Why health experts are asking governments to consider the health impacts of all policies

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'An ounce of prevention is worth a pound of cure', Benjamin Franklin is quoted as saying.

But as bang-for-your-buck as prevention may be when it comes to your health, adopting a healthy lifestyle is not as simple as it may sound.

It's easy enough to say, "don't smoke and you're less likely to get cancer", or "eat healthy food and exercise regularly and you're less likely to become overweight". But what if you grew up in a smoking household? What if you don't have enough money to buy fresh vegetables and don't have the know-how or time to prepare meals with them? What if your job pays so little, you have to work double shifts just to make ends meet and don't have time to do any exercise?

Preventive health goes way beyond individual choices, because our health - particularly when it comes to chronic diseases such as type 2 diabetes and heart disease - is influenced by factors that are often far beyond our individual control. These factors are known as the social determinants of health.


Addressing these drivers of health is challenging, says Associate Professor Lyndall Strazdins, senior fellow at the National Centre for Epidemiology and Population Health, at the Australian National University.

"Once you move beyond giving people flu shots and that sort thing, then what is it that you have to engage with?" says Strazdins.

"That's what makes social determinants of health such a difficult policy field because it steps out of what's considered to be health, which is health care, and moves into the drivers of health, the systems that will move health up or down in a society."

This means just about any policy or law is likely to have an impact on health; whether it's paid parental leave, minimum wage, working hours, education, etc. Recognition of this has given rise to a global movement for 'health in all policies'.

Strazdins says the movement emphasises the importance of policy-makers taking health into account.

One example is the knock-on health impacts of workforce participation policies. Policies that push back the retirement age and keep us in the workforce for longer, reduce the amount of time we have for leisure activity and exercise as we age. As well, some of us are going to be caring for our partners. All this means we're less able to give any emerging health issues the attention they may need.

Despite this, health is rarely even mentioned in such policies, Strazdins says.

"So here we have health at the heart of [whether] this policy is going to succeed or not, and it's not mentioned, so the very first step is putting health in," she said.

"If you come back to even economic analysis, we know these things are costing the country; what we don't realise is how the way we're structuring the country could make a huge difference."
Health in all policies - how does it work?

In 1997, the Swedish Road and Traffic Safety Agency contributed to the introduction of a bill that has had a hugely positive impact on the health of the Swedish population.

The bill aimed for zero fatalities and serious injuries on Swedish roads by 2020, by bringing together transport, justice, environment, health and education sectors to promote, enforce and assist with road safety. So far, this initiative has reduced Sweden's road fatalities by more than two-thirds.

Thailand has introduced a policy requiring the use of health impact assessments in an effort to reduce the health consequences of environmental hazards such as air pollution. The approach has been taken for developments such as coal mines, biomass power plants, waste management systems and water conservation initiatives.

It is even bringing this into consideration of patent protection laws for pharmaceuticals.
Improving health for all

Martin Laverty, the chairman of the Social Determinants of Health Alliance, says Australia is well-placed to address some of the most important social determinants of health, such as education.

"We've got universal access to education, social safety to provide access to income support, social housing scheme, universal access to health care, but despite these levers, people fall through the cracks," says Laverty, also CEO of the Royal Flying Doctor Service.

"The universal access to health care, education, social safety net of income and housing support is not providing optimal support for those most vulnerable within the community."

One major Australian initiative attempting to deal with social determinants of health is the Federal Government's Closing The Gap program.

"In Indigenous affairs we see a social determinants action plan that is informing how we are acting to improve Indigenous life expectancy and improve chronic illness," Laverty says.

The program has had some wins, particularly in child mortality, but Laverty says the next areas for improvement are in stopping people smoking and boosting Indigenous people's level of education.

He would also like to see this approach taken to improving the health of all Australians.

"The next challenge is nationally, for all Australians, the Australian Government adopting the WHO framework to drive improvements across communities and populations, remote and metropolitan," he says, but he acknowledges it's not a politically attractive target.

"Action on social determinants requires long-term commitment that goes beyond the three-year cycles of elected governments."

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