Colleagues today, we are especially delighted to welcome the Minister for Health and Aged Care in the Australian government, the Honourable Mark Butler, to open this event and to thank him for taking time to do so in a very busy period. 

Now, minister Butler's presence today acknowledges the important work undertaken by the Health, Austral Health Policy Collaboration and Victoria University's health policy team over more than a decade.

It's a 10 year long process the contribution that has been made to contemporary health policy priorities is immense, and as you have seen from media coverage today very much recognised as well. Minister Butler has administered for health and aged care since June, 2020 and is leading an extensive policy program to strengthen equitable access to healthcare for all.

Today's publication Getting Australia's Health on Track and Australia's Health Tracker 2024 are focused on the broader goal, that the minister is also committed to and is embracing.

Can I ask you all to join me in welcoming Minister Butler to say a few words? 

Thank you, professor Calder and the Australian Health Policy Collaboration for leading the work on these reports and for inviting me to take part in your launch

When you look around the world, our health system rates very highly in terms of equity of access and health outcomes. In fact, the Commonwealth Fund report released just last month ranks us as the top performing health system in the world overall and in terms of health equity and outcomes.

Importantly, number one, for health equity, and Medicare is right at the core of that, but also number one for healthcare outcomes, and that's something that should be celebrated, something we should be proud of, particularly in the year of the 40th anniversary of Medicare. 

But we do know it's a healthcare system that's under real pressure as a population we're getting older and we're getting sicker. There's more chronic, complex chronic disease, but also more mental illness in the community that's putting pressure on primary care as well as our hospital systems. 

My goal is to make us number one across all parameters and the reports released today. Make it clear that we can and must do better for many of our people. 

They so show that socioeconomic status continues to have a major impact on people's health, and increasingly related to the risks of chronic and preventable conditions. Almost one in three Australians living in our most disadvantaged communities have two or more chronic health conditions compared to just one in eight of those living in the most advantaged areas.

Disadvantaged communities also have the highest rates of suicide. I know your collaboration is seeking to achieve a greater effort on preventative health. We've already taken major steps, but there is still work to do. 

First, we've made primary healthcare affordable and accessible to all. Our government has made the largest investment in bulk billing in Medicare's 40 year history.

Data shows there's been almost 5 million additional bulk billed visits since our government tripled the bulk billing incentive last November. We're also providing fully bulk billed treatment at both Medicare Urgent Care clinics and Medicare mental health centres. We've also made PBS medicines cheaper so people can afford to purchase the medicines that they need.

This has delivered hundreds of millions of dollars in savings to patients at the pharmacy through those cheaper medicines policies. It's also meant that thousands of Australians living with high cholesterol, kidney disease, and ovarian cancer to name a few, will now have more treatment choices for just over $30.

At the same time, we're doing the groundwork to embed preventative health in primary care. My Medicare voluntary patient registration is a year old now. This model was created to support the relationship between patients, their general practice and primary care team. 

We've also targeted specific preventative health issues with increased funding, including vaccines, anti-smoking and anti-vaping measures, sexually transmitted infections, as well as lowering the age for bowel cancer screening.

We're working with communities to ensure health promotion messages are culturally appropriate and understood, and we are developing innovative measures to empower disadvantaged Australians to protect their health in their everyday lives, including a national health literacy strategy, a national consumer engagement strategy for health and wellbeing, and a feasibility study into social prescribing.

The Australian Health Policy Collaboration is undertaking this feasibility study, which is also expected to be completed in coming months. Another example of your great contributions in this area, we need to continue to reduce health inequity and give everyone an equal chance at achieving the best possible health outcomes and with your support, we can continue to work towards this.

Thank you all very much. Minister. We could not be more delighted with the support, the leadership, and the incredible vision that your government has enumerated. It is also the case that the direction of this very project with the multiple team members, but led so ably by Professor Rosemary Calder has been just terrific and very, very influential.

I know that Rosemary was quoted in the media today as saying that it's hiding in plain sight, that we have communities that have poor health conditions, higher needs, and earlier deaths. The places where they live though have significant socio socioeconomic challenges as you pointed out. And we do have a world leading healthcare and healthcare outcomes nationally, but many in Australia do not share that wellbeing and have poor health based on where they live and their opportunities. 

So therefore, universal provision is one thing, but it's not the same as equitable opportunities for good health and wellbeing. And that's what this very important tracking study addresses.

We could not be prouder on behalf of our council to say that Victoria University and the Australian Health Policy Collaboration have worked together to improve those policies, the ones that you've just enumerated for more than a decade. And for the past six years, that work has been partially supported by a grant from the Department of Health and Aged Care.

Minister, I cannot thank you enough on behalf of all of us for joining us here today. I'll now hand over to Professor Rosemary Calder, whom I mentioned earlier, to speak about today's publications, and again, we are just delighted to see them getting Australia's health on track. Australia's Health Tracker 2024.

Rosemary, congratulations. 

Thank you, vice Chancellor. Good afternoon, everyone. As you've heard, I'm Rosemary Calder. I'm a professor of health policy at Victoria University and I've led the Australian Health Policy Collaboration Program since its inception. I'm the mc for this webinar today, and I hope you'll excuse my somewhat croaky throat.

Soon after the health policy group at Victoria University was established. A HPC as it is known, has been supported by the university, and for the past six years has been partially supported through a grant from the Australian Government Department of Health and Aged Care, and we thank our colleagues in the department for their support through this work.

