Government responses to the Social Determinants of Health
This chapter discusses
current government action to address the social determinants of health in
Australia and also alternative models put forward as possible means to improve
Commonwealth government endeavours to address the social determinants of health
Efforts to address the social determinants of health by State governments
received evidence that governments around Australia are individually, and
together, taking action to address the social determinants of health. An example
of intergovernmental action is the Closing the Gap initiative, through
which the Commonwealth, in partnership with other governments, is making
efforts to address social determinants of health amongst Indigenous
Australians. The Northern Territory's Department of Health reported that:
At a national level through the Council of Australian
Governments and at a Territory level, actions have been taken to raise
awareness of the Social Determinants of Health. In the Northern Territory
responses include funding agreements with the Commonwealth Government through
Closing the Gap and Stronger Future agreements.
Different State and Territory governments are adopting a variety of
approaches to address the social determinants of health in their individual
jurisdictions. The Northern Territory, for example, reported that it is
addressing the social determinants of health through the Northern Territory
Chronic Conditions Prevention and Management Strategy 2010–2020 by
improving living conditions, food security, education, employment and health
In response to calls for greater action on social determinants of health
the Tasmanian Government initiated the Fair and Healthy Tasmania Strategic
Review in 2010 to consider the most appropriate approaches to improve
health and reduce health inequality in Tasmania.
In response to the Fair and Healthy Tasmania Strategic Review the
Tasmania Government launched A Healthy Tasmania which outlines six
streams of activity to address the social determinants of health.
One notable feature of Tasmania's efforts in improving health equality is
specific reference to the social determinants of health as an important area of
action for government.
The South Australian government's actions in addressing the social
determinants of health were regularly cited in submissions to this inquiry as
representing the best practise approach to addressing the social determinants
of health. The South Australian government has adopted a collaborative
interdepartmental response to the social determinants of health. Demonstrative
of the South Australian government's commitment to addressing the social
determinants of health, the Minister for Health and Ageing specifically
referred to the WHO Report in his second reading speech for the Public
Health Act 2011 (SA) noting that the legislation 'in part provides for
South Australia's response to this challenge.'
It was explained to the committee that 'in particular, [the legislation]
includes principles of sustainability, partnerships, equity and prevention,
providing a mandate for working together and recognising that the social
determinants of health are fundamental to improving population health
Other components of the South Australian government's approach include
the introduction of the Health in all Policies initiatives – discussed in
further detail below – and the identification of strategic priority areas in
domains such as housing, employment and education.
The Australian government has not implemented any formal response to the
WHO recommendations. The approaches taken by the South Australian and Tasmanian
Government were assessed by the Department as 'combining traditional policy
development models with locally relevant policy drivers and objectives.'
In preparation for the Helsinki 2013 8th Global Health
Conference on Health Promotion, a number of Australian jurisdictions, led by SA
Health, have formed a working group to develop a publication of Australian case
studies of action on social determinants and health equity.
As explained by the Tasmanian Department of Health and Ageing:
The Australian social determinants case studies book will be
used to promote and document examples of Australia's work on the social
determinants at the Global Conference, as well as providing a useful resource
for jurisdictions. Its purpose is to support the current momentum for action on
social determinants and health equity in Australia and overseas.
The committee heard that at the domestic intergovernmental level COAG
has developed a range of responses to indirectly address the social
determinants of health by the implementation of a range of programs, strategies
and frameworks, including those funded under the National Partnership Agreement
Preventative Health and the National Partnership Agreement Indigenous Early
The Commonwealth Government
One of the terms of reference of this inquiry is the role of the
Commonwealth in addressing the social determinants of health, and the extent to
which the Commonwealth is adopting a social determinants of health approach to
programs and services, administrative arrangements, and data gathering and
The Department, appearing at a public hearing in Canberra, informed the
committee that the Commonwealth is already undertaking a social determinants of
An approach is taken, certainly by our department, that
recognises the interconnectedness and complexity of the social determinants of
health through integrated approaches to the development and implementation of
social policy and programs, both at the Commonwealth level but also across all
levels of government...Using evidence and innovation the government is working in
a coordinated way with other governments across the spectrum of
determinants—education, housing, income support and social inclusion—to provide
a mix of universal and targeted programs that contribute to improved health and
There are instances within the Department's submission that appear to use
the common language of the social determinants approach. For example, when
discussing the development of a National Aboriginal and Torres Strait Islander
Health Plan to tackle disadvantage, the submission states:
The Australian Government recognises that avoidable health
inequalities arise because of the circumstances in which people grow, live,
work and age, and that factors such as education, income, housing and community
functions affects the health of people and influences how a person interacts
with health and other services.
