Australia’s health gaps – including those between rich and poor, between Indigenous and non-Indigenous Australians, and between the major cities and everywhere else – are starkly revealed in the latest reports from the COAG Reform Council:
• Healthcare 2011-12: Comparing performance across Australia
• Disability 2011-12: Comparing performance across Australia.
The health report is being formally launched at the AMA National Conference in Sydney today by Council chair John Brumby. You can follow the AMA’s discussions via
#amanatcon (it will be interesting to see how much of the chat, if any, is focused on addressing health inequalities versus professional interests).
In the post below, Mary Ann O’Loughlin, Executive Councillor and Head of the COAG Reform Council Secretariat, gives an overview of the new reports (don’t miss the informative graphs from the health report at the bottom of the post).
Beneath her article, you can read responses to the new reports from the Social Determinants of Health Alliance and the Consumers Health Forum, raising concerns about health inequalities and inequities in the healthcare system.
An overview of our performance in health, health care and disability services
Mary Ann O’Loughlin writes:
The COAG Reform Council’s job is to publicly report on the progress of the Commonwealth, State and Territory governments towards the goals of the COAG Reform Agenda.
The agenda covers housing, Indigenous reform, education and regulatory reform, as well as health and disability, which are the subject of this article.
The council does not offer the ‘why’ or ‘how’ of the results we report, but presents the data on whether outcomes are being met. We tell COAG and the Australian public if the Commonwealth, State and Territory governments are doing what they agreed to do.
The aim of the National Disability agreement is to ensure that people with disability achieve economic participation and social inclusion and enjoy choice, well-being and the opportunity to live as independently as possible. It also monitors whether families and carers are well supported.
In this year’s report we see that the use of specialist services by people with disability increased from 32% of the potential population to 35%.
The increase was strongest for community support services, which ensure people can live in the community and not an institutional setting. The ACT, Tasmania and South Australia were the strongest performers on this measure, with rates above 50%.
Declining economic participation for people with disability
The report also looked at economic participation for people with disability based on the proportion of people receiving the disability support pension who also report earnings. This showed a steady decline over the past four years—from an already low rate of 9.3% in 2009 to just 8.6%.
Carers and families also face barriers to economic participation with just over half of primary carers employed, compared to more than 75% of non-carers. More than half of primary carers also reported negative impacts on their health and wellbeing relating to the pressures of their caring role.
It will certainly be interesting to watch how the rollout of DisabilityCare affects these results.
The National Healthcare Agreement is, naturally, broader. Its aim is to ensure that all Australians, regardless of geographic location or socioeconomic status are born and remain healthy.
Remarkable progress on smoking
In this year’s report there were a number of standout results.
The rate of smoking among adults fell to 16.5%—down from 19.1% four years ago.
This continues Australia’s ‘remarkable progress’— as it has been described by the OECD— in reducing tobacco consumption in the last two decades. This is a great outcome and the result of work by successive governments at the Commonwealth, State and Territory levels.
COAG has set itself a target to reduce smoking rates to 10% by 2018 which, if achieved, will be a landmark moment in public health.
Smoking rates do, however, remain stubbornly high in rural and remote and disadvantaged areas and continued commitment is needed if governments are to get these areas on track.
This year we report new data for obesity rates and the news is not good. More than one in four Australian adults is now obese.
We know that obesity contributes to the burden of chronic disease in Australia and the management of conditions like heart disease and diabetes impacts greatly on the broader health system.
Next year the council will report new data on the prevalence of diabetes which should assist in focusing government health policy.
The report also found that 60 % of people can see a GP for an urgent appointment within four hours, but the proportion waiting for more than 24 hours has increased to nearly 1 in 4.
Some good news on preventable hospitalisations
A real positive the council has seen over four years of reporting is the fall in the rate of preventable hospitalisations each year—something you would expect to see as primary, community and preventive health care improve. The advantages of keeping people out of hospital are better outcomes for patients and more beds available to patients for whom hospital admission is essential.
As for elective surgery, wait times have increased nationally. At the mid-point of the waiting list, Queensland still comes in best at 27 days. Wait times increased in NSW, Victoria and Tasmania but have decreased in South Australia, the ACT and the Northern Territory.
Performance in emergency department waiting times has been more positive with improvements nationally and in most jurisdictions. In 2011–12, 70% of patients were seen nationally within national benchmarks for triage categories—up from 67% four years ago.
One of the objectives of the Healthcare Agreement is to support the long-term sustainability of the health system but governments are yet to define what that means.
