Our health care agenda maps 6 critical areas to improve health for all Australians, leading to better health and well-being, greater health equity, and greater prosperity.
1. Health Equity
Despite the availability of universal health care in Australia, there is still a social gradient of health disparity. In Australia, health inequity is experienced primarily by Aboriginal and Torres Strait Islander peoples, those living in rural and remote communities, and those experiencing socio-economic disadvantage.
Health equity means everyone having a fair opportunity to attain their full health potential. A more equitable health system that removes barriers to access and treatment and delivers high quality care regardless of geographical location (particularly for Australians living in rural and remote communities), comorbidities and socioeconomic challenges will lead to a more sustainable and efficient health care system.
The principles of health equity must be embedded in all aspects of government policy, by developing structures and processes that support equity and address the social determinants of health.
- New investment in public health interventions that address the primary contributors to the burden of chronic disease including alcohol misuse, smoking, poor nutrition, low levels of physical activity and obesity
- Initiatives that address food insecurity and enable equitable access to nutritious and fresh food
- Reform of the Health Star rating system, to include mandatory Health Stars on all food to encourage healthier food choices.
- Increased and targeted investment into local sporting facilities and programs that facilitate community-centric physical activity.
- The establishment of rural and remote health registries to support robust health data collection.
- Increase investment into digital and telehealth services
- Reinforce and expand digital infrastructure to support telehealth, especially for rural and remote communities
- Permanently include telehealth services on the MBS schedule
Without good oral health, a person’s overall quality of life and the ability to eat, drink, speak, sleep, socialise, and be a productive member of society is considerably limited. Poor oral health can manifest itself as food avoidance and nutritional deficiencies, discomfort about appearance and low self-esteem and toothache. This can lead to reduced quality of life, emotional stress, workplace absenteeism, and eventually financial stress. For children, the symptoms of poor oral health can lead to an inability to concentrate and be present in school, which in turn leads to absenteeism and poor academic performance.
Poor oral health disproportionately affects people who are socially disadvantaged or on low incomes, First Nations people, those living in rural and remote areas and people with additional or specialised health care needs
While there is no medical or economic reason to separate the mouth and oral health from the rest of the body in terms of health care, oral health is consistently overlooked and excluded from Australia’s otherwise universal health care system and Medicare.
National Oral Health Plan recommendations have generally not been (and are unlikely to be) implemented without Commonwealth leadership to fund basic primary dental care
- Secure permanent funding to State Governments, annexed specifically for dental care and growing in line with the population and inflation
- Provide children (aged 0-18) and concession card holders with comprehensive dental care, consistent across all states.
- Fund a national, Commonwealth-coordinated public dental program starting with universal preventative care, incrementally moving towards universal dental
- Mandate accessible oral health care in residential aged care through the Aged Care Act 1997
- Continued funding at per capita levels for Aboriginal and Torres Strait Islander oral health services to enable culturally safe care
- An evidenced-based graduate program for dentists and oral health therapists for rural and remote areas of need.
3. Invest in Health and Medical Research
The best health care is based on the best available evidence, which is derived from the best health and medical research. Australia currently spends just 0.6% of its total health expenditure directly on health and medical research. On a per-capita basis, Australia spends approximately $60 per person, compared to almost $200 per person in the USA.
The recent pandemic has highlighted the value of having a medical research workforce that can respond rapidly to health challenges. The health and medical research workforce must be protected with the necessary funding and governance policies to ensure that they are prepared to confront future health challenges on behalf of Australians.
We will prioritise and embed health and medical research into Australia’s health care system by increasing investment to 3% of total health expenditure.
We must embed health and medical research into Australia’s health care system by increasing investment to 3% of total health expenditure.
- Increase funding to the National Health and Medical Research Council as the peak independent body for evidence-based healthcare,
- Delegate the NHMRC with overall responsibility for distribution of health and medical research funding from the Medical Research Endowment Account and Medical Research Future Fund
- Commit to underlying principles of transparency and expert review for all research funding
4. Address the health gap for Indigenous Australians
Over the past three decades, numerous research studies have documented the health status of Aboriginal and Torres Strait Islanders. The health disparities between Indigenous and non-Indigenous people are well-documented and there is a large body of evidence to show that Indigenous people have the poorest health, lowest level of income/socioeconomic status and difficulty in accessing health services anywhere in Australia.
A ‘one size fits all’ model of prevention and intervention is not effective across the culturally diverse remote and urban Indigenous communities across Australia. Systemic racism, which has historically permeated through Australian health care institutions, has also created greater health inequity for Aboriginal and Torres Strait Islander people.
