In June 2010 Martin Laverty, CEO of Catholic Health Australia, appeared before a senate committee to give evidence about COAG health reforms. He drew attention to a lacuna in the public discussion and policy planning. There was next to no reference to the social determinants of health. He said:
I would be misleading this inquiry if I suggested we were entirely happy with the announcements that COAG made. We are critical of what was not actually agreed to.
For example, income levels, as a measure of socioeconomic status, are a better predictor of cardiovascular death than cholesterol levels, blood pressure and smoking combined. A person's access to income is more important to the chances that they face of dying of a heart attack than whether or not they have high cholesterol, high blood pressure or whether they smoke.
The social determinants of health, those factors that include housing, income, educational level, family support, supports at times of personal crisis in a person's life, can have more bearing on a person's health outcomes than access to health systems.
No senator had any interest in taking up this challenge. There were more immediate issues to tackle — like hospital funding and the mooted structure of Medicare Locals.
There are five key influences on our health: genetics, social circumstances, lifestyle, accidents, and access to health care. There is not much we can do to alter our genetics. With better occupational health and safety at work, good design standards, and improved public infrastructure, we can reduce the risk of accident.
The World Health Organisation (WHO) and Sir Michael Marmot in the UK have done a power of work finding that social determinants have a big impact on health outcomes. Fran Baum from Flinders University has worked closely with Marmot and brought home to Australia many of his key findings.
If you are from a poor, dysfunctional family with little education and low job prospects, your health outcomes most probably will be much worse than those of the person from a well off functional family with good education and fine job prospects.
Following the Blair initiative from the UK, Kevin Rudd announced a social inclusion agenda aimed at ensuring that all persons can secure a job, access services, connect with family and friends, pursue personal interests, engage with local community, deal with personal crises and have their voice heard.
The Rudd Government started concerted work on addressing the social determinants of