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.
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.