We must eliminate systemic racism and discrimination from healthcare, and empower communities with greater autonomy to drive local initiatives for flexible and tailored support.
We must establish a framework of community representatives, public health researchers and allied health professionals to develop a model of community-driven action to:
- Support and promote Aboriginal community leadership
- Prioritise Aboriginal culture and community
- Support system reform throughout health
- Prioritise support (financial and infrastructure) for community-driven initiatives for improved health outcomes, underscored by co-design, community input and Aboriginal leadership
5. Establish a National Mental Health Action Plan
The World Economic Forum reported that mental ill-health accounted for 35% of the global economic burden of non-communicable diseases – more than cancer, diabetes and heart disease. The Productivity Commission estimated that mental ill-health and suicide costs the country at least $200 billion a year.
Mental health services in Australia currently receive about half the funding that is required to be commensurate with the ‘disease burden’. In truth, individuals, their families and the wider community bear the burden of mental ill-health.
Community-based mental health centers could go some way to assisting with person-centered, connected-up services. Our recommendation for community-based youth-specific centers was adopted (Headspace) and there are now more than 100 around Australia. There still are long wait times but Headspace is a model of care that could and should be adopted more broadly.
The Australian Democrats-initiated Senate mental health inquiry in 2006 prompted additional spending by the Howard Government of approximately $2 billion over 5 years however that was well short of the committee’s recommendation for spending to reach between 9 and 12 percent of total health funding.
The problem then, as now, is that there is little funding for prevention and early intervention.
There’s a gaping hole in mental health services for people whose condition is too complex for GPs but not so acute as to require hospitalisation.
- A National Mental Health Action plan underpinned by the recommendations of the 2020 Productivity Commission Mental Health Inquiry Report, with significant new funding and system reform.
- Improved community care programs
- More mental health practitioners and care providers.
- Cost caps removed on psychosocial interventions, stigma addressed, and social supports provided, particularly housing, all of which are barriers to functional recovery
6. Plan for Australia’s Emerging Health Challenges
Australia faces several immediate health care challenges such as its ageing population, increasing incidence of chronic diseases, workforce shortages and maldistribution, growing inequity in health outcomes and access, and rising health costs.
However, there is no denying that these will be compounded by the ongoing impacts of climate change. As well as a generally hotter climate and higher propensity for heatwaves in Australia, climate change continues to lead to rising sea levels and more extreme weather events, including intense rainfall, tropical cyclones and severe storms, extended periods of severe drought and an increase in the length, intensity and distribution of bushfire conditions.
These health impacts include:
It has been acknowledged by scientists the world over that climate change is the biggest global health threat in the 21st century.
Immediate action is required to prepare for these emerging health challenges:
- A health and emergency services workforce review to ensure Australia is ready and capable of addressing emerging health challenges including climate change and increasing natural disasters and global infectious disease outbreaks,
- A national audit of health facilities and resources, including an equipment audit to determine readiness to meet emerging health challenges
- A centralised Centre for Infectious Disease, embedded within the NHMRC with responsibility for research activity and national health response planning.
Why this plan is needed
A high quality and comprehensive health care system that meets the diverse and complex needs of an entire population is essential for the maintenance and growth of a country’s overall prosperity. Quality health care is evidence-based, provided to those who will benefit, safe and patient-centred. An effective and efficient health care system recognises and respects that while health care is a universal right, access to health care must be equitable.
Despite Australia’s semi-universal public health care system funded through Medicare, the Pharmaceutical Benefits Scheme (PBS) and through subsidised private health insurance, there remains significant inequity in both access to, and provision of high quality health care, evidenced by significant discrepancies in the health outcomes for Australians living in rural and remote locations, Aboriginal and Torres Strait Islander people, people with mental illness and people living in socioeconomic disadvantage.
Australia faces additional challenges to its health care system. An ageing population and increasing burden of chronic disease is placing increased pressure on physical and financial resources, including health care providers and care facilities.
In 2017-18, total health spending in Australia, which included all of government and non-government sources, totalled $185 billion. This reflects a near doubling of spending since 2000-01 and a real increase in spending (accounting for population growth and inflation) of 2.7% per year, which is expected to continue increasing due to population growth, the increasing burden of chronic disease in Australia. Coupled with an ageing population, Australia will require more resource intensive care to maintain health and quality of life.
A whole of system approach is needed to transform Australian health care for the 21st century.
We advocate for policies that support the achievement of integrated, patient-centred health care to meet evolving population needs across the entire health system.