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.
It 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 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