Joint COSS submission to the Senate on Social Determinants of ...

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Joint COSS submission to the Senate on Social Determinants of ...

Councils of Social Service (ong>COSSong>)Submission ong>toong> ong>theong> ong>Senateong>Standing Committee onCommunity AffairsAustralia’s domestic response ong>toong> ong>theong>WHO Commission on SocialDeterminants of Health report “Closingong>theong> gap within a generation”Ocong>toong>ber 2012Council of Social Service of NSW (Nong>COSSong>)66 Albion Street, Surry Hills 2010Ph: 02 9211 2599 Fax: 9281 1968 email: solange@ncoss.org.au


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportPrepared by ong>theong> NSW Council of Social Service (Nong>COSSong>) on behalf of: ACT Council of Social Service (ACTong>COSSong>) :Australian Council of Social Service (Aong>COSSong>);Norong>theong>rn Terriong>toong>ry Council of Social Service (NTong>COSSong>)Council of Social Service of NSW (Nong>COSSong>);Queensland Council of Social Service (Qong>COSSong>)South Australian Council of Social Service (SAong>COSSong>);Tasmanian Council of Social Service (Tasong>COSSong>);Vicong>toong>rian Council of Social Service (Vong>COSSong>); andWestern Australia Council of Social Service (WAong>COSSong>).For furong>theong>r information or ong>toong> discuss this ong>submissionong>, please contact:Solange Frost, Senior Policy Officer, NSW Council of Social Service (Nong>COSSong>) onphone: +61 2 9211 2599 or email: solange@ncoss.org.auAbout ong>theong> Councils of Social Service (ong>COSSong>)The Councils of Social Service (ong>COSSong>) are ong>theong> peak bodies representing ong>theong> non-profitsocial and community service secong>toong>r and ong>theong> needs of low-income and disadvantagedpeople. There is a Council in each state and terriong>toong>ry and nationally across Australia.Our members comprise community secong>toong>r organisations, professional associations andadvocacy organisations. We work with our members, clients, ong>theong> non-profit secong>toong>r,governments, departments and oong>theong>r relevant agencies on current and emerging social,systemic and operational issues. Collectively, ong>theong> Councils form ong>theong> ong>COSSong> Network.ong>COSSong> Network approach ong>toong> health policyThe ong>COSSong> Network has long called for a health system that promotes positive healthoutcomes for all people in Australia, regardless of ong>theong>ir social or economic situation. Weadvocate against systemic barriers in ong>theong> health system that lead ong>toong> people havingpoorer health, and we work ong>toong>wards equitable access ong>toong> income, education, securehousing and employment as key social facong>toong>rs that correlate with health outcomes.As ong>theong> peak bodies for non‐government social and community services, we are alsoinformed by a membership that is engaged in ong>theong> full spectrum of ong>theong> health system:from providing primary health services, ong>toong> focusing on ong>theong> social determinants of health,ong>toong> voicing ong>theong> experience and needs of consumers. The ong>COSSong> Network brings ong>theong>sediverse perspectives ong>toong> our uniquely national focus on health policy as we work ong>toong>ensure that people from disadvantaged backgrounds have access ong>toong> ong>theong> besong>theong>althcare, and that this is a priority in any reform process.Council of Social Service of NSW (Nong>COSSong>) Page 3 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportIntroductionThe ong>COSSong> Network welcomes ong>theong> opportunity ong>toong> make a ong>submissionong> ong>toong> ong>theong> ong>Senateong>Committee’s Inquiry inong>toong> Australia's domestic response ong>toong> ong>theong> World HealthOrganisation's (WHO) Commission on Social Determinants of Health report "Closing ong>theong>gap within a generation.A healthy population is a key requirement for a fairer, more inclusive and sustainableAustralia. The ong>COSSong> Network’s shared approach ong>toong> health equity and our policypriorities is outlined in ong>theong> position paper, ong>COSSong> Health Priorities: Equity in access,equity in outcomes (attached).We believe Australia requires an approach ong>toong> health that starts where health starts, notjust where it ends. Socially, economically and environmentally responsible public policyand action by government, community and private secong>toong>rs underpins our health andwell-being. Reducing poverty and inequality so that all individuals and communities canparticipate in and benefit from social and economic life improves health and wellbeingfor everyone.Our ong>submissionong> is structured around each of ong>theong> Inquiry Terms of Reference.Specifically, it addresses ong>theong> Government's response ong>toong> oong>theong>r relevant WHO reportsand declarations; impacts of ong>theong> Government's response; extent ong>toong> which ong>theong>Commonwealth is adopting a social determinants of health approach; and ong>theong> scope forimproving awareness of social determinants of health.Comments on Australia's domestic response ong>toong> ong>theong> World HealthOrganization's (WHO) Commission on Social Determinants of Healthreport, Closing ong>theong> gap within a generation, including ong>theong>:(a) Government's response ong>toong> oong>theong>r relevant WHO reports and declarations;Rio Declaration 2011The ong>COSSong> Network believes ong>theong> Commonwealth Government must formally respond ong>toong>ong>theong> World Health Organisation’s Rio Political Declaration on Social Determinants ofHealth 2011 1 ong>toong> close ong>theong> health equity gap. We need ong>toong> move beyond recognition ofong>theong> social determinants ong>toong> concerted, systemic action in ong>theong> key areas that are critical ong>toong>addressing health inequities.The Government should formally identify how it currently is or how it will implement ong>theong>actions pledged in ong>theong> Rio Declaration ong>toong> adopt better governance for health anddevelopment; promote participation in policy-making and implementation; furong>theong>rreorient ong>theong> health secong>toong>r ong>toong>wards reducing health inequities; strengong>theong>n globalgovernance and collaboration; and moniong>toong>r progress and increase accountability.1 http://www.who.int/sdhconference/declaration/Rio_political_declaration.pdfCouncil of Social Service of NSW (Nong>COSSong>) Page 7 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportWe believe that progress on ong>theong> Government’s response ong>toong> ong>theong> Rio Declaration andoong>theong>r WHO reports should be independently moniong>toong>red and publicly reported ong>toong> increaseaccountability. This would also provide greater visibility and raise awareness of ong>theong>social determinants across government, oong>theong>r secong>toong>rs, and ong>theong> community.Recommendation:The Commonwealth Government formally responds ong>toong> ong>theong> 2011 Rio Declaration andidentifies how it is or how it plans ong>toong> implement ong>theong> actions ong>toong> address health inequities.There is independent moniong>toong>ring and reporting on ong>theong> Government’s progress on ong>theong>Rio Declaration and oong>theong>r relevant WHO reports.Adelaide Statement on Health in All Policies 2010To improve governance for health and development in-line with ong>theong> Rio Declaration, ong>theong>ong>COSSong> Network recommends that ong>theong> Government implements a Health in All Policies(HiAP) approach. Australian governments at all levels need ong>toong> move beyond recognitionof ong>theong> social determinants of health ong>toong> more concerted systemic and sustained action ong>toong>address ong>theong>m.HiAP was formally recognised in ong>theong> Adelaide Statement on Health in All Policies 2010. 2It outlines a systemic approach ong>toong> achieve joined-up working across government andoong>theong>r secong>toong>rs ong>toong> produce coordinated public policy and integrated responses on healthdeterminants. It recognises that ong>theong> interdependence and intractable nature ofcontemporary public policy issues requires a different approach ong>toong> governance. Variousmodels of HiAP have been implemented in over 16 countries and jurisdictions, includingSouth Australia.Intersecong>toong>ral action ong>toong> address ong>theong> social determinants involves health and communityservice organisations collaborating more effectively with each oong>theong>r, and with oong>theong>rsecong>toong>rs, as much as with government.Recommendation:The Commonwealth Government leads ong>theong> establishment of a platform for systemic,sustained inter-secong>toong>ral working on ong>theong> social determinants of health in line with ong>theong>2010 Adelaide Statement on Health in All Policies (HiAP).Equity Focused Health Impact AssessmentsTo mainstream health equity in all policies as part of a HiAP approach, we recommendong>theong> introduction of Equity Focused Health Impact Statements in-line with WHOresolution 62.14 (3)(1) 3 .Impact assessments introduce a systematic process ong>toong> consider ong>theong> effect ofGovernment policies, legislation, projects or services upon community health and2 http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf3 http://apps.who.int/gb/ebwha/pdf_files/WHA62-REC1/WHA62_REC1-en-P2.pdfCouncil of Social Service of NSW (Nong>COSSong>) Page 8 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportwellbeing, and ong>toong> inform and influence decision-making ong>toong> mitigate ong>theong> risks of adversehealth outcomes. 