29 June 2015

Media Release

Response to Government’s White Paper – Delivering Safe and Sustainable Clinical Services

While we agree that there is much work to be done in reforming clinical services, a healthy population can best be achieved by looking beyond health care, focusing on prevention, acting on the underlying causes of poor health and working with sectors outside of health.

The Social Determinants of Health Advocacy Network (SDoHAN) acknowledges that access to safe, quality, timely and appropriate health care is important but this must not come at the expense of recognising the long-term gains that can be made by investing in prevention. If the Government doesn’t recognise prevention as a central goal, the sustainability of its clinical services will be undermined.

In Tasmania there is a preoccupation with hospitals, not health. Focusing more on preventive and population health can reduce the frustration that many doctors feel in being unable to address the underlying cause of many of the health problems they encounter among their patients.

Members of the Social Determinants of Health Advocacy Network (SDoHAN) work together to achieve effective action on the social determinants of health in Tasmania. We believe that all Tasmanians should have the opportunity to live a healthy life regardless of their income, education, employment, gender, sexuality, capabilities, cultural background, who they are or where they live.

We take a keen interest in both strategic and local level initiatives to improve the health of Tasmanians.

We are disappointed that the Government has chosen to make the development of its strategic plan for preventive health in Tasmania a secondary priority and has not devised a more comprehensive strategy that integrates preventative health at all levels of the system.

We are also concerned about whether the Government has any plans to undertake broad stakeholder engagement or consultation in the development of its preventive health plan.

We offer the advice below to Government on how to make Tasmania the healthiest population in Australia by 2025.

Social Determinants of Health Advocacy Network 2015
Supporting Tasmanians to be the healthiest population in Australia

Whatever your preferred choice of words, one thing is clear –
Health starts long before illness - it starts in our everyday lives
Research shows that the houses we live in, the transport we are able to access, the job we have or don’t have, the social support we have around us and how much money we’ve got, have as much impact on our health and wellbeing as our genes and behaviours.

What is also clear is that not everyone in Tasmania has the same opportunity to be healthy. This isn’t fair. All Tasmanians should be able to make the choices that allow them to live a healthy life, regardless of their income, where they live, social position, education, gender, abilities or cultural background.  

It is time we expand the way we think about health and start where health starts, not just where it ends. In Tasmania there is a preoccupation with hospitals, not health. Hospitals should be a last resort not the first.1 It’s time to rethink health and include how to keep it, not just how to get it back.

The Social Determinants of Health Advocacy Network (SDoHAN) calls for action on the following priority areas to help Tasmanians become the healthiest population.

Action #1: Prioritise the early years
The early childhood period (0-6 years) is considered to be the most important developmental phase throughout the lifespan. Healthy early child development strongly influences obesity, mental health, heart disease, competence in literacy and numeracy, and economic participation throughout life. Investment in early childhood development will pay for itself many times over.2
In Tasmania we must do everything we can to give all children the best start in life. We can do this by strengthening families and communities, providing comprehensive support to families for the perinatal to three year period, building our public education system, strengthening our aspirations for lifelong learning, and reaching out to those who are at risk of falling behind.

Action #2: Build a strong primary health system  
The evidence is clear: health systems oriented towards primary health achieve better health outcomes for a lower overall cost than systems focused on specialist or tertiary care. The international trend is to move away from hospital care towards more community-based care.1 Primary health works with people in the community throughout their life course and is concerned with action on the social determinants of health and a preventive approach. It uses local approaches and multidisciplinary teams. In Tasmania we need to strengthen our regionally based community health centres and ensure that they operate within a comprehensive primary health care framework.

Action #3: Establish a government unit that works towards ‘Health for All Tasmanians’

We call on the Government to make ‘Health for All Tasmanians’ a central goal. Giving all Tasmanians the same opportunity to be healthy requires leadership and engagement across the community. 
A social determinants approach recognises that action outside of the health system is required to establish the conditions that promote good health and wellbeing and reduce our dependence on hospitals and health care services. We need to get different sectors working together towards this common purpose.
A sustainable government unit whose job it is to provide leadership in this area is urgently needed. Such a unit would undertake planning, build capacity and develop policies and programs that would give all Tasmanians the opportunity to be healthy (i.e. working towards health equity). This unit would ensure that the goal of Tasmanians being the healthiest Australians is prioritised across all public policy.

