in the AMA’s submission are below.
Sugar sweetened beverage tax
The rising rates of obesity in Australia are contributing to an increase in a number of chronic and preventable conditions including type 2 diabetes, heart disease, hypertension, stroke, gall bladder disease, osteoarthritis, sleep apnoea and respiratory problems, mental health disorders and some cancers.
The AMA proposes a sugar-sweetened beverage (SSB) tax based on sugar content on selected SSBs, at a rate of around $0.40/100g sugar, to reduce consumption, improve health outcomes, and lower the financial burden on the healthcare system. In its submission the AMA
It argues that SSBs are a logical target for a public health intervention, given the high level of consumption of these products, which provide almost no nutritional benefit but make a major contribution to the obesity crisis, and to poor dental health, through high levels of free sugar.
Aboriginal and Torres Strait Islander health
The AMA supports the National Agreement on Closing the Gap. This partnership gives Aboriginal and Torres Strait Islander leaders an equal seat at the table with all governments, and is designed to ensure Indigenous voices are prioritised in policy, budget and direction setting for policy across a broad range of areas.
In addition, the AMA calls for more effort to ensure equity of access to culturally safe, response, affordable and accessible healthcare for Aboriginal and Torres Strait Islander peoples including:
- funding for Aboriginal and Torres Strait Islander health services is allocated according to need and under the advice of Aboriginal and Torres Strait Islander expertise
- expanding and investing in successful community-controlled health service delivery models, to allow Aboriginal and Torres Strait Islander organisations to deliver culturally safe and appropriate health services to their own communities
- investing in evidence-based strategies to grow the Aboriginal and Torres Strait Islander medical workforce
- ensuring cultural safety training is embedded across the medical profession.
Other priorities for the AMA include:
- Mental health: a comprehensive government response over the long term to rebuild and reshape the Australian mental health system, and respond to a growing demand for services in the years to come.
- Climate change: working with government on the National Health Sustainability and Climate Unit, to ensure that the unit is an enduring long-term function that enables all health departments across Australia to work together to reduce emissions and elevate sustainable practices in healthcare; implements a national strategy; and incorporates waste reduction strategies as a requirement in hospital accreditation.
- Child health: the establishment of a child health taskforce to address the impacts of climate change, poverty, a poor diet, unstable housing and other social determinants on children’s health.
- Matching the medical workforce to community needs: including through the expansion of the Commonwealth Government’s Specialist Training Program; national implementation of the National Rural Generalist Pathway and promotion of regional training and research teaching hospital hubs to grow non-GP specialist capacity outside metropolitan areas.
Previously at Croakey:
This article covered pre-budget submissions of the Consumers Health Forum of Australia (CHF) and Allied Health Professions Australia (AHPA), as well as a collective campaign to address poverty through increasing income support payments.
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