4 They are an important analytical ong>toong>ol ong>toong> support a Health in AllPolicies approach.Recommendation:The Commonwealth Government implements health and health equity impactassessments ong>toong> mainstream health in all policies as per WHO resolution 62.14.(b) Impacts of ong>theong> Government's response;The ong>COSSong> Network commends ong>theong> Commonwealth Government on its policy agenda ong>toong>make Australia a fairer society. We note that ong>theong> Government has introduced significantmeasures during its two terms ong>toong> improve housing affordability and reducehomelessness, close ong>theong> gap in Aboriginal disadvantage, improve gender equitythrough Paid Parental Leave, support equal pay for workers in ong>theong> social andcommunity services (SACS) secong>toong>r, and reform ong>theong> health system.We also welcome ong>theong> Government’s commitment ong>toong> furong>theong>r social reforms. In particular,ong>theong> introduction of ong>theong> National Disability Insurance Scheme, changes ong>toong> ong>theong> aged caresystem, national dental reform, and a new national school funding model. Thesecommitments lay ong>theong> building blocks ong>toong>wards a more inclusive, equitable society.We believe that this reformist agenda requires a clear ‘road-map’ with on-goinginvestment. The ong>COSSong> Network accepts that fully realising ong>theong> Governmentscommitments will take time. However, ong>theong> long-term nature of ong>theong>se reforms makesclearly articulated plans with timeframes, deliverables and responsibilities critical ong>toong>support ong>theong>ir effective implementation. Good intentions must be translated inong>toong> real,sustainable actions.Recommendation:The Commonwealth Government develops long term plans for all major social policyinitiatives, identifying ong>theong> policy goal, milesong>toong>nes, timeframes and resources ong>toong> deliveron ong>theong>ir commitments.(c) Extent ong>toong> which ong>theong> Commonwealth is adopting a social determinants of healthapproach through:(c)(i) Relevant Commonwealth programs and services,The ong>COSSong> Network believes that no person should be excluded from ong>theong> benefits ofeconomic growth and from ong>theong> opportunity ong>toong> fully participate in society. Weacknowledge that Australia has fared relatively well during ong>theong> recent global economicdownturn largely due ong>toong> ong>theong> good economic stewardship of ong>theong> Commonwealth4 http://www.hiaconnect.edu.au/acheia_efhia.htmCouncil of Social Service of NSW (Nong>COSSong>) Page 9 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportGovernment. However, it is also clear that ong>theong>re continues ong>toong> be people andcommunities experiencing poverty, hardship and disadvantage.There is evidence pointing ong>toong> growing inequality in Australia. The proportion of peopleliving in low-income households generally increased between 2003–04 (10.8%) and2009–10 (12.2%). 5 In ong>theong> past five years, ong>theong> wealthiest households in Australiaincreased ong>theong>ir average net worth by 15% compared ong>toong> just 4% by ong>theong> pooresthouseholds. The botong>toong>m 20% had an average net worth of just 1% of ong>toong>tal householdwealth, where as ong>theong> richest 20% accounted for 62% of ong>theong> whole country's wealth. 6National policy and practice must address ong>theong> needs of people who experiencedisadvantage so that we can achieve better health, social and economic outcomesacross ong>theong> board. The ong>COSSong> Network refers ong>theong> Committee ong>toong> ong>theong> measures in ong>theong>Aong>COSSong> Budget Priority Statement (BPS) 2012-13 (attached) ong>toong> address ong>theong> mostpressing areas of social need, including affordable housing and adequate incomesupport and employment assistance.The State and Terriong>toong>ry ong>COSSong>’s also prepare budget ong>submissionong>s or policy prioritystatements on ong>theong> areas of greatest social need in ong>theong>ir specific jurisdictions. We wouldbe happy ong>toong> provide you with copies on request.AboriginalityThe ong>COSSong> Network believes that all levels of governments must make a greater effortong>toong> close ong>theong> enormous gap that still exists between Aboriginal people and oong>theong>rAustralians. The COAG National Indigenous Reform Agreement is an importantcommitment ong>toong> and framework for closing ong>theong> gap in indigenous disadvantage. Whileprogress has been slow, we urge governments ong>toong> maintain a concerted and sustainedeffort ong>toong> achieving ong>theong> targets. It will be important for ong>theong> National PartnershipAgreement on Closing ong>theong> Gap in Indigenous Health Outcomes be reviewed andextended beyond June 2013.We believe that ong>theong>re needs ong>toong> be a new direction in policies affecting Aboriginal peopleand communities based on real engagement and cooperation, not ‘intervention'. Someaspects of ong>theong> Commonwealth Governments' Compulsory Income Management andSEAM policies have provided much needed investment in many Indigenouscommunities. However, ong>toong>p-down approaches ong>toong> social problems and policies, such aswithdrawing income support payments from parents whose children aren't attendingschool, are punitive and counterproductive.The ong>COSSong> Network supports ong>theong> right ong>toong> self determination, auong>toong>nomy andrepresentation for Aboriginal and Torres Strait Islander peoples. Self-determinationmeans that Aboriginal people are in charge of ong>theong>ir own decisions and have ownershipof ong>theong>ir services. We believe that this right should underlie all Government policy,planning and service delivery. The continuation of compulsory income management in5 Australian Institue of Health and Welfare (AIHW), Australias Health 2012, p766 http://www.acoss.org.au/media/release/its_time_ong>toong>_raise_newstart_ong>toong>_tackle_growing_inequality_in_australiaCouncil of Social Service of NSW (Nong>COSSong>) Page 10 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportong>theong> Norong>theong>rn Terriong>toong>ry and its extension ong>toong> designated communities have significantlyundermined ong>theong>se principles for Aboriginal and non-Aboriginal people alike.Recommendation:Governments at all levels commit ong>toong> delivering on ong>theong> Closing ong>theong> Gap targets.Policies affecting Aboriginal Australians are based on meaningful engagement,cooperation, and self-determination, not ‘intervention'.Early Childhood, Education and TrainingThe ong>COSSong> Network affirms ong>theong> central, foundational importance of education ong>toong>improving individual outcomes and creating more inclusive, equitable and prosperouscommunities. We acknowledge that Australia has a good overall education system byworld standards.We applaud ong>theong> Commonwealth Government’s commitment ong>toong> provide universal accessong>toong> quality early childhood education through ong>theong> establishment of ong>theong> NationalPartnership Agreement and ong>theong> Early Years Learning Framework and National QualityStandards. Similarly, ong>theong> Government’s intentions ong>toong> reform school funding models ong>toong>more equitably allocate education resources are also welcome.However, ong>theong> current system of child care payments is complex and inequitable. Thereare different payment types for low and higher income families and, by internationalstandards, low levels of spending on child care overall. The Child Care Rebate (CCR) isinherently regressive as it covers part of ong>theong> gap fee between income-tested Child CareBenefit (CCB) and fees charged. In addition, ong>theong> level of subsidy available for lowincome families is generally not sufficient ong>toong> finance quality care.We note that reducing inequities in access ong>toong> learning opportunities and improving longtermeducational outcomes can be furong>theong>r supported by:Abolishing ong>theong> Child Care Rebate and increase ong>theong> maximum rate of Child CareBenefit as recommended in ong>theong> Aong>COSSong> BPS 2012-13Enhancing prevention and early intervention support services for families withchildren at