Action #4: Embed a social determinants of health approach throughout the health system
The work of the Tasmanian health system should be driven by a desire to give all Tasmanians the best opportunity to be healthy.
Every day our hospitals and health care providers see patients with complex health needs that arise from a combination of biological, psychological, social, economic and environmental factors. Many of these patients are on a treadmill of treatment – presenting again and again to emergency departments or other parts of the health care system with the same or related problems – and costing millions of dollars. It is time to ‘break the cycle’ by moving beyond an ineffective ‘fix them up and move them on’ model to a more comprehensive integrated model of care that recognises the broader determinants of health.4
Such a model would involve supporting patients along their journey through the health care system and beyond, proactively engaging services and supports along the way. It would involve identifying the underlying reasons for poor health (such as inadequate housing, family violence, poor education, unemployment, poor literacy, addiction and mental health problems) and setting people up for success by building ongoing treatment pathways that extend beyond traditional boundaries of health care and place people at the centre of their care.

References: 1. Doggett, J, 2007, ‘A new approach to primary care for Australia’, Centre for Policy Development; 2. WHO, Child Development, http://www.who.int/topics/child_development/en/; 3. Bassett, MT, 2006, ‘Health for All in the 21st Century, AJPH,96(12):2089; 4. Health Leads: https://healthleadsusa.org.

17 June 2015

Information to share

1. Hothouse on Education
Visit: http://thehothouse.net.au/the-ideas/ for the ideas that came out of The Hothouse on Education. If you didn’t get to the forum last week and would like to hear more about it visit: ABC Radio National's Life Matters: http://abc.net.au/rn/lifematters

2. Arts Health Tasmanian Network
Networking gatherings are held currently in the South but will be extended to other areas of the state in the near future.
Next Hobart Meeting will be (please note change of date)

DATE- Tuesday 21st July at 9.30-11.30.
VENUE - Hobart City Council Lower Ground Floor Conference Room off Elizabeth Street,
GUEST PRESENTER - Associate Professor Ashley Lucas, Director of the Prison Creative Arts Project, (PCAP) Theatre & Drama Department , University of Michigan. For more information about the great work of PCAP visit the websites below.

There will be opportunities for networking and sharing information. Please RSVP jacquie.maginnis@dhhs.tas.gov.au

3. Achieving gender equality to reduce intimate partner violence against women
Kathryn L Falb, Jeannie Annan, Jhumka Gupta

The Lancet Global Health, 2015, 3(6);e302-e303
Published online: June 2015

This year marks 20 years since 189 countries signed the Beijing Declaration and Platform for Action and committed to prioritisation of women’s empowerment and gender equality. Yet a recently released UN analysis1 shows that violence against women persists at “alarmingly high levels”. Worldwide, one in three women reports sexual or physical violence from a male partner at some point in their lifetime, and such experiences have been linked with harmful effects on health, including maternal morbidity, poor mental health, and vulnerability to HIV/AIDS.2 The UN report also contends that progress towards gender equality has been slow.1 Effective and scalable interventions to reduce intimate partner violence remain scarce, and questions remain about what drives individual violence and why prevalence differs across settings and countries. Lori Heise and Andreas Kotsadam’s study in The Lancet Global Health, is thus very timely, and is a major advance in the understanding of worldwide intimate partner violence. This analysis of data from 44 countries suggests that gender inequality at the macro-level (ie, country-level) serves as a key driver in women’s individual risk of violence and provides insight into why prevalence of intimate partner violence varies across countries…

How to obtain this article click here.

4. Association between gender inequality index and child mortality rates: a cross-national study of 138 countries
Ethel Mary Brinda1, Anto P Rajkumar and Ulrika Enemark
Gender inequality weakens maternal health and harms children through many direct and indirect pathways. Allied biological disadvantage and psychosocial adversities challenge the survival of children of both genders. United Nations Development Programme (UNDP) has recently developed a Gender Inequality Index to measure the multidimensional nature of gender inequality. The global impact of Gender Inequality Index on the child mortality rates remains uncertain.
We employed an ecological study to investigate the association between child mortality rates and Gender Inequality Indices of 138 countries for which UNDP has published the Gender Inequality Index. Data on child mortality rates and on potential confounders, such as, per capita gross domestic product and immunization coverage, were obtained from the official World Health Organization and World Bank sources. We employed multivariate non-parametric robust regression models to study the relationship between these variables.
Women in low and middle income countries (LMICs) suffer significantly more gender inequality (p < 0.001). Gender Inequality Index (GII) was positively associated with neonatal (β = 53.85; 95% CI 41.61-64.09), infant (β = 70.28; 95% CI 51.93-88.64) and under five mortality rates (β = 68.14; 95% CI 49.71-86.58), after adjusting for the effects of potential confounders (p < 0.001).
We have documented statistically significant positive associations between GII and child mortality rates. Our results suggest that the initiatives to curtail child mortality rates should extend beyond medical interventions and should prioritize women’s rights and autonomy. We discuss major pathways connecting gender inequality and child mortality. We present the socio-economic problems, which sustain higher gender inequality and child mortality in LMICs. We further discuss the potential solutions pertinent to LMICs. Dissipating gender barriers and focusing on social well-being of women may augment the survival of children of both genders.

