12 February 2010

What does the Marmot Review mean for Australia?

This piece originally appeared on Croakey, the Crikey Health Blog

The Marmot Review is a far-reaching review that conclusively sets out the case for tackling health inequities. It sets out a reform agenda for England that’s focused on giving every child the best start to life; ensuring work, income, and living standards; and giving higher priority to preventing ill-health.

This is actually the third major review into inequalities in England, the first one was The Black Report in 1980 and the second one was undertaken by Donald Acheson in 1998. Since then there has been considerable sustained effort to tackle health inequities, though this effort has tended to focus on promoting equal opportunities for health as opposed to the more far-reaching reforms called for in the Marmot Review. Progress on the UK government targets have been mixed, at times.

What’s interesting is that though England has been more politically willing to tackle health inequities, it hasn’t been the only place that has been trying to do so. Europe and increasingly the US are getting serious about the implications of health inequalities.

Health inequalities have been on the Australian public health radar for more than two decades. A 2002 paper estimated that 5,000 people go to “unnecessarily early graves” every year in New South Wales alone due to avoidable health inequalities.

But Australia’s health inequities are different to England’s. On one hand, we’ve historically had less income inequality, which is closely linked to health inequality. On the other hand, Aboriginal health is amongst the worst in the world. Yesterday’s Prime Minister’s Closing the Gap – Prime Minister’s Report 2010 report shows that governments in Australia are capable of making commitments to act on important inequalities if the issues are recognised.

Australia has made some progress on addressing health equity. Several Australian states have health equity policies, and equity is a professed value that underpins most Australian health systems.

The Marmot Review also call for health equity impact assessments of all government policies, which is an area of interest of mine. Australia is one of the few places in the world that has attempted to put this into practice through the development of an equity focused health impact assessment framework.

The challenge for us is to move beyond rhetoric. It’s easy for everyone to agree that we need a healthier and fairer society until we ask them to do things differently, as I’m sure many climate change activists would agree. If we want to continue to make improvements to the health of the population we’ve got to get serious about reducing unfair and avoidable differences in health outcomes.

Though it's a substantial body of work the Marmot Review is not perfect. It skims over what I believe are some of the most important aspects of addressing health inequities:

  • ensuring communities are actively involved in health system decision-making;
  • recognising the vital role of primary health care in addressing inequities; and
  • building the capacity of government to recognise and act on equity issues.

Given that the state, territory and Commonwealth Health Ministers are meeting today, they would do well to consider what targets they can set for reducing health inequities. A high profile inter-governmental review might help them.”