CPHCE Report: The Role of the Health System in Reducing Health Inequity

Following on from their forum, “The Role of the Health System in Reducing Health Inequity”, held on Wednesday 29 June 2016, the Centre for Primary Health Care and Equity (CPHCE) has produced a report summarising the proceedings.

Summary of ‘The Role of the Health System in Reducing Health Inequity’ Forum

Date: 29/06/2016


Health is an outcome of a naturally occurring phenomena, however the scale of life and death and the health determinants that serve to classify the individual, community and system are continuing to create inequity. Despite data from the Australian Bureau of Statistics showing an increasingly aging population, the differential between those in quintile one and quintile five has steepened. In Australia the fractured health system provides a difficult climate to truly provide an equitable system. Distributive justice has in affect designed a set of personal, environmental, economic and social determinants that will often contribute to an individual’s health outcomes. Research conducted by University of New South Wales professors Don Nutbeam and Mark Harris shows approximately 66% of the Australian public would be considered health illiterate. Their research focused on basic compliance testing which looked at ability to correctly read nutritional labels and follow directives on prescription boxes. So the following two questions were the central focus of the forum.

1: How do we empower health literacy in a system that inherently disempowers the individual and grades their engagement on compliance?
2: How do organisations and individuals contribute to social determinants?

While there were no clear answers to either questions some theories served to question the health industry’s climate.


Australia currently operates under 17 fragmented different levels of health governance from local, state and national levels. This includes Primary Health Networks, Local Health Districts, State and Federal bodies, community bodies and councils. And while human intent will always impact the individual’s health outcomes the collective choices society has made give reference to how and when someone finds themselves needing to navigate the health system. UNSW Associate Professor Marilyn Wise said “society has set up an inequality that the collective whole feels are justified and conscious.” However, the very act of a society endorsing a politically designed system, will inherently be filled with stigma, denigration and bias. How, then does the Australian healthcare system ensure it provides equitable access and delivery of services?

Professor of Public Health Don Nutbeam presented on the “UK Experience” which focused on the development of the Acheson Report and the health system post Thatcher and Major. He explained despite a significant increase in the average life expectancy over the 12 years, the gap between inequality in health had significantly widened. He said “improving the average age of a population has zero impact on reducing inequalities. In fact, it often exuberates it.” The mantra for change in the UK became ‘how do we improve the health of the poorest, the fastest?’ Working alongside treasury – at the time Gordon Brown – Public Health in the UK strengthened the primary care system and focused systematically on primary prevention. Initiatives that led to global reform like smoking cessation. Nutbeam explained that funding sustainability had to be a cornerstone of reform.

The recurrent theme focused on an idealistic health system that valued consumers as equal voices in the design and delivery of services. It was best described as “asset management”. The concept looked at the value, experience and expertise a consumer could add to health organisations and their strategic focus. Wise explained that organisations needed to give patients autonomy, agency and presence. That patient’s engagement should not be tokenistic but rather have formative and quantifiable input.

Through an “asset management scheme” organisations would be forced to examine how they exaggerate or perpetuate bias – internally, externally, organisationally and individually. It became apparent in identifying organisation bias; the health system could address infrastructures that
perpetuate inequity.

The afternoon workshops focused on how health literacy plays an intersectional role in the dichotomy between a system that inherently disempowers people and the individual who needs empowering. Defined by Nutbeam: Health Literacy is a framework that empowers the individual to make consented decisions about their health which aligns with their own values. The key areas for health literacy is identifying areas where health navigation needs reform and challenging the status quo for the empowerment of communities and secondly understanding a clear divergence in literacy versus comprehension.


The key learnings can be broken down into two areas – organisational and individual learnings. From an organisational perspective, health governance and service providers at all levels, need to be willing to examine how their structures, strategy and engagement serve to perpetuate existing bias and inequity. In inviting equal partnership between the community, administrators and clinicians, organisations can create valuable expertise as assets. Individual learnings, particularly those around health literacy and engagement, are about approaching concepts with distinct humility. The design
of health literacy needs to be conscious that cognitive behaviour and systematic reform require holistic approaches and that in many cases literacy is not the problem, rather comprehension.

For all presentations – CLICK HERE