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

sdoh

” 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.

 

NACCHO NEWS ALERT: Why health experts are asking governments to consider the health impacts of all policies

SDOH

The next challenge is nationally, for all Australians, the Australian Government adopting the WHO framework to drive improvements across communities and populations, remote and metropolitan, but I  acknowledge it’s not a politically attractive target.

“Action on social determinants requires long-term commitment that goes beyond the three-year cycles of elected governments.”

Martin Laverty, the chairman of the Social Determinants of Health Alliance

ABC Health & Wellbeing By Bianca Nogrady

‘An ounce of prevention is worth a pound of cure’, Benjamin Franklin is quoted as saying.

But as bang-for-your-buck as prevention may be when it comes to your health, adopting a healthy lifestyle is not as simple as it may sound.

It’s easy enough to say, “don’t smoke and you’re less likely to get cancer”, or “eat healthy food and exercise regularly and you’re less likely to become overweight”. But what if you grew up in a smoking household? What if you don’t have enough money to buy fresh vegetables and don’t have the know-how or time to prepare meals with them? What if your job pays so little, you have to work double shifts just to make ends meet and don’t have time to do any exercise?

Preventive health goes way beyond individual choices, because our health – particularly when it comes to chronic diseases such as type 2 diabetes and heart disease – is influenced by factors that are often far beyond our individual control. These factors are known as the social determinants of health.

Social determinants of health


Social determinants of health are the social and economic factors that contribute to our state of health and wellbeing, such as:

  • how much money we earn
  • what level of education we have
  • where we live and whether we have access to transport
  • our ethnicity.

Addressing these drivers of health is challenging, says Associate Professor Lyndall Strazdins, senior fellow at the National Centre for Epidemiology and Population Health, at the Australian National University.

“Once you move beyond giving people flu shots and that sort thing, then what is it that you have to engage with?” says Strazdins.

“That’s what makes social determinants of health such a difficult policy field because it steps out of what’s considered to be health, which is health care, and moves into the drivers of health, the systems that will move health up or down in a society.”

This means just about any policy or law is likely to have an impact on health; whether it’s paid parental leave, minimum wage, working hours, education, etc. Recognition of this has given rise to a global movement for ‘health in all policies’.

Strazdins says the movement emphasises the importance of policy-makers taking health into account.

One example is the knock-on health impacts of workforce participation policies. Policies that push back the retirement age and keep us in the workforce for longer, reduce the amount of time we have for leisure activity and exercise as we age. As well, some of us are going to be caring for our partners. All this means we’re less able to give any emerging health issues the attention they may need.

Despite this, health is rarely even mentioned in such policies, Strazdins says.

“So here we have health at the heart of [whether] this policy is going to succeed or not, and it’s not mentioned, so the very first step is putting health in,” she said.

“If you come back to even economic analysis, we know these things are costing the country; what we don’t realise is how the way we’re structuring the country could make a huge difference.”

Health in all policies – how does it work?

In 1997, the Swedish Road and Traffic Safety Agency contributed to the introduction of a bill that has had a hugely positive impact on the health of the Swedish population.

The bill aimed for zero fatalities and serious injuries on Swedish roads by 2020, by bringing together transport, justice, environment, health and education sectors to promote, enforce and assist with road safety. So far, this initiative has reduced Sweden’s road fatalities by more than two-thirds.

Thailand has introduced a policy requiring the use of health impact assessments in an effort to reduce the health consequences of environmental hazards such as air pollution. The approach has been taken for developments such as coal mines, biomass power plants, waste management systems and water conservation initiatives.

It is even bringing this into consideration of patent protection laws for pharmaceuticals.

Improving health for all

Martin Laverty, the chairman of the Social Determinants of Health Alliance, says Australia is well-placed to address some of the most important social determinants of health, such as education.

“We’ve got universal access to education, social safety to provide access to income support, social housing scheme, universal access to health care, but despite these levers, people fall through the cracks,” says Laverty, also CEO of the Royal Flying Doctor Service.

“The universal access to health care, education, social safety net of income and housing support is not providing optimal support for those most vulnerable within the community.”

One major Australian initiative attempting to deal with social determinants of health is the Federal Government’s Closing The Gap program.

“In Indigenous affairs we see a social determinants action plan that is informing how we are acting to improve Indigenous life expectancy and improve chronic illness,” Laverty says.

