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

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Submission <strong>to</strong> <strong>the</strong> <strong>Senate</strong> Community Affairs Committee on Australia’s response <strong>to</strong> <strong>the</strong> WHO ‘Closing <strong>the</strong> 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 <strong>the</strong> social determinants of health. The new approach <strong>to</strong> governance forhealth outlined by <strong>the</strong> WHO Commission implies a new role for <strong>the</strong> health sec<strong>to</strong>r. HealthDepartments must engage systematically across government and with o<strong>the</strong>r sec<strong>to</strong>rs <strong>to</strong>raise awareness of <strong>the</strong> social determinants of health and lead coordinated action <strong>to</strong>address <strong>the</strong> health and well-being dimensions of <strong>the</strong>ir activities.To promote action on <strong>the</strong> social determinants, Health Departments can:Re-frame health and well-being as integral <strong>to</strong> a successful society, and not just aservice sec<strong>to</strong>r.Build <strong>the</strong> knowledge and evidence base of policy options and assess <strong>the</strong>comparative health consequences of options within <strong>the</strong> policy developmentprocessBuild capacity for cross-agency and intersec<strong>to</strong>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 <strong>to</strong> prioritise and strategically thinkthrough <strong>the</strong> key health concerns in relation <strong>to</strong> o<strong>the</strong>r sec<strong>to</strong>rs and <strong>the</strong> ability <strong>to</strong> understand<strong>the</strong>ir agendas and priorities. It requires abilities in reaching out <strong>to</strong> o<strong>the</strong>r sec<strong>to</strong>rs <strong>to</strong>facilitate intersec<strong>to</strong>ral dialogue and in contributing <strong>to</strong> intersec<strong>to</strong>ral activities led by o<strong>the</strong>rsec<strong>to</strong>rsRecommendation:Commonwealth and State health departments take a leadership role in governance forhealth and build <strong>the</strong>ir internal capacity <strong>to</strong> advocate for and contribute <strong>to</strong>, <strong>the</strong>implementation of a Health in All Policies approach.Medicare LocalsMedicare Locals have <strong>the</strong> potential <strong>to</strong> improve coordination, integration and continuity ofcare in <strong>the</strong> community, and reduce population health inequities. However, MedicareLocals will only be effective if <strong>the</strong>y fully engage with <strong>the</strong> communities <strong>the</strong>y serve.Medicare Locals must have an informed understanding of <strong>the</strong> population health needsand <strong>the</strong> scope of services that are available in <strong>the</strong>ir communities in order <strong>to</strong> improvehealth outcomes, especially for <strong>the</strong> most vulnerable. To do this, <strong>the</strong>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 (N<strong>COSS</strong>) Page 20 of 31
Submission <strong>to</strong> <strong>the</strong> <strong>Senate</strong> Community Affairs Committee on Australia’s response <strong>to</strong> <strong>the</strong> WHO ‘Closing <strong>the</strong> gap’ reportThey must also have adequate funding <strong>to</strong> facilitate local service coordination andintegration. Financial incentives are needed <strong>to</strong> support organisations along <strong>the</strong> healthcare continuum and from across <strong>the</strong> spectrum of community support <strong>to</strong> work <strong>to</strong>ge<strong>the</strong>raround <strong>the</strong> needs of <strong>the</strong> 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 <strong>to</strong> preventionthan a narrow focus on lifestyle risk fac<strong>to</strong>rs. This includes targeting those areas ofgreatest inequity, such as mental health and oral health. A comprehensive, holisticapproach based on <strong>the</strong> social model of health includes <strong>the</strong> promotion of good healthand well-being, not just <strong>the</strong> prevention of chronic disease.We also recommend <strong>the</strong> ANPHA engage with a wide range of interests in healthbeyond traditional medicine, including allied health, mental health and oral healthprofessionals, and with <strong>the</strong> non-profit community services that are already working withsome of <strong>the</strong> most disadvantaged individuals and communities in Australia.National Health Performance Authority (NHPA)The <strong>COSS</strong>es welcome <strong>the</strong> establishment of <strong>the</strong> NHPA and <strong>the</strong> new Performance andAccountability Framework. The Healthy Communities Reports and Hospitals Reportswill provide an important accountability mechanism <strong>to</strong> drive improvements in heal<strong>the</strong>quity. We believe that common indica<strong>to</strong>rs between Medicare Locals and Local HealthNetworks/Districts are essential <strong>to</strong> drive collaboration and integration at <strong>the</strong> local levels.We note <strong>the</strong> NHPA has agreed <strong>to</strong> consult with stakeholders <strong>to</strong> fur<strong>the</strong>r developappropriate indica<strong>to</strong>rs, and we recommend this includes <strong>the</strong> community sec<strong>to</strong>r.(c)(iii) Appropriate Commonwealth data ga<strong>the</strong>ring and analysisThe <strong>COSS</strong> Network argues that <strong>the</strong>re needs <strong>to</strong> be more comprehensive socialmeasures that reflect levels of disadvantage at <strong>the</strong> national, state and local levels.Without appropriate measurement and indica<strong>to</strong>rs of systematic differences in healthdeterminants, it is impossible <strong>to</strong> measure progress <strong>to</strong>wards reducing health inequitiesacross <strong>the</strong> Australian community.While <strong>the</strong>re is some national data collection and reporting on inequities, it is notcomprehensive. For example, <strong>the</strong> Australian Bureau of Statistic report, Measures ofAustralia's Progress, only identifies <strong>the</strong> health outcomes for men and women, Aboriginaland Torres Strait Islander peoples, older Australians and socioeconomic status for alimited number of indica<strong>to</strong>rs.Data collection and reporting on inequities must be built in <strong>to</strong> <strong>the</strong> moni<strong>to</strong>ring andperformance frameworks of all agencies. Reports by <strong>the</strong> Social Inclusion Board are aCouncil of Social Service of NSW (N<strong>COSS</strong>) Page 21 of 31
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