On 12th May more than 120 people – including politicians, government officials, non-governmental organisations, media, researchers and the general public – came together at the Australian National University to share ideas about how political and policy processes can operate more effectively so as to tackle the widening gap in the health of Australia’s most and least disadvantaged people. The Forum was timed so as to inform debates in the build-up to the 2016 Federal election.
The Forum was an initiative of the National Health & Medical Research Council Centre for Research Excellence on the Social Determinants of Health Equity (CRE-SDHE). A key focus was policy areas that powerfully influence the ‘social determinants of health’ and that are addressed in the CRE-SDHE programme of work including Indigenous affairs, urban environments, social protection and health systems. This blog post is the first in a three part-series that summarises the event including key lessons from the day. This post, summarises the first part of the day – an overview of the event, and a summary of a Big Ideas panel on the fairness of the 2016 Federal budget.
Prof. Fran Baum (Co-Director of the CRE-SDHE) kicked off the day with an overview of why tackling health inequities matters for all Australians – those on the lowest-income will die six years earlier than those on the highest incomes; Indigenous Australians will die 11 years before their non-Indigenous counterparts. But those in the middle are also worse off than those at the top. Tackling health inequities (or in other words: achieving a fair distribution of health in Australia), is also about addressing the gradient of health across society.
The work of the CRE-SDHE builds on the World Health Organizations Commission on the Social Determinants of Health. Political challenges to tackling health inequities can occur throughout the policy process – how health equity gets onto the political agenda, how policies interact to affect health, how policy is implemented, and how policy is evaluated. The CRE-SDHE brings together a multidisciplinary team of researchers to understand how government policies can work more effectively to address the social determinants of health, so as to improve health and promote the fair distribution of health in society. Ultimately, the work of the CRE-SDHE will inform policy for a healthier and fairer Australia. Click here to read more about the aims, programme of work and people involved in the CRE-SDHE.
Radio National Big Ideas Panel on Health Equity and the Budget
The focus of this Panel was the question ‘how fair is the Government’s 2016 budget?’ – an important question in light of the forthcoming Federal election. Paul Barclay from Radio National’s Big Ideas Programme facilitated a discussion between Dr Richard DiNatale (Australian Greens leader), Dr Andrew Leigh (Labor Shadow Minister for Finance), Prof. John Hewson (former minister in the Liberal Party of Australia), Dame Prof. Margaret Whitehead (University of Liverpool), and Prof. Sharon Friel (ANU and Co-Director of the CRE-SDHE). Click here to listen to this Big Ideas podcast. A brief summary of key points made by the panel members are given below;
Richard DiNatale – climate change is one of the biggest challenges for health in the 21st Century. The budget completely neglects this, and misses the opportunity to achieve economic growth through renewable energy, a ‘win-win’ for health and the economy. The underlying assumption is that ‘trickle-down economics’ works for both economy and people, when clearly it does not. The large majority of tax cut benefits goes to the top-1% of earners, whereas the bottom two thrids get nothing. Good evidence shows that inequality is now putting the brakes on economic growth.
Another key challenge is how to raise the profile of prevention? Most prevention programs have a long term gain but politics is not a long term game. Often vested interests (e.g. sugar lobby and nanny-state proponents) will oppose progress. We need to take up some of the former National Preventive Health Agency’s recommendations including restrictions on the availability, marketing and pricing of highly processed foods. A sugar-sweetened beverage tax could be hypothecated and reinvested to improve health. Ultimately we need to see health spending as an investment in healthier happier people as the outcome, not just as a cost. After all what is the point of economic growth if we can’t reinvest in health systems to enable people to live healthy lives?
Andrew Leigh – how much money you have impacts considerably on your health. Reflecting on his book Battlers and Billionaires, the richest socio-economic groups have seven more teeth than the poorest in Australia. This at least partly reflects poor access to dental services. The distribution of smoking also hurts disadvantaged Australian’s hardest. Prevention works – interventions in tobacco, road safety and others have a clear return on investment, are evidence-based and effective. The 2016 Budget cuts taxes to big corporates but hurts working families financially. It also fails to invest in prevention measures and health promotion activities so as to reduce the economic burden on our health system. This is likely to exacerbate existing health inequalities.
Prof Friel – cuts to flexible funds and frontline services, for example those to alcohol and other drugs services, are likely to worsen health inequities in Australia. We should acknowledge evidence that austerity measures targeting public health programmes have led to increased HIV infection rates in some countries. Cuts in the Federal budget are on top of those at State / Territory level, for example extensive cuts to public health programmes in Queensland. Health is much more than health care – we need to ensure people can live lives that they value. This requires that individuals and communities are connected to resources, are enabled through healthy environments, and have a voice in the policy decisions that affect them. Health is often framed as a matter of individual choice – but this neglects opportunities to address the wider determinants of health. There is a real opportunity to pursue economic, social and health goals together in policy.
John Hewson – affirmed that the 2016 budget would have negative inter-generational effects on health equity, including the low-rates for the new-start allowance scheme supporting youth, and through complete neglect of climate change and investments in the renewable energy sector. The pension rate also remains below the poverty line. Prevention makes good economic sense and so it is frustrating to not see it budgeted for. We need routine consideration of the economic and social impacts of government actions. All new cabinet submissions, policies and budget measures should have to address social impacts through an inequality impact assessment.
Margaret Whitehead – offered her reflections on the UK experience of austerity measures and the impacts on health inequities. Government austerity measure in the UK has hurt disadvantaged parts of population much harder, very clearly seen in changes in the distribution of health across the social gradient. We were making good progress on child poverty before the recession and austerity measures enacted. Our research shows strong welfare measures are very important to child health and austerity measures detrimental. Also, giving children a best start in life, especially tackling child poverty, makes good economic sense. UK research shows welfare security and labor market opportunities are important to people with disabilities. UK welfare reforms negatively impacted mental health of people – there is a very tight correlation between increased suicide rates and austerity measures.
Please go to the Croakey website: https://croakey.org/a-briefing-for-the-new-government-on-delivering-a-healthy-fair-go-for-all/