It's a report card that charts progress in Australia towards improvements in key risk factors for poor health and preventable chronic diseases. Australia's Health On Track is a compendium of feasible and affordable policy proposals that will achieve effective improvements in those risk factors.

Getting Australia's health on track reports are easy to understand, clear and precise about what will work and how. And for those who may not be experts, but who are key decision makers and advisors in the Australian policy environment, HPC publications include a series of policy issues and implementation papers on specific ways in which physical and mental health and health care can be improved through policy or system improvements.

All of these publications are resources for wide use. They are for you and others to use in your work. Today's new reports are focused on the extent to which the socioeconomic status of local areas in Australia is a strong indicator. The extent to which people in those areas are likely or not to have good health and wellbeing.

Where you live, does indeed influence your likelihood of lifelong good health and your risk of early death. 

Australia's Health Tracker 2024, chronic conditions by socioeconomic status, spotlights the disparities in health across our country. 40% of people who live in Australia's most disadvantaged communities experience significant and increasing rates of preventable health conditions.

Getting Australia's health presents a suite of implementable policy proposals aimed at improving those health outcomes in communities experiencing high levels of socioeconomic disadvantage. I'm now going to hand over to Stella McNamara of the BU Health Policy Team to discuss the data presented in Australia's Health Tracker 2024.

Hello, uh, I'm Stella McNamara, the senior policy Associate here at the AHPC. 

Socioeconomic status is the measure of people's access to material and social resources. This tracker shows us that those with limited resources are at greater risk of both experiencing chronic health conditions and dying early from those conditions. 

At the moment, you can see we have rates of premature deaths and suicide. On the top left in the bar graph, you can see the premature mortality rate divided into socioeconomic quintiles. Left to right show the least to most disadvantaged. So the bars on the left are the 20% of communities with the least disadvantage, and the bars on the right are the 20% of communities with the most disadvantage.

The darker blue is the most recent data, the light blue represents for comparison year, but both bar graphs on the screen, you can see that the most disadvantaged communities have higher rates of premature deaths and suicides.

I'm now going to talk a bit about comparative data over time. 

The line graph on the right compares just the least disadvantaged quintile in pink to the most disadvantaged quintile in purple across the two time points to highlight the gap between them. And while both are decreasing in this instance. There's a greater decrease in the least disadvantaged areas, increasing that gap.

And we see a very similar trend in chronic disease prevalence as well. On the next screen, we've got the chronic disease, prevalence of cancer, heart stroke, and vascular disease and diabetes. In general, the more disadvantaged, the higher the prevalence of the individual chronic disease.

And over time, the gap between the most and least disadvantaged quintiles is increasing, and that's regardless of whether it's increasing or decreasing in prevalence. The cancer prevalence is particularly stark. In the initial time point, there was actually a relatively similar prevalence across the quintiles, however, the latest data shows a large gap.

On the next slide, we have COPD and mental illness.  With COPD, chronic obstructive pulmonary disease, the same trend applies, but in this case, you can see that only the most disadvantaged quintile has increasing prevalence while all other quintiles are decreasing. 

It's quite a stark gap.

Now, mental illness is the one that bucks the trend and you can see that there was a bigger increase in the least disadvantaged areas between the two time points.

Setting aside the reporting on mental illness, what most of this data show is that essentially health disparities within the Australian population are persistent and widening. The gap in prevalence between those in the most disadvantaged socioeconomic quintiles compared to the least disadvantaged quintiles is growing for almost all the chronic conditions highlighted in the tracker.

And this is despite policy, efforts to date that address increasing rates of chronic disease. 

And that's not to say that attempts are futile. They can and do work, but one size fits all approach is not effective everywhere. So tailoring preventive health initiatives and looking upstream to the wider determinants of health is essential and this is where getting Australia's health on track fits in.

On that note, I'll have, I will hand back to Rosemary.

Thanks, Stella. I'm now going to talk about the process that we've used to develop the reports that we are talking about today, getting Australia's Health on Track 2024. 

Let me first say, as you can see on this slide on the left, the AHPC first came together through a sector-wide agreement in 2014 to work on developing targets and indicators for preventable chronic diseases in the Australian population.

This work was aligned with targets established by the World Health Organization for global reduction in preventable chronic conditions. The HPC targets and indicators were compiled by leading experts and have been updated in line with the most recent population health data. Subsequently, these targets and indicators have been the baseline for all of the AHPC work.

As you can see from this slide, a consensus building approach is used for the work undertaken by the IPC's expert participants. This slide shows you the particular process for getting Australia's health on track 2024. Topic specific expert working groups are drawn together by nomination and recommendation and work collaboratively to identify problems, consider evidence, including lived and professional experience, and to develop through an iterative process, a distilled suite of the policy proposals that are most relevant and most feasible to redress those problems.

Previous getting Australia's health on track policy proposals have been focused on improving the rates in specific risk factors that are identified by Australia's Health Tracker report cards. 

The first two volumes of getting Australia's health on track have recommended policy proposals that would encourage and support healthy behaviours and reduce exposure to harmful products and environments.

Importantly, the work has emphasised over and over again that socioeconomic status is a key indicator of risk for poor health, and that socioeconomically disadvantaged groups and communities fare much less well than the rest of Australia. These communities have higher levels of risk factors, as you've just seen, with higher rates of chronic conditions.

As Australia's health Tracker emphasises, these communities commonly have higher concentrations of those factors called the wider determinants of health factors, such as lower income levels among people within the community, lower levels of educational attainment, fewer employment opportunities, lower housing quality and stability, and lower levels of resources and services within the community.