However, in spite of the evidence presented to the committee arguing
that the Commonwealth is taking numerous measures to address the social
determinants of health, evidence for these claims appears to be minimal. Word
searches of recent annual reports and appearances by the Department at Senate
Estimates hearings reveal that:
- The 564–page 2011–12 Annual Report makes one mention of social
determinants of health; 
- The 634–page 2010–11 Annual Report makes one mention of the
social determinants of health;
- There have been no mentions of the social determinants of health
during appearances at Senate Estimates in either 2011–12 or 2012–13.
Evidence provided in the Department's supplementary submission also
appears to emphasize that they currently maintain a traditional focus on
addressing health concerns using the health system as the primary vehicle for
attaining improved health outcomes, stating:
While many factors affect health, recognition must be given
to the importance of health programs and policies on health. There is a risk
that focusing on delivering programs more broadly, outside the health sector,
may result in inadequate resourcing of health programs. If such diversity leads
to dilution of health effort, or adversely impacts on access to health
services, health outcomes may suffer.
The committee was not alone in querying whether the Department was
taking the kind of social determinants approach as indicated in their
submission. HealthWest Partnership, at the request of the committee,
reviewed the submission of the Department and concluded:
On review of the DOHA submission, it was not clear that
social determinants were being considered as complex, interlinked and requiring
comprehensive response, as would be expected if a Health in All Policies
approach was adopted.
These facts appear to support the observation made to the committee by
Catholic Health Australia that noted that Australia has so far addressed the
social determinants of health 'in an ad hoc and not necessarily coordinated
Catholic Health Australia did highlight however that on many fronts
the Commonwealth, and Australia as a whole, already has important investments
and mechanisms in place:
The submission of the Department of Health and Ageing
indicates the significant investment the Australian government makes and we,
too, from Catholic Health Australia's perspective, acknowledge that the quality
of early childhood development, of our schools and of workforce participation
programs in Australia and, indeed, the social safety net which exists in our
welfare system, that all of these important parts of social infrastructure go a
long way to addressing social determinants of health. But what we see, despite
this very good social safety net and very good social infrastructure of
schooling and early childhood support, is that some Australians still slip through
Catholic Health Australia put forward a three-point plan to improve the
Commonwealth's ability to address the social determinants of health in
- The Australian Parliament should formally adopt the WHO Report;
- The Prime Minister should table an annual report indicating
progress against the social determinants of health; and
- All Cabinet submissions be required to consider the social
determinants of health.
Current Commonwealth action addressing the social determinants of health
A number of examples were put to the committee as evidence that the
Commonwealth is cognisant of, and addressing, the social determinants of
health. Although each of the following examples are worthy measures to improve
the health of Australians, it is not always clear whether they take a social
determinants approach by accident, design, or at all.
Closing the Gap
In 2007, the Council of Australian Governments (COAG) agreed to a
partnership between all levels of governments to work with indigenous communities
to achieve the target of Closing the Gap in indigenous disadvantage. Closing
the Gap is cited by a number of submissions as the principal example of a
social determinants of health approach being undertaken by the Commonwealth.
As explained by Flinders' University's Professor Baum:
The Council of Australian Governments National Indigenous
Reform Agreement on 'Closing the Gap' in health and other social outcomes
between indigenous and non-indigenous Australians incorporates goals in areas
of early childhood education, literacy and education improvements, employment
outcomes, healthy homes and safe communities, and governance; as well as
improved access to healthcare. As such it is a good example of policy
recognising and taking action on SDH within a particular segment of the
Following the commitment by Australian governments to close the gap
between indigenous and non-indigenous groups, the Indigenous Health Equality
Summit Statement of Intent (Statement of Intent) was signed between
representatives of the Commonwealth and key non-government organisations.
