Successive Australian governments have failed to tackle the social and economic inequities that result in some people having shorter, unhealthier lives than others, according to a leading public health expert.
Professor Fran Baum, who was a commissioner on the World Health Organisation’s Commission on the Social Determinants of Health, has called on the Federal Government to establish an Australian Health and Equity Commission to work across government to improve the population’s health and to reduce inequities.
“This commission would have a specific brief to look beyond behavioral explanations of health inequities and consider the underlying factors that perpetuate inequity,” she said.
Writing at Croakey today, Baum said the focus of health reform in Australia has been narrowly limited to a discussion of health services rather than how to create a fairer society with a more equitable distribution of good health.
And she warned that government policies such as quarantining of welfare payments were out of step with the evidence, which suggests this policy has considerable potential to do harm.
Baum, professor of public health at Flinders University, said Australia had been slower than some other comparable countries to address the underlying causes of ill health and to act on the social and economic determinants of health.
Her comments followed the recent release in England of the Marmot Review, which was commissioned in response to the Commission on the Social Determinants of Health’s (CDSH) landmark 2008 report.
“What the CSDH report and the Marmot Review do so well is to knock on the head any simplistic idea that our health status reflects our individual determination to be healthy,” said Baum. “They both show that health and its distribution are the result of how we organise our political, economic and society affairs.”
Baum said both major political parties tended to blame the personal lifestyles and habits of the groups that suffer the worst health, rather than looking at the underlying causes.
“There are examples of this from both the last two health ministers’ (Tony Abbott and Nicola Roxon) speeches, that they easily revert to this position and see that chronic disease could be reduced if only people would eat the right food or exercise enough,” she said.
“It is rare for an Australian health minister to give a speech that shows a sophisticated understanding of the underlying determinants of health and health inequities.”
Baum also said that none of the major reports driving health reform in Australia have truly offered “a progressive alternative to business as usual in the health sector but rather suggested some tinkering with the way we currently organise health services in response to illness”.
“Thus, the National Health and Hospital Reform Commission final report A Healthier Future for All Australians just considered reform within hospitals and primary health care and while it contained the odd mention of social determinants of health, did nothing to lay out a comprehensive plan of action for tackling them,” she said.
Baum argues that one reason we’ve been slower than some other countries to address health inequity is that “Australians still like to hang on to the idea that we are a classless society or certainly one where class counts less than in Europe”.
“We are now in an election year and I would love one of the major parties to develop a platform based on tackling the underlying causes of ill-health and health inequities,” she said.
Good article Melissa,
One of the issues is that people are rewarded for unhealthy behaviours.
For example a person that makes claims on their health fund because they smoke a pack of poo sticks (smokers’ breath smells like #^%$!) pays the same premium as a fit vegan yoga instructor!
Yep – until the argument gets to financial carrots and sticks to determine health insurance premiums we won’t see any turnaround in health care inequities. It’s not about income when health care costs are so high!
So I’l like the debate to include moving AWAY from the holy grail of ‘community rating’ (designed to protect the funding of aged care health costs) to a system that penalises smokers 2 percent on their hospital cover for every year they remain a smoker after year zero. Give them quit smoking packs and a subsidised trip to a GP then say YOU’RE acountable for health care costs you knowingly create!
Market research has shown that even smokers believe it’s fair they pay a higher premium then non-smokers, as they know smokes rot them from the inside out!
Alternatively, let the health funds provide a discount for non-smokers to reflect their lower lifetime claims cost likelihood.
Australia has a great system of private and public health care – yet big bang policies are NOT the answer. There are always sensible paths to take until such time as public hospital elective surgery waiting lists are reigned in.
As an example, I’d say private hospital cover is essential. Dont #%$@! with it or you could wait in pain for months or longer – or worse your child could! Yet the rebate on getting a massage??? Not so essential…
Until there are rational price signals that change personal lifestyles to save money on haelth care costs, we’ll keep getting fatter, keep puffin’ on poo sticks and let others pick up the tab -whther publicly OR privately.
And yes, my goal is to change the economics of private health care, starting with my free and commission free health insurance website, through to my goal of funding research into dogs abilities to detect cancer and diabetic hypos before symptoms appear.
If we can end up with an electronic sniffer nose to detect early stage cancers – costs will come down in both the public and private sectors.
Best wishes,
Jonathan Crabtree
Founder | Dogtors.info and
http://HealthInsuranceHounds.com
“And she warned that government policies such as quarantining of welfare payments were out of step with the evidence, which suggests this policy has considerable potential to do harm.”
Hear ye!!!