Those wider determinants of health underpin the major risk factors for chronic conditions, particularly factors such as high levels of physical inactivity, unhealthy diets, smoking and tobacco use, alcohol consumption, overweight and obesity. 

For these reasons, the 2024 volume of Getting Australia's Health on track is focused on why and how socioeconomic disadvantage acts as a barrier to good health and wellbeing within communities and on what can readily be done to mitigate those impacts.

Increasing evidence indicates that place-based approaches tailored to the specific needs and strengths of local communities are the best way to achieve community level improvements. 

Indeed, there are now a number of substantial national policy initiatives focused on improving aspects of health and wellbeing in communities.

There are also numerous state government level initiatives and local government level initiatives. There are philanthropic and not-for-profit organisations also engaging in place-based work addressing health and wellbeing disparities. 

There is increasing experience that this multiplicity of initiatives is adding complexity for communities in which these are concentrated and often adds confusion and can be almost self-defeating because policies affecting local communities are multilayered with Australian government and state government levels of responsibility along with those of local governments.

We took a systems level approach to this work. To do so, we established three working groups, drawing together experts to consider the problems and needs from the micro level perspective of local communities, from the medium level perspective of regional and state-based agencies, organisations, and stakeholder groups, and from the perspective of national policies, agencies, organisations, and stakeholders.

The macro level, the process itself centred on the local community level. The micro system group, chaired by Dr. Erin Laylo, met first and the range of gaps and barriers that inhibit the capacity of communities to have better health and wellbeing and to benefit from preventive health policies and initiatives.

The summary of that meeting was provided to the first meetings of the meso and macro level groups chaired by Tracy Johnson and Professor Timothy Gill. Their groups considered the identified gaps and barriers from the perspective of their system levels and added to the problems and issues, and started to consider options for improvement.

The second round of discussions focused on the policy initiatives that would most effectively on contemporary evidence redress those gaps and barriers. The third meeting of the Microsystem group reviewed and added to the summary outcomes of that round of meetings and a composite meeting of the three working groups confirmed the suite of policy objectives and proposals.

The three chairs and the project team worked throughout the process to synthesise and refine the information emerging from the meetings leading to the integrated policy objectives and related policy proposals that this report presents. 

The next slide shows you the three working groups that met through the first half of this year to develop the policy proposals in getting Australia's health on track.

This is not a slide for you to speed read. It's a public acknowledgement of the experts who collaborated in this work and assurance to you of the deep experience that has informed this policy compendium. 

Let me now look at the policy objectives that have emerged through this process. There are four policy objectives, and they're the areas where policy attention needs to be focused and where significant change can be achieved in reducing health disparities in disadvantaged communities.

For each policy objective, two or more policy proposals have been agreed by the working groups. The policy proposals for each objective are those that are considered the most important to achieve immediate improvement at the community level. Policy objectives and individual policy proposals will be discussed by the chairpersons of the working groups in the panel session shortly.

My aim now is to introduce the policy objectives to you all briefly. 

The first is to provide enhanced community capability and capacity through collaboration and place-based community development. Current policies are increasingly recognising the need to support communities to develop the capability and capacity to design and deliver locally relevant approaches to policy problems in ways that work for these communities.

Community capacity and community development can help to build social capital and inclusion to mitigate some of the impacts of disadvantage. Community development can empower communities and individuals to implement solutions that are appropriate to their communities, particular characteristics and circumstances.

Community capacity achieved through a range of people, organisations, and others working with adequate and stable resources to address local needs. The second policy objective is for healthier environments to be achieved through the appropriate use of planning, regulation and legislation. The importance of decisions that affect the health and wellbeing of the environments in which people grow, live, play, work, and age is now well recognised.

Inclusion of the potential impacts on health and wellbeing as core requirements in government planning, legislation and regulation relevant to urban, rural, and remote communities would directly facilitate reduction in health inequities, and promote healthier outcomes, particularly in disadvantaged communities.

The potential for local governments to shape the health and wellbeing of their communities through their statutory responsibilities, such as community infrastructure and town planning is also recognised, but only several Australian states require and support their local governments to do so through mandatory health and wellbeing plans.

The third objective is investment in tailored preventive health initiatives with and within local communities. Preventive health initiatives can have less benefit in disadvantaged communities. This adds to and exacerbates lower levels of health literacy for individuals and for the communities themselves.

The primary health networks and the local health networks that deliver and support health services in all communities are very well positioned to tailor preventive health initiatives for specific communities. It should be a central responsibility of both these critically important organizations to do so collaboratively and effectively.

And finally, but not least, achieving equitable access to comprehensive high-quality healthcare is the fourth policy objective. While Australia, is arguably one of the best health systems in the world, access to healthcare and equity in healthcare is lacking for many in our communities.

For people without health insurance, longer waiting times for treatment in the public system are common and can contribute to poorer health. For those who have limited resources, the added costs to see a doctor, to have a diagnostic test or to have allied health treatment can be prohibitive. Access to healthcare for people who live in remote areas is also lacking with lower availability of services.

Targeting funding to those for whom financial capacity is a solid barrier to healthcare is consistent with the first aim of Medicare to make access to healthcare universal and to remove healthcare as a cause of financial distress. 

As a long-term general practitioner in a socioeconomically diverse community in Melbourne's West, he's also been a strong advocate for community leadership and health and wellbeing. 

Thank you Rosemary and good afternoon. 

Thank you for inviting me to launch the report getting Australia's Health on track 2024. I've been involved with Rosemary Calder and the team at BU for many years

The common thread through all this, is Rosemary Calder, who is a sensational inspirational driver of thinking and collaboration in this space that is getting the evidence to provide policy makers with good information to make wise and sound investment decisions, including evidence-based policy decisions.