The program has had some wins, particularly in child mortality, but Laverty says the next areas for improvement are in stopping people smoking and boosting Indigenous people’s level of education.

He would also like to see this approach taken to improving the health of all Australians.

“The next challenge is nationally, for all Australians, the Australian Government adopting the WHO framework to drive improvements across communities and populations, remote and metropolitan,” he says, but he acknowledges it’s not a politically attractive target.

“Action on social determinants requires long-term commitment that goes beyond the three-year cycles of elected governments.”

You might also like to read other stories from our Social Determinants of Health series:

NACCHO Aboriginal health :Culture is an important determinant of health: Professor Ngiare Brown at NACCHO Summit

Ian Ring

It’s time to move away from the deficit model that is implicit in much discussion about the social determinants of health, and instead take a strengths-based cultural determinants approach to improving the health of Aboriginal and Torres Strait Islander people. This is one of the messages from Ngiare Brown, Professor of Indigenous Health and Education at the University of Wollongong.

Professor Brown also stresses the importance of a focus on resilience, and the value of the Aboriginal Community Controlled Health sector as a national network for promoting cultural revitalisation and sustainable intergenerational change.

The summary below is taken from her presentation at the recent NACCHO summit

***

Connections to culture and country build stronger individual and collective wellbeing

Professor Ngiare Brown writes:

Although widely accepted and broadly researched, the social determinants approach to health and wellbeing appear to reflect a deficit perspective – demonstrating poorer health outcomes for those from lower socioeconomic populations, with lower educational attainment, long term unemployment and welfare dependency and intergenerational disadvantage.

The cultural determinants of health originate from and promote a strength based perspective, acknowledging that stronger connections to culture and country build stronger individual and collective identities, a sense of self-esteem, resilience, and improved outcomes across the other determinants of health including education, economic stability and community safety.

Exploring and articulating the cultural determinants of health acknowledges the extensive and well-established knowledge networks that exist within communities, the Aboriginal Community Controlled Health Service movement, human rights and social justice sectors.

Consistent with the thematic approach to the Articles of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), cultural determinants include, but are not limited to:

•Self-determination;

•Freedom from discrimination;

•Individual and collective rights;

•Freedom from assimilation and destruction of culture;

•Protection from removal/relocation;

•Connection to, custodianship, and utilisation of country and traditional lands;

•Reclamation, revitalisation, preservation and promotion of language and cultural practices;

•Protection and promotion of Traditional Knowledge and Indigenous Intellectual Property; and

•Understanding of lore, law and traditional roles and responsibilities.

The power of resilience

The exploration of resilience is a powerful and culturally relevant construct.

Resilience may be defined as the capacity to “cope with, and bounce back after, the ongoing demands and challenges of life, and to learn from them in a positive way”, positive adaptation despite adversity or “a class of phenomena characterized by good outcomes in spite of serious threats to adaptation or development”

Resilience is important because:

• It is culturally significant – we are a resilient culture, surviving and thriving;

• Resilient people/communities are better prepared for stronger, smarter, healthier, successful futures and have better outcomes across the social determinants of health (education, health, employment);

• Resilient individuals are more likely to provide a positive influence on those around them and are better able to develop and maintain positive relationships with others – family, friends, peers, colleagues;

• Resilience promotes collective benefits – social cohesion, community pride in success, economic stability, and improved health and wellbeing.

There is a developing body of international work describing cultural continuity and cultural resilience.

Scholars such as Fleming and Ledogar propose dimensions including traditional activities, traditional spirituality, traditional languages, and traditional healing.

Further, Native American educators propose cultural protective factors and cultural resources for resilience such as symbols and proverbs from common language and culture, traditional child rearing philosophies, religious leadership, counselors and Elders.

(For example, Chandler, M. J. & Lalonde, C. E. (2008). Cultural Continuity as a Protective Factor Against Suicide in First Nations Youth. Horizons –A Special Issue on Aboriginal Youth, Hope or Heartbreak: Aboriginal Youth and Canada’s Future. 10(1), 68-72; Olsson 2003, Stockholm Resilience Centre; John Fleming and Robert J Ledogar, ‘Resilience, an Evolving Concept: A Review of Literature Relevant to Aboriginal Research’,  Pimatisiwin. 2008 ; 6(2): 7–23. Iris Heavyrunner et al 2003).