risk of harmEnsuring universal access ong>toong> quality education for all AustraliansImproving support ong>toong> students with a disability, including those in mainstreamschools so that ong>theong>y are fully included with ong>theong> supports necessary ong>toong> meet ong>theong>irindividual needs.Employment and social securityUnemploymentReducing long-term unemployment is one of ong>theong> most important things that governmentcan do ong>toong> prevent social exclusion and poverty. While Australia’s unemployment levelsare low by OECD standards, a majority of recipients of unemployment payments areCouncil of Social Service of NSW (Nong>COSSong>) Page 11 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportlong-term unemployed (over 12 months). Prolonged joblessness is socially corrosive,leading ong>toong> severe health problems, family breakdown and ong>theong> entrenchment of socialexclusion in ong>theong> worst affected communities.In ong>theong>ir Budget Priority Statement 2012, Aong>COSSong> calls for a substantial investment byong>theong> Government in a paid work experience program for long term unemployed people ong>toong>give ong>theong>m experience and training in regular employment and ong>theong>reby improve ong>theong>irfuture job prospects.Recommendation:Improve employment assistance and establishes paid work experience for long termunemployed people as recommended in ong>theong> Aong>COSSong> BPS 2012.Establish an independent public inquiry ong>toong> review current employment participationpolicies for people receiving income support payments and recommend future directionsfor reformIncome support paymentsThe ong>COSSong>es have serious concerns about ong>theong> inadequacy and inequity ofunemployment and income support payments. We believe that it is everyone's right ong>toong>have access ong>toong> paid work, and when looking for paid work, ong>toong> have income support ong>toong>live with dignity. Yet our social security system is failing ong>toong> provide people with this basicguarantee, plunging people inong>toong> poverty.Payments for Newstart Allowance and unemployed young people living independentlyof ong>theong>ir parents are inadequate. The allowances are not enough ong>toong> meet ong>theong> most basicessential costs such as housing, food, and clothing. Consequently, unemployed peopleon ong>theong> Newstart Allowance experience deeper financial hardship, with 40% unable ong>toong>afford ong>toong> pay a utility bill on time compared with 12% of all households. 7There is also significant inequity in ong>theong> levels of allowance payments and pensions forpeople with similar living costs. The ‘poverty gap' between pensions and Newstart is$140 per week. 8 This gap is primarily ong>theong> result of different indexation arrangements forpensions and allowances.We refer ong>theong> ong>Senateong> Committee ong>toong> ong>theong> Aong>COSSong> 2012 Submission on ong>theong> adequacy of‘allowance’ payments 9 that provides detailed evidence and recommendations ong>toong>improve income support and Australia’s social security system.Recommendation:7 Aong>COSSong> (2012) Submission ong>toong> ong>Senateong> Employment Committee on ong>theong> adequacy of ‘allowance’ payments, Aong>COSSong>,August 2012, Sydney.8 http://www.acoss.org.au/media/release/mind_ong>theong>_gap_people_on_newstart_falling_furong>theong>r_behind9 http://acoss.org.au/images/uploads/Allowance_adequacy_ong>submissionong>_FINAL_120817.docxCouncil of Social Service of NSW (Nong>COSSong>) Page 12 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportIncrease allowance payments for single people by $50 per week as recommended byong>theong> Henry Review.Reform indexation of allowances, so that all payments reflect ong>theong> real community cost ofliving based on typical fulltime wage levels (before tax) and ong>theong> Consumer Price IndexUndertake structural reform of ong>theong> system of income support payments for people ofworking age and replace ong>theong> present three tier system of payments for people ofworking age with a common ‘core’ rate of payment ong>toong>geong>theong>r with supplements foradditional living costsEnvironment and climate changeClimate change disproportionately impacts on people on lower incomes and peopleexperiencing disadvantage because of geography, poorer infrastructure and lowercapacity ong>toong> adapt and adjustments ong>theong>ir living circumstances.For instance, increases in power and water costs have a greater impact on low incomeearners as on average ong>theong>y spend a greater proportion of ong>theong>ir ong>toong>tal weekly householdbudget on utilities than wealthier households. Fewer low income households are able ong>toong>afford significant energy efficiency measures such as insulation, new hot water systemsor rainwater tanks.The WHO has noted that climate change is a health equity issue (ResolutionWHA61.19). Due ong>toong> ong>theong>ir higher risk and vulnerability and lower responsive capacity,ong>theong>se groups will need a greater level of support as part of Australia's response ong>toong>climate change.The ong>COSSong>es support improving energy efficiency and pricing carbon through anemissions trading scheme ong>toong> protect low income Australians from ong>theong> long-term costs ofclimate change. We note ong>theong> policy platform of ong>theong> Souong>theong>rn Cross Climate Coalition 10ong>toong> drive a fair and inclusive transition ong>toong> a low pollution economy by reducing oureconomy's dependence on pollution; fair and inclusive action on climate change;unlocking new clean energy jobs and industries; and strengong>theong>ning global action.Recommendation:Strengong>theong>n fair and equitable action ong>toong> reduce carbon pollution and transition ong>toong> acleaner economy.Food securityAll Australians should have access ong>toong> healthy, affordable and acceptable food. Foodstress, ong>theong> situation where households need ong>toong> spend a disproportionate amount of ong>theong>irhousehold income ong>toong> eat healthy and nutritious food, is both a financial and health issuefor low-income households. Poor dietary intake increases ong>theong> risk of developing chronicdiseases, including heart disease and diabetes.10 Souong>theong>rn Cross Climate Coalition (2011) A Policy Platform for a Low Pollution Economy, April 2011.Council of Social Service of NSW (Nong>COSSong>) Page 13 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportThe most recent COAG Reform Council healthcare report found that Australians livingoutside major cities, in socio-economically disadvantaged areas, and IndigenousAustralians continue ong>toong> have poorer health outcomes and poorer access ong>toong> healthcareoverall, despite some small equity gains. 15Structural barriers in Australia’s health system inhibit equitable access ong>toong> health careand cause or compound health inequities. These include health care costs and userfees, unavailability of timely, quality services, and low health literacy. For instance, morethan a quarter of people (26.4%) report financial barriers ong>toong> seeing a dentist, and nearlyone in ten people (8.7%) delayed or did not see a GP due ong>toong> cost. Australians in ong>theong>most disadvantaged areas have lower rates of dental services, opong>toong>metry services, andambulaong>toong>ry mental health services. 16The ong>COSSong> Network welcomes ong>theong> Commonwealth Government’s commitment ong>toong>address core areas of health inequity, including closing ong>theong> gap in Aboriginal health,investments in rural and remote health, national mental health reform and ong>theong> recentdental health package. However, more needs ong>toong> be done ong>toong> achieve a comprehensive,equitable universal coverage health system recommended by ong>theong> WHO Commission.The national oral health reforms are illustrative of ong>theong> additional work required ong>toong>address on-going structural inequities. While ong>theong> 2012 package is a significantimprovement ong>toong> ong>theong> dental policy framework, funding is unlikely ong>toong> be sufficient ong>toong> meetong>theong> comprehensive needs of eligible adults given demand for public dental services. Itdoes not address people on low incomes without health care cards who are unable ong>toong>afford eiong>theong>r private insurance or basic dental care. For those with insurance, copaymentswill continue ong>toong> drive health inequalities.We believe health funding needs ong>toong> be redirected ong>toong>wards a more equitable set ofnational priorities with a long-term view ong>toong> address ong>theong> ongoing and structural inequitiesin Australia’s health system in line with ong>theong> WHO Commission report.Recommendation:Governments at all levels strengong>theong>n action ong>toong> address ong>theong> structural barriers thatimpede equitable access ong>toong> universal healthcare.Prioritising primary and community healthWe believe that ong>theong>re needs ong>toong> be a greater proportional investment in evidence-basedcomprehensive primary health care, particularly health promotion, prevention and earlyintervention as recommended by ong>theong> WHO Commission. 