ADDRESS TO THE MACQUARIE UNIVERSITY CONFERENCE ON ECONOMICS OF HEALTH, INEQUALITY AND BEHAVIOUR

SYDNEY -MONDAY, 11 NOVEMBER 2019

You have invited me here today to answer the question is inequality our biggest health risk?
The answer to your question is Yes.

I answer in the affirmative, but say it is not so much a risk, but the determining factor today in health outcomes much more than it should be, and we need a much stronger focus on the social determinants of health in Australian health policy.

It is also the case, I argue, that other challenges and risks like the health impacts of climate change, leave people in situations of disadvantage particularly exposed.

Hence I believe, a much greater focus on the social determinants of health is important in health policy design and will be a focus of my tenure in the health portfolio.

In that vein, I acknowledge the traditional owners of this land, the Wattamattagal people of the Darug nation and in doing so, I acknowledge the difference in health outcomes for our first peoples is where the Australian health gap is at its most acute and that we are not on track to close the gap of indigenous life expectancy by 2031, as we intended to do.

Thank you for the invitation to this the inaugural International Conference on the Economics of Health, Inequality and Behaviour. And thank you to the Macquarie Business School Economics Department, the Macquarie University Centre for the Health Economy (MUCHE), and the Global Labor Organisation (GLO) for hosting such an important conference.

Let us briefly go over some of the facts in an Australian context.

We know from the recent work of Professor Philip Clarke and Guido Erreygers that the average gap in life expectancy between the bottom 20 per cent of the population in socio-economic terms and the top 20 per ent is six years in Australia.

Wealthy people live six years longer than poor people.

This is essentially confirms the 2007 work of Professor Clarke and my now colleague Professor Andrew Leigh.

Very concerningly, the latest study reports that gap is widening, not reducing.

The latest Australian Bureau of Statistics data on 2018 death rates showed for residents of, for example Rooty Hill, in Western Sydney, nine people per thousand died. This is three times more than the death rate for areas of advantage in Sydney, areas like Crows Nest.

It is an affront to social justice, and an affront to me, that there are so many more funerals in poorer suburbs and that you can track the upward trajectory of deaths as you drive from the Sydney CBD West. Youd think a finding like this would attract more outrage, or at least more attention, than it has in Australia.

Analysis of this same ABS data by Macquarie Universitys own Professor Nick Parr, has shown the 14.5 per cent reduction in death rate for the most advantaged 10 per cent of Sydney areas over the last six years.

This is triple the average improvement in the most disadvantaged suburbs.

To look at things through a slightly different prism, I represent the electorate with the highest number of diabetics in New South Wales. 7.9 per cent of the population of Fairfield Local Government Are has been diagnosed with either type 1 or type 2 diabetes.

One of Western Sydney Universitys Professors in Urban Planning, Nicky Morrison recently said "Where you live shapes how easy it is to buy healthy food, use active transport and make social connections. The concentration of food deserts is particularly pronounced within Sydneys western suburbs, which compounds the problem of lower socio-economic groups eating poorer diets leading to associated health problems."

And while we know food deserts arent the sole key driver, we know that this, in conjunction with conditionality of income, hours of employment and many other factors prone to those in the Western Suburbs, increase nutrition inequality and lead to those residents being sicker and dying sooner.

We also know that people in rural and remote Australia are 13 per cent more likely to be inactive.

Theyre 50 per cent more likely to drink at risky levels. And theyre 69 per cent more likely to smoke. And those people are 40 per cent more likely to wait 24 hours for an urgent GP appointment. All these factors lead to gap in life expectancy between the city and the bush which is, at is worst, 15 years.

So, to put it bluntly, we know that the rich are living longer and more healthily, and the poor are dying sooner.

Like I am sure the rest of you, I am a big admirer of the work of Sir Michael Marmot, whom we like to claim as an Australian although the Brits would probably argue our claim on him is perhaps just a little bit of a stretch. But his teachings are certainly relevant to Australia. As he says The lower you are in the hierarchy, the worse your health. The higher you are, the better your health.

Status anxiety makes you sick.

Of course, all this has economic as well as social implications.

Productivity is dramatically affected when so many Australians suffer poor health because of their wealth, or more accurately, lack of wealth.

And so, what is the right policy response?

I like to pose three questions when framing the discussion about health policy in Australia.

First, can Australians access affordable health care when and where they need it?

Second, do all Australians have a fair shot at a healthy life?

And third, are we reforming our health system to improve outcomes and meet the demands of the future?

The answer to each of these questions is currently no.

Let me briefly deal with each in turn.

Can Australians access affordable health care when and where they need it?

Well, we are rightly veryproud of our universal system of health care, Medicare.

But in its operation, it is currently not entirely universal.

We know this from the Governments own data. Each year 1.3 million Australians delay Medicare services, and 2 million avoid or delay dental services.

Weve dealt with the second question about a fair shot at a healthy life, we know the social determinants run strong in Australia.

And so to the third question, are we reforming our health system to improve outcomes?

Clearly there is more to do.

There is a strong link in my mind between preventative health policy and the social determinants.

I also believe we need a much bigger focus on preventative health within the Australian health system.

In Australia we spend 1.3 per cent of our health budget on prevention.

The OECD average is 5 per cent.

And although I support the Governments 10-year National Preventive Health Strategy, with an Expert Steering Committee, I would point out that they are playing catch ups after abolishing the National Preventive Health Agency in 2014.

We could have been having action on prevention right now, not just discussion. Moving forward when considering the architecture of health bureaucracy and policy making both prevention and social determinants need to be strongly reflected and will be strongly reflected as I develop the alternative governments health policy for the next federal election.

We also need to consider whether how we compensate doctors in the primary care sector is fit for purpose as attempt to tackle the chronic disease burden.

I support the Governments trials of coordinated models of care, as well as new MBS telehealth items. In my time so far as Shadow Health Minister I have seen impressive work being undertaken by doctors and allied health professionals working together on comprehensive care plans for sufferers of chronic disease. Some are using impressive technology to allow patients to interact with their entire health care team and telehealth is part of the mix.

But we need to acknowledge there is a long way to go until Medicare can truly be said to have caught up with available technology and properly remunerates best practice in chronic health management. This will need to be a focus for health reform in coming years.

We also need to ensure we do no harm. For example, every so often, someone in Australia suggests putting the GST on fresh food. The most recent example was a Liberal Party Senator in the last fortnight.

These suggestions are blithely made with seemingly no appreciation of the public health impacts of making fresh food 10 per centmore expensive when we already have very price sensitive consumers in lower socio-economic cohorts suffering poorer health outcomes with diet as a significant factor in those outcomes. So we need to call out ideas like this as being pretty dumb when it comes to good health. The only dumber thing you could do would be to make fresh food 10 per cent costlier and make health care 10 per cent costlier. Which some conservatives have advocated.

So to conclude.

Than you again for the invitation to be here.

I was keen to be here because the subject matter of this conference is so important to me and to the policy development work we are doing.

We know inequality in Australia, and across the globe, has been highlighted as a fundamental threat to well-being and economic growth.

We need to focus on increasing our health prevention strategy and we must broaden our scope, and focus on the social determinants of health.

Unless and until we have tackling the social determinants of health at the core of health policy, we will not be tackling one of the key challenges and opportunities for health.