The Conversation is running a series, Class in Australia, to identify, illuminate and debate its many manifestations. Here, Sharon Friel considers the points where class and health interact.
The unequal distribution of power, money and resources also creates health inequities. Nowhere is this clearer to witness in Australia than in the fact that the richest 20% of the population can expect to live an average of six years longer than the poorest 20%.
Australians who are socially disadvantaged by income, employment status, education and place of residence, and Indigenous Australians, also have a higher risk of chronic diseases, such as diabetes, heart disease and cancers, and depression.
Things don’t have to be this way. Differences in health outcomes at the population level are not explained by genetic variation or because of some mythical deviant behaviour particular to people in lower social class groups.
Indeed, the existence of systematic social differences in health outcomes show there’s something in our society creating an unequal distribution of opportunity to be healthy. These health differences are both avoidable and unfair.
People need the basic material requisites for a decent life, they need to have control over their lives, and they need a voice in decision-making processes and implementation of policy and programs that affect them.
Economic and social policies generate and distribute political power, income, goods and services. And who you are will affect your access to quality and affordable education and health care, sufficient nutritious food, good work and leisure conditions, among other things.
Together these factors constitute what determines your health and social health inequities.
A first glance, the “social determinants of health” approach suggests that health inequities are produced (and prevented) by policies and actions within the health sector. The possible $6 co-payment for a visit to the doctor touted by the health minister, for instance, would undoubtedly affect lower income groups more than others.
But much of the responsibility of the social inequity that leads to different health outcomes lies elsewhere. Health is affected by policies in other sectors, such as education, taxation, transport, and agriculture too.
Education, for example, equips people with the resources needed throughout life to achieve a secure income, provide for family, and cope with disease. Children from economically disadvantaged backgrounds are more likely to do poorly in school and drop out early.
They usually grow up to be adults with lower incomes and are less empowered to provide good health care, nutrition, and stimulation to their own children. This is how disadvantage is transmitted through generations.
Decent work, including wages that reflect the real cost of living, is also important for health. Work can provide financial security, social status, personal development, social relations and self-esteem, and protection from physical and psychosocial hazards.
In Australia, the wages of a worker in the bottom 10% of income earners has risen by 15% since 1975, while wages of people in the top 10% have risen by 59% in the same period. In 2009, the top 20 CEOs in Australia earned more than 100 times the average wage.
What’s more, the number of factors affecting health may actually be growing. Because we live in a rapidly globalising world, we now need to consider the effects of trade on lives and health as well. We need to ensure trade policy doesn’t undermine governments’ capacity to regulate in favour of health;
And that deregulation of working conditions doesn’t widen the gap between good and poor quality jobs, which can be worse for health than no job at all. Australian data show adverse job conditions (high job demands and complexity, low job control, job insecurity and unfair pay) are worse for mental health than being unemployed.
One way of looking at this is that it’s all too complex and difficult to do anything about. Another is to recognise the numerous entry points and opportunities to improve health and quality of life.
For people not convinced by the argument that health inequities are unethical, the fact that they’re also incredibly inefficient should stimulate action to reduce them. Preventing health inequities would result in savings of $2.3 billion in hospital expenditure; and 5.3 million fewer Pharmaceutical Benefit Scheme scripts would be filled each year, resulting in annual savings of $184.5 million.
Clearly, reducing health inequities is not something that can be achieved overnight. It requires a long-term view, and sustained political will.
The intersectoral nature of the determinants of health inequities demands a holistic response. It requires ministers from all policy domains to each consider the impact of their decisions on the social well-being and health of all Australians.
But the current political climate doesn’t bode well for health inequities in this country. The apparent focus on productivity at any cost, and the control of public discourse by a powerful business elite suggests we have a long way to go before we can create economic and social conditions that support all people to achieve their potential.
See the other articles in the series Class in Australia here.