I also reflect as a former president of the Australian Medical Association, which in its own way has opened many doors and opportunities to participate widely and for many in advocacy and policy development. 

I have been actively engaging and working with local governments, with state governments, and with health ministers and officials in the Australian government to develop and influence health policy and to provide the best opportunity for better health for all.

As a clinician, I see too many people with health conditions that could have been prevented if patients had access to better information.

Early interventions, health support, and reinforced structured proactive care pathways can mitigate severe outcomes. Good advice, information and guidance can prevent deterioration. 

The man who came to my practice this Sunday with chest pain, almost collapsed in the car park and in the reception should have been in an ambulance from home and with better knowledge and literacy, he would've known how to call them. 

I've worked with colleagues in my profession and other professions to improve the circumstances of patients with whose health is jeopardised by their housing. Their lack of resources and their isolation endeavouring to do this often adds frustration to an already heavy workload.

Finding special support services can transform lives with guidance and actual face-to-face support from a real person once in the hospital system. The outcomes have improved over time with better communications between GPs and the hospital system, and more recently between non-GP out of hospital providers.

Getting technology, deploying it and achieving a joint up system has been like pulling teeth, but we are now light years ahead of where we were when Journey 90. Collaboration was when the doors opened, albeit reluctantly. This was in 1992. And reforms then included the funding of divisions of general practice to advocate for better services and interactions and exchange of information.

As a community member, I had worked with my colleagues and public services to untie the tangle of red tape and duplicated effort to get health, healthcare support services and preventative health support to people in my community and others when they need it and where they need it. That, of course, is much more easily said than done.

We spoke of the doctor as a patient's physician, philosopher, and friend. Those qualities are needed more and more. We seek to be the patient's guides through the health and social care maze, the multiple tiers of government bureaucracy.

Disjointed, often unintelligible and incoherent policy, tends to trip us up when we're just trying to do the best that we can for our patients

I'm eager to see the policy proposal recommended in this report taken up by all levels of government. This work has been done for policymakers and is ready to be put into policy improvements that will begin to stop the growing disparities in health that we are seeing within our otherwise wealthy, healthy country.

Addressing the needs of vulnerable people in these settings, and setting up the system to provide for them strengthens and makes systems more robust. 

That has been known for a long time. Health policy has increasingly recognised that there are priority population groups that need specific policy attention if they are to have health outcomes that are as good as those of the rest of the population. 

It therefore seems remarkably straightforward common sense that to improve the health of people who are known to experience poorer health outcomes, who are known to be more like to experience socio disadvantage, we need to work not on them, but within the communities in which they live.

We must address the barriers to good health and also within the community, within those communities. But straightforward common sense doesn't easily infuse policy making. I'm going to use my experience as a GP during the COVID pandemic emergency to reflect on what it took to get some common sense and expert advice and evidence taken up and implemented by multiple government agencies, initiatives to deliver actual, real time effective preventive care and care to vulnerable, hard to reach people.

We were asked run a Commonwealth respiratory, provide care, and later on to provide vaccinations to community. In the peak of the COVID-19 pandemic, it was discovered that our area had a high rate of infection and was indeed in greater need of testing services and to trace and test the cases. There was an agreement with the federal government and the state government to allow more testing at our site. There was then further collaboration with state governments to provide wraparound services to provide for people having to isolate and to provide health messaging to prevent spread within the community.

Local schools used their teachers and students skills in local languages to work with council to produce video and audio clips that could be understood by those who could not read or communicate in English. A state government community group was also set up to pick up the needs and concerns and mitigate these with clear, further respectful messaging for various groups.

When it came to providing vaccinations, the need in the area was deemed to be urgent and high risk. So the local government and the mayor advocated with state government and with local GPs. We also worked with federal government to provide vaccination sites and practices, the local badminton hall and the site of the Western Bulldogs, AFL team whose magnificent netball and basketball halls were used.

All level of government working with community was an awesome outcome. The report that we are launching today, getting Australia's Health on Track 2024 presents evidence-based and known to be effective policy improvements that will directly enable communities to create healthier environments. They have to want to do this to understand the need and not be out of pocket for doing so.

That's why funding must be provided and must flow. It can also make preventive health initiatives more effective, but designing within the communities needs, to meet the needs of different particular community groups. The wrangle with COVID taught us which messages can and can't work.

And they vary community by community, but core messages would improve access to the most appropriate care for people who face financial and practical barriers, making the case that at stitch in time saves nine. 

Probably most importantly, that we can get national, state and local governments working together in a common sense approach to all the communities of Australia so that you can stop the worse outcomes happening for people who shouldn't have them.

The policy actions that are recommended by the Australian health policy collaborations experts were developed by investigating what makes it difficult for many communities in Australia to have the same good health and wellbeing within their populations as others do. Taking a systems approach to preventive healthcare is not new.

Using it as a way of identifying what policy barriers cause problems and what can be done to change those and to create opportunities for better health instead, is practical and grounded in the recognition that universal policies are not enough. This is for people. This is for people who know the system and work within the sector.

It's clearly obvious that while they benefit many, they don't work well for many others. 

The report puts forward four policy objectives. 

Those might sound like motherhood statements, not real ambitions, but they're not. For those Australians who live in well-resourced communities and have adequate resources themselves, living in good health and wellbeing for as long as possible is now normal. People in these communities have stopped smoking, reduced all health harms that tobacco use brought into otherwise healthy lives they have taken to heart.

