Last night as frazzled journalists and departmental staffers filed out of the Department of Health and Ageing budget lock-up in the Hellenic Club at Woden, an eager crowd was gathering just across the hallway for an evening with someone billed as one of the “rock stars” of global health.

Sir Michael Marmot, a researcher and public health advocate from University College London, had a receptive audience for his entertaining, engaging account of his mission to persuade governments around the world to address health inequalities by acting on the social determinants of health.

Marmot and his call to “put health equity at the heart of all decision making” have attained such profile, in some quarters at least, that the Public Health Association of Australia dinner sold out on the first day of ticket sales. But you only had to look to the health budget lock-up over the hallway to realise just how far governments (and the media) have to come if there is to be truly “health in all policies”.

If it’s the other portfolios that are at least as important for our health, then what’s the point of a DoHA budget lock-up that confines the health debate to health services and health department spending? (Particularly when so much of the health budget had already been announced or leaked beforehand.

One of the budget measures with significant health implications for a group who are already likely to be disadvantaged in the health stakes is the cut in single parent benefits. ACOSS estimates this will affect 100,000 families and force many into poverty.

ACOSS says that people on Parenting Payments will be left about $60 a week poorer by being forced off their current payment ($324 a week) onto the lower paying Newstart Allowance ($265 per week) when their youngest child turns eight.

This will have significant implications for many children’s health, which — as Marmot’s reports for the WHO and UK government, have made clear, is a vital area for positive action to address health inequalities. Will this budget move increase the chances of some people having shorter, sicker lives?

While some critics see the social determinants of health agenda as part of some left-wing conspiracy, Marmot says some conservative politicians and governments have been supportive — while some on the other side of politics have been disappointing.

He singled out London’s mayor Boris Johnson as an example of a conservative leader who has been prepared to act on health inequalities.  We shouldn’t be fooled by Johnson’s buffoon act, says Marmot. “He’s very smart, very clever, he gets the intellectual ideas very quickly.”

On the other hand, Marmot made clear his disappointment in the Obama Administration. The US had actively tried to undermine the declaration from the World Conference on Social Determinants of Health last October. he said.

“We hoped if Obama were elected, things would change,” Marmot said. “It’s not as good as we would have liked.” He added that this lukewarm assessment was made “through clenched teeth”.

Marmot also said some of the barriers to action on health inequalities lie within the public health community itself. “I hate to say that some of our public health colleagues are the resistance, when they should be the allies,” he said. “A lot of colleagues in public health think the social determinants of health is not their business. They see it as about the welfare system.”

Marmot, who has previously met with Tanya Plibersek, before she became health minister, is scheduled to meet with DoHA secretary Jane Halton this morning. He is hoping for a receptive ear.

Given his performance last night — verging on stand-up comic in some parts — she had better watch she doesn’t provide fodder for his wicked mimicry of politicians and officials.

Meanwhile, Michael Moore, CEO of the PHAA, plans to skip the DoHA budget lock-up next year. He says: “The challenge for me is trying to understand all the factors that impact on public health that are beyond the Department of Health and Ageing.  Next year we will might have one of our staff in the Health lock-up but a priority for me will be to get into the main lock-up so that I can have a better overview of the range of issues impacting on health.”

Something for health journalists to consider as well? Or maybe DoHA could lock up a room of journalists to examine the health implications of the wider budget? Now that would be an interesting way to spend an evening.

Peter Fray

Save 50% on a year of Crikey and The Atlantic.

The US election is in a little over a month. It seems that there’s a ridiculous twist in the story, almost every day.

Luckily for new Crikey subscribers, we’ve teamed up with one of America’s best publications, The Atlantic for the election race. Subscribe now to make sense of it all, and you’ll get a year of Crikey (usually $199) and a year’s digital subscription to The Atlantic (usually $70AUD), BOTH for just $129.

Peter Fray
Editor-in-chief of Crikey

JOIN NOW