Recognition of the social determinants of health is still in its infancy in Australia though momentum is building, says Dr Gemma Carey, a population health and political science researcher and member of the Australian Social Determinants of Health Alliance.
What it needs now, she says, is the energy and insight of other sectors – particularly the community sector.
In the post below, Carey also writes about a recent Alliance event in Melbourne on the impact of racism and discrimination on health. One of the speakers was Associate Professor Yin Paradies from Deakin University’s Centre for Citizenship and Globalisation) who was also interviewed by Croakey recently on the issue.
While social determinants of health has been a central concern of the World Health Organisation for well over a decade, and been the subject of extensive reviews in the UK and Europe, in Australia the movement is in its infancy. Researchers such as those at the Southgate Institute have been studying social determinants in Australia for some time, but it took until 2013 for federal politicians to begin to think about how Australia should respond to the WHO’s research and recommendations.
Similarly, the Australian National Health and Medical Research Council (NHMRC) only recently held roundtable discussions to discuss priority research areas concerning the social determinants of health. This is yet to flow on to grant committees, with the most recent NHMRC funding round awarding only 65 out of 652 to public health, and even less to social determinants of health research.
This means that we are yet to break down the barriers between different sectors that have a stake in addressing the social determinants of health. For instance, public health is still taken to mean health care and more ‘lifestyle’ based issues such as smoking and obesity. This means that shared territory is yet to be recognised.
However, with the Senate Committee on the social determinants of health, and the establishment of the Social Determinants of Health Alliance, the momentum is building.
To keep this going, it needs the energy and insight of other sectors – particularly the community sector.
Much public health research around the social determinants of health is focused on population level data, using abstract statistical models. This data is very important for understanding critical trends and changes in the population.
However, how this data relates to the real lives and contexts of individuals is largely unknown. This means that the models that underpin the social determinants of health movement are, as David Coburn argues, “unable to address the ways in which people individually and collectively act to improve their health”.
Here, the community sector in particular has a lot to offer. The sector is perfectly positioned to strengthen explanatory models concerning the social determinants of health. It works closely with individuals, building an understanding of their lives and the barriers and enablers they experience to improving their social circumstances (and in turn, their health).
This type of insight is pivotal to unpacking the relationships between social issues and health outcomes and, importantly, finding the pathways for change. In fact, without it, social determinants of health research and advocacy can’t move forward.
With the growing recognition of the importance of addressing the social determinants of health, the community sector and public health – as well as health providers – are increasingly concerned with the same issues and confronted by the same problems. That is, how to address disadvantage.
The social determinants of health has the potential to act as a bridge between these different sectors – improving the way they work together and creating more fire power when it comes to arguing for policy change.
What can the community sector do?
The community sector must make sure its voice is heard in this new debate.
In building the social determinants of health movement, healthcare providers and the community sector can not only help shift the focus of funding bodies like the NHMRC so there is greater investment in research that tackles the problems of social disadvantage and inequity, but can be involved in, and indeed lead, the synthesis of evidence into practical strategies for change.
Health impacts of racism
The Australian Social Determinants of Health Alliance recently gathered at an open meeting in Melbourne to discuss the impact of racism and discrimination on health – an issue that has been weighing heavily on our national consciousness over the past week.
Over 70 attendees discussed a range of cultural and social groups experiencing heightened levels of disadvantage, including Aboriginal and Torres Straight Islanders, refugees and new migrants and the LGBT community. Speakers included:
Professor Dennis McDermott (Faculty of Health Sciences, Flinders University)
Associate Professor Yin Paradies (Centre for Citizenship and Globalisation, Deakin University)
Dr Barri Phatarfod (Doctors for Refugees)
Professor Andrew Markus (School of Philosophical, Historical and International Studies, Monash University)
Liam Leonard (Director, Gay and Lesbian Health Victoria)
It’s a sad fact that discrimination still cuts across so many issues, and affects such a large swathe of the population. As Prof Markus revealed, the core level of intolerance in Australia ranges between 10-30 per cent of the population, depending on the issue in question.
The flow on effects of racism and discrimination are profound: experiences of racism lead to higher levels of drug and alcohol use amongst indigenous Australians, suicide, depression and behavioural problems in children. In the US, Arabic women in California had lower birth weight babies after 9/11 than they did before.
But the outcomes of removing discrimination from public policy can be equally profound: in the US, LGBT communities have better health outcomes in states where same sex marriage is legal.
As we mark our first anniversary, it’s clear that, like all ‘wicked’ policy problems, knowing where and how to take action on the social determinants of health can be hard. It is a sprawling, quagmire of a policy problem; just as you sure up one part, it falls away underfoot in another. But some policy actions are clearer than others. Doing away with racist and discriminatory policies – whether they impact people from different cultural backgrounds, those seeking asylum, or people with different sexual preferences – isn’t hard.
We face growing challenges when it comes to combating discrimination. People living in culturally diverse communities report higher levels of discrimination. As Prof Markus asked those in attendance yesterday, how do you foster education and national identity across an increasingly diverse community?
This is indeed a challenge. But knowing where to start isn’t.