The Treasurer, Wayne Swan, is out and about, as you may have heard, talking up the benefits of a fair society, following his essay on this subject in The Monthly.

Remarkably, his essay did not explore how social and economic inequalities contribute to an unfair distribution of health – the fact that some Australians will have shorter, unhealthier lives than those who are more economically and socially privileged.

Earlier this week, Swan convened a Twitter chat with the theme #FairGo, but Catholic Health Australia had no luck in engaging him in these broader health issues, as per the tweets below.

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Meanwhile, Professor Fran Baum, a leading authority on the social determinants of health, suggests below that the Treasurer should acquaint himself with the economic and social benefits of taking action to reduce health inequalities.


Wayne Swan’s essay was on the right track but health inequities also need attention

Professor Fran Baum writes:

Treasurer Wayne Swan’s essay  on the threats to equity in Australian society is very welcome. For too long the issue of how fair we are as a society has been largely absence from national debate.

Swan rightly points to the growing economic inequities in Australia and particularly to the growth of the super rich. He could have extended his argument by considering the public health impacts of the inequities he describes. An increasing amount of public health research is telling us that the more unequal society is the less healthy it is.

The eminent researcher Sir Michael Marmot describes the “Status Syndrome” whereby our health is adversely affected when we have less status and control than other people. He shows that these issues of status really get under out skin and can reduce our life expectancy and increase our chances of getting sick.

Richard Wilkinson and Kate Pickett (in The Spirit Level) add to this picture of inequity being bad for our health with their analysis that shows that societies which distribute their income more equally are better off in a range of ways in including being more trusting, more mentally healthy and having higher life expectancy.

This is likely to be in part because more equal societies (such as Norway and Sweden) are those that spend more on social welfare and devise policies that aim to reduce inequities. The public health evidence is strong – egalitarian societies tend to be healthier.

A major public policy concern currently is the growth in the amount of money we spend on health care services and, as Treasurer, Wayne Swan would undoubtedly like to find ways of reducing this spending. In seeking to do this he would be well advised to follow through his arguments about equity to the health impacts of growing inequity.

Currently our national efforts to reduce chronic disease are focussed on persuading people to change their lifestyles without reference to the social and economic conditions that give rise to those lifestyles in the first place.

I spent three years from 2005-08 working as a Commissioner on the World Health Organization’s Commission on the Social Determinants of Health (CSDH) and this experience made it very clear that improving population health and reducing health inequities means dealing with the underlying social and economic conditions that create inequities.

The CSDH’s report was structured around three main concerns – improving the conditions of daily living, the need for redistribution of power and resources, and better means of measuring, understanding and educating about the social determinants of health equity. This report recognises the public health importance of chronic disease to health in rich countries like Australia and presents the evidence that shifts in the pattern of disease largely reflect the organisation of societies and the distribution of power.

The CSDH report says little about directly changing individual behaviours because it accepted the evidence showing such strategies are largely ineffective without significant structural change to support them.

Bringing Wayne Swan’s concern with growing inequities together with the national desire to reduce health care spending and need to reduce chronic disease leads to an argument for an explicit national strategy to reduce health inequities. This strategy would include the Closing the Gap strategy designed to increase Indigenous Australian’s life expectancy and also focus on the many health inequities resulting from differences in socio-economic status.

Life expectancy in Australia reflects a gradient whereby the higher up the social ladder a group is the better their health and the longer they live. The CSDH report suggests that any country that is serious about reducing health inequities needs a systematic approach to doing so which pays attention to the social determinants of health and has an approach which calls on all sectors to be accountable for their impact on health and health equity.

This approach – often called Health in All Policies – would, for instance, consider the health impacts of transport, education, housing, food supply, urban design, employment and communications policies. A focus on achieving health equity would also involve a national debate about levels of taxation.

The CSDH report called for fair taxation and in doing so presented taxation as a means by which societies can achieve the public good. This lens would present any tax on mining super profits as good for our collective health because it would reduce inequities (in itself good for health) and provide us with public funds to spend on improving health.

Thus I urge the Treasurer to extend his thinking to consider the health impacts of growing economic inequities and then to ways in which health equity can be increased.

Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from associated illness (including productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs). It will also have many social benefits including extending people’s lives and allowing them to live healthier and more productive lives.

 • Fran Baum is Professor of Public Health and Director of the Southgate Institute of Health, Society and Equity, and the South Australian Community Health Research Unit, at Flinders University.

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Peter Fray
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