The cultural determinants of health and wellbeing may be seen to be wrapping around, or cutting across individual, internal, external and collective factors.

A ‘social and cultural determinants’ approach recognises that there are many drivers of ill-health that lie outside the direct responsibility of the health sector and which therefore require a collaborative, inter-sectoral approach.

There is an increasing body of evidence demonstrating that protection and promotion of traditional knowledge, family, culture and kinship contribute to community cohesion and personal resilience.

Current studies show that strong cultural links and practices improve outcomes across the social determinants of health.

There are certain services only NACCHO and ACCH sector can and should do – child protection; mental health; women’s business; and men’s health.

This is useful in assisting policy and resourcing decision-making dependent upon context, geography, demography and tailoring services to local needs and priorities

The ACCH sector provides a true national network and a vehicle for cultural revitalisation. A cultural determinants approach and cultural revitalisation drive sustainable intergenerational change.

NACCHO NATSIHP News:What a report about Aboriginal health can teach journalism

Gi

The document portrays racism as being institutionalised within health care — rather than being an aberrant behaviour by a minority. Journalism that has learned this lesson might end up with much more powerful and instructive stories.

Lessons from a report on Aboriginal health issues can be transferred to journalism.

from Melissa Sweet Croakey

Journalism has a lot to learn from the health sector, I’ve often thought. Many of healthcare’s challenges — reducing errors, becoming more responsive to the community, avoiding capture by powerful interests — are relevant for journalism as well. So when the new National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was released last week, I read it looking for what journalists might learn.

Although a federal government publication, it involved extensive consultation with Aboriginal and Torres Strait Islander communities and the health sector. These are some points I took away …

The report makes it clear that racism is a huge health issue. Lately there has been some self-reflection by the media about our role in entrenching gender inequality (including on the front pages of The New York Times). We could also reflect on our own role in entrenching rather than confronting racism.

The document calls for culturally supportive and culturally safe environments in health care. A large part of the media industry has not grappled with what this might look like in journalism, whether for members of our industry, or for communities and people interacting with us.

The document portrays racism as being institutionalised within health care — rather than being an aberrant behaviour by a minority. Journalism that has learned this lesson might end up with much more powerful and instructive stories. As the ABC presenter Waleed Aly wrote earlier this year, in the wake of yet another publicised incident of abuse, “our real problem is the subterranean racism that goes largely unremarked upon and that we seem unable even to detect”.

Nareen Young, CEO of the Diversity Council of Australia (and a tweeter on these issues), says the media could help by spending less time arguing about what constitutes racism, as this unending debate is exacerbating the hurt. “We need to say that if something hurts someone deeply, it is racist,” she said. The council would like to work with the media to identify areas for improvement.

The plan’s holistic approach to health is something we all could learn from. Indeed, GP Dr Tim Senior has argued for a wider adoption of the Aboriginal definition of health. Much media reporting reinforces a narrow biomedical focus, and neglects the wider determinants of health — like the importance of an equitable education system, an inclusive society and a healthy environment. If journalists incorporated the plan’s broad understanding of health into our work, we might see more useful reporting — whether on health or wider policy issues.

The document stresses the importance of culture, language and cultural identity to the social and emotional wellbeing of Aboriginal and Torres Strait Islander people. Yet so often, media reports portrays culture as a negative. If reporting such concerns, then at the least this broader context needs to be included. Beyond that, how might journalism contribute to wider acknowledgement of culture? Through use of language, for example?

The plan also stresses the importance of acknowledging and understanding the diversity of Aboriginal and Torres Strait Islander peoples. The fact that different people hold different views does not automatically mean conflict and division. Is journalism capable of respect for diversity?

The plan emphasises the importance of strengths-based approaches to Aboriginal health, rather than a focus on the deficit model that is so common amongst both the media and health sectors. Journalism can be overly focused on the deficit model — telling us about problems we often already know about — rather than investigating potential solutions. This is not an argument for “soft” journalism — it is actually easier to describe problems, whether in Aboriginal health, climate change or obesity, than to do the hard yards of solutions-focused journalism.

