We must learn the lessons of COVID and invest in public health and prevention.
While the threat of COVID-19 remains an ongoing concern in South Australia and nationally, the health priorities of pre-COVID times continue to impact the health and wellbeing of our community. Chronic conditions such as cardiovascular disease, arthritis and diabetes remain priorities. Social inequity continues to contribute to significant preventable illness, and is a key driver of ill-health. Increased funding is required for preventative health approaches and policies that support education, employment and housing, as well as workforce capacity, to prevent and reduce the burden of illness and support the wellbeing of all South Australians.
The pandemic has provided global lessons on the importance of public health and prevention strategies, and the importance of health research, data analysis, and public access to health information. While Australia is rightly proud of its public health system, there are key areas that require improvement. Access and affordability of health services are a challenge for many people – examples include gap payments and ambulance fees. We need to assess what is working, and what is not, to learn, plan and invest appropriately to optimise the health of all South Australians.
What SACOSS is calling for
In association with the SA Public Health Consortium we call for the following:
- 4.1 Increase public health, disease prevention and health promotion expenditure to 5% of the health budget.
- South Australia is facing significant challenges with increasing demands on the health system, rising health care costs and a need to reprioritise the system to focus on prevention and improving the health of the whole population. We call on the government to increase investment in public health, disease prevention and health promotion, with an ongoing commitment of at least 5% of health expenditure directed towards disease prevention and health promotion. Such a benchmark is in line with targets in Australia’s National Preventive Health Strategy 2021-2030 and would see an increase from current levels of around 2.3% of total health expenditure. A commitment is also required to report annually on public health preventative expenditure.
- 4.2 Build the capacity of the public health workforce.
The response to COVID-19 has demonstrated the importance of public health workers, and the SA Public Health Consortium calls for a commitment to build the capacity of the public health workforce into the future and beyond COVID-19. This should include conducting a comprehensive review of the preventative health workforce in South Australia so as to provide a greater understanding of sector characteristics, core activities, and needs. Informed by the review, a dedicated employment, training and development program should be established to provide career pathways in health promotion and disease prevention.
- 4.3 Introduce a floor price for cheap alcohol.
The SA Public Health Consortium is calling for the introduction of a floor price for cheap alcohol products in order to reduce the harms caused by alcohol. There is strong evidence that setting a floor price for alcohol is one of the most efficient and cost-effective strategies to reduce consumption and harm. This would involve setting a minimum price per standard drink of alcohol that can be sold, thus increasing the price of cheap alcohol beverages (e.g. cask wine). The floor price should be regularly adjusted for inflation. This measure is expected to primarily impact off-licence sales (e.g. bottle shops) and have little impact on on-licence sales (such as bars, pubs or nightclubs), and is in line with directions in the National Alcohol Strategy 2019-28 and the National Drug Strategy 2017-2026.
- 4.4 Establish independent state-wide monitoring for health inequalities.
The SA Public Health Consortium is calling for the establishment of an independent state-wide monitoring system to track health inequities and provide data in accessible formats (e.g. an online portal) to all sectors of government and the public. Such a system is needed to shine a light on where health inequities exist in South Australia, and to provide both an evidence-base to inform interventions, and a means of tracking progress over time. It would need to be led by an independent body, such as the Health Performance Council, and would utilise existing datasets and ongoing surveys within SA Health, as well as the collection and analysis of additional data (e.g. housing, employment, education, income and health care). The data and findings of this monitoring system will need to be reported on publicly in annual reports.
- 4.5 Create healthier environments for children, particularly in relation to healthy diets
The SA Public Health Consortium calls for a commitment to create healthier public environments for all children, particularly in relation to food marketing and the promotion of healthy diets. This includes phasing out all advertising of unhealthy food and drinks on government- owned property by 2025, as well as revising the Right Bite Healthy Food and Drink Supply Strategy for South Australian schools and preschools. This Strategy outlined criteria for school food supply, but was not mandated or monitored. It is now time to mandate a minimum of 60% high-nutrient category foods on school menus, with no low-nutrient excessive energy foods or beverages. These initiatives must ensure that equity variations are addressed so that every child has access to healthy food and drink options.
Other SACOSS health policy proposals:
- 4.6 Ensure the continued provision of independent health research and data analysis through an adequately resourced Health Performance Council.
Given the persistent inequities across the health care system and the lack of inclusion of consumer perspectives about their health experiences and outcomes, it is essential that appropriate independent mechanisms are in place to enable people’s voices to be heard, for public data to be collected, and for active and responsive independent health research and advocacy to be undertaken. In order to design and implement sound health policy and implementation strategies, informed by public engagement and input, it will be essential that adequate resourcing is provided to ensure the establishment of a reliable evidence base, in the form of high-quality information and data analytics, as provided by the Health Performance Council. The Council must be adequately resourced to continue to deliver independent health research and data analysis, and provide reliable information to the public, the community health sector, policy-makers and clinicians.
- 4.7 Extend the Ambulance Cover concession for pensioners to all those on equivalent/lower incomes.
Ambulance fees are set by regulation and are flat rate fees depending on the type of service. At over $1,000 for an emergency response with transport to hospital, such flat rate fees are regressive (accounting for a higher proportion of income for low-income households) and cause financial hardship at a time of household stress. SACOSS has previously called for free emergency ambulance services in South Australia, and this remains our preferred policy position. However, at a minimum, the poverty premium in the Ambulance Cover scheme should be removed. Ambulance Cover provides for free ambulance services, but the concession of $35 on the annual fee for a single person is only available for age pensioners and veterans. The concession should be extended to those on lower incomes such as JobSeeker, Parenting Payment or Youth Allowance.
On a range of health indicators, the most disadvantaged South Australians have poorer health outcomes than the most affluent. SACOSS’ health advocacy utilises a “social determinants of health” approach in linking poverty with health and wellbeing outcomes. We focus on the importance of prevention, early intervention, access and equity. With this in mind, our report with the Southgate Institute for Health, Society and Equity at Flinders University, The Heaps Unfair State, provided a major stocktake of health issues in South Australia, examining why health inequities have increased and how this trend can be reversed.
South Australians need our government to create healthy public policies and initiatives that support people to live healthy and productive lives. This requires our government to invest in early intervention and prevention, to stem the tide of chronic disease, with wide-reaching and long-term positive impacts for both public health and the economy.
Policy brief, report and plan:
- 4. South Australian Public Health Consortium Plan: Five evidence-based priorities
- 4. South Australian Public Health Consortium Plan Summary: We seek the 5 following commitments
- 4.6 Policy Brief: Independent health research and advocacy
- 4.7 Ambulance Cover
- SA: The Heaps Unfair State