Volume 180 - Issue 6
Achieving equity in the Australian healthcare system
Authors: Elizabeth Harris, Sarah J Simpson, Rosemary Aldrich and Jenny Stewart Williams
Med J Aust 2004; 180 (6): 308. || doi: 10.5694/j.1326-5377.2004.tb05935.x
Published online: 15 March 2004
Published online: 15 March 2004
Elizabeth Harris,* Sarah J Simpson,† Rosemary Aldrich,‡ Jenny Stewart Williams§
* Director, † Program Manager, Centre for Health Equity Training Research & Evaluation (CHETRE), University of NSW, LMB 7103, Liverpool BC, NSW 1871. ‡ Conjoint Academic, School of Medical Practice and Population Health, § Research Officer, Newcastle Institute of Public Health; University of Newcastle, Newcastle, NSW. elizabeth.harrisATswsahs.nsw.gov.au
To the Editor: Leeder rightly points out that increased funding of the healthcare system does not necessarily result in improved equity within the health system or better health outcomes for the population.1 This challenges us to develop ways of systematically examining how current healthcare practices either increase or decrease equity. The following two Australian initiatives illustrate how we might work to achieve equity in health — that is, provide opportunities for all Australians to achieve their full health potential.2
Clinical practice guidelines (CPGs) are one mechanism frequently used to facilitate improvements in the quality of clinical practice and healthcare. However, the evidence on which CPGs are based often excludes, or does not consider, the needs of relatively disadvantaged populations.3-5 Recognising this gap, the Health Advisory Committee of Australia’s National Health and Medical Research Council published a handbook for developers of guidelines about ways to access, review and collate evidence of the effect of socioeconomic position on health, and apply that evidence when developing CPGs.5,6
At the policy level, Health Impact Assessment (HIA) is gaining increasing recognition as a tool for assessing the potential effects of a policy or program on health. Health Impact Assessment that systematically addresses equity may also offer a way of incorporating equity concerns into the decision-making process. However, HIA is a comparatively new field, and decision makers are not usually trained in assessing the impact of policy decisions on equity. Through the Public Health Education and Research Program, the Australian Government has commissioned the development of an HIA framework to assist decision makers in systematically identifying potential health equity impacts of policies. This equity-focused HIA framework is currently being tested (through case studies in Australia and New Zealand) to assess whether and where it adds value to the decision-making processes.
These two examples illustrate practical ways in which decisions by practitioners and policy makers can routinely incorporate equity issues in the Australian healthcare system. Ongoing investment and commitment is required to evaluate whether such initiatives make a real difference in achieving equity in health.
Acknowledgements
We were contracted by the National Health and Medical Research Council to draft the handbook Using socioeconomic evidence in clinical practice guidelines, and by the Australian Government Department of Health and Ageing to develop the Equity Focused Health Impact Assessment framework.
References
- Leeder SR. Achieving equity in the Australian healthcare system. Med J Aust 2003; 179: 475-478. CHDEEJGI
- Whitehead M. The concepts and principles of equity and health. Copenhagen: World Health Organization Regional Office for Europe, 1990. i1083059
- Seaton A. “There’s none so blind as the double blind.” Discuss. BMJ 2003; 326; 889. i1083061
- National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1998. Available at: www.nhmrc.gov.au/publications/synopses/cp65syn.htm (accessed Nov 2003).
- Aldrich R, Kemp L, Stewart Williams J, et al. Using socioeconomic evidence in clinical practice guidelines. BMJ 2003; 327: 1283-1285. i1083064
- National Health and Medical Research Council. Using socioeconomic evidence in clinical practice guidelines. Canberra: NHMRC, 2003. Available at: www.nhmrc.gov.au/publications/pdf/cp89.pdf (accessed Jan 2004).