The plan also underlines the impact of the past upon contemporary health and wellbeing, referring to the legacy of intergenerational trauma. Most of the recent media coverage celebrating the 200th anniversary of European explorers crossing the Blue Mountains did not even canvass the implications for the area’s Aboriginal peoples. Surely this type of coverage — that privileges one historical experience and account over another — exacerbates the intergenerational trauma identified by the new plan.

No doubt some hackles will rise about the idea that we in the media have a responsibility for our work’s impact. But the industry’s engagement with mental health initiatives suggests there is a wider awareness and willingness to evolve our practices.

This piece is written from my perspective as a non-indigenous journalist. I wish I’d had the chance to reflect on these issues earlier in my career. There are many journalists and organisations, particularly in the community sector, whose work reflects the principles underlying the new national health plan.

And the digital era is enabling initiatives like the Cherbourg MoJo project in Queensland which is equipping young people with the skills to tell their community’s stories. You can see this as a digital media project or as a health intervention, given that it aims to improve self-esteem, confidence, literacy, and to “present a less marginalised view of the community”.

So while journalism can learn plenty from the health sector, it works both ways. The Cherbourg project suggests the skills of journalism can be harnessed for improving a community’s wellbeing. Mind you, the ancient art of telling stories was around long before the modern concept of journalism was invented.

*Melissa Sweet is a PhD candidate at Canberra University, and is researching journalism and Aboriginal and Torres Strait Islander health

NACCHO health news:Some advice for researchers and services wanting to improve Aboriginal health

RHEF A Valued Profession Flyer

Some suggestions for how researchers and health services might do a better job of engaging with Aboriginal patients and communities have come from a research project spanning rural, regional and remote NSW.

The suggestions include taking time to develop trust and relationships (including with community members outside of the health sector), recruiting Aboriginal staff, and engaging patients and communities through art and social media.

The NHMRC-funded Gomeroi gaaynggal program recruits Aboriginal women in early pregnancy and monitors their health and that of their infants throughout pregnancy.  It aims to promote the early detection, diagnosis and prevention of diabetes and kidney disease.

Work began on setting up the program in 2006, recognising that many Aboriginal women are deeply mistrustful of mainstream pregnancy-related healthcare services, and this contributes to low uptake of antenatal care.

Thanks to Lynsey Brown from the Primary Health Care Research and Information Service (PHC RIS), for reporting on a recent article about the program in the journal, Rural and Remote Health.

Our thanks to Melissa Sweet once again for your assistance

blogmasthead

Sharing some strategies that work for Aboriginal health

Lynsey Brown writes:

Based on their experiences in Walgett (NSW) and other regional, rural and remote Aboriginal communities, Dr Kym Rae and colleagues describe strategies to improve recruitment and retention of Aboriginal people in research and antenatal programs.

The lessons learnt stem from the NHMRC-funded Gomeroi gaaynggal program, which investigates health issues across pregnancy and the post-natal period.

The Gomeroi gaaynggal team also works in partnership with the Aboriginal community and a range of health service providers to deliver an ArtsHealth program that addresses health literacy and service use.

The authors describe key strategies for recruitment and retention that can be applied across diverse regions.

Promoting both ownership and engagement, they note how community consultation must occur across multiple levels. For example, when establishing a health service, it is important to include conversations with not only health professionals but also organisations and individuals working in different areas across a range of social determinants of health (eg, housing, education, justice system), and particularly engaging with local community Elders.

It is this open and trusting dialogue that enables partnerships between researchers, clinicians and communities.

Community consultation is a step towards building trust, which is necessary between researchers and the community, and between research teams and partner organisations. However, trust takes time.

The authors describe prioritising recruitment of Aboriginal staff to enable open discussions, friendships and a supportive mentored environment, which helps this trust and sense of collaboration to develop.

The use of new technologies (in areas with adequate internet connectivity) is also discussed in detail. Social media such as Facebook can be beneficial in establishing connections, maintaining contact, keeping up-to-date with developments, providing opportunity for private emails, and encouraging communication at less cost than a phone call.

The importance of addressing local needs is emphasised, with the authors identifying successful recruitment and retention strategies in different areas.

For regional areas, provision of food and transport vouchers reduces costs for families travelling to health services. Further, Aboriginal staff spend time liaising closely with community members and health services staff.

In rural areas arranging transport and improving local access to services are key strategies. Facebook is also particularly valuable in promoting connection between the program and participants in this space.

