Beyond COVID-19: Consumers call for greater focus on health equity.

The Australian public health community has long advocated for increased investment in health promotion and prevention. , , , , This has paralleled advocacy from consumer groups and has frequently included calls for a much sharper focus on health equity and action on the social, political, economic, environmental and commercial determinants of health. , , , , , The recent global COVID‐19 pandemic has cast a glaring spotlight on health and social inequities experienced by vulnerable and marginalised populations worldwide, particularly those living in poverty. , , , , These observations have been noted in Australia, the United States, the United Kingdom and elsewhere across the globe. In some instances, it has exacerbated already well‐documented health inequities, , , , , such as those relating to race and ethnicity, , , , , , socio‐economic status, homelessness, , , disability and ageing. In other instances, it has created new and unforeseen inequities, particularly with respect to education and employment. , , ,

In Australia, concerns have been raised about the disproportionate impact of vulnerable populations, including Aboriginal and Torres Strait Islander people, , homeless people, migrant and refugee populations, , people with a disability and those living in rural and remote communities. These concerns are genuine and clearly require thoughtful health (and social) policy and practice responses.

In July 2020, the Consumer Health Forum of Australia established the Consumer Commission: Beyond COVID‐19. The general premise of the Consumer Commission was to contribute views and ideas about the future of the Australian health and social care system. Thirty Commissioners met through online workshops on multiple occasions over the past few months to discuss topics such as mental health and wellbeing; integration and care co‐ordination; digital health; and health equity. A series of communiques have been developed based on these discussions. The health equity discussion held on 12 August 2020 highlighted the following positive changes that occurred as a result of COVID‐19 ( , p2):

Improved social supports including income support; accommodation for the homeless; and child care

More flexible and responsive policy and decision making

Increased mental health supports

Faster data/evidence cycles (about inequities)

Recognition of Aboriginal and Torres Strait Islander leadership

Pockets of excellence in partnering with consumers

Digital health, including telehealth, was embraced

Home‐based services were highly valued, particularly medication options and

A general sense of community togetherness.

However, these discussions also contributed to the development of the Consumer Commission Report ‐ Making Health Better Together: Optimising consumer‐centred health and social care for now and the future. This was framed as a diagnosis, and subsequent prescription, made by the Consumer Commission. The prescription for health equity stated:

‘We must recognise the inequalities across age groups that have been widened due to COVID‐19 and engage and empower young people in the recovery. We should adopt a social determinants approach and implement it be developing a national social prescribing scheme, increasing investment in health promotion, prevention and health literacy, and investing in critical social supports and infrastructure to build communities’. ( , p4).

The call for investment in health promotion was explicit. Calls for investment in social infrastructure including social housing, income support, childcare, public transport, broadband coverage, aged care and disability care were also repeatedly mentioned. More specific recommendations aimed at improving health equity in Australia included:

Permanently increase income support payments

Urgently build more social housing to meet demand

Broaden the Australian Charter of Healthcare Rights to include a right to health

Increase investment in prevention to at least 5% of overall health spending as part of the National Preventive Health Strategy. ( , p6).

The abovementioned call to action has emphasised the important role that health consumers play in describing the challenges associated with health inequities in Australia. However, it also conveys that consumers are well‐positioned to identify tangible actions that can lead to improved health equity over the longer term. Indeed, much of the discussion was highly consistent with decades of public health evidence suggesting that increased investment in health promotion and prevention is critical for reducing health inequities. , , , , This is clearly articulated in the Australian Health Promotion Association and Public Health Association of Australia joint policy position statement on health promotion and illness prevention. In particular, actions to address the social determinants of health, and calls for the adoption of health‐in‐all‐policies approaches, have been a prominent feature of these discussions. , , , , , , , ,

Importantly, this feedback is extremely timely. The Australian Government is currently in the midst of developing a National Preventive Health Strategy (NPHS). While the consultation period has recently closed, the consultation paper identified the importance of ‘an agile health system focused on prevention and equity’ and a commitment to ‘addressing inequity in health’. Yet, there is little doubt that the NPHS can go much, much further. An explicit goal of reducing health inequities would be a good start. Implementing the Consumer Commission's recommendations would be a logical action to follow. The Minister for Health, Australian Government and the National Preventive Health Expert Steering Committee must recognise and prioritise consumer voices in shaping policy responses that explicitly aim to curb health inequities in Australia.

It seems that listening to the collective voice of the Consumer Commission would be both an easy and sensible option. There are many ideas and solutions that have been shared that are ready to be adopted and implemented if bureaucrats and politicians are willing to act. Political will is what is required to mandate greater investment in health promotion and prevention in Australia. The research evidence and consumer voice are synonymous – reducing health inequities across Australia need to be a key health policy priority. COVID‐19 has only been a vehicle to make this more apparent. Please let us learn from this pandemic experience and be bold in our response.

CONFLICT OF INTEREST

The authors declare no conflict of interest.