Social determinants of health

The Senate is inquiring into Australia's domestic response to the WHO Commission on Social Determinants of Health report Closing the gap within a generation. The hard-working Senators’ report is due towards the end of March.

This is throwing a very useful spotlight on this critical issue. Just how can Australia reduce the inequities in people’s access to resources, income, education and power which do so much to determine health outcomes? Is it possible to put into operation a joined-up government approach to health? What do the ‘Health in all policies’ programs in South Australia and Tasmania tell us about the practicalities of this?

Led by Catholic Health Australia, a new organisation has been launched this week: the Social Determinants of Health Alliance (SDOHA). Its immediate purpose is to have the Australian Government sign up to the recommendations in the WHO report. That done, the SDOHA will involve itself in the steps Australia needs to take to achieve the report’s goals.

For its part the NRHA is re-defining its approach to the social determinants as they affect people in rural and remote areas. It made a submission to the Senate Inquiry and three of its Councillors have submitted a piece on the matter for journal publication. A working group of Council has met to progress the development of a new NRHA discussion paper on these complex issues.

The SDOHA launch on 7 February was quite inspirational. (Hopefully it might have been recorded?) The MC was Catholic Health Australia’s fluent and dapper CEO, Martin Laverty. Special comments were provided by Fran Baum, a member of the WHO Commission on Social Determinants, and Sharon Friel from the ANU, who did some of the background technical research for the WHO Commission.

Stephen Duckett emphasised the relative importance of inequity (more than obesity, for example) as a risk factor for diabetes. And Lin Hatfield Dodds spoke in her capacity as Chair of the Australian Social Inclusion Board, a position to which she was appointed in August 2012. (Lin’s day job still sees her as National Director of UnitingCare Australia.)

The best was left until last. Social Inclusion Minister Mark Butler made it clear that in his view the critical debates to be had in Australia about health outcomes relate to two things: their social determinants; and the tweaking that needs to be done to make sure the nation’s universal health services are available to everyone, not just an entitlement that is not universally delivered. His case study of the latter was music to the ears of rural health advocates: the fact that the Better Outcomes in Mental Health Care program, being delivered through GPs and allied health professionals who are elusive or absent in more remote areas, is less well distributed according to need than the (admittedly, much smaller) Access to Allied Psychological Services program (ATAPS).

Where a whole of government approach to health in rural and remote areas is concerned, the NRHA still has high hopes of the contribution that could be made by Rural and Regional Health Australia. It can no longer be called “that new entity in the Department of Health and Ageing”. By now it should be delivering as the Ministers’ ‘go-to’ entity for integrating regional affairs, rural education, community services, housing and development with rural health programs.

As Martin Laverty said at the launch, in reaching for whole of government work on health and wellbeing, it is good to have mental health, ageing and aged care, social inclusion, and now housing and homelessness under a single Minister.

Gordon Gregory
NRHA