And they've opened up their wallets to the public health methods that being physically active in this sedentary world of ours is very important. Both the physical and mental health. 

They're knowledgeable about good nutrition and have ready access to fresh food and products.

Some areas like mine are regarded as food deserts and the accessible foods tend to be fast food, often drive through cheaper, but not nutritious. 

Supporting investment and augmenting provision of better supply and facilities can be done by local health, local government authorities, and it would pay dividends in better health for the population. 

Australia has a long history in bold health policy measures regarding tobacco smoking cessation. The current smoking rates are amongst the lowest in the world. There are strong public health requirements on food premises or public premises, and on public spaces that smoking near these places is not allowed and often is in breach of legal provisions.

That was a tough battle. It was a long campaign with many threats, but ultimately it led to successful good policy, informed by good evidence and executed by buy-in from all sectors of community. That is a public health overlay requiring all public policies to address a health priority that is getting close to health in all policies and shows the value of a health and wellbeing overlay for all state and territory and local government planning provisions.

Having to consider the health impacts of our community, and of more fast-food outlets or more alcohol outlets or of developing new communities without adequate access to fresh food outlets, walking zones, tree canopy cover and green spaces will directly benefit health of communities not being able to appeal.

Planning decisions that are based on health and wellbeing impacts will cement in the import importance of the retail and commercial and built environments on the health and wellbeing of our communities, ensuring that every local government authority has a clear role in improving the health and wellbeing of the communities.

Makes common sense, doesn't it? 

In Victoria, we have become used to health and wellbeing of communities being one of the core roles, and responsible is the local governments. In my own local government area, Hobsons Bay Local Council keeps track of the health status of our community. So we know that less than half of young people in our region say they can lack mental health care services when they need it.

We know that 54% of the community are meeting physical activity guidelines, and we know we have higher rates of some health conditions than the wider right region. The council has four priorities to promote active living, active living, to tackle climate change and its impact on health to increase participation in the community and to provide a safe and healthy equitable society.

We health professionals and services health can see benefits for our patients when the community environment considers their health and wellbeing. Should every community have a benefit of local government engaging in that? The policy proposal that the forthcoming national health literacy strategy should have a particular focus on the need of disadvantaged communities will help not just individuals but also health services and professionals like myself.

The health needs of communities of disadvantage are so great that spending time to explain basic health information for some who have limited, some of who have limited and understanding of what health them to be healthy and how to be healthier is rather like robbing Peter to pay Paul. 

Supporting communities to learn about the way to produce, prepare, cook, eat, and store food, food safely.

Nutritious food and good value for money with improved food management skills is acknowledged as useful. 

Intervention policy today, however, does not support this deployment. There is no funding model for such innovations. My own personal journey will attest to this. To spend time to do this is to provide the best healthcare and to someone who needs it, but it takes time from others also, or others also need that time.

It is also expensive time for me to provide that and a financial barrier. 

Like language literacy, health literacy is a product of our environment and is fostered and grown by being part of the health literate community requiring public primary health networks and local government networks to formally collaborate and publicly report on preventative health needs of their shared communities Also make sense.

PHNs and LNS both have the same responsibilities to provide and improve the healthcare and health outcomes of their communities. Changes suggested as far back as the 2008 nine report I mentioned earlier identify this, that has not changed. If a program of process or process works, they will be utilised because it works, not because participants are compelled to use it.

And at a time when we know health services and both primary and acute levels are not keeping up the community needs very well, doesn't it make sense to require them to work together to improve health and wellbeing and prevent chronic diseases in the communities? 

The buck passing and cost shifting, blame game benefits, no one and conjoint ownership of problems and solutions is better expenditure of the tax dollar and personal contributions and leads to better outcomes. 

The minister made clear he wants to see multidisciplinary healthcare and coordinated care. 

This is the proposal that is really made for government consideration and implementation. 

Reducing financial access to barriers to health people is what Medicare in its first iterations, as Medibank has brought in.

If people don't have access to bulk billing medical care, they're likely not to be able to pay gap free. When I started practice in Australia, I was blown away with our access to community-based services, particularly pathology, radiology, and non-GP services, medical and non-medical.

This allowed me to look after patients in the community almost entirely, unless they had an emergency forcing them to go to hospital. We had access, we had affordability. We could instigate, investigate, and intervene early. These components made the Australian healthcare system a standout in the world. Now, being referred for diagnostic services or allowed health therapies may not be affordable.

Access to GP services is dwindling as those in practice retire or reduce their hours. And unless new graduates choose GP as a career, our excellent service system is under threat. 

The cost of availability of transport to specialists or other services may be a complete barrier. It's clear that universal provision of healthcare is not sufficient to enable universal or equitable opportunities.

For good healthcare, we must do better. And getting Australia's Health Track 2024 is an excellent set of proposals. To conclude this report represents the best expert advice that can be provided to policy makers and others in government at all levels and immediate guidance about what can and how this can be done.

It's a resource for us to help professionals, to add proposals to our endeavours, to see how we can grow from them. It's an important resource for service providers and administrators who want to see improvements. I encourage our policy leaders and makers to consider this report very carefully and to see it as a resource for decision making.

I encourage your professionals to engage, think outside the box and think how they can participate and enhance the system. We all work in improving access and outcomes to better care for our patients. I'm very pleased to launch getting Australia's health track on track 2024, and I wish this report and all those who put together considerable success and in improving healthcare for all Australians.

Thank you very much. 

Now, Erin? I'm going to tell Tim Gill first.