The Statement of Intent commits governments to 'adopting a rights based
approach to health'.
Closing the Gap and the associated Statement of Intent are based on the
principles highlighted in the WHO Report. For example, the Statement of Intent
articulates the right for Indigenous peoples to:
Participate in decision-making through a commitment to a
partnership between Aboriginal and Torres Strait Islander peoples, their representatives
and Australian governments that will underpin the national effort to address
The Central Australian Aboriginal Congress Inc. reported to the
committee that the advances in Aboriginal health improvement in the Northern Territory
– a 26 percent improvement in the age standardised death rate since 1998 –
can be attributable to improved access to healthcare.
It was highlighted to the committee that the positive results being achieved
under the auspices of Closing the Gap are archetypal of the actions and
results that can be expected when a social determinants of health approach is
Medicare Locals are another program that was highlighted by the
Commonwealth as a way in which it is currently addressing the social
determinants of health. The work of Medicare Locals was also supported by a
number of stakeholders, with St Vincents Health, for example, noting:
Medicare Locals are critical to what it is that we are
talking about, because they really do have a remit within their terms of
reference to take more of a population-based health approach to the health
outcomes of the community that they are responsible for.
The Public Health Association of Australia were positive about Medicare
Locals, stating that it appears that Medicare Locals are taking social
The Department cited Medicare Locals as an important tool to enable health
solutions being tailored to local needs.
As explained by Mr Smyth:
I think that Medicare Locals is a key area now where at the
local level we are going to be doing some service mapping, but also getting a
better understanding of the health profile and the social profile of those
groups to ensure that interventions are appropriately constructed to ensure that
you are going to get a better outcome.
Professor Friel highlighted the Medicare Locals program as a way in
which the Commonwealth is addressing the health needs of Australians:
The national rollout of Medicare locals with a prevention
mandate is encouraging and they have proactively sought input [from me and
others] on how best to take a social determinant of health approach to
population health and equity.
However, Professor Friel cautions that: 'It will be important to monitor
the effectiveness of Medicare Locals in terms of impact on disease risk, health
outcomes and their social distribution.'
The committee received evidence from other stakeholders querying the
efficacy of Medicare Locals as a mechanism to address social determinants:
Whilst you might have stated commitments to addressing
determinants or, more likely, discussions around primary health and primary
care, what we are seeing on the ground is that the mechanics of funding and
supporting organisations to work in this space do not actually realise those
aspirations at all effectively...I think it is highly likely that significant
amounts of those funds will in fact go more to early intervention or, at best,
tertiary prevention, largely because they is not sufficient specificity in the
There was also some concern expressed regarding the structure of the
Medicare Local scheme. Although primary care service provision that takes into
account local needs appears to have positive outcomes, it is unclear if the
fragmented structure is appropriate for addressing social determinants. As
explained by HealthWest Partnership:
The language says that 'these are going to be locally
focused'—well, of course we believe in that; we are passionately committed to
things that are locally focused. But we are a little bit worried that the Pty
Ltd structure creates a level of variability in how each of the Medicare Locals
interprets matters like population health data, burden of disease, health
inequalities, and necessary community strategies. Those are things for which
you need a coherent approach. I talked in the beginning about vertical
integration. You really need to drive that quite comprehensively through your
various policy schemas, through your various levels of government, and our
concern is that, whilst Medicare Locals might be locally focused, they are very
dispersed and different and have greater or lesser capacity in the population
health, planning, prevention space, and that worries us enormously.
The establishment of the Australian National Preventive Health Agency
(ANPHA) and the Australian Social Inclusion Board (ASIB) in recent years has
created infrastructure that has the capacity to address the social determinants
Established on 1 January 2011, ANPHA is tasked with overseeing
improvements in how Australians can deal with lifestyle risk factors such as
obesity, tobacco use, and excessive consumption of alcohol. The committee was
[ANPHA] will support all Australian Health Ministers in
managing the complex challenges of preventable chronic disease, focusing on
issues such as poor nutrition, physical inactivity, smoking, obesity and
excessive alcohol consumption through research and social marketing programs.