17 Health systems contribute15 COAG Reform Council (2012), Healthcare 2010–11: Comparing performance across Australiahttp://www.coagreformcouncil.gov.au/reports/docs/healthcare_10-11/Healthcare_2010-11-Overview.doc16 COAG Reform Council (2012), Healthcare 2010-11: Comparing outcomes by socio-economic status, p7,http://www.coagreformcouncil.gov.au/reports/docs/healthcare_10-11/Healthcare_2010-11_by_SES.pdf17 Recommendation 9.1, Commission on ong>theong> Social Determinants of Health (2008), Closing ong>theong> Gap Report, WorldHealth Organisation, p96Council of Social Service of NSW (Nong>COSSong>) Page 15 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportmost ong>toong> improving health and health equity where ong>theong> system as a whole is organisedaround Primary Health Care.Local 18 and international 19 evidence indicates that health care systems orientatedaround wellness are more efficient and effective than crisis-driven systems orientated ong>toong>treating illness. Yet primary and community health care in Australia continues ong>toong> bepoorly funded in comparison ong>toong> ong>theong> acute secong>toong>r.The Public Health Association of Australia has identified systemic structural barriers ong>toong>effective primary health care in Australia. These include administrative fragmentationbetween ong>theong> jurisdictions, short-term project funding; lack of agreed definitions, hospitalavoidance and post-acute care pressures; dominance of primary medical services; andinsufficient support for research and evaluation. 20We are hopeful ong>theong> National Strategic Primary Health Care Framework and bilateralstate plans (in development) may address some of ong>theong>se systemic issues. It is essentialthat ong>theong> Framework clearly defines primary health care, articulates ong>theong> roles andresponsibilities of ong>theong> key acong>toong>rs in ong>theong> system, supports collaborative models of careand integrated service delivery, and strengong>theong>ns consumer and communityengagement.We support ong>theong> Aong>COSSong> BPS 2012-13 recommendation that primary health care fundingstreams are used as a way ong>toong> improve dynamic efficiency by pooling funds andallocating ong>theong>m ong>toong> support multidisciplinary teams, linking clinical services with alliedhealth and associated community services. Funding should be needs-based,distributing funds according ong>toong> population health needs with enhanced investment inouter years.Recommendation:Increase proportional investment in primary health care ong>toong> deliver a national,comprehensive, community-based primary health care program.Housing and infrastructureThe ong>COSSong> Networks strongly advocates for measures ong>toong> improve ong>theong> availability ofaffordable housing and reduce homelessness in Australia. Australia has amongst ong>theong>most expensive housing in ong>theong> world. Rents and mortgages are ong>theong> biggest source offinancial stress in many households. More than a million people on low incomes18 See for example Owen A et al, Community health: ong>theong> evidence base: A report for ong>theong> NSW Community HealthReview. Centre for Health Service Development, University of Wollongong, 2008; and National Health and HospitalsReform Commission, A Health Future for All Australians: Final Report, Canberra, 200919 The Marmot Review, Strategic review of health inequalities in England post‐2010, Fair Society, Healthy Lives ‐ TheMarmot Review Final Report, London, 201020 Public Health Association of Australia (PHAA), Primary Health Care Policy (Revised 2011),http://www.phaa.net.au/documents/111204_Primary%20Health%20Care%20Policy%20FINALwith%20cover%20sheet.pdfCouncil of Social Service of NSW (Nong>COSSong>) Page 16 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportcontinue ong>toong> experience housing stress, with housing costs exceeding 30% of householdincome. 21The Commonwealth Government has acknowledged ong>theong> anticipated increase in publicand community housing from ong>theong> stimulus package was only about half of what isneeded ong>toong> meet ong>theong> 2020 homelessness targets.The Aong>COSSong> BPS 2012-13 calls for a long term commitment ong>toong> affordable housing song>toong>ckgrowth and furong>theong>r development of ong>theong> community housing secong>toong>r ong>toong> meet ong>theong> high levelof housing need in Australia. 22The WHO Commission also recommended ong>theong> greater availability of affordable housingong>toong> support healthy places, healthy people and reduce inequity.Recommendation:Increase affordable housing in-line with ong>theong> Aong>COSSong> BPS 2012-13 by:Establishing a long-term Affordable Housing Growth FundIncreasing ong>theong> funds for ong>theong> National Rental Affordability SchemeReviewing Commonwealth Rent Assistance and increase ong>theong> maximum rate ofCRASocial and community servicesThe ong>COSSong> Network believes that Commonwealth and State Governments mustadequately fund ong>theong> not for profit community secong>toong>r ong>toong> continue providing vital servicesong>toong> ong>theong> community. The health and social secong>toong>rs continue ong>toong> show economic growth,even in periods of downturn such as ong>theong> GFC, in part due ong>toong> ong>theong> projected increase indemand that shows no sign of slowing over coming decades. Yet ong>theong> community secong>toong>rhas been continually run down through inadequate funding for ong>theong> cost of deliveringservices and failure ong>toong> fund capacity and innovation within existing and new fundingsources.The secong>toong>r provides a wide range of services that support ong>theong> health and welfare of allAustralians. In addition ong>toong> mainstream services, community secong>toong>r organisations providespecialised responses ong>toong> targeted population groups and alternative services formarginalised people who may not oong>theong>rwise access mainstream services. Their flexible,innovative structures and client-focused ethic and equities base make ong>theong>m well suitedong>toong> respond ong>toong> ong>theong> needs of vulnerable groups.Community secong>toong>r organisations contribute ong>toong> community well-being through directservices and also through ong>theong> processes and ong>theong> framework ong>theong>y work within. The waythat organisations are organised, engage people, make decisions, and go aboutdelivering services reflect and contribute ong>toong> social capital. This is critical ong>toong> socialinclusion and developing a fairer society.21 Ryanti Miarant and Binod Nepal, Housing Stress in Australia 2007, National Centre for Social and EconomicModelling, University of Canberra, 2008, cited in Aong>COSSong> BPS 2012-13.22 Prime Minister, House of Representatives Hansard, Tuesday 3 February, pg 11-12, cited in Aong>COSSong> BPS 2012-13.Council of Social Service of NSW (Nong>COSSong>) Page 17 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportThe ong>COSSong> Network applauds ong>theong> decision by Fair Work Australia ong>toong> award equal payfor workers in ong>theong> social and community services (SACS) secong>toong>r and ong>theong>Commonwealth Government’s commitment ong>toong> fund its share of ong>theong> costs. This is acrucial step ong>toong>wards ensuring viable, effective social services by requiring appropriatelevels of pay for ong>theong> staff we depend upon ong>toong> deliver those services.We also welcome ong>theong> creation of ong>theong> Australian Charities and Not-for-profit Commissionong>toong> improve ong>theong> regulaong>toong>ry environment for our secong>toong>r. Effective regulation and goodevaluation provide opportunities ong>toong> improve ong>theong> structure and outcomes of ong>theong> not forprofit community service secong>toong>r.However, many community service organisations continue ong>toong> face a major challenge ong>toong>ong>theong>ir effectiveness due ong>toong> routine underfunding. The Productivity Commission found thatgovernments tend ong>toong> fund only 70% of ong>theong> costs of ong>theong> services that ong>theong>y contractcommunity secong>toong>r organisations ong>toong> provide. 23 Government contracts have grosslyundervalued inflation and so have driven a decline in funding in real terms, even asdemand for services in many areas has increased. 24Inadequate resourcing of community secong>toong>r organisations is being exacerbated by risingdemand for services. The annual Australian Community Secong>toong>r Survey 2011reportedmore people are turning ong>toong> community groups for help, leaving organisation unable ong>toong>meet demand. The survey showed a 12% increase in assistance provided by agencies.It revealed that 1 in 20 people were being turned away, a 19% increase on ong>theong> previousyear. 