Michelle Morgan, PHAA member, Healthy Communities Officer at the Tasmanian Department of Health, and PhD candidate at the University of Tasmania
Over the past few years, we have all experienced major disruption from the COVID-19 pandemic. But our experiences have not been equal. The pandemic has exposed and worsened existing social and health inequities, with people in socio-economically disadvantaged areas disproportionately affected. Social determinants of health cause these inequities, which are driven by policy decisions prioritising economic goals over people’s health and wellbeing.
Reflecting on the governmental actions that occurred in response to the pandemic and using data from the local government sector in Tasmania, I offer a systems perspective to highlight the opportunities from the pandemic to address crises such as health inequities and preventable chronic, noncommunicable diseases and conditions (NCDs).
Systems thinking and leverage points
From a systems perspective, societies can be seen as systems that are made up of many parts that interact in unpredictable ways to produce outcomes. If system outcomes are undesirable, such as a high prevalence of disease, then a systems thinking perspective can help inform decision-makers about the system’s many interacting factors and where changes can be made to shift the system so it produces more desirable outcomes.
Understanding systems in this way can help system actors identify leverage points that could help improve system outcomes. However, different leverage points have different levels of effectiveness. These vary from shallow leverage points often involving interventions that address immediate causes of problems, such as taxes or subsidies, and are influenced by deeper leverage points, such as system goals or mindsets from which a system arises. An example of a system goal is economic growth.
During the earlier stages of the pandemic, all tiers of governments took radical and swift actions to control the spread of COVID-19. Kerwin Datu described the remarkable “lack of vociferous political conflict” in the health response and observed that “normally economically conservative governments … moved rapidly to implementing conventionally socialist policies such as massive welfare outlays”.
In addition to physical distancing, hygiene measures, and vaccinations, a raft of temporary income support measures were introduced in Australia, such as JobKeeper and JobSeeker. These measures aimed to ensure people complied with movement restrictions to reduce the spread of disease — actions that demonstrate a shift from an economic system goal to one that prioritises people’s health. From a systems perspective, these are changes to deep system leverage points: the goals of the system and the mindset out of which the system arises.
A Tasmanian local government perspective
In October-November 2020, I surveyed elected representatives and council staff from the local government sector in Tasmania. In that survey, I asked what changes occurred in response to COVID-19 that could be used to improve the health of Tasmanians more broadly.
From the 81 survey participants, there was overwhelming support for the prioritisation of health and action on the social determinants of health to continue.
Participants wanted many of the changes introduced in response to the pandemic to continue, such as income and housing support, due to the broader health, social, environmental, and economic benefits they offered. Participants also wanted telehealth to continue, which was particularly beneficial for people living in rural and remote communities, as well as increased funding for mental health services. Further, participants valued the caring and compassionate communication from governments, which promoted whole-of-community unity.
These perspectives from local government personnel reveal parts of governmental systems that have been disrupted, are susceptible to change, and affect health-related outcomes at the local level.
These changes also serve as a reminder that a system’s rules can be changed and do shape the conditions that affect population health outcomes, whether they relate to the ongoing threat of COVID-19 or the slow emergency of NCDs.
All tiers of government in Australia have power and influence to change these rules, and each tier needs to prioritise achieving a higher standard of health for all to the same degree that is given to achieving economic goals. Prioritisation must also be given to planetary health because there is “no public health without planetary health”.
An opportunity to change entrenched system behaviours
The disruption from the pandemic provides an opportunity to reassess collective priorities and change entrenched system behaviours to work towards better outcomes for current and future generations. This should include prioritising human and planetary health on par with economic goals.
A wellbeing economy is a system goal that can help us achieve better outcomes for all. An alliance of countries including Finland, Iceland, New Zealand, and Wales are championing wellbeing economies by embedding wellbeing in government decision-making.
In Australia, the new Federal Treasurer, Dr Jim Chalmers MP, has indicated a shift toward a wellbeing economy with the government’s first wellbeing budget expected to be delivered on 25 October. This budget should support existing efforts toward a wellbeing economy in Australia, such as those in the ACT, Victoria, and Tasmania.
But to achieve the transformative systems change needed to improve health and reduce health inequities, a wellbeing economy needs to be embedded throughout every level of government and requires a clear reform agenda. Working towards a wellbeing economy system goal would offer many co-benefits for other systems, including the economy: improved health and wellbeing outcomes will increase productivity, reduce absenteeism, and reduce pressure on the health care system.
Unless action is taken now to reorient governmental systems to achieve better outcomes for all, social and health inequities are likely to worsen in the longer term.
This article is based on a journal paper published by Geographical Research. Read the original here.
This research was supported by The Australian Prevention Partnership Centre through the National Health and Medical Research Council (NHMRC) partnership grant scheme (Grant ID: GNT910003) with the NHMRC, Australian Government Department of Health, ACT Health, Cancer Council Australia, NSW Ministry of Health, South Australian Department for Health and Wellbeing, Tasmanian Department of Health, and VicHealth.
This research was supported by the Tasmanian Government, Department of Health, Public Health Services. The contents of this published material are solely the responsibility of the individual author and do not reflect the views of the Tasmanian Government.