COVID-19 and equity: A mandate for investment in health promotion and prevention

The Australian public health community has long advocated for increased investment in health promotion and prevention [1-5]. 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 [6-11].

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 [12-16]. These observations have been noted in Australia, the United States, the United Kingdom and elsewhere across the globe. 

… it has created new and unforeseen inequities, particularly with respect to education and employment.

In some instances, it has exacerbated already well documented health inequities [12, 15-18], such as those relating to race and ethnicity [19-24], socio-economic status [25], homelessness [26-28], disability [29], and ageing [30]. In other instances, it has created new and unforeseen inequities, particularly with respect to education and employment [16, 18, 31-32].

In Australia, concerns have been raised about the disproportionate impact of vulnerable populations, including Aboriginal and Torres Strait Islander people [33-34], homeless people [26], migrant and refugee populations [35-36], people with a disability [29], and those living in rural and remote communities [37]. 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. The 30 Commissioners have 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 [38, p2]:

  • Improved social supports including income support; accommodation for the homeless; and childcare
  • 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

Discussion also emphasised the importance of investing in health promotion, illness prevention, and literacy, including the associated public health workforce. Calls for investment in social infrastructure including social housing, public transport and aged care were also repeatedly mentioned [38].

… the important role that health consumers play in describing the challenges associated with health inequities…

The abovementioned feedback 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 [1-5]. 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 [,7, 9, 38-43]. Importantly, however, 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 on reducing health inequities would be a good start.

The 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 needs 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.


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