What public health has been doing about social inequalities in Austrlaia

Last year saw the establishment of the Australian Social Determinants of Health Alliance (SDOHA) (now with over sixty organisational members) and the release of the final report from the Senate Inquiry into the Social Determinants of Health. The ‘social determinants of health’ is simply another name for the type of social problems the community sector works to address every day, such as housing, income insecurity, poor access to education and disadvantage. Public health research has shown that these social issues are the primary cause of health problems like cardiovascular disease, diabetes and obesity. Socioeconomic position can predict who develops and eventually succumbs to heart disease, diabetes, respiratory disease and particular cancers. These findings have given us new allies in the fight to see policies that reduce, not expand, social inequalities. 

 Below, Melanie Walker, SDOHA Manager and Deputy CEO of the Public Health Association of Australia, reports on the recent activities of SDOHA (@sdohalliance), including their National Press Club Address and Research Forum progress Social Determinants of Health goals.

The Social Determinants of Health Alliance (SDOHA) is a collaboration of like-minded organisations from the areas of health, social services and public policy established to work with governments to reduce health inequities in Australia. The Alliance was formed in October 2012 and currently has over 60 organisational members.

Over the last couple of months, SDOHA has held two high profile events designed specifically to raise awareness of the Social Determinants of Health in public discourse and to progress key policy goals.

 On 20 August, three prominent leaders from the very different spheres of business, Indigenous affairs and health united in Canberra to deliver a joint address to the National Press Club. The event entitled: A Year of Nothing - Why Australian Governments need to respond to the social determinants of health, was a call to action for governments around the nation.

“On 20 March 2013, the Senate Standing Committee on Community Affairs tabled its inquiry report into Australia's domestic response to the World Health Organization's (WHO) Commission on Social Determinants of Health report ‘Closing the gap within a generation’. More than a year on from the release of the inquiry report, no discernible action has been taken to address the recommendations. The evidence-based recommendations from the WHO’s Commission on the Social Determinants of Health Report have reaped benefits around the world, but we have yet to see Australian governments commit to their implementation,”

explained Martin Laverty, Chair of the Social Determinants of Health Alliance and National Chief Executive Officer of the Royal Flying Doctor Service.

“There is currently a significant gap in life expectancy between rich and poor in Australia, and evidence also shows that when Australians in the lowest socioeconomic group reach the age of forty five, they suffer three times the amount of chronic illness than those in the highest group. Let me say that again, the poor in Australia face three times the prevalence of chronic illness then do the rich, and there is no biological reason for this to be the case. Further, the Australian Institute of Health and Welfare recently reported male death rates as 80% higher in remote areas compared to major cities."

Dr Tom Calma AO, Founding Chair, Close the Gap Campaign and Chancellor of the University of Canberra added: “The absence of Australia’s First Peoples from the Constitution – the lack of recognition of Aboriginal and Torres Strait Islanders as the original occupants and custodians of the continent – perpetuates a lingering sense of separation, a gulf between black and white Australians and continues to erode our potential and our confidence. The choice to keep intact the constitutional silence about our tens of thousands of years of history in this land discounts, diminishes and dismisses our contribution to the making of Australia. We have another important task before us in relation to Constitutional Reform - the job of removing racial discrimination from our highest document, so that future generations do not have to re-live the exclusions of history.

“From a medical perspective, the Australian Indigenous Doctors Association, the Australian Medical Association, the Australian Psychological Society and the Australian Indigenous Psychologists Association all say Constitutional Recognition, and the removal of racial discrimination from our highest law, would help to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples. Racism has been acknowledged as a determinant of health for Indigenous populations and ethnic minority populations worldwide. There is solid evidence that racism is a significant determinant and driver of inequities in health. Unless we take a holistic approach, a social determinants approach, a social inclusion approach that includes fighting racism where-ever it appears, we will continue to struggle to ‘break the cycle’ and ‘close the gap’ and move Australian society as a whole onto a new trajectory based on principles of fairness, equality, respect, dignity, opportunity, sustainability, resilience, wellbeing,” said Dr Calma.

