In 2008, the World Health Organisation provided an action plan to Australia and other countries to tackle the health disparity between rich and poor which sees an Australian in the lowest group of wealth-holders live with up to three times the amount of chronic illness of a person in the highest wealth-holding group.
One year ago last week, Catholic Health Australia and the members of the Social Determinants of Health Alliance applauded a co-authored report of a Coalition, Labor and Greens Senate Inquiry that recommended the Parliament endorse the 2008 World Health Organisation’s recommendations on how to address health equity – that we had argued must be the first important step towards meaningful action on social determinants.
But last week, on the one-year anniversary of the release of this rare tri-partisan report, there was nothing to celebrate. There was nothing to welcome. There was just a moment to bemoan the fact that yet another year had passed since the Senate Inquiry reported and the Federal Parliament has not pushed ahead with the Inquiry’s recommendations or any plan to address unacceptable disparities in the health of Australians.
Reports seem to emerge every couple of weeks pointing to those unacceptable variances based on people’s socioeconomic status or their ethnicity or where they live or their education level. These reports – like last year’s Senate report – are not prompting action from federal politicians.
While we have been advocating for change at the political level and in the public domain, CHA has also been presenting compelling evidence as to why action on the social determinants is crucial. One of those contributions is The Cost of Inaction on the Social Determinants of Health; a report commissioned by CHA and prepared by the National Centre for Social and Economic Modelling (NATSEM).
That report found that $2.3 billion in savings could be found annually through avoidable hospital admissions if Australian Governments were to implement the findings of the World Health Organisation’s Closing the Gap in a Generation report. Those are the same recommendations that the Senate Committee said the Parliament should endorse.
The NATSEM report also found implementing the WHO recommendations could see:
• 500,000 Australians avoid suffering a chronic illness;
• 170,000 extra Australians enter the workforce, generating $8 billion in extra earnings;
• $4 billion in welfare support payments saved each year;
• 5.5 million fewer Medicare services utilised each year, resulting in annual savings of $273 million;
• 5.3 million fewer Pharmaceutical Benefit Scheme scripts being filled each year, resulting in annual savings of $184.5 million.
These staggering opportunities are what new approaches to health policy could achieve, yet counter-intuitively they do not require change to the way our health system operates.
The opportunity to reduce chronic illness and save on hospital and pharmaceutical expenditure requires action outside of the formal health system. Doing so would improve the lives of half a million Australians. It would also help the Federal Government achieve savings it is very keen to find.
Australia suffers the effects of a major differential in the prevalence of long-term health conditions. Those who are most socio-economically disadvantaged are twice as likely to have a long-term health condition as those who are the least disadvantaged.
Put another way, the poorest are twice as likely to suffer chronic illness and will die on average three years earlier than the most affluent. Poor health of low-income Australians can be avoided, allowing Government to spend less money on treating health conditions that should never have occurred in the first place.
Drug-, alcohol-, tobacco- and crisis-free pregnancies are understood to be fundamental to a child’s lifelong development. So, too, is early learning that occurs in a child’s first three years of life.
School completion, successful transition to work, secure housing and access to resources necessary for effective social interaction are all determinants of a person’s lifelong health. These are factors mostly dealt with outside of the health system, yet they are so important to the health of the nation.
We can’t afford – in dollar terms, but more importantly in human terms – for this to be a political can that is kicked down the road. Action on social determinants will save lives, and deliver both government and community an extraordinary financial and social surplus.
A resolution passed in the House of Representatives in 2010 compelled the sitting Government to respond to a Senate committee’s report with six months.
Labor can point to the federal election – held within six months of the report being tabled – and the Coalition can point to the fact the report was tabled during the last Parliament, but we are becoming increasingly impatient with politicians who aren’t addressing the causes of poor health.
Isn’t 12 months of increasing inequity more than enough? It’s time for action.
Martin Laverty is the CEO of Catholic Health Australia. CHA represents the largest single grouping of non-government health, aged and community care services in Australia.