Baum Fran, Fisher Matthew
Southgate Institute for Health Society and Equity, School of Medicine, Flinders University, Adelaide, SA 5001, Australia.
Aust J Prim Health. 2011;17(4):320-6. doi: 10.1071/PY11041.
This paper examines commitments to address health inequities within current (2008-11) Australian government initiatives on health promotion and chronic disease prevention. Specifically, the paper considers: the Council of Australian Governments' 'National partnership agreement on preventive health'; the National Preventative Health Taskforce report, 'Australia: the healthiest country by 2020'; and the Australian Government's response to the taskforce report, 'Taking preventative action'. Arising from these is the recent establishment of the Australian National Preventive Health Agency. Together, these measures represent a substantial public investment in health promotion and disease prevention. The present paper finds that these initiatives clearly acknowledge significantly worse health outcomes for those subject to social or economic disadvantage, and contain measures aimed to improve health outcomes among Indigenous people and those in low socioeconomic status communities. However, we argue that, as a whole, these initiatives have (thus far) largely missed an opportunity to develop a whole of government approach to health promotion able to address upstream social determinants of health and health inequities in Australia. In particular, they are limited by a primary focus on individual health behaviours as risk factors for chronic disease, with too little attention on the wider socioeconomic and cultural factors that drive behaviours, and so disease outcomes, in populations.
本文审视了澳大利亚政府在当前（2008 - 2011年）健康促进和慢性病预防举措中解决健康不平等问题的承诺。具体而言，本文考量了：澳大利亚政府理事会的“国家预防性健康伙伴关系协议”；国家预防性健康特别工作组的报告《澳大利亚：到2020年成为最健康的国家》；以及澳大利亚政府对特别工作组报告的回应《采取预防行动》。由此催生了澳大利亚国家预防性健康局的近期设立。这些举措共同构成了对健康促进和疾病预防的大量公共投资。本文发现，这些举措明确承认，那些面临社会或经济劣势的人群健康状况明显更差，并且包含旨在改善原住民及社会经济地位较低社区人群健康状况的措施。然而，我们认为，总体而言，这些举措（到目前为止）在很大程度上错失了一个机会，未能制定一种能够解决澳大利亚健康的上游社会决定因素及健康不平等问题的政府整体健康促进方法。特别是，它们主要局限于将个体健康行为作为慢性病的风险因素，而对驱动人群行为进而影响疾病结果的更广泛社会经济和文化因素关注过少。
