There are a number of high level reviews occurring nationally, which will shape the future of health and health care delivery in Australia and directly impact on strategies for CVD. Ernst & Young has analysed several key reports/discussion papers related to these review processes, which comment on and/or may influence future health strategy. These include:
- Towards a National Primary Health Care Strategy 91
- Beyond the Blame Game: Accountability and performance benchmarks for the next Australian Health Care Agreements 92
- Australia: The healthiest country by 2020 93
- Social Inclusion – Origins, concepts and key themes 94
The reports/discussion papers are consistent in their key themes of:
- Prevention and self-management
- Health information and accountability
- Equity and Social Inclusion
5.7.1 PreventionPrevention is identified as a priority in each report/discussion paper. It is generally recommended that the government identify at risk population groups and target these groups through population wide interventions. The report Beyond the Blame Game advocates the use of social marketing to make unhealthy products less attractive and to promote an active lifestyle. The reports all agree on the need for further research into factors such as obesity, alcohol use and smoking to inform policy.
5.7.2 Health information and accountabilityThe discussion paper, Towards a National Primary Health Care Strategy, supports the development of an individual Electronic Health Record (EHR) to improve continuity of care across the complex range of service providers and different health sectors. The report Beyond the Blame Game proposes that care should be redesigned so that there is increased accountability if the care does not meet certain standards and fails to achieve required outcomes. Also recommended is a series of indicators to track progress in this area with responsibilities being divided between the Commonwealth and the States, based on financing and policy responsibility.
5.7.3 Workforce ReformWorkforce strategies proposed in the discussion paper Towards a National Primary Health Care Strategy include developing flexible working and training arrangements and expanding current opportunities for health professionals to become multi skilled. Funding is also being called for to assist in clinical trials and to ensure a continuous learning and research culture. These recommendations are reinforced in the report Beyond the Blame Game.
5.7.4 Equity and social inclusionConsistent throughout the reports/discussion papers has been the issue of poorer health outcomes for Indigenous and specific groups of non-Indigenous Australians and the need to close the gap. The reports/discussion papers identified a lack of research and information about the health care patterns of Indigenous Australians and that this is should be addressed before further interventions can be planned. Also highlighted is the issue of equity for those who are geographically, mentally, physically or socially excluded or have other barriers to participation.
Social exclusion has a number of aspects, such as locational disadvantage, lack of employment, poverty, intergenerational disadvantage, homelessness, cultural and language barriers and disability. Families and individuals who experience some or many of these manifestations of social exclusion also experience poorer health outcomes.
People from culturally and linguistically diverse (CALD) backgrounds may experience social exclusion as a result of language or cultural barriers. The ability to acquire knowledge about health enables a person to recognise health problems (in themselves or others), make choices about behaviours, and access health services when required and some members of CALD communities within the wider community may have difficulty accessing, understanding or using information about health. They may not assimilate new information as quickly and may therefore retain traditional beliefs and use traditional health treatments. 95
Migrants bring to Australia their own unique health profiles – the ‘healthy migrant’ effect. Migrants often less exposed to harmful risk factors for CVD and other non-communicable diseases in their countries of origin, before they move to Australia. Despite these advantages, certain health risk factors and diseases are more common among some country-of-birth groups in Australia, reflecting diverse socioeconomic, cultural and genetic influences. 96
Social inclusion agendas have been implemented internationally, including in the United Kingdom and the European Union. The Australian Government’s Social Inclusion paper highlights the importance of Australia learning from international experiences to build on what has worked and avoid some of the pitfalls. One of the central insights of social inclusion/exclusion agendas internationally is that interventions have to be developed to respond specifically to the needs of particular groups. The process of identifying the needs and challenges of disadvantaged groups needs to be specific to the Australian context.
Social Inclusion aspirations and approaches for Australia are spelt out in the Australian Social Inclusion Board’s Principles for Social Inclusion. 97 They are listed below:
- Reducing disadvantage - Making sure people in need benefit from access to good health, education and other services;
- Increasing social, civic and economic participation - Helping everyone get the skills and support they need so they can work and connect with the community, even during hard times; and
- A greater voice, combined with greater responsibility - Governments and other organisations giving people a say in what services they need and how they work, and people taking responsibility to make the best use of the opportunities available.
- Building on individual and community strengths - Making the most of people’s strengths, including the strengths of Aboriginal and Torres Strait Islander peoples and people from other cultures;
- Building partnerships with key stakeholders - Governments, organisations and communities working together to get the best results for people in need;
- Developing tailored services - Services working together in new and flexible ways to meet each person’s different needs;
- Giving a high priority to early intervention and prevention - Heading off problems by understanding the root causes and intervening early;
- Building joined-up services and whole of government(s) solutions - Getting different parts and different levels of government to work together in new and flexible ways to get better outcomes and services for people in need;
- Using evidence and integrated data to inform policy - Finding out what programs and services work well and understanding why, so you can share good ideas, keep making improvements and put your effort into the things that work;
- Using locational approaches - Working in places where there is a lot of disadvantage, to get to people most in need and to understand how different problems are connected;
- Planning for sustainability - Doing things that will help people and communities deal better with problems in the future, as well as solving the problems they face now.
The Australian Government’s social inclusion agenda is influencing how policies and programs are developed; requiring them to be considered in the light of their impact on reducing aspects of social exclusion. One of the key factors influencing access to health care continues to be ability to pay. It is recommended through a number of reform strategy reports and discussion papers that a system be devised so that health care is received based on the need for care, not ability to pay.
91 Department of Health and Ageing, 2008. Available at http: //www.health.gov.au/internet/main/publishing.nsf/Content/PHSDiscussionPaper [Broken link - valid at time of publication]
92 National Health and Hospitals Reform Commission, 2008. Available at http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/commission-1lp
93 Preventative Health Taskforce, 2008. Available at http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/discussion-healthiest
94 Hayes A, Gray M, Edwards B, AIHW, for Social Inclusion Unit, Department of Prime Minister and Cabinet, Australian Government, 2008.
95 Australian Institute of Health and Welfare, Australia’s Health 2008, Australian Government, Canberra: AIHW, p 131
96 Ibid, p 91
97 Australian Social Inclusion Board, Principles for Social Inclusion, Australian Government Canberra.
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