Additionally, the authors highlight the benefits of requesting details of three contact people for each participant, to enable connection with families who often change residences.

In the remote region, the key factor is collaboration between the research team and the local Aboriginal Medical Service – with co-located offices and matching uniforms promoting an ongoing partnership.

Despite centres in different locations determining their own approach, it seems the generated strategies are applicable to other health professionals working to close the gap.

• Lynsey Brown is Research Associate, PHC RIS

• Rae K, Weatherall L, Hollebone K, Apen K, McLean M, Blackwell C, et al. (2013). Developing research in partnership with Aboriginal communities – strategies for improving recruitment and retention. Rural and Remote Health 13: 2255. (Online)

This article, which can be accessed at http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2255, features in the 11 April 2013 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.

The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php.

NACCHO Aboriginal Health News Alert:Download:Senate report on social determinants deserves cross-party support

SDOH%20Chart

Please note NACCHO is a member of the SDOHA

DOWNLOAD THE FULL REPORT FOR NACCHO SITE

The Social Determinants of Health Alliance (SDOHA), representing more than 25 organisations calling for urgent action on the social determinants of health, has applauded last night’s report from the Senate Community Affairs Committee on the social determinants, saying it represents a significant first step towards addressing the causes of health inequity in Australia – if all parties adopt the recommendations made by Labor, Liberal and Greens Senators.

“The establishment of the Senate Inquiry to investigate action on the social determinants was seen as the key that could unlock this debate, and if political parties follow their colleagues’ lead, that expectation will prove to be true,” SDOHA spokesman Martin Laverty said. “There is good reason to be optimistic that the Senate committee’s work will deliver real results for the people of Australia.”

SDOHA, representing health, social service and public policy organisations, said the fact the report’s five recommendations are almost lifted from its submission means the Senate report has the strong backing of many of the key groups working to bring about health equity.

“Our top priority was to have the Commonwealth, and hopefully other governments, ratify the World Health Organisation report Closing the gap in a generationand that’s the committee’s first recommendation,” Mr Laverty explained. “That will make governments accountable and also give them a roadmap for how to actually address the social determinants of health.”

Social Inclusion Minister Mark Butler spoke at last month’s SDOHA launch about the 600,000 Australians living with complex, multi-layered disadvantage that was often caused by social factors. “We know that the surest path out of that is fixing those health problems and giving them decent education and training to find employment,” the Minister said.

Mr Laverty said the Senate committee’s recommendation that governments particularly look at education, employment, housing, family and social security policy through a social determinants of health lens again has the potential to make a real difference.

“We know that the Senators recognise that all policies – transport, infrastructure environment and economic policy are a few other areas that could be added to the list – have an effect on people’s health, so we hope politicians don’t limit themselves to the specific, and pivotal, areas the committee mentioned.”

Mr Laverty pointed to the report by the National Centre for Social and Economic Modelling that last year outlined the financial benefits – in addition to the social advantages – that would be derived from government action on the determinants of health. Billions of dollars could be saved in health costs, including prescriptions, while billions more could be injected into the economy by helping Australians suffering from health conditions be made well and able to enter the workforce.

“At its core, addressing the social determinants of health is an issue of justice, of fairness, of equity; we’re supposed to be the country of the ‘fair go’,” Mr Laverty said. “But addressing the social determinants also makes sense economically, and would allow governments to save money and generate additional revenue.

“To the Alliance, this is a no-brainer. The multi-partisan Senate committee has offered a way forward. Let’s hope partisan politics – and an election campaign – doesn’t distract politicians from acting in Australians’ best interests.”

Social determinants-NACCHO Submission to the Senate Standing Committee on Community Affairs-Oct 2012

NACCHO Submission to the Senate Standing Committee on Community Affairs

Australia’s domestic response to the World Health Organisation’s (WHO) Commission on Social Determinants of Health report “Closing the gap within a generation”

For complete submission download here

Introduction 2 pages of 5

The National Aboriginal Community Controlled Health Organisation (NACCHO) thanks the Senate Standing Committee on Community Affairs for the opportunity to make a submission regarding the government’s response to the “Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health” (WHO 2008).

The Commission on the Social Determinants of Health attempted to focus attention on a number of countries across the developmental and income spectrum in order to aggregate evidence on the promotion of health equity at a global level.

