Australia’s health divide: time to address the underlying causes

With the release of the 2017 Australia’s Health Tracker by Socio-economic Status1 comes the latest evidence of an unjust health divide in Australia.

With few exceptions, people who are more socially disadvantaged have worse health than their advantaged counterparts — a paradigm known as the social gradient of health.1 Despite increased need, socially disadvantaged individuals are less likely to access health care compared with advantaged people.2 It was refreshing, therefore, to read that the federal Shadow Minister for Health and Medicare Catherine King has placed health inequities front and centre of the Australian Labor Party health strategy, highlighting the importance of equitable prevention and public health and pledging to reduce the inequities in access to health care.3 Only 1.3% of the total Australian health expenditure is dedicated to the prevention of non-communicable diseases, much of which is directed at behavioural factors, including physical inactivity, poor diet and smoking1 — all of which are known to influence non-communicable diseases, such as diabetes, cardiovascular disease and osteoporosis.4

However, focusing primarily on behaviour ignores the wider context of health problems: the social, economic and cultural factors influencing that behaviour.5 The mounting costs of living and insecure employment increase vulnerability to non-communicable diseases. Improving the availability of affordable housing, quality employment and educational opportunities may better serve individuals at the economic margins, thereby addressing the stark inequities observed between advantaged and disadvantaged people. Dealing with these inequities would achieve discrete sectoral and health goals, providing cost-effective intersectoral cobenefits.

What then is the role, for example, of the employment or educational sectors in driving the policies that address the socio-economic conditions which ultimately contribute to a healthy Australia? What is role for the health sector? The Department of Health could play a stewardship role, supporting and enabling other government agencies to manage their own sectoral goals while positively influencing health outcomes. Dealing with health inequities requires an intersectoral approach, a long term view, courageous leadership at the highest executive level, and support by an empowered public sector based on principles of fairness. Australia must act on social determinants of health and address this major problem for the health of our society.