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Prognosis negative as election health debate stagnates



As I think about the critical health issues that should be dominating policy and public debate as we approach the federal election, a photograph from Canada keeps recurring in my mind's eye.

HiAP truck rides in to fight fire. Chris Johnston cartoonIt was taken by photojournalist Mark Blinch on 7 May, and shows a huge storm of fire and dark smoke billowing behind a solitary vehicle on the highway near Fort McMurray, Alberta.

The apocalyptic image speaks powerfully to the vulnerability of humanity as extreme weather events become ever more common — as people now are experiencing right around the globe, from Paris to Texas to Tasmania, among other places.

It also encapsulates why so much of our public dialogue around health and health policy — particularly during elections — is deeply unhealthy, undermining the likelihood of current and future generations experiencing good health.

When politicians and journalists speak about 'health' in an election context, they invariably are referring to healthcare, and usually hospitals at that.

However, the health of individuals and communities is the result of many factors, of which access to healthcare is just one determinant. When we focus so much on healthcare, we limit the possibilities for addressing some of those wider determinants.

Evidence suggests that healthcare services contribute somewhere around 20 per cent to overall health, while broader social and economic factors account for most of the rest, according to Professor Fran Baum, Director of the Southgate Institute of Health, Society and Equity at Flinders University.

She made this observation in the context of a recent submission urging the Medical Research Future Fund to take a broader focus in funding research than the fund's name suggests is likely. The submission highlights the importance to health of factors such as income and wealth distribution and the extent of publicly provided health, education and welfare services. 


 "I'd vote ONE for a party promising to appoint a minister with the power to work across portfolios, ensuring that the health impacts of wider policies are routinely assessed."


Baum states: 'While it seems that finding cures for diseases would make the biggest contribution to promoting health, this isn't the case. Introducing preventive measures which make small changes in the non-medical risk across a whole population is much more effective at creating a healthier population.'

Meanwhile, climate change — the defining issue for public health this century, according to the World Health Organization's outgoing director general Dr Margaret Chan — barely figures in election health debate. Perhaps this is not surprising, given how little health policy work has been done in this area.

Fiona Armstrong, executive cirector of the Climate and Health Alliance, says: 'In places like the United States there is longterm and detailed plans and preparation underway to support the health care sector and protect people's health from the adverse effects of climate change. Yet in Australia there is a significant lack of policy direction and leadership from most political parties.'

Over at Croakey.org, the social journalism project for health of which I am founding editor, we have been running a hashtag project — #healthelection16 — to try and inject some of these wider health considerations into election debate. Early in the campaign, I nominated my five priorities for #healthelection16 as: climate change; human rights; healthy, safe environments; action on the social determinants of health; and equitable access to healthcare, particularly primary healthcare. Addressing these five priorities has the potential to help reduce health inequities, especially for Aboriginal and Torres Strait Islander people.

At last count, more than 2500 participants have engaged in #healthelection16. But this is like a pimple on an elephant compared to what is needed to recast our health narratives, so that they promote rather than undermine community health. Turning the ship around is a monumental effort given all the structures and systems and careers invested in the status quo. One way forward would be for government structures to empower health in all policies (HiAP) approaches. WHO has some suggestions for how to do this.

Personally, I'd vote ONE for a party promising to appoint a HiAP minister with the power to work across portfolios, ensuring that the health impacts of wider policies are routinely assessed and incorporated into decision-making processes. The ministers for Health Care and for Population Health would report to this minister. The HiAP minister might take up John Hewson's recent suggestion to introduce health equity assessments, to assess whether policies are likely to exacerbate health disparities. Applying this lens to policy — in health and other portfolios — would likely produce some very different policy debates to those we now endure.

None of this is to say that equitable access to safe, quality healthcare is not important. Of course it is, and cuts since the 2013 election have been destructive at so many levels. The respective parties should be judged on their healthcare histories as much as their election promises. But we are all, metaphorically, in that photo from Canada, looking very vulnerable in the face of looming disasters.