The commissioners, with widely varied political, academic, civil and advocacy backgrounds, (WHO 2006) were charged with developing understandings of the social determinants of health and determining how those understandings might be applied in practical actions to improve population-wide health equality and equity.

NACCHO submits that this seminal publication has made a compelling argument for the inclusion of population-wide health matters in all government policies that influence the lives of Aboriginal and Torres Strait Islander peoples, including housing, law and justice, education and infrastructure planning, with the report describing how “gaps in health outcomes are indicators of policy failure” (WHO 2008).

The government’s response

NACCHO is committed to the ideals and social realities of Aboriginal community control of a collective community destiny and therefore fully supports the report’s simultaneous call for the integration of personal health care and public health at the level of the local community (Pammolli et al., 2012). In order to achieve or at least to initiate movement towards the achievement of its goals, the commission’s key findings and final overarching recommendations were categorised into the three distinct but interlocking areas of:

1. Improving daily living conditions

2. Tackling the inequitable distribution of power, money and resources

3. Measuring and understanding the problem and assessing the results of action (WHO 2008)

NACCHO agrees with the commission in recognising the need to address the inequalities and inequitable conditions of daily living and, in so doing, to address the inequities in the way that society is structured and organised. NACCHO, again, fully supports the commission’s position and encourages the current Commonwealth government to act, particularly in the area of political and economic power (Russell et al., 2012). However, the most effective actions to achieve greater health equity for Aboriginal and Torres Strait Islander peoples at a societal level are those that create or reassert societal cohesion and mutual dependence and responsibility within communities (Marmot et al., 2012).

NACCHO contends that this should be the real project of reconciliation, since reconciliation has the capacity to become a major social determinant of health for all Australians, not just Aboriginal Australians.

Extent to which the Commonwealth is adopting a social determinants of health approach through:

(i) Relevant Commonwealth programs and services

NACCHO is particularly keen to point out to the Standing Committee that unless the outmoded funding formulae of the Aboriginal Community Controlled Health sector – formulae that focus their performance indicators on narrow healthcare policy rather than on policies that are good for health – are fundamentally addressed we will see Aboriginal populations drift toward and place considerable pressure upon secondary and tertiary services (Sunderland et al., 2012).

Particularly in the state and territory context, if the recommended blueprint of the Health and Hospital Reform Commission (H&HRC 2009) report is not substantially adopted, implemented and coordinated with the ‘Closing the Gap’ policies, similar strains will be placed upon these over-extended sectors with predictable consequences in all Australian states and territories.

(ii) The structure and activities of national health agencies

NACCHO further points out to the Standing Committee that the simple resourcing of the Australian primary care sector will not be enough (Tait 2011). Fundamental reform of the Medicare Benefits Schedule (MBS) and its more equitable distribution in Aboriginal communities is needed (Couzos et al 2010).

In its report of October 2010, the Australian Institute of Health & Welfare (AIHW 2010) noted that MBS expenditure per person was lower for Indigenous Australians than for non-Indigenous Australians, with fifty-eight cents spent on Indigenous patients for every dollar spent on non-Indigenous patients (AIHW 2010).

In the area of MBS-funded surgical procedures, spending on Indigenous patients was sixty-seven percent lower than for their non-Indigenous fellow citizens (AIHW 2010). Access and uptake of the Pharmaceutical Benefits Scheme (PBS) for Indigenous Australians has followed a similar trajectory and is itself in need of analysis and eventual overhaul (Hayman 2011).

(iii) Appropriate Commonwealth data gathering and analysis

NACCHO respectfully points out that in its final overarching recommendation, the commission saw as essential the need for the measurement, at a national and international level, of health inequity.

It recommended the establishment, by national governments in collaboration with international organisations with support from the WHO, of global health-equity surveillance systems to regularly and systematically assess the impact on health equity of policies and actions (SmithBattle, 2012)(WHO 2008).

The commission argued that creating the organisational capacity to act effectively in health equity required a significant investment by all players in the training of policy-makers and practitioners, a powerful commitment of resources to raising public health literacy in the area of social determinants and a much stronger focus on social determinants in public health research and debate (WHO 2008).

NACCHO strongly recommends that he Commonwealth recognise that, in this feature, there is a strong and irreducible link between the WHO report’s recommendations and those of the National Indigenous Health Equality Summit’s report in Australia (HREOC 2008).

For complete submission download here