5. The policy process for health promotion
Erik Söderberg and Ewa Wikström
Scand J Public Health first published on May 21, 2015

6. A Road to Home: The Right to Housing in Canada and Around the World: http://digitalcommons.osgoode.yorku.ca/jlsp/

7. Education Improves Public Health and Promotes Health Equity
Robert A. Hahn; Benedict I. Truman

International Journal of Health Services, 0(0) 1–22
SAGE Journals
Published online: 19 May 2015

This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health – an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits.

How to obtain this article click here. (Let me know if you want to access this article but are unable via the link)

8. State of inequality: reproductive, maternal, newborn and child health
The World Health Organization.

Published online: May 2015

The health of the world’s population is in a state of inequality. That is to say, there are vastly different stories to tell about a person’s health depending on where they live, their level of education, and whether they are rich or poor, etc. Monitoring the state of inequality in health takes into account the current experiences of population subgroups, as well as the trends of how health experiences in these subgroups have changed over time. This 2015 report demonstrates best practices in reporting the results of health inequality monitoring, and introduces innovative ways for audiences to explore inequality data.  Interactive data visualization components – including story-points, equity country profiles, maps and reference tables – accompany the key messages and findings of this report, allowing users to customize data displays and engage in benchmarking according to their interests. A series of feature stories indicated that inequalities in reproductive, maternal, newborn and child health persist, despite having narrowed over the past decade. There is still much progress to be made in reducing inequalities in reproductive, maternal, newborn and child health through equity-oriented policies, programmes and practices. Though the report draws on data about reproductive, maternal, newborn and child health in low- and middle-income countries, the approach and underlying concepts can be widely applied to any health topic.

Access the full report click here.
Interactive visuals click here.

9. St. Michael’s Hospital health team offers prescription for poverty

10. This is Our Community is a bisexual anti-stigma campaign by Rainbow Health Ontario and the Researching for LGBTQ Health team. http://www.rainbowhealthontario.ca/bisexual-health/

11. eLearning - The Health inequality monitoring eLearning module
The World Health Organization
Released online: May 2015

The Health inequality monitoring eLearning module is an overview of health inequality monitoring, aiming to build theoretical and technical capacity for health inequality monitoring across diverse settings and health topics. This module introduces and explores the five general steps of monitoring as they pertain to health inequality monitoring: selecting health indicators and equity stratifiers, obtaining data, analysing data, reporting results and implementing changes. A comprehensive applied example of health inequality monitoring in the Philippines demonstrates how the concepts can be applied in the context of low- and middle-income countries. This module is presented in eight chapters, which are each followed by a number of quiz questions and an application exercise. In each chapter, additional information and examples are available to facilitate a more-thorough understanding of the material. The entire module takes approximately four hours to complete, and is not timed.

Chapter 1: Introduction
Chapter 2: Health indicators and equity stratifiers
Chapter 3: Data sources
Chapter 4: Simple measures
Chapter 5: Complex measures
Chapter 6: Reporting inequalities I
Chapter 7: Reporting inequalities II
Chapter 8: Cumulative example

Note: This eLearning module is available in a standard format (with audio), suitable for users with access to broadband internet, as well as in a no-audio, low-bandwidth format.

How to access the eLearning platform click here.

12. The State of Food Insecurity in the World 2015: http://www.fao.org/hunger/en/

14. Social determinants of health, inequality and social inclusion among people with disabilities
OBJECTIVE: to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life.

METHOD: qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action.

RESULTS: the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation.

CONCLUSION: there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.

Access this article in English

03 June 2015

Two opportunities

1. Come and meet Tasmania’s new Commissioner for Children and join him for a conversation about the social determinants of health

Wednesday 17 June 2015

Hobart Youth Arts & Recreation Centre
44 Collins Street, Hobart

Free – all welcome
RSVP (by 15 June) & enquiries:

Social Determinants of Health Advocacy Network

Mark has worked for much of his career in the area of children and young people's services and policy development.  He is a committed advocate for young people's rights. Having commenced his five year term in October 2014, Mark will focus on the rights and interests of children, and the laws, policies and programs that impact on them.

Mark has had extensive experience in issues facing children and young people, having worked with children from all types of backgrounds, including undertaking significant work with vulnerable children.  He has practical expertise in child protection, child development, juvenile justice, children's services, child care, disabilities, and early intervention and prevention services.  Mark has been a strong advocate for the importance of the social determinants of health and wellbeing as a critical factor and consideration, in the development of policy and service delivery.

2. The Hothouse on Education – some of us involved in this network were part of Dark Mofo’s Hothouse this week.

Next Thursday 11 June there is a forum in Hobart where they will present the ideas that were developed. Everyone is welcome and it’s free. We encourage you to come along if you can. http://thehothouse.net.au/the-forum/