A fairer, healthier world for all

April 7, 2021

Today is World Health Day, and as we slowly ease out of the pandemic, today we join the call for “a fairer, healthier world”.

In this spirit, we want to talk not just about health, but about the social conditions that determine whether a person or a population enjoys good health.

It can be easy to slip into the trap of thinking that health is solely determined by genetics, on how many yoga classes or walks around the block you take each week, on how often you go for check-ups or whether you remember to take your vitamin tablets.

In reality, the conditions under which people are born, live, grow, work and age – what are called the ‘social determinants of health’ – have more to do with a person’s health than their biology, behaviour or health care. Indeed, research suggests that medical care, itself, accounts for an estimated 10 to 20 per cent of the “modifiable contributors to healthy outcomes for a population”. The other 80 to 90 per cent of contributors relate to social determinants of health.

Poverty, structural racism, gender inequality, ableism and other forms of inequality drive health inequities. In other words, the overarching systems, structures and cultural norms that shape how we live our lives – and the unique and intersecting forms of disadvantage or privilege we might each experience – determine a person’s, indeed, a population’s, health outcomes.

We have seen stark examples of this during the COVID-19 pandemic. The pandemic acted as a “magnifying glass”, highlighting and amplifying health inequities in Australia, as it did both within and across other nations. We saw this in:

• higher incidences of respiratory failure and death among people infected with COVID, who also had pre-existing health conditions like diabetes, obesity, health disease, lung disease, asthma;
• the fact that these pre-existing health conditions are disproportionately experienced by older people, low-income people and under-served racial and ethnic groups;
• the greater ease with which people who had secure financial resources and employment, comfortable and spacious homes, access to green space, reliable internet were able to physically distance and isolate themselves during lockdowns, while maintaining social connections and their related mental health benefits;
• the higher incidence of negative effects of isolation/lockdown on people who were homeless, living in over-crowded homes without access to outdoor space, without access to reliable internet, or living in institutions (like prisons or detention facilities);
• job losses – and their related mental and physical health impacts – experienced by people who were in insecure or casualised jobs (a disproportionate number of whom were women);
• increased domestic burdens – and their related mental and physical health impacts – experienced by women as children transitioned into homeschooling;
• the unrolling of telehealth services that provided patients to access health care via video-conferencing or telephone, which made health care more accessible, but only if one’s internet or phone connection was reliable;
• the positive and effective leadership of the Aboriginal Community Controlled sector, which organised to ensure remote communities were protected and involved in health responses and that Indigenous people received adequate and timely information.

Pandemic response measures, in terms of the scale and nature of lockdowns, economic stimulus payments, social welfare payment and job support changes, and even the rollout of the vaccine all had (and have) the potential to either exacerbate or address existing inequities.

Addressing existing inequities – realising the “fairer, healthier world for everyone, everywhere” that we are calling for this World Health Day – relies on recognition at every level of government and community that such a world can only be achieved by addressing the social determinants of health and by eliminating inequities of every kind by restructuring our economy, redistributing wealth, power and resources, championing Indigenous self-determination and creating social welfare policy that serves the under-served and values and cares for individuals, in all their complexity.