Australian Politics and Policy - Senior, 2019a

Australian Politics and Policy
which commands a large and growing proportion of government budgets. In
Australia one-fifth of government outlays are for health care.
Governments and the health of nations
Public health
Many government interventions that contribute to (or detract from) people’s health
take place in areas other than the health portfolio. Regulations such as those
applyingtofirearms,foodsafety,airqualityanduseofseatbeltsallhaveaneffecton
health. So too do provision of infrastructure such as clean water and sewerage, and
town planning (do our cities encourage walking, are there enough playing fields?).
Policies to do with slowing the rate of climate change or mitigating its effects may
seemtobedistantfromhealthpolicy,butclimatechangecanhaveprofoundeffects
on the incidence of heat stress, food supply, the spread of diseases, air quality,
natural disasters and dislocation of entire populations. 1
Then there are specific measures that are generally described as ‘public health’.
These include vaccinations, and campaigns on safe sex, discouragement of smoking
and on responsible use of alcohol. The reach of a government’s ‘health’ portfolio
varies between states or other divisions within nations: governments may, for
example, include sport in the health portfolio.
Social determinants of health – unsung but effective policies
Sound health and socio-economic conditions are strongly correlated. Those who
enjoy connections to the community, well-paid and meaningful work, social
support and control over their lives enjoy better health than those who don’t.
The Australian Institute of Health and Welfare (AIHW) points out that ‘people in
lower socio-economic groups are at greater risk of poor health, have higher rates
of illness, disability and death, and live shorter lives than those in higher socioeconomic
groups’. 2
Correlationdoesnotprovecausation:thosewhosufferpoorhealthcannot
easily find well-paid employment, for example. But there is strong evidence that
there is also causation in the other direction: people’s health over their lifetimes
is influenced by their socio-economic conditions. Among what are known as the
‘social determinants of health’ are early childhood development, education attainment,
people’s occupation (those with more control over their work enjoy better
health), job and financial security, and people’s degree of social integration. 3
1 McMichael 2017.
2 AIHW 2018a, 256.
3 Wilkinson and Marmot 2003.
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