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    Liz Callaghan

    “Let’s talk about health inequity, not just waiting lists”.

    While people around the country continue to focus on waiting lists in any discussion of health care in Australia, Catholic Health Australia says this morning’s report from the COAG Reform Council reveals – once again – the great injustice of health inequity continues to grow in this country.

    “The report Healthcare 2011–12: Comparing performance across Australia found its way into today’s newspapers with the usual fascination with waiting list times leading the story,” Catholic Health Australia CEO Martin Laverty said. “It is important that people receive health care in a timely fashion, but it would be great if people around the country were as interested in the reality that people living in different parts of Australia, or from different cultural or socioeconomic backgrounds, are seeing their health suffer. In fact, it’s those most disadvantaged Australians who are further impacted as they are left to languish on the longest waiting lists.

    “The Senate Inquiry report recommending a path forward for action on the social determinants of health was issued 65 days ago. It is sitting on politicians’ desks gathering dust, rather than being followed.”

    Mr Laverty said COAG Reform Council chair John Brumby quite succinctly summed up the current disparity facing the country.

    In a letter to the Prime Minister Julia Gillard, Mr Brumby said Australians “continue to experience health inequalities based on who they are, how much they earn and where they live. We do not see consistently strong performance across all states and territories in key areas of hospital care and continue to find that there are health inequalities for Indigenous Australians”.

    Said Mr Laverty: “We hold out hope – albeit not great hope – that this might be the report that flips the switch in the minds of our politicians and makes them realise that they can’t ignore the overwhelming evidence forever.”

    Among findings in today’s report were:
    • smoking rates increased with socioeconomic disadvantage inside and outside major cities;
    • whether an adult is likely to engage in behaviours that affect health outcomes varies depending on where they live;
    • two out of three adults outside a major city were overweight or obese across all areas of socioeconomic disadvantage. In major cities, around two-thirds of adults in the most disadvantaged areas were overweight or obese;
    • Those in the least disadvantaged areas were more likely to drink alcohol at levels that put them at risk of long-term harm;
    • People living in the most socioeconomically disadvantaged areas were more than twice as likely to experience very high levels of psychological distress.
    • The rate of potentially preventable hospitalisations for chronic conditions is highest for the most disadvantaged areas.

    “This is hardly the first report to present these stark realities, and we fear it won’t be the last. It certainly won’t be the last if governments – particularly the Commonwealth – don’t take this issue seriously,” Mr Laverty said.

    “The social determinants agenda should be one that transcends politics, with something in it that should appeal to all of the major parties. In an election year, we’ll be asking hard questions of Labor, the Coalitions and the Greens, seeking their solution to unacceptable levels of health inequity.”

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    It is tempting, and relatively easy, to talk about inequalities and inequities in health with reference to factors such as geographic location and socioeconomic status. However, there are other important social determinants which play important roles, both individually and in combination with other influences. Gender and occupation would be the ones which spring immediately to mind as having significant impacts on health-related attitudes, beliefs and behaviour (and noting that the national women’s and male health policies seem to exist primarily in name only).
    This is not to deny that many of the options which impact on health outcomes are limited by easily-measurable factors such as where we live and SES. However, commercial marketers have long understood that what defines us in terms of behavioural determinants are not necessarily the crude factors such as age, education, or SES but are things like identity, goals, risk acceptance, and aspirational values. Being able to tap into these, by understanding what people want from their lives and what they (rather than the ‘health lobby’) see as problems, is what influences decisions. There is tremendous merit in addressing the classic SoDH, but I am not persuaded that Australia’s health problems, such as those related to smoking, alcohol abuse and obesity, would disappear if everyone had a tertiary education, a nice house, and a $200 000 annual salary.

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    Karen Warner posting on behalf of AML Alliance CEO, Claire Austin

    The COAG report, Healthcare 2011-12: Comparing performance across Australia confirms the investment that needs to be channelled into the primary health care sector through Medicare Locals if further improvements are to be realised in the health outcomes of all Australians.
    The report, which showed a 7.3% reduction in potentially preventable hospital admissions over the past four years, highlights the purpose of Medicare Locals, Australia’s primary health care organisations, which are working now to keep people well and out of hospital.
    Hospital care is the most expensive care to deliver in this country and most people with chronic diseases and complex conditions should be, and will be, increasingly managed through frontline team-based care at the community level through Medicare Locals.
    It is unacceptable that the proportion of people who felt they waited an ‘unacceptable time’ to see a GP increased to 27.4% from 17.8% over a four year period.
    Improvements in after hours care and access to GPs is happening now with Medicare Locals working systematically in 61 catchment areas to identify where there are gaps in after hours services and where services need to be adjusted to meet local community needs.
    With Australia’s ageing population and the increasing proportion of adults who are either overweight (35%) or obese (28%), the acute care sector cannot be expected to cope with this onslaught of increasing chronic disease, in terms of patient numbers and cost to the system.
    Medicare Locals have been set up to take this load away from the hospital sector to effectively free it up for the acute care episodes that need intensive treatment.
    Managing the treatments, care plans and prevention programs for chronic diseases like diabetes, heart disease, smoking cessation programs and asthma for example, are better dealt with through coordinating organisations like Medicare Locals.
    AML Alliance, the peak primary health care body for the 61 Medicare Locals, is working to strengthen and support its members to deliver the integrated care at the frontline, locally.


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