It’s the day on which many of us make resolutions to improve our individual health and well-being. But what resolutions should we be adopting to improve the well-being of our health system and our community?
In Croakey’s first post for the year, Jennifer Doggett proposes six resolutions that would improve our health system and promote a healthier, happier and fairer society in 2018.
Jennifer Doggett writes:
1. Lose weight
With obesity rates at record levels, it’s not surprising that losing weight is one of the most common New Year’s resolutions. Typically our 2018 weight loss goals are focused at the individual level but trimming the fat is just as important for our health system as it is for our waistlines. Excess spending, in areas of inefficiency, detracts from overall health system performance and reduces the funding available for areas of need.
There’s no point beating ourselves up about areas in which we have been over-spending. It’s easy for inefficiencies to grow slowly, but steadily, over time without realising that the ‘small’ increases each year to an inefficient program can result in billions of dollars wasted every year. For example, the Private Health Insurance rebate started at a relatively modest $1 billion subsidy in 1998/99 and now costs us around $11 billion per year.
However, the start of a new year is an optimum time to start reviewing all major areas of the health system to see where there is some excess fat that can be removed. This means looking at areas where spending is inefficient, cutting funding from inequitable or inefficient programs and redirecting this funding into areas which will deliver better outcomes. It also means addressing inefficient practices and programs and ensuing that our health workforce is being used to maximum advantage.
2. Spend more time with friends and family
It can seem easier in day-to-day life to focus on our individual goals and forget that our well-being depends, to a large extent, on the relationships we develop with friends, family and community – even (and perhaps especially) with those whose values, beliefs and experiences differ from our own.
Similarly, the success of our health system relies on the attention and effort paid to the relationships within it. Health systems are complex and involve the inter-relationship of many disparate components, such as governments, consumers, health care providers and private sector organisations. In order to achieve maximum outcomes these different stakeholders – all with their own separate goals, prejudices and cultures – need to work together collaboratively towards shared goals. This requires ongoing communication and genuine efforts on all sides to engage with their point of view of others.
Health Minister Greg Hunt (and before him Sussan Ley) made a considerable effort in 2017 to improve relationships with stakeholders and has worked hard to engage specific groups in negotiations around issues specific to their area of focus within the heath system. This has created a solid base of trust on which to build in 2018.
What is needed now is to move beyond ‘single issue’ collaboration towards a collaborative and consumer-centred approach to developing shared goals for the health system and the ongoing planning processes to ensure they are achieved.
This is particularly important if we are to successfully address the most urgent health challenges facing our community, such as reducing the health and life expectancy gap between Indigenous and non-Indigenous Australians.
A welcome resolution for 2018 would be for the Government to commit to a comprehensive consumer consultation process on the future of the Australian health system, including a genuine, respectful and comprehensive engagement with Indigenous communities.
A starting point for this could be the acceptance of the Uluru Statement, supported by many health groups and experts in recognition of the health impact of colonisation on the Indigenous Australians.
3. Get rid of clutter
The New Year is an ideal time to de-clutter our houses and assess whether all of our current possessions are meeting our needs. Similarly, it’s important to look around our health system and get rid of cultures, programs and practices which may have been useful once but which are no-longer serving our interests. That funding scheme or workplace practice may have been useful when first introduced but may now be the health system equivalent of a 1998 Nintendo 64, gathering dust in the back cupboard.
For example, private health insurance was a useful innovation in the 19thh century when it was introduced into colonial Australia as a way of sharing the cost of medical expenses between members of a guild or ‘friendly society’.
However, this form of health funding has not served our needs since the introduction of Medicare in 1983. It no longer provides us with equitable or efficient access to private health services and an ideal resolution for 2018 would be to finally get rid of this outmoded form of health financing and replace it with a system more suited to the needs and priorities of modern health consumers.
Other types of ‘de-cluttering’ of the health system that we could undertake this year would be to get rid of the unnecessary and hierarchical professional boundaries within medicine which restrict efficient practice and to say goodbye to any form of regulation that protects providers at the expense of consumers, such as restrictions on pharmacy ownership.
4. Spend money more wisely
Saving more and spending less are common goals for many of us at the beginning of a new year. These goals are also important for the health system. No matter how much we spend on health care, there will always be limits to the health budget and we therefore will need to make decisions as to where we allocate resources. To ensure maximum benefit, these resources should be directed to areas where they deliver best value.
Reducing spending on areas of inefficiency and increasing spending on areas of greater efficiency will increase the overall performance of our health system. For example, we know that addressing the social determinants of health would improve health status of disadvantaged people and increase health equity. Investing funding into these areas, such as housing, education and employment, would deliver health improvements and target some of the most fundamental causes of poor health, delivering benefits to all in the community.
A positive initial step would be for the Government to support the recommendations of the Senate Community Affairs Committee’s Inquiry into Australia’s Domestic Response to the WHO Report on the Social Determinants of Health.
5. Get organised
Improving the organisation of our complex health system would be another useful resolution for 2018.
While individually most areas of our health system work well, they often fall down when they attempt to interact. This is a major problem for consumers, particularly those with chronic and complex conditions who typically require care from more than one area of the health system at once. Poor organisation across the health system also impacts negatively on health outcomes and reduces overall efficiency.
Areas with the greatest potential to benefit consumers are the interface between the hospital and primary/community care sector and the interface(s) between mental health, disability care and mainstream health services.
This resolution would assist in meeting the physical health needs of people with mental illnesses and disabilities who currently experience poorer health outcomes than the general population, even for conditions unrelated to their mental illness and disability.
A report from the Royal Australasian College of Psychiatrists outlines a number of areas in which coordination of care across the mental health, medical and community care systems could be improved in order to reduce the current life expectancy gap between people with mental illnesses and the general community.
6. Be more environmentally responsible
The health of our community depends on the health of our planet in many and varied ways. The health threats of global warming and environmental degradation are among the most significant threats to our future health and well-being. While sometimes these are dismissed as long-term problems, there is good evidence that effects of these changes are already impacting on our health in a number of ways.
For example, extreme heat waves are already killing people in Australia – the 2009 heatwave was responsible for 370 deaths. One government report has found that heatwaves have killed more Australians than any other natural hazard and have caused more deaths since 1890 than bushfires, cyclones, earthquakes, floods and severe storms combined. The increased incidence and severity of heatwaves from global warming could contribute to several thousand additional deaths nationwide by 2050
Other health threats related to climate change include increased spread of infectious diseases, food insecurity, loss of housing due to extreme weather events and higher levels of air pollution.
Adopting the recommendations of the Framework for a National Strategy on Climate, Health and Well-being, produced by the Climate and Health Alliance would provide a comprehensive approach to preparing Australia to meet the challenges of global warming and climate change, while also reducing our contribution to these threats.
This framework outlines the key actions that must be taken at the federal, state/territory and local level to achieve the vision of “a fair and environmentally sustainable national policy framework that recognises, manages and addresses the health risks of climate change and promotes health through climate change action.”
As most of us know, making New Year’s resolutions is easy – it’s keeping them that is the challenge. At an individual level, we can struggle to maintain our resolve to implement new practices and easily fall back into old habits.
However, at the community level we have the benefit of the accountability and support that comes with sharing a common goal.
By working together to set and implement health system resolutions for 2018, we have a much better chance of achieving our goals and ending the year with a better health system for our future.