It will collect, analyse and disseminate information and is required to publish
a report on the state of preventive health in Australia every two years.
The Australian Social Inclusion Board was established in May 2008 as the
main advisory body to the Commonwealth on ways to achieve better outcomes for
the most disadvantaged individuals in society.
The 'Social Inclusion Approach' was presented to the committee thus:
The Australian Government's vision of a socially inclusive
society is one in which all Australians have the opportunity and support they
need to participate fully in the nation's economic and community life, develop
their own potential and be treated with dignity and respect.
The Australian Social Inclusion Board's role is to provide
advice to Government on the social inclusion agenda, and ways the Government
can achieve better outcomes for the 5 [per cent] most disadvantaged in our
The committee heard that:
The Australian Government's Social Inclusion agenda
recognises the complex nature of entrenched social disadvantage, and the
importance of ensuring that people have access to employment opportunities,
social services, secure housing and community connections.
The National Health and Medical Research Council (NHMRC) is mandated
under its 1992 Act to raise the standard of individual and public health
throughout Australia. It was reported to the committee that the NHMRC is
currently providing funding for 89 grants looking at the social determinants of
health with a combined value of $15 million.
The committee heard some concerns regarding the narrow focus of these agencies.
Women's Health Victoria noted for example that ANPHA currently has an
issues-based focus rather than a social determinants approach and that social
inclusion is only one of the social determinants of health.
The committee also heard that the current focus on individual lifestyle factors
did not represent a social determinants approach that call for complex
intersectoral strategies that achieve long-term improvements:
We see responding to the social determinants of health to
prevent the unfair difference in health outcomes between population groups and
responding to disease epidemics as similarly needing a complex set of
strategies. The current focus of programs on changing individual's behaviours
is equivalent to teaching people to swim to prevent Titanic-like disasters. It
is a limited and inadequate response.
This view was echoed by Professor Baum who observed that:
...while the preventative health agenda does attempt to focus on
the causes of disease it is limited by the absence of a national agenda
devising strategies to address social determinants of health in a systemic way.
The predominant focus on individual 'lifestyle choices' and behaviour change as
the target of interventions does not adequately address the social context in
which behaviours occur, or give sufficient emphasis to the role of health
promotion strategies focused on creating healthy settings and development of
The narrow focus of ANPHA in particular, but also ASIB to a lesser
extent, limits their ability to take a social determinants approach.
National Partnership Agreements
In November 2008 COAG allocated significant amounts of money to
infrastructure necessary to sustain social development. Five new national
specific purpose payments (SPP) were created with funding of $60.5 billion in a
National Healthcare SPP; $18 billion in a National Schools SPP; $6.7 billion in
a National Skills and Workforce Development SPP; $5.3 billion in a National
Disability Services SPP and $6.2 billion in a National Affordable Housing SPP.
The committee heard that 'each of these SPP and National Partnerships has the
potential to really improve the lives of people and consequently their health
The National Healthcare Reform Alliance criticised the national
partnership agreements for not taking a social determinants approach and
perpetuating the policy siloes:
If you look at all of the COAG agreements they are all very
separate—education is education, transport is transport, health is health—they
don't really link together. Even the actual actions in the health agreement do
not really link together other than through your being able to do a
hypothetical link between safety and quality and between performance and health
workforce. But how those people actually talk to each other and how it actually
happens in reality is very different. I think that happens across all of the
current agreements; I don't think there is this overarching: 'Well, what are we
doing this all for,' perspective.
Suggested Commonwealth response to WHO Report and the social determinants
The four key areas of action suggested throughout this inquiry to be
implemented at the Commonwealth level were to endorse the findings of the
WHO Report and its associated recommendations; to include a 'Health in All
Policies' approach to public policy making; to centralise administrative
responsibility for addressing the social determinants of health; and to
establish reporting mechanisms to track progress in addressing the social
determinants of health.