Thanks Rosemary. 

You'll notice from the presentations that we've chosen, to examine the issues and potential solutions in this report from a whole systems perspective. 

The Socioecological model, which you can see on the screen at the moment of health here. Illustrates this concept nicely, although there's probably more sophisticated models that highlight the complexity of a system level action. 

This simply and clearly visualises the multiple layers and levels of societal factors that influences individuals or communities, behaviours and health.

It highlights the importance of the need for action across each of these layers. To ensure actions to address chronic disease in Australia have the greatest chance of success. 

So whilst most people accept action at the lowest levels, the rationale for action at the macro or higher policy and regulation level, often confuses people because they may not by themselves directly impact upon health, but they are essential to enable and reinforce programs and projects initiated at those lower and local levels.

And more importantly, they also helped remove some of the social and structural barriers that prevent disadvantaged communities from gaining the same benefits from well-designed health promotion programs and projects. S

o if you want to address difficult societal problems such as chronic disease. It's not possible just to act at one level of the system.

Local government, as we're all aware, is the tier that's closest to the community and thus best able to respond to the specific needs for a healthier life. But they need the legislative support and funding of state and federal governments to take this task on in a consistent manner.

And so the development of local health and wellbeing plans as recommended in policy objective two here will enable and encourage LGA is to build on existing services aimed at creating the best environments for promoting health, but also at the same time responding to the specific needs of the communities they serve.

And in doing so, we believe this will help reduce rather than exacerbate prevailing inequalities pointed out. There are good examples where this approach has been effective at addressing specific issues such as sustainability, transport, recreation, but it needs a broader application within the health perspective.

We all now recognise that health and wellbeing are influenced by so many factors that are outside the health domain. And as such much of the regulation and legislation introduced by state and territory governments has enormous potential to impact on community wellbeing. Yet rarely are these regulations and legislations assessed in terms of their impact on health in addition to the direct impacts that these regulations may have.

These regulations also define the framework in which local governments operate and make planning determinants of their own, that impact on the wellbeing of the communities and the absence of a health lens in this situation to planning decisions. It means that local environments may become less supportive of health and wellbeing and contribute to widening health qualities in disadvantaged communities.

As we see when other considerations drive planning decisions around issues such as the number and siting of fast food, tobacco and alcohol outlets, the need to create local environments that support and enable healthful behaviour is also essential in improving health literacy. Health literacy is one of the focuses of policy objective three, which addresses initiatives tailored to disadvantaged communities.

Health literacy is the capacity for people to access, understand, and act upon health information in ways that benefit their health. And we know that disadvantaged communities often have poorer health literacy, which is associated with wealth, worse health outcomes. 

Unfortunately, actions to improve health literacy often are restricted to a focus on individual skills and understanding instead of addressing some of the other key influences, such as the services available and the access to those services, especially in rural, remote areas, as well as the development and provision of culturally appropriate information and programs and services tailored to the specific needs of the community.

And in addition, we also need to consider the environmental changes that are going to make it easier rather than harder for people to act on any learnings gained. 

So I know now hand over to Tracy. 

Thanks, Tim. 

The group that I had the privilege of chairing was the Meso System Group, and one of the things that we agreed on fervently is that what we have is a sickness system. 

We have a siloed group of individual players, whether they be hospitals or primary health networks or primary care players and what we are funded for is activity where people are already unwell. 

We do far too little around planning for how we can make them well for longer, how we can address deficits in their behaviours that they might be carrying with them because of their poverty and circumstance. 

And most importantly, what we agreed on is at the moment, there are no incentives formalised and written into the agreements that we have with our LNS and PHNs to formalise their collaboration around needs assessment around collaborative planning, and most importantly, investment in preventative health as opposed to investment in building more hospitals and delivering more services for those who are already sick.

There was a very strong call for creating that common objective and planning framework so that we in fact end up with a health system rather than a sickness, activity based funding model. 

We moved fairly quickly into the need for team-based care. T

In an environment where we've got workforce shortages everywhere, but particularly in low income areas and rural areas, we need to be thinking about who is it that can do this care? 

What is their scope of practice? How do we fund them to work together, and how do we ensure that they get access to the whole team to deliver comprehensive care?

We're not doing this thinking in an environment that's a vacuum at the moment. There are a number of reports that government has commissioned that we are speaking into. One of those reports talks about having a ratio for every GP in general practice having an equivalent non-GP clinician available to support the needs of the patients in that practice.

This was highly endorsed and supported by the group that I chaired. In addition elements around implementing a social prescribing model and working with our mental health sector differently, were also heavily induced. The third thing that our group looked at was looking at ourselves, as a community of healthcare providers.

Too often, we in fact are the problem and the barrier. 

So making it attractive for healthcare providers to work in low SES communities like the one we serve, which is a social housing area in Brisbane's West or in rural areas or in areas where you might be dealing with patients who are particularly vulnerable.

Two, often we look at those patients and go, isn't it nice that somebody else is prepared to do this work even though we've been trained to do it? 

So we need different incentives to attract and retain workforce, and we also need to educate our young people coming through our education system that most of their work, when they're working in the healthcare system, will in fact be with those who are older, those who are sicker, and those who might have less means than they do.

The final area that we looked at was. What are the financial barriers that are real? 

To give you an example from my own recent experience in the last few days, we work in Queensland's largest social housing community. 

It's highly multicultural. We have the biggest burden of mental health issues in all of Queensland and the highest rate of disability pensioners. Despite that, last year in this region, 37,000 consultations occurred across psychology, psychiatry, general practice, and other service providers in the mental health space.

