Social

by Martin Laverty

The statistics don’t lie – and they’re pretty confronting. A 2010 Catholic Health Australia report independently prepared by NATSEM found Australian males in the lowest socioeconomic group die on average 3.4 years earlier than those in the highest group. That same report found men in the lowest group had twice the amount of illness than those in the highest.

And just last week, we’ve seen again the stark contrast between the health of those living in more affluent areas and those in less affluent suburbs, with obesity rates much higher in areas of socioeconomic disadvantage.

The cause of this gap in wellness and life expectancy is social factors that have nothing to do with the health system. A person’s early development, their educational attainment, their employment and their living environment determine much of their health outcomes, and if they will die early.

This reality has been recognised – tragically, and only lately – in relation to Australia’s first peoples.

An Indigenous person has a life expectancy of up to 17 years less than a non-Indigenous Australian. Effort is under way to close this gap, but so too is there a gap in health outcomes and life expectancy across the entire Australian population.

The World Health Organisation (WHO) said in 2008 of health disparities that there is no biological reason for differences in life expectancy between socioeconomic groups in countries such as Australia. Change the social determinants and there will be dramatic improvement in health equity, the WHO said.

Both the WHO and the social determinants agenda have its critics, and Gary Johns -- writing in The Australian -- is one such critic. It’s easy to criticise the World Health Organisation, because it’s big and bureaucratic. It’s also easy to criticise the social determinants agenda, because the agenda at first appears so large.

Yet critics of social determinants are finding themselves increasingly marginalised by mainstream thinkers recognising the need for new action on social factors that influence health, in part to stem demand on our already expensive health care system.

The Canadian Medical Association in July said its number one priority for their health system was reducing poverty.

Canadian doctors weren’t saying their medical system itself should address poverty. Rather, to reduce demand on health services, they argued action should be taken outside of the health system to address the social factors that cause some people to get sick and die prematurely.

In August, during our federal election campaign, the head of the Australian Medical Association spoke in similar terms. Steve Hambleton said poverty has a major impact on health and premature death, and called for poverty reduction.

The Canadian Medical Association and the Australian Medical Association follow in the footsteps of the British Medical Association and the American College of Surgeons. These groups can hardly be called socialist revolutionaries. They are professional bodies, informed by science and experience.

The type of social action these medical bodies are calling for involves effective supports for parents to give kids a good start in life, effective support for at-risks kids to stay in and finish school, effective support to get the unemployed into stable jobs and safe and secure housing that meets needs.

These types of actions are not part of a radical agenda, as Australia and most western countries already have programs in each of these areas. A social determinants framework already underpins Australian and most western societies’ thinking. Social determinants advocates in developed western nations simply want more refined actions, based on evidence of what is known to work.

For those of the Left, these actions are about social justice and fairness. For those of the Right, they are the necessary tools of a productive and growing economy. For those in the middle, they’re plain common sense. For Gary Johns, they seem to be a feared revolution.

A Senate report on social determinants was delivered in March of this year. That report had the backing of the Labor Party, the Greens and the Liberals. It agrees with the WHO, the many medical bodies and other health and social service organisations that Australia should target action on social factors that influence health, and that this action need not be focussed on the health system.

The Senate accepted evidence that Australia spends $2.3 billion annually on hospital services that we don’t need to, a finding of a second NATSEM report Catholic Health Australia released in 2012. The Senate also accepted evidence that we spend $4 billion in welfare we don’t need to.

With the new Government’s Commission of Audit looking at future revenues and costs for the Australian Government, and with Australia’s long-term budget position gradually heading south, as a nation we need to act to keep more people healthy and in the workforce.

If Tony Shepherd and his fellow Commissioners of Audit want a ready-made plan that gets more people into work and paying tax whilst cutting growth in health and welfare cuts, they should start by recommending that the Labor, Greens and Liberal Senate report be implemented. They needn’t listen to Johns.

Martin Laverty is the CEO of Catholic Health Australia and the chair of the Social Determinants of Health Alliance.