25The Aong>COSSong> BPS 2012-13 strongly recommends funding processes withinprogrammatic budget allocations that facilitate better collaboration between Governmentand ong>theong> community secong>toong>r and that support ong>theong> secong>toong>r ong>toong> continue providing services ong>toong>reduce disadvantage and improve community health and well-being.RecommendationAdequately fund ong>theong> full cost of delivering community services, including appropriatelevels of indexation for continuing funding, in-line with ong>theong> Aong>COSSong> BPS 2012-13.TransportTransport is a critical facong>toong>r ong>toong> social inclusion and well-being. Transport should beaffordable, available, accessible and appropriate – enabling everyone ong>toong> be able ong>toong> getong>toong> where ong>theong>y need ong>toong> go within an acceptable amount of time, cost and ease.People who have ready access ong>toong> transport are more able ong>toong> access essential services,undertake education and employment, and participate in social activities. Yet manypeople are prevented from accessing ong>theong>se opportunities and services due ong>toong> transportdisadvantage. People most likely ong>toong> experience transport disadvantage are those who23 Australian Productivity Commission (2010) Research Report inong>toong> ong>theong> contribution of ong>theong> Not-for-profit secong>toong>r,Productivity Commission, http://www.pc.gov.au/projects/study/not-for-profit/report24 Aong>COSSong> BPS 2012-1325 Aong>COSSong> (2011), Australian Community Secong>toong>r Survey 2011, Sydney.http://acoss.org.au/images/uploads/ACSS_2011_Report_Volume_1_National.pdfCouncil of Social Service of NSW (Nong>COSSong>) Page 18 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportare already experiencing socio-economic disadvantage and who live in isolated or ruralcommunities.We note that Governments at ong>theong> national, state and local levels can support a fairertransport system that contributes ong>toong> improved social, environmental and healthoutcomes through:Incentives ong>toong> reduce car dependency and encourage active transportLand use planning and development that encourages walking, cycling, and publictransport useProvision of affordable, accessible, safe, and convenient public transportWhole-of-government approaches ong>toong> transport planning and funding.Ensure adequate resourcing for coordinated local transport services, includingcommunity transportA lack of transport as a barrier ong>toong> accessing health services is a concern frequentlyraised by ong>theong> social and community services secong>toong>r. Transport difficulties can reduce ong>theong>likelihood that people will access preventative treatment, receive effective care, or bediagnosed early. The lack of clear policy responsibility for transport ong>toong> health servicesfollowing ong>theong> 2010 and 2011 health reform agreements has contributed ong>toong> a system inwhich ong>theong>re are significant policy and service gaps. Responsibility for transportinfrastructure and public transport services sits outside health yet supplementarytransport services are required for equitable access ong>toong> health care.Of particular concern is ong>theong> impact of increased demand for health transport oncommunity transport. Community transport’s provision of social inclusion transportservices, predominantly funded through ong>theong> Home and Community Care Program, isbeing constrained by increasing demand for health transport. Long-term, this will furong>theong>rexacerbate ong>theong> social isolation of older people and people with disability who rely oncommunity transport.To address ong>theong> significant policy and service gaps around health-related transport,Governments at ong>theong> national and state levels should:Facong>toong>r transport considerations inong>toong> health service planning and deliveryEnsure adequate resourcing for health transport servicesRecommendation:Coordinated, joined-up planning and funding of transport systems that focuses onimproving social, environmental and health outcomesClarify responsibility for health transport services through ong>theong> COAG process ong>toong> improveequitable access ong>toong> health care.Council of Social Service of NSW (Nong>COSSong>) Page 19 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ report(c)(ii) Structures and activities of national health agenciesHealth DepartmentsWe believe that national and state Health Departments must take a leadership andoutreach role on ong>theong> social determinants of health. The new approach ong>toong> governance forhealth outlined by ong>theong> WHO Commission implies a new role for ong>theong> health secong>toong>r. HealthDepartments must engage systematically across government and with oong>theong>r secong>toong>rs ong>toong>raise awareness of ong>theong> social determinants of health and lead coordinated action ong>toong>address ong>theong> health and well-being dimensions of ong>theong>ir activities.To promote action on ong>theong> social determinants, Health Departments can:Re-frame health and well-being as integral ong>toong> a successful society, and not just aservice secong>toong>r.Build ong>theong> knowledge and evidence base of policy options and assess ong>theong>comparative health consequences of options within ong>theong> policy developmentprocessBuild capacity for cross-agency and intersecong>toong>ral action through regular platformsfor dialogue and problem solving, resources, staff, and evaluationFacilitate consumer participation and building health literacyThe WHO Commission states this role requires skills ong>toong> prioritise and strategically thinkthrough ong>theong> key health concerns in relation ong>toong> oong>theong>r secong>toong>rs and ong>theong> ability ong>toong> understandong>theong>ir agendas and priorities. It requires abilities in reaching out ong>toong> oong>theong>r secong>toong>rs ong>toong>facilitate intersecong>toong>ral dialogue and in contributing ong>toong> intersecong>toong>ral activities led by oong>theong>rsecong>toong>rsRecommendation:Commonwealth and State health departments take a leadership role in governance forhealth and build ong>theong>ir internal capacity ong>toong> advocate for and contribute ong>toong>, ong>theong>implementation of a Health in All Policies approach.Medicare LocalsMedicare Locals have ong>theong> potential ong>toong> improve coordination, integration and continuity ofcare in ong>theong> community, and reduce population health inequities. However, MedicareLocals will only be effective if ong>theong>y fully engage with ong>theong> communities ong>theong>y serve.Medicare Locals must have an informed understanding of ong>theong> population health needsand ong>theong> scope of services that are available in ong>theong>ir communities in order ong>toong> improvehealth outcomes, especially for ong>theong> most vulnerable. To do this, ong>theong>y must be open andtransparent, engage with multidisciplinary health teams, and work in collaboration withlocal stakeholders, including non-government health and community services andconsumer organisations.Council of Social Service of NSW (Nong>COSSong>) Page 20 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportThey must also have adequate funding ong>toong> facilitate local service coordination andintegration. Financial incentives are needed ong>toong> support organisations along ong>theong> healthcare continuum and from across ong>theong> spectrum of community support ong>toong> work ong>toong>geong>theong>raround ong>theong> needs of ong>theong> person.Australian National Preventive Health Agency (ANPHA)The ANPHA is a key mechanism through which improved health can be achieved forpeople on low incomes. It is vital that ANPHA take a broader approach ong>toong> preventionthan a narrow focus on lifestyle risk facong>toong>rs. This includes targeting those areas ofgreatest inequity, such as mental health and oral health. A comprehensive, holisticapproach based on ong>theong> social model of health includes ong>theong> promotion of good healthand well-being, not just ong>theong> prevention of chronic disease.We also recommend ong>theong> ANPHA engage with a wide range of interests in healthbeyond traditional medicine, including allied health, mental health and oral healthprofessionals, and with ong>theong> non-profit community services that are already working withsome of ong>theong> most disadvantaged individuals and communities in Australia.National Health Performance Authority (NHPA)The ong>COSSong>es welcome ong>theong> establishment of ong>theong> NHPA and ong>theong> new Performance andAccountability Framework. The Healthy Communities Reports and Hospitals Reportswill provide an important accountability mechanism ong>toong> drive improvements in healong>theong>quity. We believe that common indicaong>toong>rs between Medicare Locals and Local HealthNetworks/Districts are essential ong>toong> drive collaboration and integration at ong>theong> local levels.We note ong>theong> NHPA has agreed ong>toong> consult with stakeholders ong>toong> furong>theong>r developappropriate indicaong>toong>rs, and we recommend this includes ong>theong> community secong>toong>r.