Deadly gap robbing Tasmanians of decades of life
This week many of you will have travelled between two worlds, unaware that for each kilometre you drove on the Brooker Highway the median life expectancy between suburban areas declined by one year — 19 years of life expectancy lost for 19km travelled.
Between these Hobart suburbs, the life expectancy drops to a level not seen in Australia since the 1930s.
How can this be?
Research from Torrens University released on Monday showed an alarming health and survival gap between Tasmania’s most and least socioeconomically advantaged suburbs. Rates of obesity, diabetes and smoking were two to three times higher in disadvantaged areas, with similar differences for cardiovascular disease and psychological distress. And while the quality of life impact of chronic illness is substantial, the most alarming observation was the difference in median life expectancy of up 19 years.
Many readers will recognise causal links between obesity and diabetes, between diabetes, smoking and cardiovascular disease, and between these risk factors and premature death. This is well established, and we typically understand these risks as they relate to the individual.
But this is where it gets very real and personal; we are not talking about individual people with risk factors, or a faraway country or remote region of the globe, we are talking about entire suburbs on the urban fringes of Tasmanian cities. The research showed median age at death varies from 66 years for people living in Bridgewater-Gagebrook, to 85 in New Town. These are the ends of a spectrum, with the data for regional Tasmania intermediate. How is it, you might wonder, that in a privileged country, and a privileged state such as Tasmania, are there such disparities between suburbs so close to each other?
Research demonstrates that health and life expectancy vary dramatically based on the socioeconomic wellbeing of a community. The explanation relates to Social Determinants of Health. These are the social conditions where we are born and raised, live and work, and how we support each other as a community. Improving the Social Determinants of Health is about building robust health from the earliest stage of life. It’s about reducing need for hospitalisation by preventing disease.
While there is rightly much focus on performance of our acute hospitals and improving access to community services and general practice, addressing the extremes of poor health and intergenerational disadvantage requires an equally sophisticated approach, one embedded in all government policy; what Social Determinants of Health advocate, Sir Michael Marmot refers to as health in all policies, health in all portfolios.
The 2010 Marmot Review into health inequalities in England presented an evidence-based strategy:
HEALTH INEQUALITIES arise from a complex interaction of housing, income, education, social isolation, disability, all strongly affected by one’s economic and social status
HEALTH INEQUALITIES are mostly preventable
ACTION requires work on all the social determinants of health, including education, occupation, income, home and community. In particular, addressing intergenerational disadvantage, including its starting point beyond the necessities of housing, nutrition and physical security, requires a strategy that addresses education. Education empowers people, it leads to better health and long-term financial resilience and opportunities.
About 120,000 Tasmanians live in poverty. Families can struggle to find stable accommodation and provide appropriate nutrition for their children. Access to medical care and health literacy can be challenging. The health, wellbeing and environment of these families fundamentally impact the growth and development of the foetus as well as the child. A safe and stable family environment along with literacy precursors such as being read stories in early childhood and addressing family violence are critical to socialisation, wellbeing and education when children start school.
The AMA believes all government policy and action can be assessed against five domains to ensure every child has a healthy start to life:
FAMILIES: Ensure access to housing, food and employment which will provide good physical and mental health and emotional security to a child; provide programs to assist parental literacy and particularly health literacy, so parents can make decisions that will impact positively on their children,
PRECONCEPTION PLANNING: Help prospective parents look after their nutrition; stop or reduce tobacco, alcohol or other drugs; increase iodine, folate and exercise; reduce obesity,
PREGNANCY: Encourage exercise to help reduce obesity and increase fitness; encourage better general nutrition and increase iodine and folate; discourage consumption of tobacco, alcohol or other drugs,
EARLY CHILDHOOD: Promote exercise, play, general nutrition, iodine, folate and immunisations; encourage healthy family environments to help provide emotional and physical security for children; improve parental literacy and education,
EDUCATION: Support language development, which is the foundation of literacy and later learning.
If we sincerely ask ourselves whether we’ve done enough for our fellow Tasmanians, we would have to say no. However, we are working towards improved outcomes. An excellent example of bipartisan and sustained effort by successive Tasmanian governments can be seen in the Child and Family Centres program that continue to be supported and rolled out across our state. These Centres provide a hub for early childhood and family engagement and support by educators and health providers. They act to build and strengthen communities, bringing them together to support early childhood health and development.
Improving life expectancy in communities struggling with entrenched socio-economic disadvantage requires dealing with the immediate necessities of life as well as tackling the root causes. A healthy start to life from before conception to the time of formal school entry is critical to lifelong health and wellbeing. As a state, we must all rise to the challenge and play a key role through thoughtful design and implementation of all policies and programs to ensure all children get a healthy start to life and achieve their full potential for long and healthy lives.
Professor John Burgess is president of the Australian Medical Association Tasmania.