NACCHO Aboriginal Health #SDoH News: Delivering better health is about more than healthcare


” The social determinants of health include the obvious physical things such as clean water and air, healthy workplaces, adequate housing, transportation services and safe communities.

Education and employment provide income and make housing, food and healthcare affordable. Equally important are less tangible factors such as social support networks, culture and beliefs, stress and exposure to violence, discrimination and racism

The strong associations between these factors and health outcomes mean that providing for the health and wellbeing of the population requires more than hospitals, doctors and prescription pads and tackling the wicked issues such as obesity, ageing, mental health reforms and Closing the Gap on Indigenous disadvantage requires government involvement beyond the Department of Health.

There can be no question that government involvement is essential for two reasons: many of the determining factors for health lie beyond the ability of individuals and communities to influence and population health contributes to national productivity and prosperity.”

Dr Lesley Russell is adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney. From Canberra Times

Last month it was announced that the 2016 Boyer lecture series would be delivered by Sir Michael Marmot, a leading researcher on health inequality. He will explore how health is not simply a matter of genetics and access to healthcare but is intrinsically linked to economic and social factors. This lecture series comes at a time of growing recognition of the increasing inequalities in income and wealth and the subsequent impacts on health.

Life expectancy is the traditional way we measure population health, the effectiveness of our healthcare system and the value we get for the healthcare dollars we spend. By international comparisons Australia, with an average life expectancy of about 83 years, rates well. But this statistic hides many different stories for many different groups.

On average: men die five years earlier than women; Indigenous Australians die up to 17 years earlier than non-Indigenous Australians; people living in rural areas die up to seven years earlier than those in urban areas; and people with mental illness die up to 20 years earlier. Between one-third and one-half of these life expectancy gaps are explained by differences in the social determinants of health.

Health disparities have a devastating impact on individuals and families, and there are substantial costs involved to both the healthcare and welfare budgets and to the economy as a whole.

The National Centre for Social and Economic Modelling estimated that in 1998, $3 billion in healthcare costs and $1.2 billion in disability pensions a year would have been saved if the health status of the whole population was equal to that of the most advantaged 20 per cent.

Almost 20 years on, those figures must have at least doubled. How much money could be saved if our least healthy population groups were brought up to the healthiest level?

The case that Sir Michael Marmot will present will highlight why the education and economic policies of the new Turnbull government will have a direct impact on national healthcare costs.

There is a very strong link between education and health. It is not just that better educated people get better jobs, housing and healthcare. It is also about making better life decisions and the positive effects on health of having greater control over your lifestyle.

Australian data show there is a five-year difference in life expectancy between people with 12 years of education and those with more than 12 years of education.

Poverty has a major impact on health and premature death. The greater the length of time that people live in disadvantaged circumstances, the greater the risk for ill health. People who are unemployed, and the families of those who are unemployed, experience a much greater risk of premature death. The adverse health effects begin when people first feel their jobs are under threat, before becoming unemployed.

As a warning sign of what could happen here, a recent study showed that life expectancy for White Americans with less than a high school diploma is decreasing. This population group has high rates of unemployment and has seen wages decline over the past two decades. They also have many of the risk factors for poor health such as obesity, smoking and stress.

Low income has less impact if basic needs such as housing, food and healthcare are met through strong social policies. A recent study suggests that social spending, not medical spending, is the key to health. The United States has a ragged social safety net and spends only 56¢ on social services for every health dollar. The major OECD countries spend about $1.70 for every $1 spent on health.

In Australia we are seeing housing costs rise and the erosion of both welfare income and the affordability of healthcare. A report last year from ACOSS found that increasing inequality of income and wealth is dividing the country. Once thought of as the archetypal egalitarian society, Australia has been slipping over the past two decades and is now the 11th most unequal of the 34 OECD members.

We are already a country where good health and access to life’s opportunities come down to postcode. Growing inequalities will make this worse and we will all pay, directly and indirectly, the associated costs. We must hope that senior government ministers will be listening carefully to the Boyer lectures and that lessons learnt play out in budget policies.

Dr Lesley Russell is adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney.


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