(c)(iii) Appropriate Commonwealth data gaong>theong>ring and analysisThe ong>COSSong> Network argues that ong>theong>re needs ong>toong> be more comprehensive socialmeasures that reflect levels of disadvantage at ong>theong> national, state and local levels.Without appropriate measurement and indicaong>toong>rs of systematic differences in healthdeterminants, it is impossible ong>toong> measure progress ong>toong>wards reducing health inequitiesacross ong>theong> Australian community.While ong>theong>re is some national data collection and reporting on inequities, it is notcomprehensive. For example, ong>theong> Australian Bureau of Statistic report, Measures ofAustralia's Progress, only identifies ong>theong> health outcomes for men and women, Aboriginaland Torres Strait Islander peoples, older Australians and socioeconomic status for alimited number of indicaong>toong>rs.Data collection and reporting on inequities must be built in ong>toong> ong>theong> moniong>toong>ring andperformance frameworks of all agencies. Reports by ong>theong> Social Inclusion Board are aCouncil of Social Service of NSW (Nong>COSSong>) Page 21 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportgood compilation of data and provide useful benchmarks. However, this siloedapproach ong>toong> reporting fails ong>toong> embed accountability for addressing disadvantage andimproving equity across all government agencies.There is also an issue with nationally consistent, accurate quality data. The COAGReform Council (CRC) previously identified concerns with ong>theong> conceptual adequacy anddata quality of ong>theong> National Health Agreement performance framework and relatedindicaong>toong>rs. 26 The Australian Institute of Health and Welfare notes ong>theong>re are importantgaps and data quality issues, particularly relating ong>toong> ong>theong> primary care.“Despite its critical importance, ong>theong> Australian primary care setting has notexperienced ong>theong> same national focus on data collection, collation and reportingas oong>theong>r areas of ong>theong> health system, such as hospitals. As a result, in somecases ong>theong>re are little data or only poor quality data collected about a particularservice type at any level of government.Alternatively, in some cases ong>theong>re are many ‘bits’ of data collected at a variety ofdifferent levels of government that are often overlapping, non-standardised andnot centrally collated. And in oong>theong>r cases ong>theong>re are significant volumes of datacollected and song>toong>red within ong>theong> private secong>toong>r that ong>theong> government has hisong>toong>ricallynot accessed....” 27We note COAG has agreed a new revised National Healthcare Agreement (NHA)performance framework ong>toong> improve data quality and overall conceptual adequacy. Wewelcome ong>theong> disaggregation of all performance indicaong>toong>rs by Indigenous status,disability status, remoteness and socioeconomic status ong>toong> improve moniong>toong>ring of healthinequities.The new National Health Reform Performance and Accountability Framework alsoprovide an opportunity ong>toong> improve data collection and analysis on health and healthinequities at ong>theong> local, state and national levels. We note that many of ong>theong> initialindicaong>toong>rs will be refined over time, including ong>theong> equity domain for Medicare Locals. Werecommend that ong>theong> NHPA consults with ong>theong> community secong>toong>r ong>toong> furong>theong>r developappropriate, meaningful indicaong>toong>rs of health equity.Recommendation:Improve disaggregated data collection and reporting on health equity across all keyagencies.Consult with ong>theong> community services secong>toong>r ong>toong> develop additional indicaong>toong>rs for ong>theong>National Health Reform Performance and Accountability Framework26 CRC report NHA: Baseline performance report for 2008-09, reported in National Healthcare Agreement ReviewWorking Group (2012), National Healthcare Agreement Review Report July 201227 AIHW, Australia Health 2012, p20Council of Social Service of NSW (Nong>COSSong>) Page 22 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ report(d) Scope for improving awareness of social determinants of healthThe WHO Commission has recognised that good health is dependent on ong>theong> dialoguewith and involvement of oong>theong>r secong>toong>r and acong>toong>rs. The non-profit community secong>toong>r playsa vital role in improving awareness and coordinating action on ong>theong> social determinantsof health. In addition ong>toong> direct provision of community services, ong>theong> community secong>toong>rcontributes through policy, advocacy, education, information, and coordination.The Productivity Commission recognised ong>theong> additional contribution of non profiong>toong>rganisations beyond service delivery through: exerting influence and promoting changeon economic, social, cultural and environmental issues; connecting ong>theong> community andexpanding ong>theong> social networks available ong>toong> individuals; and enhancing ong>theong> communityendowment by investing in skills, knowledge and physical, social, cultural andenvironmental assets for ong>theong> benefit of future generations. 28The Social Determinants of Health Advocacy Network operated under ong>theong> umbrella ofTasong>COSSong>, is an example of ong>theong> coordination, information, advocacy and leadership rolethat community secong>toong>r organisations, in particular peak bodies, can provide ong>toong> advanceaction on ong>theong> social determinants. Fact sheets and information developed by ong>theong>Network is attached.Furong>theong>r examples of ong>theong> various roles that non-profit community secong>toong>r organisationsundertake that improve awareness and facilitate action on ong>theong> social determinants ofhealth are at Appendix 1.However, ong>theong> community secong>toong>r’s capacity ong>toong> advocate on ong>theong> social determinants ofhealth is limited by ong>theong> lack of government priority for non-profit communityorganisations, and increasingly prescriptive contract based funding.A lack of appropriate recognition and priority afforded ong>toong> ong>theong> community secong>toong>r bygovernment means that it is routinely sidelined from major national processes. Recentexamples include ong>theong> omission of community secong>toong>r involvement in ong>theong> CommonwealthGovernment’s Queensland Flood Taskforce and ong>theong> failure ong>toong> fund community secong>toong>rpeak bodies ong>toong> support organisations and ong>theong>ir clients under ong>theong> Climate Change GrantProgram.Inadequate resourcing and increasingly prescriptive funding contracts limited ong>toong> directservice delivery impact ong>theong> capacity of organisations ong>toong> participate in governmentprocesses and initiatives, advocate on behalf of low income and disadvantaged people,build community networks and improve service coordination.The Government must strengong>theong>n ong>theong> secong>toong>r’s contribution by adopting measures ong>toong>enable ong>theong>ir effective participation for ong>theong> public interest in decision-making and buildingong>theong> secong>toong>r’s capacities ong>toong> address social determinants of health.Recommendation:Build ong>theong> capacity of ong>theong> non-profit social and community secong>toong>r ong>toong> support action on ong>theong>social determinants of health through appropriate resourcing.28 Australian Productivity Commission (2010), Report on ong>theong> Contribution of ong>theong> Not for Profit Secong>toong>r, p32Council of Social Service of NSW (Nong>COSSong>) Page 23 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportFund processes within programmatic budget allocations that facilitate bettercollaboration between Government and ong>theong> community secong>toong>r as recommended in ong>theong>Aong>COSSong> BPS 2012-13.ConclusionThe ong>COSSong> Network would like ong>toong> thank ong>theong> ong>Senateong> for ong>theong> opportunity ong>toong> provide thisong>submissionong>.For inquiries or furong>theong>r information in relation ong>toong> this ong>submissionong>, please contact SolangeFrost, Senior Policy Officer (Health) Nong>COSSong> on 02 9211 2599 ext. 130 orsolange@ncoss.org.auAttachments:1. ong>Jointong> ong>COSSong> statement on Health Priorities: Equity in access, equity in outcomes2. Aong>COSSong> 2012-13 Budget Priority Statement: Recommendations for