Dealing with the Big-Picture in Australia: Public Health Challenges Cannot Be Tackled by Departments of Health Alone. Matthew Heath Reports on How the State Government of South Australia Is Taking a New Approach

By Heath, Matthew | Bulletin of the World Health Organization, October 2011 | Go to article overview

Dealing with the Big-Picture in Australia: Public Health Challenges Cannot Be Tackled by Departments of Health Alone. Matthew Heath Reports on How the State Government of South Australia Is Taking a New Approach


Heath, Matthew, Bulletin of the World Health Organization


"Health is not just about providing doctors and nurses" says April Lawrie-Smith, executive director of the Aboriginal Health Division in the South Australian Department of Health. "It's about having running water, a good transport system and technology. People need to have proper housing, safe roads and flesh food that they can afford."

The health of Australia's indigenous people is often held up as an example of the stark inequities that exist within this prosperous country of more than 22 million people, with Aboriginal men dying an average of 12 years younger than other Australian males. "The whole environment where a person lives, from where you are born to where you die, affects your health outcomes. Aboriginal people have been saying this for years" says Mary Buckskin, chief executive officer of the Aboriginal Health Council of South Australia. According to a report published in July by the Australian Institute of Health and Welfare, indigenous children are up to three times more likely to be born with lowweight and to die as infants or from injury, than the rest of the Australian population.

These health inequities are not confined to Aboriginal people. The report found that children living in Australia's lowest socioeconomic groups are 70% more likely to be overweight or obese and 60% more likely to have dental decay than those living at the opposite end of the spectrum.

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Improving health, particularly of people from disadvantaged communities, requires action on several fronts. As Buckskin puts it: "If you don't deal with the big picture, then you won't improve health. Without [inter-departmental dialogue] you are not going to be able to have long-term, sustained improvements." According to Buckskin, in the past, funding for Aboriginal health was too narrowly focused on just providing health services. "We would be dealing with housing and welfare issues and we would be constantly told 'you shouldn't be doing that, that is not your core business' but, unless you identify those problems and deal with them, you are not going to improve health outcomes for the individual."

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For Riidiger Krech, director of Ethics, Equity, Trade and Human Rights at the World Health Organization (WHO), it is essential that government policy-makers from different sectors work together. "Public health is often influenced by policy drawn up by government departments outside the health ministry," he says. "When the ministry of transport decides to build roads rather than developing a public transport system, there are implications for health." It would make sense for the ministers of transport and health to discuss the implications before starting the work but often this does not happen. Transport ministry agendas do not always dovetail with those of the ministry of health, and executives are under pressure to meet their own targets.

These are the kind of barriers that the South Australian government is trying to overcome with a new approach that brings together policy-makers from departments such as agriculture, education, housing and transport, to improve health while achieving their own goals. The approach is the result of the government's collaboration with public health expert, Ilona Kickbusch, who proposed that South Australia apply the concept of Health in All Policies, already well established in Canada and Finland, to tackle its health problems. This way of working encourages all government sectors to consider the health impacts of their policies. In South Australia, policy-makers are putting this concept into practice by applying what they call a "health lens analysis" to the work of other departments. So far six projects with strong potential impact on health have been through this process. For example, one such project is aimed to help migrants settle into Australian society and another is intended to help parents support their children's learning and literacy. …

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