On 20 June, the Climate and Health Alliance plans to release a scorecard of the political parties' commitment to issues such as the creation of a national climate and health strategy (yes, believe it or not, we don't have one), greenhouse gas emissions reduction targets, phasing out of coal and unconventional gas mining, and a national moratorium of new mines. 

We should read the scorecard closely.


Melissa SweetMelissa Sweet is the founding editor of Croakey.org, a public health journalist, and a PhD candidate at the University of Canberra. Follow her on Twitter @croakeyblog

Original artwork by Chris Johnston

Topic tags: Melissa Sweet, climate change, health



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Existing comments

Another factor in healthcare will be internet speeds, or lack of speed, enabling expert diagnosis from a long way away from the patient. Not to downgrade any of the factors you've mentioned, Melissa.

Jim Jones | 10 June 2016  

I also think 'climate change is the defining issue for public health this century', as stated by the World Health Organisation's outgoing director general Dr Margaret Chan. The Coalition have a low 20% Renewable Energy Target by 2030, compared with Labor's 50% RET by 2030, and the Greens 90% RET by 2030. The Greens are the only one of these parties that don't support the opening up of new coal mines. Climate change action should be the major election issue, not just on health grounds but on very survival grounds. We're currently heading for a 4 degree Celsius hotter world. Temperatures in India recently reached 55 degrees Celsius, causing the grave-diggers there to be very busy. If you want your grand-children to have a liveable planet, I suggest you put the Greens first this election and Labor second. A Labor/Green/ Independent alliance is our only hope of playing our part in helping the world community to have a liveable planet. Even the Greens won't be able to save the Great Barrier Reef now, but could help save Planet Earth. Coalition and Labor politicians are prepared to sacrifice a habitable planet for the sake of donations from the fossil fuel industry.

Grant Allen | 12 June 2016  

An excellent wakeup call Melissa. As a recent retiree ,due in part to health issues stemming from my Vietnam Service, I am very conscious of my excessive smoking and alcohol consumption during my service, causing me health issues now.. We were not aware of the consequences in the early 1970's of smoking and alcohol , both huge issues at the time ( I was an Army Medic). Today we do know that these, plus poor diet, fast foods and sugary drinks cause widespread obesity and other health issues, yet nothing is being heard from our political leadership. More effective reventative educational programs to inform the population, particularly young people, of the risks is required , yet all we hear is the need for more and more hospital services being required to treat the outcomes of this preventable lifestyle. I agree with Jim Jones that a proper NBN is required for better diagnosis . I would hope too that more funds are devoted to preventative education to counter the very pervasive sell of the vested interests in the food processing industry- maybe a TAX on fast foods and sugar as well as more effective taxes on alcohol beverages by alcoholic content.... BUT I'll not be holding my breath!

Gavin | 14 June 2016  

Yes, first time the relevance of the other portfoloios to health matters has been clearly enunciated, to my knowledge. Good on you, Melissa Sweet!

Johanna Blows | 14 June 2016  

A much neglected aspect of health, at least in mainstream medicine is the role mind plays in determining health outcomes. It is well known that the 'placebo effect' can bring about dramatic results, and even the confidence a patient has in their doctor can improve outcomes. A well founded belief in a Personal God has long been a foundation for a mind to avail itself of the latent powers within it. Since Science has indicated that God acts only through constant and universal causes, belief in the Personal God has required a rethink. It can be accepted that God does not intervene in human affairs by suspending or negating the laws of 'nature', by thinking of God as 'Super-Personal'; providing an abundance of measures for us to respond, each according to their degree of development and personality, as illustrated by the 'Serenity Prayer'. Some things we can change; others we must accept; hopefully being able to distinguish between the two. Unfortunately many religions, intent on maintaining their erroneous claims to exclusive relationships with God, ignore this; resulting in the decline in true religious beliefs, allowing the 'false-gods' like Mammon, pleasure, power and fame, to bring us so much grief.

Robert Liddy | 14 June 2016  

no one has made much of the numerous businesses great and small which stand on the sale and encouragement to further consumption of every sort of health destroying product or activity. Research and stats on details would be useful projects for Health journalism.

Jillian | 16 June 2016  

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