We are currently planning to launch a practice in a nearby suburb. It's just 20 minutes away. Despite our suburb having a 35% higher population, that nearby suburb delivered 40,000 mental health consultations for a group who are far more affluent. What this tells me is that our provider network is driven by money.

It is driven by easier work. It is driven by the incentives that we need to get right so that in fact, when people have illness, they have access. And at the moment, that was strongly spoken to in our group as not always occurring. I'd implore you to think more broadly than just about money, but also thinking about service provision and preventative health in creative ways.

Thank you. 

I'd now like to introduce my colleague, Erin, and the work that her group did. 

Thanks Tracy.

The Micro Resistance Group, which I had the privilege of chairing, was considering the context and roles of local communities in addressing inequity.

And much of the discussion we had centred around place-based approaches. So we know that place-based approaches have been a core part of strategies to improve community wellbeing for many years. 

But paradoxically, as Rosemary noted, we find that if it's not done right, they can lead to inequity. And governments, philanthropic organisations and others have been investing in place-based approaches to address disadvantage.

And we see many teams delivering programs within a single community. And as an example of this, some of the communities that my organisation, the Alcohol Drug Foundation works in, have about 16 different teams working on adjacent issues such as alcohol and drugs. 

Homelessness, suicide prevention, adolescent wellbeing, youth justice, entrenched disadvantage, et cetera, with very little operating to join those efforts up.

So the group discussed the challenges that communities face in delivering place-based approaches, and these include fragmentation such as that which I've just described, difficulty accessing and using local data challenges in evaluation and finding ways to ensure that there are enough people and capacity in the community to support sustainable efforts.

So we talked about what solutions might look like and how community efforts in addressing space needs can be supported by attention to also strengthening the system that they operate within. As Tim's outlined, they've heard that our proposed solutions were workshopped over many sessions with iterations alongside the proposals from the other working groups to deliver what we see here today.

And what we identify the solutions operating at that microsystem level, need to consider our workforce both paid and volunteer, better access to data and mechanisms that support coordination using systems thinking approaches and that support local communities to do rather than be done to. 

The national framework would provide an overarching structure to guide the development, implementation, and evaluation of place-based programs to provide support for local collaboration and community-led solutions. Coordination of the many funding streams and services and coordination of local efforts at a system level.

And this framework could also include resources that support information sharing and systems thinking and delivering place-based approaches. But we also recognise that a national framework wouldn't be enough and that it, we know that addressing disadvantage and social issues that contribute to poor health outcomes does take time.

And community organisations working to strengthen community wellbeing need time to engage with their community, identify local needs, and understand the best way to address those needs. We also know that evaluation of these sorts of approaches takes time, and that means that funding to community organisation needs to provide flexibility for programs and initiatives to be co-designed and implemented with the community, focusing on addressing community needs and measuring outcomes.

And the third policy proposal that we identified really recognises the importance of the workforce at a local level. Community development workforce with skills in engaging community, accessing and interpreting local data, evaluating co-designing, building strong partnerships at a local level is really critical, as is the volunteer workforce that sits alongside them.

None of these policy options exist in isolation. They're all connected. We've spoken about the socioecological ecological model of health and policy options identified in getting Australia's health on track that stretch from the policy context to the community, to the organisations within community, to the organisations that influence community and the people that live there.

We need action on them all. If we're going to address the inequity in health outcomes that were identified in Australia's health Tracker report that Stella spoke to, and I'll hand back to you now.

Thanks, Erin.

Can I ask Therese to speak first? 

Thank you. I'd say firstly, we've certainly come a long way, from a time when we would develop programs and initiatives outside of community context and helicopter them in and then wonder why they don't work. In the field of complex intervention research, which is where my research is positioned, we now understand that place-based community interventions are complex social processes. 

So people's health is embedded in a community ecosystem, that's made up of not only organisations, and service infrastructures, but communities that have histories, that have resources, they have networks, and have narratives.

That makes up the nature of the community ecology for where people live, work, and play, as we say. And knowledge of the complexity of community life is now understood to be a critical to the work of program and intervention design, implementation and devaluation. 

So as a result of needing to better understand the complexity of community life, a big part of that is what do we do and how do we gather the knowledge about the dynamics of communities that we need in order to be able to make sure that our efforts and our programs and our work at a community level actually sticks and delivers the kind of population outcomes that we hope to achieve.

And a part of that task, has been to bring together differing forms of knowledge and perspectives at a community level, in terms of the kinds of collaborative structures. And collaboration has been an important part of health promotion and prevention from way back to the Ottawa charter. And still an important component of the work that we do at a community level. 

However, today, certainly from a research perspective, there is a big focus on what is the nature of our multi-sectoral configurations. When we bring different sectors together, how do we begin to pay attention to system level or community level impacts, in addition to the effects on individuals.

And importantly from a community perspective, how do we ensure that our collaborations, embrace an empowerment agenda when we are bringing community members around the table? 

So current research has and continues to focus on the understandings of collaborative practices. So how do we go, how do we go about this work?

And it builds on an increasing relational infrastructure, being built at a community level and then up through other systems to our regional and state level that's able to harness the existing knowledge and resources of communities and community members to strengthen that community capacity in order to deliver on those community outcomes.

So the policy recommendations that have been presented to you today definitely go some way to creating that enabling environment where both health and community literacy coalesce. 

We need the health literacy of community members and the community literacy of a health and other workforces and that that can exist within and across that workforce.

So that community outcomes are not only a possibility, but also a likelihood into the future. 