ong>theong> FederalBudget3. Tasmania Social Determinants of Health Advocacy Network Fact SheetsCouncil of Social Service of NSW (Nong>COSSong>) Page 24 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportAPPENDIX ONEAustralians for Native Title and Reconciliation (ANTaR)"ANTaR listens ong>toong> and supports ong>theong> aspirations of First Peoples and works ong>toong> educateong>theong> wider community, shape public opinion, speak up against injustice and influencepublic policy ong>toong> advance our vision."ANTaR has been working with Aboriginal and Torres Strait Islander organisations andleaders on rights and reconciliation issues since 1997. ANTaR is an independent,national network of organisations and individuals working in support of Justice, Rightsand Respect for Aboriginal and Torres Strait Islander peoples in Australia. ANTaR is anindependent non-government organisation and is non-party-political.ANTaR's purpose has always been ong>toong> support Aboriginal and Torres Strait Islanderpeople speaking for ong>theong>mselves, raong>theong>r than ong>toong> speak for ong>theong>m. ANTaR works closelywith national Aboriginal and Torres Strait Islander organisations and leaders and has anAboriginal and Torres Strait Islander Reference Group which provides ANTaR withdirection and feedback.Central ong>toong> ANTaR's activities has been ong>theong> Sea of Hands. Over 300,000 Australianshave put ong>theong>ir signatures on a hand in ong>theong> Sea of Hands and helped in its installation inlocations around Australia.ANTaR works on many levels ong>toong> achieve its goals. This includes maintaining closeliaison with Aboriginal and Torres Strait Islander national organisations and leaders andcommunities, supporting ong>theong>m ong>toong> communicate ong>theong>ir aspirations and concerns ong>toong> ong>theong>wider community and conducting national education and awareness campaigns onAboriginal and Torres Strait Islander social justice issues.Much of ANTaR's work is carried out by state and terriong>toong>ry ANTaRs and by numerouslocal groups. This includes activities focused at a grass-roots level - local reconciliationinitiatives which are carried out in conjunction with local Aboriginal and Torres StraitIslander groups and oong>theong>r members of ong>theong> local community.ANTaR’s advocacy includes:constitutional recognition for Australia’s First Peoples,justice,UN Declaration of ong>theong> Rights of Indigenous People,Native Title legislation,self-determination for communities in ong>theong> Norong>theong>rn Terriong>toong>ry,health equality,reconciliation, andSong>toong>len Generations.Council of Social Service of NSW (Nong>COSSong>) Page 25 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportClimate and Health Alliance (CAHA)The Climate and Health Alliance (CAHA) is a national coalition of organisations andindividuals from a broad cross section of ong>theong> secong>toong>r, including health care professionals,health care service providers, institutions, academics, researchers, and health careconsumers. Australian Council of Social Service (Aong>COSSong>) is a current member.The Alliance aims ong>toong> protect and promote health by acting, encouraging andempowering organisations and individuals in ong>theong> health care secong>toong>r and ong>theong> widercommunity ong>toong> contribute ong>toong> developing effective political, secong>toong>ral and communityresponses ong>toong> climate change.The Climate and Health Alliance (CAHA) was formed in August 2010. It works ong>toong> raiseawareness of ong>theong> links between ong>theong> biosphere and human health (ong>theong> environmentaldeterminants for health) and encourages ong>theong> development of policy that recognises ong>theong>impact on human health from a degraded natural environment and climate change.CAHA produces Briefing Papers and Position Statements and Reports on particularong>toong>pics ong>toong> share with parliamentarians, policymakers, ong>theong> media, health carestakeholders and ong>theong> community, position statements and oong>theong>r resources. It recentlymade a ong>submissionong> ong>toong> ong>theong> Productivity Commission Inquiry inong>toong> barriers ong>toong> climatechange adaptation, ong>toong> which not a single health agency made a ong>submissionong>.The Alliance recently made a ong>submissionong> in response ong>toong> National Food Plan GreenPaper in relation ong>toong> ong>theong> importance of recognising climate change impacts on ong>theong>availability of natural resources and ong>theong> profoundly important considerations for healthand wellbeing and equity associated with access ong>toong> fresh, affordable and quality food.CAHA’s ong>submissionong> ong>toong> ong>theong> Australian Parliament House Environment Committeeexamining climate impacts on Australia’s biodiversity highlighted that climate change ishaving severe adverse impacts on biodiversity, on which humans depend as a lifesupport system (including for food, clean air and medicines), and sought for that ong>theong>value of biodiversity and ecosystem services be recognised in public policy decisionmaking ong>toong> prevent furong>theong>r destruction of natural ecosystems on which hundreds ofspecies, including humans, depend.The Alliance recently launched ong>theong> Global Green and Health Hospitals Network inAustralia, as part of a new global network of hospitals and healthcare organisationsworking ong>toong>geong>theong>r ong>toong> reduce ong>theong> environmental footprint of ong>theong> healthcare secong>toong>r. Thelaunch was part of a joint think tank on greening ong>theong> healthcare secong>toong>r with ong>theong>Australian Healthcare and Hospitals Association.The Climate and Health Alliance and The Climate Institute have released a joint report“Our Uncashed Dividend” on ong>theong> health benefits of climate action. The report drawsong>toong>geong>theong>r a large and growing body of evidence from health and medical researchshowing substantial health benefits linked ong>toong> measures ong>toong> cut emissions.Council of Social Service of NSW (Nong>COSSong>) Page 26 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportMt Druitt AVO ProjectBackground: The ShedThe Shed, which is an Aboriginal male targeted suicide prevention project, is auspicedby ong>theong> Men’s Health Information Resource Centre at ong>theong> University of Western Sydney.The Shed is funded by ong>theong> Department of Health Ageing. The Shed is a small servicewith two fulltime Aboriginal male staff. The Shed is also welcoming of males, femalesAboriginal and Non Aboriginal people.The holistic/social determinants of health approach adopted by ong>theong> Shed is inclusive ofbut not limited ong>toong>: Legal matters (Family, Civil and Criminal), Health (Mental andPhysical), Housing/Homelessness, Financial, Oong>theong>r services as required by clients.The Shed delivers its services by building strong collaborations with oong>theong>r governmentand non-government services ong>toong> address ong>theong> social determinants of health. The MtDruitt AVO Project is led by The ShedPurpose of ong>theong> Project (Mt Druitt AVO Pilot Project):Assist defendants of Apprehended Violence Orders (Domestic and Personal) with: Legal support for both criminal and family law matters Links ong>toong> support services ong>toong> assist clients ong>toong> address causation that lead ong>toong> ong>theong>mcoming inong>toong> contact with ong>theong> justice system Access for both defendants and PINOP ong>toong> The Shed and oong>theong>r services To support both males and female defendants To run a Project carried at Mt Druitt Local Court on AVO Hearing DayProject Impact:Before Project No legal representation forDefendants unless criminal chargesattached No Family Law parenting plans forcontinued contact with children No on ong>theong> spot support for social,health, financial counselling andhousingDuring Project Legal Representation for defendants Family law representation andparenting plans On ong>theong> spot support for mental health,substance abuse, housing, financialand oong>theong>r as defined case by caseCouncil of Social Service of NSW (Nong>COSSong>) Page 27 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportStakeholders:Agency Role Position that attends projectThe Shed Lead service The Shed workersLegal Aid NSWMt Druitt localCourtWestern SydneyArea HealthServiceCriminal Law& FamilyLawVenueMental Health andAddictionsMA Housing Housing Housing OfficerCriminal Law Soliciong>toong>r & Family lawSoliciong>toong>rAllow project ong>toong> be done at local courtAboriginal Mental Health Clinical Lead& Addiction Counsellor Drug, Alcoholand oong>theong>rMuru Mittigar AC Financial Counselling Indigenous Money Menong>toong>rProbation andParoleClient SupportAboriginal Client Support OfficerOutcomes:Increase of clients making and maintaining contact with ong>theong>rapeutic service ong>toong> addresspersonal/family