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Expert healthcare panel discusses closing the gap in health equity

Contributor:
Fuseworks Media
Fuseworks Media

Universal healthcare is built on the principle that every Australian should have equal access to quality healthcare based on medical need, not the size of their wallets, their postcode or their ethnicity. However, it’s estimated that 80% of health outcomes are affected by social, economic, and environmental factors.

Professionals in the medical and healthcare sector have exclusively shared their views on the impacts of the COVID-19 pandemic on health equity in Australia. The panel interview was hosted by MedicalDirector, a Telstra Health owned business, and covered issues of access, affordability, data, and the collaboration required to close the growing gap.

Panellists

Dheepa Jeyapalan, former Advisor to CEO, Victoria Health Stephen Duckett, Director of Health Programs, Grattan Institute Karl Briscoe, CEO of the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners Professor Carla Treloar, Director of the Centre for Social Research in Health and the Social Policy Research Centre, UNSW

Panel Interview and Transcript link:  https://www.medicaldirector.com/news/clinical-practice/2022/01/closing-the-gap-in-health-equity

Key Outtakes

Although the issue of health equity has existed long before the emergence of COVID-19, the pandemic brought mainstream attention to the problem, amplifying the profound impact that social, economic and environmental factors can have on our health and wellbeing.

"COVID-19 was a microcosm, a spotlight, on the underlying problems we have already in the health system," says Stephen Duckett, Director of Health Programs, Grattan Institute. "Time and time again we saw the uneven nature of the exposure, the uneven nature of prevention, and the consequential uneven nature of vaccination rates."

Karl Briscoe, CEO of the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, says the pandemic has brought the systemic racism and inequality that exists within our country back into the spotlight.

"Aboriginal and Torres Strait Islander leaders have been raising the issue of health and equity, and the need for holistic joined-up approaches to address the social, cultural and environmental determinants of health and wellbeing for many, many decades."

Despite the significant challenges faced, there were some positives that emerged from the pandemic. Briscoe says it not only strengthen the capacity of Indigenous leadership, it also highlighted the critical importance of Aboriginal and Torres Strait Islander-led responses.

"Prior to COVID 19 reaching our shores, we understood the risk and we knew our communities were vulnerable and at elevated risk of serious infection and mortality," he notes. "We raised issues of geography, overcrowding, the need for culturally safe responses, health services’ capacity and awareness. We exercised our leadership and we worked collaboratively to develop responses, mobilise our networks and harness support."

"The way we partnered with government to successfully keep our people safe demonstrates a need to stand with us, to hear us and support our leadership," he says.

The dangers of data without context

Research shows that lower socio-economic groups have higher instances of obesity and other chronic illnesses such as type 2 diabetes. For example, Western Sydney in NSW is recognised as a hotspot for diabetes, with twice the incidence of the northern and eastern suburbs.

And while these statistics highlight the impact that our environment has on health outcomes, Professor Carla Treloar, Director of the Centre for Social Research in Health and the Social Policy Research Centre, warns against using data like this as a stick to label these communities as "lacking" or "deficient".

"We live in a very data-full world, but data can be used really problematically," she warns. "It’s about understanding how an individual and their community lives with themselves and each other," she says.

For example, are there green spaces available to go for a walk versus having to pay for expensive gym fees? How available and affordable is fresh food? What kinds of community supports are available for educating people about food choices or activity?

"Allowing communities to look at that data themselves, make sense of it, understand how it fits into their world and the solutions that they can see for themselves, is the way to go here," she advises.

Dheepa Jeyapalan, former Advisor to CEO, Victoria Health agrees that data is most powerful when used to uncover the underlying causes rather than focusing on outcomes.

"As a public health dietician, I think about the barriers that people face to accessing and enjoying nutritious food," she says.

She points out that people in these so called "hot spots" often face a long-commute, and may have language barriers or financial limitations that can significantly prevent them from accessing nutritious food.

"When you slowly interrogate that, you realise that there are 10 to 20 barriers to having a nutritious meal at dinner. So then that’s where data should come into play, for us to figure out what barriers exist and how to dismantle those barriers so that having a nutritious meal for dinner is not a far off dream, but an easy and accessible reality for more families," she says.

Affordability and accessibility inconsistent across Australia

Despite the fact that between 81-87% of all Medicare services are bulk-billed, and 10 per cent of our GDP is spent on healthcare, many Australians still find themselves paying out of pocket for healthcare.

Stephen Duckett says that while our healthcare system and access to bulk billing services is a good foundation, it’s still unbalanced in terms of financial barriers.

"Depending on who you are, you can have a very different experience of the healthcare system," he explains. "If I live in rural or remote Australia, I have less access to seeing a bulk billing specialist. If I have a chronic illness, I spend much more of my income on healthcare than if I don’t have a chronic illness."

He says that Medicare is a good foundation, but it needs to be improved.

"We need to be addressing these out-of-pocket costs for access to general practice and specialist services," he stresses.

Karl Briscoe points out that for some groups in our society, such as Aboriginal and Torres Strait Islander people, there has never been health equity. And for these groups, healthcare in Australia is becoming increasingly unaffordable and inaccessible.

Karl says that the government’s push to increase representation in the healthcare workforce is one way to increase agency and ownership of health outcomes. However, ABS data shows that Aboriginal and Torres Strait Islander people only represented 1.8% of the health workforce, despite accounting for 3.3% of the Australian population.

"Aboriginal and Torres Strait Islander people must have equal representation in all roles, levels and locations across Australia’s healthcare system, education and training sectors to have a true ownership and autonomy of health, social and emotional wellbeing," he says.

GPs are vital in balancing health equity

Although GPs may feel powerless to tackle this issue on an individual level, Stephen Duckett points out they do have an important role to play in influencing change.

"GPs, in their associations such as in the college of GPs, can highlight these issues of equity and where our health provision is going wrong," he says. "We need to make sure everybody can get access to these services."

However, this needs to be supported from the top to have any sort of lasting impact, he points out.

"If we pursue a strategy at both the individual level and the organisational level, we’ve got a better chance of dealing with this issue," he concludes.

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