Addressing Health for All by 2030

By Kathleen Prokopovich, University of Wollongong

The first two weeks of May saw two very timely publications released. One publication is from the World Health Organisation’s (WHO) Independent Panel for Pandemic Preparedness and Response (IPPPR)1,2. The other is a supplementary issue published by the Medical Journal of Australia (MJA). One looks at COVID-19 from a global context, while the other is specific to the Australian context. Both publications highlight how health inequities have accelerated in the past year. 1,2,3

The IPPPR takes us back to 2020 and shows us how national governments responded and reacted to the COVID-19 pandemic1. The MJA takes us to a future3 where the government of Australia has shifted to a ‘health for all’ mindset. The point of both documents is to show where government policy change needs to happen to build a resilient and fair society 1,3.

 

The Pandemic Affects Everyone but Not Everyone Equally2

First, we will look to the global stage. As pointed out by the IPPPR, structural inequities related to health, income, education, housing, gender, and ethnicity have increased globally during COVID-191,2. In terms of those who remained employed, those who were able to cover income expenses, work remotely and abide by stay-at-home orders were safer than the essential or front-line workers, many of whom ensured that systems functioned properly. But then these essential, and in many cases low-income, workers had an increased risk of exposure to infection 1. The IPPPR also emphasised that within some countries, the COVID caseload disproportionately affected poorer populations and ethnic minorities2. Gender inequities with informal labour were also identified, as caregiving for children, parents and other relatives often fall to women2. The social and mental impact of lockdowns, stay-at-home orders, and continued uncertainty is also acknowledged in the IPPPR report and how someone mentally responds to the impact of these measures depends on social determinants like socio-political background, social networks, income and where one lives5.   These social disparities need to be addressed for countries to respond better to future health crises1,2.

Though Australia responded swiftly to the pandemic, it has been vulnerable to pandemic related health inequities6.  When the national lockdown occurred over 600,000 Australian’s lost their jobs or were stood down, and the Australian Federal and State/Territory governments implemented commendable temporary economic interventions. These interventions included: income support for businesses; relief payments and cost of living expenses; and free childcare7 but as approximately 1 million casual workers were ineligible to access any assistance and most of the income support and relief payments have stopped, health inequities will return to pre-COVID levels or widen further by pushing people (including children) below the poverty line7. These factors have no doubt contributed to Australian’s feeling more anxious, nervous, lonely, depressed and restless compared to pre-COVID times8.

As Australians have now had a taste of economic policies that help reduce health inequities the opportunity to reimagine a new Australia is now at hand. The Medical Journal of Australia’s supplement publication provides us with a bold vision of Australia in 9 years if a “health for all” path is chosen9. In this imagined vision, actors from a range of departments and sectors collaborate and will draw on multiple frameworks to address health issues and foster sustainable policies to address income, education and housing inequities10. Future Australia also promotes the inclusion of the cultural determinants of health within the traditional Social Determinants of Health (SDoH) framework, thus supporting the needs of Aboriginal and Torres Strait Islanders communities11. In our imagined future, strong government commitments are made on the ecological determinants of health, with the government implementing four directions to promote health in the age of the Anthropocene12.

So how can we act now to ensure that Australia chooses a path that leads to ‘Health for All’?

Public Health expert Dr Sandro Demaio suggests that the evolution of existing health promotion frameworks and investment in the public health workforce will be critical to reaching the 2030 goals6.  This investment will have to move past just incorporating the SDoH and ‘Health for All’ approaches in curriculum and use educational spaces for health students to reflect on the power, privilege, and inequities embedded in social relationships and build skills to confidently intervene on the SDoH13. This type of “critical consciousness” approach would support students and health workers to intervene on the SDoH rather than stay neutral or complacent13.  So, in a time of great uncertainty and unease in the world two publications have highlighted how the recent past can more equitably inform the future. This will (hopefully) ensure that a post-pandemic pathway to ‘health for all’ is created1,6,9.

#SDoH #HealthEquity#HealthForAll

References

  1. The Independent Panel for Pandemic Preparedness & Response (IPPPR) 2021, COVID-19: Make it the last pandemic, accessed 12/05/2021: http://theindependentpanel.org/wp-content/uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf
  2. The Independent Panel for Pandemic Preparedness & Response (IPPPR) 2021, How an outbreak became a Pandemic: The defining moments of the COVID-19 pandemic, accessed 12/05/2021: http://theindependentpanel.org/wp-content/uploads/2021/05/How-an-outbreak-became-a-pandemic_final.pdf
  3. Australia in 2030: what is our path to health for all?, The Medical Journal of Australia, vol.214, no.8, Suppl, accessed 09/05/21: http://www.mja.com.au/system/files/2021-05/MJA%20supplement_214_8_3%20May.pdf
  4. World Health Organization (WHO) & The Commission on Social Determinants of Health 2008, Closing the gap in a Generation: Health equity through action on the social determinants of health, accessed 10/05/21: http://www.who.int/publications/i/item/WHO-IER-CSDH-08.1
  5. Lee, S 2021, “COVID-19 amplifiers on health inequity among older populations”, Frontiers in Public Health, vol.8, http://doi.org/10.3389/fpubh.2020.609695
  6. Demaio, S “Health for all by 2030 is within our grasp: we must act now”, The Medical Journal of Australia, vol.214, no.8, pp.363-364. doi: 10.5694/mja2.51018
  7. Friel, S., Goldman, S., Townsend, B. and Schram, A. (2020) Australian COVID-19 policy responses: Good for health equity or a missed opportunity? Canberra: School of Regulation and Global Governance (RegNet), Australian National University. Accessed 5/05/2021: http://regnet.anu.edu.au/sites/default/files/uploads/2020-08/2020%2008%2021%20MCHG-COVID19PoliciesHealthE.pdf
  8. Shakespeare-Finch, J, Bowen-Salther, H, Cashin, M, Badawi, A, Wells, R, Rosenbaum S & Steel, Z 2020, “COVID-19: An Australian perspective”, Journal of Loss and Trauma, vol.25, no.8, pp.662-672, http://doi.org/10.1080/15325024.2020.1780748
  9. Shill, J, Büsst, C, Horton, K, Corben, K & Demaio, S 2021, “Our path to health for all: Australia in 2030”, The Medical Journal of Australia, vol.214, no.8, S5-6.
  10. Friel, S, Baum, F, Goldfeld, S, Townsend B, Büsst, C & Keane, L 2021, “How Australia improved health equity through action on the social determinants of health”, The Medical Journal of Australia, vol.214, no.8, Suppl, S7-S11.
  11. Finlay, SM, Canuto, K, Neal, N & Lovett, RW 2021, “Aboriginal and Torres Strait Islander connection to culture: building stronger individual and collective wellbeing”, The Medical Journal of Australia, vol.214, no.8, Suppl, S12-S15.
  12. Patrick, R, Armstrong, F, Capon, A, Bowenm K, Lo, SN, & Thoms, A 2021, “Health promotion in the Anthropocene: the ecological determinants of health”, The Medical Journal of Australia, vol.214, no.8, Suppl, S22-S25.
  13. Sharma, M, Pinto, AD & Kumagai, AK 2018, “Teaching the social determinants of health: A path to equity or a road to nowhere?”, Academic Medicine, vol.93, no.1, pp25-30.