Adopting the WHO Report and its
submissions received by the committee, there is widespread support for
addressing the social determinants of health in Australia in line with the
recommendations put forward in the WHO Report.
Articulating the sentiment of many submissions, Catholic Health Australia
called for the formal adoption of the WHO Report arguing that:
The Australian Government, supported by all political parties,
hopefully in the Australian Parliament, should enforce and formally adopt the
World Health Organisation's 2008 Closing the gap in a generation report.
the Australian Psychological Society noted that:
Poverty harms the poor most – but it is everyone's
problem...and requires that all of us attend to its solutions...The adoption of the
recommendations contained in the WHO report, and each of the priority areas is
important if Australia is to address the health inequalities and improve health
outcomes for all people.
The WHO Report was written for a global audience and as such some of the
recommendations would have little application in Australia – such as access to
drinking water. There are however areas only tangentially touched by the WHO Report
that are of critical concern to Australia such as the health consequences of
living in rural and remote locations,
and gender-related health concerns.
The Department reported to the committee that 'Australia is committed to
progressing the Rio Political Declaration on Social Determinants of Health'
which confirms the commitment of United Nations Member States to take action to
address the social determinants of health.
Given this commitment to action, a response to the WHO Report appears a logical
The committee considers the WHO Report as an important document in the
evolving thinking around the social determinants of health. The Commonwealth,
like many other governments internationally have done, should adopt the WHO
Report. As is noted in the WHO Report, 'although there are general principles,
the precise nature of policy solutions needs to be worked out in national and
The means and manner in which the Commonwealth address the social determinants
of health will necessarily depend on the needs of the Australian people, but
the general principles of health equality expressed through the social
determinants framework should be recognised as an important policy goal by the
adoption of the report.
The committee recommends that the Government adopt the WHO Report and
commit to addressing the social determinants of health relevant to the
Adopting a Health in All Policies
The pre-eminent idea put to the committee to address the social
determinants of health in Australia was for the Commonwealth government to
adopt a similar mechanism as the South Australian 'Health in All Policies'
(HiAP) approach to government action. HiAP is a horizontal health policy
strategy that incorporates health as a shared goal across all parts of
Government and addresses complex health challenges through an integrated policy
response across portfolio boundaries.
As explained by representatives from the South Australian Government:
Health in All Policies is essentially an approach to working
collaboratively on policy issues across government to enable joined up policy
responses to complex, so-called wicked, policy goblins. The problems faced by
the health department results from these wicked problems, such as obesity,
chronic disease and health inequities. All of these have serious impact on
health services and health financing and budgets, but health departments do not
actually have the policy levers to address them. Other sectors and departments
do have the policy levers—such as transport, agriculture, employment and
education—however many of these agencies that are able to take action on these
determinants of health and wellbeing do not see health as their business...Our version
of Health in All Policies looks at how we can assist other agencies in meeting
their goals, in a way that supports health and wellbeing...In South Australia the
Health in All Policies approach is applied in the internal government policy
process, focusing strongly on Health being a partner rather than a director in
the public policy process.
Under the South Australian model, in order to ensure that policies have
considered potential health impacts, health impact assessments are used.
Health impact assessments consider the potential health consequences of a
A large number of stakeholders called for the Commonwealth to adopt HiAP
approach similar to the one used by the South Australian government.
It was argued by some that a HiAP approach would improve the efficacy
and value for money of programs designed to improve health outcomes. For
example, the Central Australian Aboriginal Congress Inc. argued:
There has been a lot of new funding coming into the NT in
these areas in recent years from COAG, FaHCSIA, DoHA and other sources but it
is not been allocated into these core services and programs in a planned
manner. The investment is now largely being wasted...because competitive
tendering of new funds on non-evidence based services and programs will not
lead to further improvements.
