Only the wealthy are healthy: CHA study
Economists divide Australia into five income groups.
A report released today finds people in the lowest of these income groups live 3.1 years less than those in the highest income group.
The report, Health Lies in Wealth, finds 65 per cent of people in low income groups have long term health problems, compared with only 15 per cent in high income groups.
The report also finds obesity rates are three times as high in low income families as they are in high income families.
For the duration of the Rudd Government, health reform focused mostly on hospital beds.
There are 84,000 hospital beds in Australia – roughly one hospital bed for every 266 people. Catholic health services operate about 9,000 of these total hospital beds.
The Rudd Government made changes to hospital financing to better position State and Territory Governments to meet the cost of public hospital services into the future. For this, the Government deserves credit.
But health reform in the last term of Government was rather limited.
Reform did not prioritise keeping people out of hospital in the first place.
It did not prioritise the social determinants of health.
Health reform needs more than a focus on hospital beds.
Catholic Health Australia, the voice of 75 not-for-profit hospitals across the nation, is deeply interested in the working of hospital beds.
We’re more motivated to keep people healthy and out of hospitals altogether.
Health reform requires action in three distinct areas, only part of which concern hospitals.
The first step of reform is to strengthen the responsive or reactive components of health care.
Hospitals need to be funded to cope with demand. There need to be enough doctors and nurses to treat patients. Universal access to medical and pharmaceutical treatment is required.
There is much on the ground work to be done in strengthening responsive health care.
More dollars are needed, but at least government policy is focused on the traditional components of hospitals and health care professionals that are the backbone of Australia’s health system.
The second step of policy reform is to ensure community commitment to preventive health.
There is growing awareness of the need for physical activity and healthy diets, combined with tobacco and alcohol control.
The policy focus on preventive programmes could be better, but again governments are at least aware of the need for more action.
The third, and mostly ignored component of health reform, is action on the social determinants of health.
Social determinants are the building blocks of good health.
The determinants are such things as the experience of an unborn child in the womb.
If an unborn child is exposed to undue stress, trauma, or substance abuse, it is possible that child’s long term health will be adversely impacted upon.
Other social determinants include early childhood development, primary and secondary schooling, and the level of education a person completes.
A United States study reveals non-completion of high school is a greater risk factor than biological factors for development of many diseases.
Another US study found the level of a person’s formal education better predicted cardiovascular death than random assignment to an active drug during a three year clinical trial.
Income levels, job status, housing, and whether a person lives in a metropolitan, regional or remote setting are all social determinants of health.
Put together, a person’s education, access to income, and access to housing greatly impacts upon a person’s health status to the point that on national average, those in the lowest socioeconomic group will die 3.1 years earlier than those in the highest socioeconomic group.
There is nothing new about the social determinants of health.
In 1998, the American College of Physicians said job classification, as a measure of socioeconomic status, better predicted cardiovascular death than cholesterol level, blood pressure, and smoking combined.
In 2008, the World Health Organisation (WHO) developed a framework for countries like Australia to take action on the social determinants of health.
The WHO was rightly critical of the low life expectancy for Indigenous Australians.
The WHO framework has not been adopted in Australia, but at least the ‘Closing the Gap’ initiative is taking action on Indigenous health.
If early childhood development, schooling, income levels, housing, and welfare services are so important to health outcomes, how can we integrate them into the health reform agenda this new hung (and regionally focused) parliament will be asked to implement?
As new Local Hospital and Primary Health Care networks are established around the country, they must be tasked to report and act on the social determinants of health.
The most disadvantaged areas of Australia, many of which are in regional and remote locations, will need extra resources for social service interventions.
Action on the social determinants of health does not mean less focus on hospital policy, or less focus on preventive health.
Instead, it requires broader recognition that if we only worry about a person’s health when they present at a doctor’s surgery, for many the social determinants will have already dictated their eventual health outcome.
Martin Laverty is the Chief Executive of Catholic Health Australia, which released the report Health Lies in Wealth on 27 September.