Given that we know the system faces the pressures of an ageing population, an increasing chronic disease burden and growing consumption of health services, the council has recommended that COAG moves to bed down the measures necessary to ensure long term sustainability. Once we can measure it, the council can start monitoring it and assist governments to manage it.
• Mary Ann O’Loughlin is Executive Councillor and Head of the Secretariat, COAG Reform Council
SDOH Alliance: Further evidence of the urgent need to address health inequity
An alliance working for health equity in Australia says a new report from the COAG Reform Council provides further evidence of health gaps widening in this country, underlining the need for governments to follow international recommendations on how to address the social determinants of health in a way that’s relevant to the Australian context.
Responding to the Healthcare 2011–12: Comparing performance across Australia report, the Social Determinants of Health Alliance renewed its call for Parliament to adopt the World Health Organisation’s Closing the gap in a generation report and for the social determinants of health to be considered across all policy areas.
The Social Determinants of Health Alliance (SDOHA), representing more than 45 health, social service and public policy organisations, was launched in February. Its members believe it is well and truly time for action on health inequity in a nation that aspires to give everyone a “fair go”.
“The findings from COAG’s report are shocking. How many more of these reports do we have to wait for – as health gaps widen further and further – before we take action on the social determinants of health?” SDOHA spokesman Michael Moore asked.
“The report shows that people from the most disadvantaged areas are more likely to be overweight or obese, and smoke. Those living outside major cities are also more likely to be overweight or obese, and smoke than those living in major cities. This is a country that prides itself on giving everyone a ‘fair go’, but it’s clear from these finding that we’re a long way from actually being fair.”
SDOHA spokesman Martin Laverty said “the report also shows that when it comes to accessing elective surgery, people living in the most disadvantaged areas wait longer for elective surgery and the gap is widening. Similarly, while waiting times are improving for patients in major cities, they are getting worse for patients in remote areas.”
COAG Reform Council chair John Brumby said in his letter to Prime Minister Julia Gillard that Australians “continue to experience health inequalities based on who they are, how much they earn and where they live. We do not see consistently strong performance across all states and territories in key areas of hospital care and continue to find that there are health inequalities for Indigenous Australians”.
Professor Sharon Friel, a health equity professor at Australian National University and one of the lead advisors to the WHO’s Commission on the Social Determinants of Health, said this report reinforces the need to act on the recommendations of the Senate Inquiry report.
“Senators from across the three major parties worked diligently to produce a report that offered thoughtful recommendations on important first steps in addressing health inequity in this country,” she said. “As we see another report today laying bare the extent of the challenges, the Alliance is hopeful this will remind governments around the country of the urgent need to implement those recommendations, which will support economic, social and health policy goals.”
Consumers Health Forum: We have a two-tier health system
“The COAG Reform Council has today reported a widening disparity between income groups in accessing public hospital surgery, highlighting the emergence of a two-tiered health system in Australia,” says Carol Bennett, the CEO of the Consumers Health Forum.
“CHF finds it deeply troubling that the most disadvantaged patients in Australia usually face a 44 per cent longer wait for recommended surgery than those in well-off areas. This access gap has worsened in recent years. Those in disadvantaged areas now wait a median 13 days longer than the 29 days wait for those from better-off suburbs.
“Health inequality is becoming ingrained in the operations of our public hospitals. How long you wait for care is determined not just by your health needs, but also your income level. Universal healthcare is now clearly on the ropes.”
Ms Bennett was responding to the publication today of the COAG Reform Council’s report into healthcare performance prepared for the Council of Australian Governments.
“The plight of many thousands of patients, disabled and in pain, waiting for hip replacements and other elective procedures, raises questions about whether taxpayers are getting any return on the major increases in funding provided to public hospitals. Claims that health insurance growth would ease the pressure on public wards are also in doubt. Elective surgery waiting times have risen from a median 34 days to 36 days in the past five years.
“Waiting times of 24 hours or longer for an urgent appointment with a GP, are also up by 12 per cent last year on the previous year.
“Indigenous infant death rates at 7.4 deaths per 1000 births still remain nearly double the rate of that for other Australians — a shameful figure in a prosperous country like Australia.
“We are also failing to win the fight against obesity with 63 per cent of people overweight or obese in 2011-12, up two percentage points on 2007-08.
Ms Bennett also highlighted some of the bright spots in Australia’s health performance revealed in the report, which she said “are a credit to the quality of care that is available. The 16 per cent fall in heart attacks between 2007 and 2010 is a remarkable achievement, even though the fall for indigenous people was less than half that.
“Other achievements have included the 14.9 per cent decline in the rate of potentially preventable hospitalisations for chronic conditions, and the meeting of a national benchmark for hospital acquired infections”.
Graphs from COAG’s health report