In a similar vein it was noted by the Northern Territory Department of
Health that the best health outcomes would be achieved through inter
For Australia to fully benefit from the utilisation of HiAP
to achieve action on the [social determinants of health], COAG would have to
adopt it as a generic approach and fund the implementation in States and
One of the key benefits of a HiAP approach is that it provides a focus
for policy makers. The importance of centralisation was highlighted by St
Vincents Health Australia which noted:
Unless you have one body with the responsibility for
collecting the information, collecting the data, having the data reported to it
and reporting on the KPIs to see if we are making a difference within the
Australian healthcare system then we are going to continue the fragmentation.
The role of the Commonwealth government was cited as the key driving
force behind tackling inequality on a national scale. The Australian Medical
Students' Association for example argued:
Action to address health inequalities in Australia as a
result of inequalities in social determinants of health should be tackled
through a multi-sectoral approach spearheaded by the Commonwealth government.
Professor Baum argued that the HiAP approach relies on leadership from
the top levels of government to motivate agencies traditionally removed from
the health portfolio to 'buy-in', positing:
If the agencies are not on the side of government and you are
not getting buy-in from those central agencies who are seeing that this is part
of their core business, you have got to find a way of making that work. I am
sure there are several ways you could do that, but I think the outcome you would
want is that whatever strategy you had was really led from Prime Minister and
Cabinet and had that kind of status behind it.
One argument put forward for the adoption of a health impact or equity
assessment framework was that it would 'create a little bit more awareness and
consciousness around how decisions we make in every government department
impact on people's health and equity issues.'
The actions already taken by a number of state governments point towards some
jurisdictions being well ahead of the Commonwealth when it comes to ensuring
that there is a sufficient understanding of the social determinants of health
within government programs. Improving the awareness of health in areas outside
the traditional health field is to be encouraged.
Although the Department conceded that health impact assessments might be
useful, it was argued that this needs to be considered alongside their time-
and cost-heavy nature:
Health impact assessments have been promoted as a means of
assessing the health impacts of policies, plans and projects using
quantitative, quantitative and participatory techniques. While we think that
they may be a useful tool, we believe that they have the potential to be
expensive and time-consuming, and we believe that this needs to be taken into
account in any further consideration of these.
This point was expounded upon in the Department's supplementary
In the case of both the South Australian Government and
Tasmanian Health in All Policies Collaboration, key drivers have been
established through legislation; in particular Public Health Acts, as well as
state based strategic plans and/or targets. Duplication of such approaches at a
national level could add further complexity to an already complicated
environment without a clear mandate for action.
The Australian Social Inclusion Board made a similar case against the
use of a South Australian style approach:
The development of a more formally structured framework, such
as the South Australian approach, could introduce ambiguity into existing
Commonwealth mechanisms and therefore detract from the social inclusion
narrative. It could also result in current measurement and reporting framework
and social inclusion principles holding less currency.
However, representatives from the Department argued that there was
already adequate consideration given to health in public policy making:
An approach is taken, certainly by our department, that
recognises the interconnectedness and complexity of the social determinants of
health through integrated approaches to the development and implementation of
social policy and programs, both at the Commonwealth level but also across all
levels of government. Key aspects of the approach include a number of things:
firstly, strong governance arrangements. Some examples of those are the
Australian Social Inclusion Board, the Social Policy and Social Inclusion
Committee of Cabinet and also COAG's standing committees that look into these
issues...[W]e believe that other approaches can and are also being used to
achieve coordination across sectors and levels of government.
The committee did not receive any evidence in the form of improved
health outcomes that the South Australian model is more effective than
comparative systems. The diversity of international and domestic responses to
rising awareness of the social determinants of health points to a field of
practice undergoing rapid evolution of thought. As noted by the Chief Executive
Officer of ANPHA:
We are not sure which approaches will work best. We have almost
got a set of natural experiments going on in Australia, which we think ought to
be evaluated before we come to a conclusion on that. The South Australian
method is one way of doing it...We are not quite sure what will do the trick
here. It is one of the reasons we looked at Canada so closely. They do a bundle
of different things, and other countries have done different things as well.
The committee notes that the Department believes that it effectively
takes a social determinants approach within its own policy making. However, the
key point is that such an approach needs to be taken across government, and in
particular in social, economic and employment policy decisions that affect
social determinants (such as employment status, levels of welfare benefit, and
access to education). The need for a social determinants approach lies not only
within, but beyond, the health portfolio.
