Is Australia’s national health reform agenda taking account of social determinants of health?

Never shy of a tough question, on April 28, the Sydney University's Menzies Centre for Health Policy (MCHP) and the Oxford Health Alliance (OxHA) Asia Pacific Centre co hosted a seminar to ask Australia's three imminent major health policy reform commissions if and how they are approaching the core issue of the role of social disadvantage in health and illness.

Attracting over 200 people, the largest seminar ever hosted by MCHP, this is clearly a question of considerable importance to the University and broader community.

The seminar was set in the global context of the World Health Organisation's recent landmark report on social determinants of health, Closing the Gap in a Generation - which was lead by Professor Sir Michael Marmot an alumnus of Sydney University - and against the backdrop of the five points of the Sydney Resolution. A brainchild of the OxHA Asia Pacific Centre, the Sydney Resolution highlights the inextricable link between physical, mental, social health of people and the 'health' of the planet, and sets out a call for urgent action to achieve healthy places, healthy food, healthy business, healthy public policy and healthy societies.

Co-chaired by Professor Stephen Leeder and Associate Professor Ruth Colagiuri, the seminar brought together the perspectives of the three major, national health reform policies commissioned by, and soon to be delivered to, Australia's Federal Health Minister, the Hon. Nicola Roxon ie:

• The National Preventative Health Taskforce (NPTF) report
• National Health and Hospital Reform Commission (NHHRC) report
• The Primary Care Strategy

A stellar cast of national luminaries addressed the theme of the seminar - Australia's journey to being the' healthiest country by 2020': we have the maps but can we follow the tracks?- provided commentaries and engaged in a lively debate with the audience.

Professor Mike Daube, Deputy Chair of the NPTF and President of the Public Health Association of Australia, a friend of OxHA and well known anti-smoking activist, detailed the directions being taken by the National Preventative Task Force - after which the seminar was named. But is seems there is more than one viewpoint about the aspiration "Australia the healthiest country" and Professor Fran Baum, a commissioner on the WHO's Commission on Social Determinants of Health, Regional Representative of the People's Health Movement and a longstanding champion of the social determinants of health and reducing inequalities, challenged this notion vigorously. Questioning the need to be the healthiest country or be 'in a fair world with health fairly divided', Professor Baum, spoke eloquently of the benefits of 'creating health versus preventing disease' and the need to commit to a social justice approach. She used the 'tip of the iceberg' analogy to illustrate the folly of addressing illness in isolation from socio-economic context ie treating deviations via the traditional bio-medical model then sending people back to the same conditions that made them sick in the first place.

Dr Tony Hobbs, Chair of the Primary Health Care External Reference Group, argued that a well-resourced, integrated primary care system based on a whole of government approach and positive community engagement were critical to enabling Australia to address issues of social equity in relation to health. Professor John Catford detailed the advocacy case for how we might convince governments to act on these imperatives and the Hon. Professor Geoff Gallop, NHHR Commissioner and Director of the University of Sydney's Graduate School of Management, emphasised the primary and fundamental importance of "starting the wheel of reform in the right place" and the political imperative to maintain choice.

So what did the audience say? The short answer is much and passionately. Much about the need for a true 'health' system rather than an 'illness' system. Much about the need to create, as the norm, a seamless interface between health and public and social policy. Still more about the critical urgency of ensuring that Australia's health policies are geared to take account of social determinants of health. Are there synergies between the three current reform agendas? On what issues do they diverge? Are the commissioners talking with each other about their respective reports and recommendations? Will the reports simply pay lip service to social justice or will they tackle this fundamental issue? And the pragmatists wondered what will Minister Roxon do when these reports, and the multiplicity, complexity and implications of their various recommendations for government spending and structural barriers, land on her desk? What are outcomes achievable? What would be a possible way forward?

Typically, the general debate raised more questions than it answered. But this is not a bad thing and, after all, the role of the Menzies Centre is to help provide the Australian people with a better understanding of their health system and what it provides for them. The Centre encourages informed debate about how Australians can influence health policy to ensure that it is consistent with their values and priorities and is able to deliver safe, high quality health care that is sustainable in the long term.

By Associate Professor Ruth Colagiuri