Kate Carnell AO, Chief Executive Officer of the Australian Chamber of Commerce and Industry went on to say:

“A recent report by the National Centre for Social and Economic Modelling titled 'The cost of inaction on the social determinants of health' found that if action on social determinants was able to lift the health status of low socioeconomic groups to that of the average health status of all Australians:

• 500,000 Australians could avoid suffering a chronic illness
• 170,000 extra Australians could enter the workforce, generating $8 billion in extra earnings
• Annual savings of $4 billion in welfare support payments could be made
• 60,000 fewer people would need to be admitted to hospital annually, resulting in savings of $2.3. billion in hospital expenditure
• 5.5 million fewer Medicare services would be needed each year, resulting in savings of $273 million
• 5.3 million fewer Pharmaceutical Benefits scheme scripts would be filled each year resulting in savings of $184.5 million each year

“These are significant savings and make a compelling case to governments to act. But government can't be expected to do this alone, business also has a leading role. Increasing the hiring and retention of people who are unemployed or currently not participating offers considerable benefits to businesses and to the community. For this to occur, business must work with government and the broader community to remove impediments to work and to improve access and affordability of appropriate skills training to ensure people are work ready. Australia could do much better than it does in putting in place a holistic program to address this important issue”.

The action the Social Determinants of Health Alliance seeks from Government is action it has already signed on to in last year’s tri-party Inquiry report. The five recommendations of that Inquiry, that involve Parliamentary ratification of the WHO plan, a coordinating process across government to consider health in all policies, annual reporting on social determinants to the Parliament, and priority within National Health and Medical Research Council grants for social determinant research, are not controversial and not expensive. Implementing the recommendations of the Inquiry would certainly be a good place to start in terms of addressing these important issues impacting on the future health, wellbeing and prosperity of our nation, concluded Mr Laverty.

You can watch the National Press Club Address online at: http://www.abc.net.au/news/2014-08-20/national-press-club-social-determinants-of-health/5684538 .

The National Press Club Address was preceded in July by a Research Forum on the Social Determinants of Health. Around 120 people from the health and community sectors came together in Canberra on 14 July for the public forum to address factors affecting health outcomes in Australia. 

“It’s vital that the Commonwealth, state and territory governments work together if Australia is to address those social determinants of health that are holding us back in seeking to achieve better health outcomes for the Australian community. Speakers at the Research Forum presented the latest research findings and evidence in relation to factors impacting on the health of Australians and efforts to improve the nation’s health,” said Michael Moore, SDOHA spokesperson and CEO of the Public Health Association of Australia.

 “A brand new report Taking Action on the Social Determinants of Health: Insights from politicians, policymakers and lobbyists was launched at the event by speakers from the Australian National University and Monash University. These speakers argued that it’s time for a targeted, solutions-focused approach to improve health outcomes,” said Mr Moore. 

Speakers at the forum included:

• Professor Sharon Friel (Professor of Health Equity, National Centre for Epidemiology and Population Health and Director, Menzies Centre for Health Policy, Australian National University)
• Professor Mike Salvaris (Professorial Research Fellow, Deakin University and Board Member, Australian National Development Index)
• Adjunct Associate Professor Rebecca Cassells (Curtin University)
• Dr Gemma Carey (Research Fellow, National Centre for Epidemiology and Population Health, Australian National University) and Mr Bradley Crammond (Lecturer, Monash University)
• Ms Mary Guthrie (General Manager, Policy and Communications, The Lowitja Institute)

SDOHA will continue to undertake a range of activities over the coming months to both raise awareness of the Social Determinants of Health in public discourse and to progress key policy goals at the national level.

The report Taking Action on the Social Determinants of Health: Insights from politicians, policymakers and lobbyists, speaker presentations from both the Research Forum and National Press Club Address, and more information on SDOHA, its activities and membership are available at: www.socialdeterminants.org.au .

Posted by Gemma Carey