There are already mechanisms in place to ensure that important issues
are considered across government when necessary, such as the requirements for
inter-departmental consultation in the preparation of cabinet submissions, the
requirement for Regulatory Impact Statements in conjunction with the
introduction of legislation, and statements of compatibility with human rights.
Introducing a health in all policies approach of some sort would not
therefore represent a completely new dimension to policy development. While the
committee does not have a fixed view about how it should be done, the
government's adoption of a social determinants approach should influence the
policy development process, particularly in relevant areas such as education,
employment, housing, family and social security.
The committee recommends that the government adopt administrative
practices that ensure consideration of the social determinants of health in all
relevant policy development activities, particularly in relation to education,
employment, housing, family and social security policy.
Centralising responsibility for
addressing the social determinants of health
The committee heard from several stakeholders that there was a need for
additional leadership at the Commonwealth level to address the social
determinants of health.
The Australian Healthcare Reform Alliance noted that there is not necessarily a
need to establish any new agencies, but that 'what you do need is...the
leadership and the point of reference to be able to channel all the resources
The importance of centralised coordination to address social
determinants was articulated by both community and the government stakeholders.
Women's Health Victoria, for example, argued that:
It is really important to have something that is centralised.
Whilst there is a lot of work that has been going on in different departments
to varying degrees, it is really important to have a coordinating approach and
having someone take a leadership role and being in an advisory position...We
think it is vital to have something that is quite concrete and central.
Similarly, ANPHA informed the committee that:
The whole point of social determinants is that the health
outcomes are determined by things other than the health system. You need the
overarching entity not sitting within one of the portfolios, such as education
or health or something...there needs to be a central agency.
Suggestions put to the committee included ANPHA adopting a more
proactive approach to advocating for action on the social determinants of
It was argued by Women's Health Victoria and the Australian Healthcare Reform
Alliance for instance, that ANPHA would be a natural fit if its remit was
broadened from an issues based focus to a broader social determinants focus.
Professor Baum argued a similar point, positing:
[T]heir terms of reference have pushed them in the direction
of doing a lot of direct lifestyle and behavioural change. If they could have
an extension of their role to really considering social determinants then it
could be that they could fulfil the role that we imagine for a commission. I
think the important thing in this areas is not to come in and pretend that
there is nothing there already...because of their somewhat narrow terms of
reference they are constrained when it comes to looking at social determinants.
There is no reason why that could not change, but currently there is that
constraint on the way that they operate.
ANPHA was the agency most frequently mentioned, but is not the only
Commonwealth body that could act as a central point for driving a social determinants
policy agenda. It is something that could appropriately be located within the
Prime Minister's Department. The Department, Australia's Social Inclusion
Board, the ANPHA, and the Australian Institute of Health and Welfare all
provided some form of evidence to the committee on the subject, and could play
a role in taking responsibility for the issue.
Catholic Health Australia nominated ASIB as a potential lead agency in
addressing the social determinants of health at the national level.
ANPHA commented that the Social Inclusion Board is not 'an absolutely perfect
[fit], but it is pretty close.'
The ASIB were equivocal in their response to the proposal:
The Board’s role in relation to the social determinants of
health, and similar matters, is to highlight the importance of such issues
within the broader framework of the social inclusion agenda...
Where the Board’s role in
advising the Government on these priorities areas is relevant to the promotion
of the social determinants of health, the Board would bring this to the
attention of the Minister for Social Inclusion, who in turn could bring this to
the Ministers of Health.
In line with many of the submissions provided to this inquiry, the
committee is of the view that it is necessary for one body to take
responsibility for coordinating responses to social determinants at the
Commonwealth level. The committee would like to see the government engage with
key stakeholders to assess whether this is done through extending the remit of
an existing agency, the creation of a new agency, or within an existing
department such as Prime Minister and Cabinet.
The committee recommends that the government place responsibility
for addressing social determinants of health within one agency, with a mandate
to address issues across portfolios.
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