issues, better understanding of court orders for clients, increase inparenting plans for contact between parents and children, 1 in 4 clients are female.Council of Social Service of NSW (Nong>COSSong>) Page 28 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportNational Oral Health AllianceThe National Oral Health Alliance (NOHA) represents community, dental and healthorganisations seeking solutions ong>toong> ong>theong> poor access ong>toong> services and oral health outcomesexperienced by many Australians. It has come ong>toong>geong>theong>r at various points over ong>theong> pastdecade, ong>toong> show ong>theong> broad support for a national, equitable approach ong>toong> oral health.As an example, ong>theong> following text is taken from ong>theong> Alliance’s statement during ong>theong>Federal Election 2010, seeking commitments from all parties on an improved future fororal health in Australia.National Oral Health Alliance Election Statement, 2010We seek commitments from all Parties in this year’s Federal election campaign ong>toong>undertake clear, direct and effective action ong>toong> address key priorities in oral health. Animproved oral health system will be part of a more equitable and more effective healthsystem. More than one in three Australians delay or avoid dental treatment becauseong>theong>y can’t afford it and increasing numbers of people are sitting on long waiting lists forpublic dental care.Public dental patients are more likely than oong>theong>r Australians ong>toong> have dentaldecay.Nearly half of 6-year-old children have decay in ong>theong>ir ‘baby’ teeth.Aboriginal and Torres Strait Islander children aged between 4-15 years are morelikely than oong>theong>r children ong>toong> experience dental disease.People with particularly poor oral health least likely ong>toong> be able ong>toong> access proper care andtreatment are those on lower than average incomes, people living in rural and remoteareas, Indigenous people, aged care facility residents, people with disabilities, youngadults on income support payments and sole parents.The health and social impact of poor oral health is immense. Among people with seriousoral health problems:9 out of 10 experience pain or discomfort;9 out of 10 have experienced embarrassment due ong>toong> ong>theong>ir teeth, contributing ong>toong>poor self image, reducing ong>theong>ir social interactions and limiting employmentprospects; andCommon dental diseases cause extensive tissue infection, resulting in anestimated 32,000 preventable hospitalisations per year.It is vital ong>toong> improve accessibility so that all Australians have equitable access ong>toong> oralhealth care. National community, dental and health organisations have formed ong>theong>National Oral Health Alliance ong>toong> seek solutions ong>toong> ong>theong> poor access ong>toong> services and oralhealth outcomes experienced by many Australians.The Alliance is seeking a commitment from all political parties in ong>theong> federal election fordirect and effective action ong>toong> address ong>theong> following priorities in dental and oral health:1. Timely access ong>toong> oral health care2. Planning for ong>theong> future3. Prevention and educationCouncil of Social Service of NSW (Nong>COSSong>) Page 29 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportNSW Oral Health Alliance (NSWOHA)The structure of ong>theong> national alliance has also been replicated at ong>theong> state level, with ong>theong>NSW Oral Health Alliance (NSWOHA). The NSWOHA is convened by ong>theong> Council ofSocial Service of NSW (Nong>COSSong>). It comprises around 15 organisations from ong>theong>community secong>toong>r and dental profession.The NSWOHA provides a forum ong>theong> discussion of oral health issues and undertakecoordinated activities ong>toong> improve access ong>toong> dental service for low income anddisadvantaged people in NSW.Earlier this year, ong>theong> NSW Oral Health Alliance issued a call ong>toong> action ong>toong> NSW StateParliamentarians ong>toong> get behind dental reform by lobbying ong>theong>ir federal counterparts for anational oral health plan and advocating ong>theong> NSW Government for increased publicdental funding in line with ong>theong> Nong>COSSong> Pre-Budget Submission 2012-13. The Alliance iscompiling responses and publishing ong>theong>m on ong>theong> Nong>COSSong> website.The Alliance previously developed An Advocacy Kit for Community & Welfare Non-Government Organisations (NGOs). It aimed ong>toong> raise awareness of oral health issuesfor low income and disadvantaged people and encourage advocacy with politicians,media and in ong>theong> wider community.Currently, ong>theong> Alliance is developing an Information and Referral Guide ong>toong> Dentalservices for Community Workers. The Guide is ong>toong> meet a need identified by ong>theong> Alliancein ong>theong>ir previous research report on access ong>toong> dental services for clients of nongovernment human service organisations.Queensland Centre for ExcellenceIn its Fairer Queensland Plan, ong>theong> Queensland Council of Social Service (Qong>COSSong>)recommends ong>theong> establishment of a Queensland Centre for Excellence ong>toong> improveoutcomes for families and children.Evidence based best practice should be ong>theong> cornersong>toong>ne of any effective prevention andearly intervention strategy aimed at improving outcomes for families and children andreducing reliance on costly crises interventions. There is a significant gap in ong>theong>translation of evidence inong>toong> practice in Queensland. There also needs ong>toong> be a moresystemic evaluation culture that enables good practice ong>toong> be accessed and ong>theong> elementsof success embedded more widely.To ensure that programs and services are best practice and cost effective requiresaccess ong>toong> information about ong>theong> types of interventions that work and ong>theong> ability ong>toong> applyresearch inong>toong> every day practice. A secong>toong>r led centre for excellence, similar ong>toong> ong>theong>Centre for Excellence in Outcomes for Families and Children (C4EO) model in ong>theong>United Kingdom (C4EO 2012), will facilitate ong>theong> application of best practice ong>toong> policymakers, program managers and front-line services and staff.C4EO fulfilled a demand from ong>theong> early childhood development secong>toong>r for anorganisation ong>toong> facilitate ong>theong> translation of research evidence inong>toong> practice i.e. acting asan “intermediary knowledge broker”. There are ong>theong> beginnings of a similar movement inCouncil of Social Service of NSW (Nong>COSSong>) Page 30 of 31


Submission ong>toong> ong>theong> ong>Senateong> Community Affairs Committee on Australia’s response ong>toong> ong>theong> WHO ‘Closing ong>theong> gap’ reportong>theong> health industry in Australia through ong>theong> establishment of “translational” units. Suchorganisations “act as a bridge between research and user communities. For example,ong>theong>y translate research accounts for practitioners, and can ensure that research findingsare targeted at ong>theong> right people, at ong>theong> right time.” (Nutley 2010).The aim of establishing a Queensland secong>toong>r-led centre for excellence is ong>toong> improvepractice and strengong>theong>n prevention and early intervention service delivery channels ong>toong>improve ong>theong> lives and well-being of children and ong>theong>ir families, particularly those who areong>theong> most vulnerable. It would do this by facilitating a culture of improvement throughevaluation and a focus on applying “what really works”. It would deliver:Improved outcomes for children and families;Improved collaboration between service providers and government and nongovernmentagencies; andCost efficienciesA centre for excellence led by ong>theong> secong>toong>r would translate validated research evidenceinong>toong> useable formats for practitioners; provide focused and tailored support ong>toong>organisations and ong>theong>ir practitioners ong>toong> apply ong>theong> evidence; fill a major gap in investmentin practice improvement for child and family services in Queensland; and provide ong>toong>olsfor evaluation of outcomes.It would not undertake its own research. Instead it would focus on collecting, translatingand disseminating ong>theong> findings of validated relevant research in useable and practicalformats ong>toong> practitioners. It would incorporate elements of ong>theong> C4EO model including ong>theong>secong>toong>r-led tailored “peer ong>toong> peer” support service. This service utilises experts from ong>theong>secong>toong>r ong>toong> work with organisations ong>toong> strengong>theong>n ong>theong>ir programs and service deliverymodels based on best practice.Council of Social Service of NSW (Nong>COSSong>) Page 31 of 31

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