Bridging the health gap

Average life expectancy numbers hide stark differences of race, geography and sex. Nurses can play an important role in helping to bridge the gaps says a leading health policy expert.

Average life expectancy in Australia is 83 years but the figure disguises different outcomes for different groups, says Dr Lesley Russell of the Menzies Centre for Health Policy at the University of Sydney.

People with mental illness die up to 20 years earlier than average and indigenous Australians die 10-17 years earlier than other Australians, Dr Russell told the recent NSWNMA annual conference.

Men die five years earlier than women, rural residents die up to seven years earlier than city people and residents of Western Sydney die 2.5 years earlier than those in Northern Sydney.

“The average life expectancy of people who live in Burke in northern NSW is about the same as people who live in North Korea. It always amazes me that we’re so accepting of these stark differences,”  she said.

“We are already a country where good health and access to life’s opportunities comes down to your postcode. Growing inequality is going to make this worse.”

It is estimated that between one third and one half of life expectancy gaps are explained by differences in the “social determinants of health” such as housing, clean water and air, healthy workplaces, transportation services and safe communities.

Low education, low health

“People who are unemployed and their families experience a much greater risk of premature death,” Dr Russell said.

“These health effects begin when people first feel their jobs are under threat. Job insecurity or very unsatisfactory employment can be as harmful as unemployment with increasing effects on mental health and heart disease.

“Generally those with the lowest health standards also have the lowest educational and literacy levels.

“There is a five-year difference in life expectancy between people with 12 years or less education and those with more than 12 years’ education.

“More educated people have lower morbidity from the most common acute and chronic diseases like heart conditions, stroke, emphysema, diabetes and ulcers. They are less likely to smoke and be overweight. Their physical and mental functioning is better.”

Support for families offsets poverty, improves health

Dr Russell said protective social factors, including social and cultural supports, could offset material disadvantage and boost life expectancy.

This is exemplified by what is known as the ‘Hispanic paradox’: Hispanics living in the US have on average a higher life expectancy and lower rates of infant mortality than white Americans even though Hispanics on average are poorer, have harsher jobs and less access to education and health care services.

“However they have relatively healthy lifestyles and a social cohesion and support network which nurtures young mothers and children in particular.

“We also know that low incomes have less impact if basic needs such as housing, food and health care are met.”

She cites Cuba as an example of a low-income country with strong social policies and life expectancy to match first-world countries.

Dr Russell advocates a “whole-of-government approach to health” that systematically takes into account the health implications of government decision-making.

“If welfare and pension payments decrease then there are consequences for the health care budget and usually at the acute end of the spectrum.

“Ironically the reason why whole-of-government approaches are hard to introduce is not because they cost money – they don’t. They do require real changes in policy and political culture and breaking down of silos and power bases.”

She said South Australia adopted a whole-of-government approach in 2010 but “I’m not sure how well implemented it is these days. There is a need for ongoing high level commitment and champions.”

She urged “immediate, pragmatic” steps to raise life expectancy among disadvantaged groups “focusing on early interventions with children and families and on taking health services to places where people spend most of their time.”

“The best value for money would be more community health workers and more Aboriginal health workers.”


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Health and inequality – Dr Lesley Russell on bridging the health gap.

Nursing programs make a difference

“Nurses and midwives are well placed to know what’s needed beyond clinical services to deliver improved health,” Dr Russell told annual conference.

“The real challenge comes not in knowing what to do but in finding the resources to undertake these increased responsibilities.

“Too often the barriers to action are issues such as scope of practice and who pays. Somehow we need to get beyond 20th century turf wars, financing issues and siloing of responsibilities for the health of the population.”

She says the following programs involving nurses and midwives are proven successes:

Australian Nurse-Family Partnership Program focuses on first time, low-income mothers through home visits by trained nurses. Dr Russell says it has reduced child abuse and neglect, with children less likely to be hospitalised with injuries, less likely to have behavioural problems at school, less likely to engage in substance abuse by age 12 and a reduction in criminal behaviour by parents.

Dr Russell says the Kentucky School Nurses Program in the USA “doesn’t just help with health crises, kids’ medication needs and bullying. School nurses have been shown to prevent absenteeism and boost educational achievements.”

She calls the Royal Flying Doctor ‘pit stop’ program a great example of taking health and prevention services to workplaces such as remote mining areas. “We all know that men take better care of their cars than they do of their bodies. This program aims to engage men in their health by likening areas of the body to body parts of a car.”