A series of equity actions have been identified to enable the SA health system to address the social gradient affecting the health targets of South Australia’s Strategic Plan (SASP). The equity actions were based on an extensive review of the literature and consultation with key stakeholders. They were endorsed by Portfolio Executive in April 2007. Targets for which Health has lead agency responsibility in primary prevention were nominated for action, and a series of best strategic actions were identified for:
Aboriginal health and well-being is treated as a cross-cutting issue and integrated into identified action across these target areas. The SASP target for chronic disease (T2.6) was not included as a target at the time that the health equity actions were being formulated. To address this issue SA Health ensured that equity actions are incorporated within its forthcoming Chronic Disease Action Plan.
SA Health is progressing equity actions against the nominated targets as follow:
T2.1 – Smoking: reduce the percentage of young cigarette smokers by 10 percentage points between 2004 and 2014.
- Action 1
The development of a youth friendly QUIT model for 12-18 year olds.
Intensify the support for disadvantaged and Aboriginal young people to reduce uptake and encourage cessation of smoking.
T2.2 – Healthy weight: increase the proportion of South Australians 18 and over with healthy weight by 10 percentage points by 2014.
- Action 1
Prioritise disadvantaged children and families in the planning, implementation and evaluation of the Under 5’s initiative. Focus on settings where disadvantaged children live and play, such as children’s centres, preschools and neighbourhoods.
- Action 2
Support policy initiatives which make healthy choices the easier choices for all but with benefit to disadvantaged communities.
Support legislative and policy change to:
- In conjunction with the Commonwealth Government, incorporate front of package food labelling such as, multiple traffic lights to enable simpler and healthier food choices. This would need to be accompanied by a tailored communication strategy that supports low SES families to effectively use the system.
- Control unhealthy food advertising during children’s viewing time.
- Action 3
Conduct an Equity Focused Health Impact Assessment (EFHIA) on the Australian Better Health Initiative (ABHI), school and community program. This will help ensure funded strategies will assist those who are disadvantaged in particular.
- Action 4
Maximise opportunities to support initiatives that focus on assisting disadvantaged communities to eat well and be active Explore opportunities for collaboration across government.
T2.4 - Healthy South Australians: increase the healthy life expectancy of South Australians by 5 % for males and 3 % for females by 2014.
- Action 1
Develop tailored smoking cessation programs to the needs of low SES people, with particular focus on Aboriginal people, manual workers, unemployed people and people with a mental illness.
- Action 2
Develop models of antenatal and postnatal services to better meet the needs of those families in the lowest SES quintile. Aim to increase access to services and decrease children’s exposure to preventable health and social risk in the early years.
- Action 3
Ensure GP Plus and other primary health care services have a strong equity focus by:
- Tailoring chronic disease prevention and self management programs to the needs of people from low SES within their catchment area;
- Actively recruiting men from low SES in need of health interventions for secondary prevention; and
- Developing a responsive referral process for smoking cessation.
- Action 4
Develop a multilevel departmental approach to improving health literacy. This should include:
- Defining the extent of the problem by establishing a baseline of adult health literacy
- Building health literacy to reduce inequalities through:
- developing recognition of the diversity of individuals and communities. The role of family, social context, culture and education must be factored into the development of health literacy messages and proposals
- developing simple and practical information
- developing a research and network agenda
- training health care staff.
T2.7 – Psychological well being: equal or lower than the Australian average for psychological distress by 2014.
- Action 1
Further research the association between psychological distress and socio-economic status.
T6.3 - Early childhood – low birth weight babies: reduce the proportion of low birth weight babies.
- Action 1
Enhance access to antenatal services to better meet the needs of those women in the lowest SES quintile who are not currently accessing services.
- Action 2
Ensure as a priority state wide rollout of best practice community ante natal care models for Aboriginal women and their babies and integration into all regional plans/programs. The Aboriginal Maternal Birthing Programs are to be based on the principles and successes of the Whyalla Family Birthing Program and the Anangu Bibi Birthing Program (Port Augusta).
- Action 3
Introduce subsidised NRT as an adjunct to the “Quit Smoke-free Pregnancy project”. This follows the lifting of the pregnancy contra-indication guideline, and must ensure access to women of low SES and Aboriginal background.
SA Health is building evidence for interventions to improve equity in health outcomes. Ongoing monitoring of the current actions will contribute to improved evidence and understanding and assist in building further basis for action.
Other activities
The equity actions have provided an opportunity for the South Australian health system to move forward in enhancing health equity. The health system is also responding in other ways, by:
- Continuing to monitor the implementation of the SASP Equity Actions;
- Working in partnership with the Department of Education and Children’s Services (DECS) and the Department of Family and Children’s Services (DFC) in implementing the Children’s Centres Health and Wellbeing Framework across established and planned Children’s Centre sites;
- Commissioning the Planning for Health Study to provide a systematic review of urban planning trends, processes and structures affecting population health outcomes;
- Fully funding a three year, Health in Planning position, to be located in Planning SA to provide advice and assistance to the agency to ensure policies, key planning documents and practices maximise good health.
- Implementing equity-related projects across the health portfolio, including:
- Research and consultation on the current and future scope of antenatal services to better target women of low SES and Aboriginal backgrounds from an equity perspective;
- Scoping other opportunities to embed a health equity focus across the work of the health system.
- Contributing to a more comprehensive understanding about health interventions to build health equity through:
- workforce development; and
- sponsorship of visiting experts for seminars and conferences.
- Working in partnership with the Department of Premier and Cabinet (DPC) to progress the Health in All Policies (HiAP) agenda across government agencies. The HiAP initiative is casting a health lens across South Australia’s Strategic Plan (SASP) to:
- integrate health considerations across a wide range of policy areas that affect the social determinants of health;
- build these into the policy development process of all sectors and agencies.
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