We are all familiar with the various government service announcements telling us to exercise more, get out of the house, start eating more fresh food and so on. What we don’t hear is how our social status, our education level, our economic situation, and our direct environment is effecting our potential to live a fully healthy life.
Professor Sir Michael Marmot argues that health inequalities do not exist in isolation of social inequalities. Policy on health therefore needs to take a more comprehensive approach in order to achieve health equity for all citizens. According to the Health Impact Assessment by the World Health Organisation (WHO), determinants of health include:
- Income and social status
- Physical environment
- Social support networks
- Health services
This can be seen within Australia. For example, the disparity between the health of Indigenous and non-Indigenous Australians is pronounced. Life expectancy for Indigenous Australians is significantly shorter than that of non-Indigenous Australian. According to the Australian Institute of Health and Welfare, as of 2011 the gap between Indigenous and non-Indigenous life expectancy was 11.5 years. Yet, it’s not just the official Department of Health and Aging that should be concerned about this.
Health inequalities should also be addressed in policy by other government departments. Health equity can be reached in a number of ways by other government departments either directly or indirectly aiming for health objectives. For example, improvements in housing such as properly insulated homes and proper housing design are shown to have positive effects on mental and general health.
The Australian Bureau of Statistics has linked housing conditions with disparities in Indigenous health within Australia. While the Department of Family and Community Services who are responsible for overseeing housing are not directly related to health, it seems that the actions taken by the department still have subsequent effects on the health of individuals, especially those who rely on their services.
These findings can also be applied internationally in foreign aid health programmes. At the moment, various non-government organisations as well as multilateral and bilateral initiatives exist to address health problems in developing nations. These organisations and initiatives distribute resources for the provision of health services to citizens in developing nations. Overall it can be said that aid has helped improve health in developing nations in that there is a noticeable increase in life expectancy in developing nations relative to the aid given to those nations. People in Sub-Saharan Africa now live 20 per cent longer than in 1960, with life expectancy increasing from 40.6 years to 50 years, despite the HIV/AID epidemic and other issues such as famine and political instability.
However, current aid initiatives have been considered to be unsustainable as they do not address the causes of health inequality and thus fails to prevent health issues from occurring again. This does not mean simply spending more on aid but rather attempting to find a more effective approach to distributing aid resources.
Whether health equity is being addressed at the international or domestic level it is fair to say that health issues should be approached in a co-operative manner, need not be expensive for society, and should have an impact early on in an individual’s life. For example, 44% of children in England were not considered to have reached appropriate development levels by the time they are 5. The Marmot Review of health inequalities in England found that reading to children every day, regular bedtimes, and cuddling children, had a positive impact on their health and mental development and that there is a link between socioeconomic status and the likelihood of parents to partake in such activities with their children.
A similar pattern was also evident between socioeconomic status and child school readiness. As such it is apparent that all these factors were interrelated and a comprehensive approach needed to be taken in order to address these issues.
The Marmot Review recommended that public health officials needed to work along with local authorities and community groups in order to achieve health equity. It was not simply a matter of telling parents to read more to their children as there are clearly issues regarding socioeconomic status which were impacting on a parent’s ability or likelihood to do such things. Therefore the government needed to acknowledge that investments needed to be made to address the socioeconomic inequalities as well.
Links between social inequality and other health issues are also evident in society including obesity and rates of smoking and drinking. The Marmot Review recommendations are being implemented throughout the U.K. and there has been a move in the U.K. toward local bodies being responsible for community-based initiatives which help address the social factors that impact on health rather than simply relying on national government authorities alone.
So should there be a Marmot Review equivalent in Australia? Director of the Southgate Institute of Health, Society and Equity at Flinders University, Fran Braum thinks so, do you agree?
Feature Image: Drew Sheldrick