A new report from the Australian Council of Social Service (ACOSS) investigating the increasing inequality of income and wealth is an important resource for those working to improve the community’s health, according to public health experts.

“Finally there is recognition that economic, health and social agendas are colliding,” write Professor Fran Baum and Professor Sharon Friel in the article below.

“It seems to us that one of the best ways to promote health in Australia will be to follow the recommendations of the ACOSS report and reform capital gains tax discounts, negative gearing and superannuation tax concessions.”

(Follow @WePublicHealth and #ACOSSConf2015 for news from the ACOSS national conference over the next few days. Also check #TellingOurStories from a pre-conference forum held today at the National Centre of Indigenous Excellence).

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A Nation’s Health Divided

Fran Baum and Sharon Friel write:

The release of the ACOSS report this week has once again highlighted the existence of widening income and wealth inequities in Australia, the dangers they pose and the ways in which public policy and responsive regulation can intervene to reduce them.

As the report describes, times when Australia had “full employment policies, universal access to public education, a unique system of wage regulation, progressive income taxes, and a well-targeted social security safety net, meant that we were able to place limits on inequality within an open economy with relatively low taxes and public expenditures, and a flexible labour market.”

The benefits of Australia’s economic growth from the recent mining boom have been shared much more unequally than in the past.

These inequities are a major risk to our collective health. Wilkinson and Pickett (2007) and others have shown that greater levels of inequity are associated with worse health and social outcomes. Other research has shown that countries with equity-focused public policies can achieve high health status despite not being the richest of countries (for example Sri Lanka, Kerala state in India and Costa Rica (Balabanova, McKee & Mills 2011; Baum, 2008).

This body of evidence demonstrates that it isn’t how wealthy a country is that determines the health of its population, but rather how the products of its economic growth and national wealth are invested and distributed.

The benefits of the recent economic boom have flowed largely to individuals rather than being invested for the public good.

Patterns of taxation, employment, housing, social exclusion, education and income are some of the social determinants of health, and combine to affect health inequities. In Australia differences in opportunities in each of these areas mean that Aboriginal and Torres Strait islander people die on average around 11 years earlier than other Australians (AIHW, 2015) and low income people lose about 6 years of life compared to better off Australians (Leigh, 2013). The distribution of power, money and resources shape these opportunities.

Policies in each of these areas, therefore, can have a powerful impact on how long we live and how healthy we are. It has been encouraging to note in the last year that Australians have rejected (with the help of the Senate) policies that were inequitable and which would have made the inequities reported in the ACOSS report more extreme in the future. This is good news for public health and more needs to be done to ensure that inequity is reduced to at least the levels it was at in the 1970s.

Dr Cassandra Goldie, CEO of ACOSS, noted when launching the report that growing inequities in income and wealth are a “problem both socially but also, importantly, economically as the IMF (International Monetary Fund) has alerted us to, with an important report just last week, that if we’re serious about economic growth, concentration of income and wealth in the top is bad for the economy”.

Finally there is recognition that economic, health and social agendas are colliding.

More knowledge is needed on exactly how we construct public policy to ensure less income and wealth inequities, which will in time convert to health inequities. This is the reason we designed a Centre for Research Excellence on Health Equity to research the ways in which public policies do or do not support health equity. We started from the strong evidence that health equities do not primarily reflect individual behaviour but rather the structures within which people live, work, and play.

It seems to us that one of the best ways to promote health in Australia will be to follow the recommendations of the ACOSS report and reform capital gains tax discounts, negative gearing and superannuation tax concessions.

This will enable more public resources to be available to provide services that address the social determinants of health. Evidence suggests that these are more effectively and efficient provided through universal services that are open to all citizens and which built in special measures to ensure that those facing multiple disadvantage in their lives can benefit from the public services as much as richer people who are able to navigate complex systems.

In order to ensure we are a healthier and more equal nation we need a strong social movement that demands equity from our political leaders and demands that they take account of the evidence that equity is good for our collective health.

ACOSS has presented a strong evidence base in this report, which will enable health groups such as the AMA, the specialist colleges, the Public Health Association and the People’s Health Movement to keep advocating and lobbying for equity informed policy and rigorous social and health equity impact assessment on all policy proposals.

• Professor Fran Baum, Southgate Institute for Health Society and Equity, Flinders University and NHMRC Centre for Research Excellence, Health Equity.

• Professor Sharon Friel, Regulatory Institutions Network, Australian National University and NHMRC Centre for Research Excellence, Health Equity.

References

AIHW. 2015. Life expectancy of Aboriginal and Torres Strait Islander people [Online]. Canberra: Australian Institute for Health and Welfare Available: http://www.aihw.gov.au/deaths/life-expectancy/#indigenous [Accessed April 2015].

Balabanova, D., McKee M and Mills A (eds.)  (2011). ‘Good health at low cost’ 25 years on. What makes a successful health system? London, School of Hygiene & Tropical Medicine.

Baum, F (2008) The New Public Health, Melbourne:  Oxford University Press

Leigh, A. 2013. Battlers & Billionaires: the Story of Inequality in Australia, Collingwood, Redback

Wilkinson, R. and K. Pickett (2009). The spirit level: Why more equal societies almost always do better. London, Allen Lane.

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