And this from ABC News 14th.inst. Quoting Tony Abbott:
“I very much doubt that the Government has had any serious consultation with the women of Hermannsburg for instance, or the women of Yuendumu for instance, who have been so supportive of the intervention, particularly the welfare quarantining aspects,” he said.
Well I happen to live in Yuendumu and can tell you that whilst there are a few people here that think Income “Management” (the Interventionists no longer call it “quarantining”) is OK, the vast majority find it a terrible nuisance and are strongly opposed to it. Even the few supporters object to its compulsory blanket imposition. It is counter-productive, demoralising, inefficient and being imposed on a community that was quite capable of looking after their own money before the Intervention.
Last year a commemorative $1 coin was minted on the Centenary of Commonwealth Age Pension… the motto on the coin is “Security.Support.Dignity”
You tell that to the Yuendumu couple that were awarded the Order Of Australia, or to the two retired Little Sisters of Jesus (that incidentally knocked back an offer to be exempt from Income Management). They have to go to Centrelink to have some young public servant “manage” 50% of their income. “Managing” is an oxymoron that in practice translates in allocating this money to licenced stores or the “green card” (basics card) or the red card or the “kitty”. To ascertain the balance on your basics card you have to ring a number or if you overspend you have to put stuff back on the shelves. If you happen to do your purchases in Alice Springs (an increasing number of people are moving to major centres- “Income Management Refugees”) you have to put up with people looking down on you whilst you hold up the queue at the supermarket.
To rub a bit more salt in the wound, Centrelink’s motto is “giving you choices”.
But I digress… what has all this to do with health?
As Melissa Sweet says at the beginning of the article:
“Successive Australian governments have failed to tackle the social and economic inequities that result in some people having shorter, unhealthier lives than others, according to a leading public health expert.”
First a hail unto thee Jungarrayi, way out there as you are, and blessings on your undertakings.
Thereafter speak to the article, I accept that I’m reading a journalist’s summary but nowhere can I see a single suggestion for what the author of the report (Prof.Baum) demands, ie. her own clear plan for “a progressive alternative to business as usual.”
It might be there and simply not presented by Ms Sweet, or it might not be there at all. The report may simply be yet another piece of easy blame without concrete solutions.
More specifically, the professor targets both major parties for tending to “blame the personal lifestyles and habits of the groups that suffer the worst health, rather than looking at the underlying causes.” A legitimate complaint if it were accompanied by some definition of the point at which people can be expected to be responsible for themselves rather than reliant on government and, having accepted responsibility, then also accept blame for failure.
GS
Superpuppy and Gary Stowe each make some very good points.
Stowe implies the need to remember the old dialectic of theory & practice: it would be useful if Fran (along with Abbott & many others) refrained from framing this issue – personal responsibility vs social change – as simply an either/or debate.
It would also help if we refrained from promoting the assumption that addressing most of ‘the social determinants’ ultimately can be anything other than very long term, complex & difficult political & economic struggle that will never be sustainably achieved, or even helped much, by health policy and political figures issuing proclamations without detailing their proscriptions for practical everyday actions.
Kerala and Cuba didn’t achieve better health for their downtrodden masses by waiting for their legislatures & bureaucrats & academies to set the right taxation rates to achieve more equitable societies. They did their level best to ensure everybody got out of bed to do their calisthenics & send their kids to school & go to work for a living every morning as well!
What most academics don’t appreciate is that the Income Management in many Aboriginal communities actually is much more empowering and beneficial than disempowering in the lives of many of the affected individuals.
This applies particularly to those who are most stressed by the struggle to keep food on the tables, blankets on the beds, fuel in the cars and clothes on the bodies, pay the power and water costs and household rent and other bills, and keep the substance consumption at manageable levels.
(Obviously these people are different to the small group of strident egotists who lap up electronic media attention and waltz with the Trotskyites and Greens around the Intervention Rollback circuit).
It’s the balance of these two forces – the empowering and disempowering aspects of Income Management and some other measures – that is important in this context, for both individuals and communities, something which doesn’t seem to have occurred to most of the academic and political commentators.
If you take the social determinants of health seriously, it takes you away from anything much to do with the health system as currently conceived. Its much more than the balance between preventative yoga veganism and curing fat old smokers. The evidence is that you can better predict a persons long term health by their income, education and employment than their ‘health’ behaviours as such.
The issue of health inequalites points directly at the ‘economic rationalist’ form of societal management championed by governments of all stripes (you can have right or really right with extra craziness in Oz these days), and is its major downside. You can have a corporate boom, a competative labour market, regressive taxes and a consumer/shareholder democracy but there are casualities. Myself, I don’t think the CEOs salary can be traded off against a lifetime of suffering by disenfranchised people – and my question is whether there is any political party who feels the same.