I might pass on now to Rosemary Hancock to talk a little bit about local government. 

As you know, councils have many touch points impacting local health and wellbeing, parks and gardens, local services, funding for sport and recreation, blue green infrastructure. You know, so many things as well as their community services. 

It's quite a formal process, and local communities will be consulted on their health and wellbeing priorities early on in the new council term. And having statutory responsibilities in place also provides opportunities for that connection with the state, state government, bringing councils together so they learn from each other.

It saves time and really helps those councils with fewer resources. You know, of course there's great disparity across the state from small rural councils to really large, complex metropolitan councils. And this is particularly relevant in the context of addressing inequities across the state, which is one of the issues arising in the discussion today.

Local government is always very practical. So I'll cite a couple of very practical examples where having statutory roles of local government really contributes to health and wellbeing. 

Most councils in Victoria are participating in very extensive local government tobacco control program where they are visiting tobacco retailers across the state. And because of that state local interaction, for example, with the rapid rise of e-cigarette retailers.

They were seeing these places emerge and selling products and inevitably that generated consideration of how the regulatory environment at the time influenced national strategies. 

The other one is how health and wellbeing could be used better in the planning system.

Certainly, councils through the planning permits that they issue for certain activities, would love to have a bit more backup at times in terms of where certain places are located such as tobacco outlets, alcohol outlets, and fast food.

Just a few weeks ago we had over 300 town planners on the line, all thinking about gender equality and how that might impact or should be considered in the municipal statements, guiding council's, planning policies for towns and cities.

What can we do in the meantime to increase what happens in the local communities to increase collaboration? Do you have any tips for how to do that? And the other is how do we better work across policy silos? How do we work with what we've got better than we are doing in? 

What else can be done by people at the local level?

I might kick in as a person at the local level. 

So we see patients, we see data, we see lives affected by this sort of thing all day, every day. 

And one of the things I like to remind my team is that we are the system. 

And if we all gave a little bit, and participated in some of the play-based, co-design work, that one of our colleagues has just spoken about, we can make a difference. 

And certainly my team, we're a normal general practice. We get our funding from Medicare. 

Medicare is not a generous payer, but at the end of the day, when we are looking at the lives of the patients that we serve, unless we do the sorts of things that our teams have done for many years, which is get out from behind our desks, attend meetings, engage with our PHN because it's surprising how often they can seed fund little projects. 

We've certainly benefited from that. And then likewise, looking at our data and loving our data, a lot of general practices are not very good at looking at their data and loving their data. 

We can produce business cases that I've certainly taken on behalf of our team to Queensland Health and other funders and they've funded initiatives.

So sometimes it's got to start with us and what we know on the ground, the ideas that we might want to progress and the partnerships that we think we can put in place so that we can share our resources and do this better. 

Thanks, Tracy. Any others? I

'm happy to chip in Rosemary and I think there is a lot that can be done and all the policy proposals in the report today really go to the fact that we need action 50 levels of the system.

Government alone can't do it. But when I was talking to the policy proposals that the Microsystem group came up with, we identified that there are often many groups working within a single community, all delivering initiatives to improve the wellbeing of that community and address disadvantage.

And often there's visibility of each other group because there's cross membership, but there's no bringing them together. 

And I think just a conversation about what's happening within a community across the different groups happening from time to time to increase visibility of what's going on and how those initiatives by one group might add value or be used by another group would be a really constructive way to start to see change happening from a place-based approaches perspective.

But I don't think we should ever excuse that as an excuse. 

Our government will take time, but it has to happen at every level. 

So we've still got to be working at trying to influence the decisions that government makes. 

To Tracy's point, speaking out, representing community, gathering information about the impact, the needs, the opportunities for change, the results that we're seeing from the efforts that we make at the community are all things that help push the bar a little bit further along in terms of achieving change that we need to see.

I'd just like to reinforce that from a policy perspective, because I know a lot of people say, oh, just be so much easier if government would just make the right policies and everything would be solved. But as Erin and Tracy have said, all the other levels have to be in place as well. We all have to be working towards achieving that multi-level action.

Sometimes, governments do take a leadership role, but more often than not, they have to be forced into making the right sort of decisions and action. 

If we're not prepared to keep working with communities, keep pushing, keep putting things on the agenda, then we're never going to pull governments into making the right sort of decisions.

Thank you. 

Necessity is the mother of invention and we saw that decline during the pandemic. I hate to bang on about Victoria because we did pretty hot up down here. But it actually gave us the opportunity to do things differently. Directly with state government, with general practice, and primary care.

We've even seen the treasurer, of Victoria put money into health and try and support general practice, do things slightly differently, as in a trial methodology. 

We actually saw state government in this state providing money to help more areas and more sites, and more people do vaccinations, so they get the numbers through.

That would never have happened before, because of cost shifting and blaming. 

I remember walking into the premier's office with my phone on speaking to someone. Only very rude. But nonetheless, I had to finish off my conversation with Commonwealth, trying to get some more funds to do what he wanted me to do and go to the press conference with. 

Can I put one more question to you from the questions we've received? And that is a question that says, one effective way is to encourage governments to enshrine these issues in legislation And Wales is quoted, Wales has established a wellbeing for future generations act, which requires health and wellbeing in all policies.

As many of us know, there's been a long-held hope. In fact, aspiration of the World Health Organisation, that health would be enshrined in all policies. 

The question is, do we think Australia will ever do this? And if so, how do we get there? 

If we look at what Jim Chalmers has done, as treasurer, he's broadened a reporting card fo