Policy Stakeholders
Public policies are made in the interest of a nation’s citizens and address a specific problem. The concept of public policy is crucial to health promotion and since the 1980s, building a health public policy has been adopted as an effective way to solve public health problems (Keleher, 2016). Chronic health diseases are those that last more than a year and hamper routine activities. They are a principal cause of disability, illness, and death in Australia. In 2018, 47% of Australians were found to have one or more chronic diseases (ABS, 2018). The purpose of this paper is to discuss the National Strategic Framework for Chronic Conditions which is a policy document of the Australian government designed to help Australians effectively prevent and manage chronic conditions. For this purpose, the paper will explore the policy’s stakeholders, problems in the sector, challenges that the policy addresses, and how this policy affects social determinants of health for people with chronic conditions.
Figure 1: Policy Concept Map
Source: (Australian Health Ministers’ Advisory Council, 2017, p.7)
The key stakeholders of the policy include state and territory governments, other non-government bodies, clinical experts, researchers, academics, peak bodies, health professionals, consumer representatives, industry members, and community members comprising of persons with chronic illnesses and their families and carers (Australian Health Ministers’ Advisory Council, 2017).
The major health challenges in this sector include the aging population of Australia (prevalence of chronic illness increase with age (figure 2)), a rise in consumer expectations, increasing cost of medicines and treatment, and the increasing rates of chronic conditions. All these factors contribute to the increasing burden on the community, individuals, and healthcare systems. The disease burden is not distributed uniformly with some communities like Torres Strait Islander people and Australian Aboriginals being more vulnerable to poorer health outcomes (Beks et al., 2019).
Moreover, some problems in patient care have also been reported. These problems include uncoordinated care (services and providers working in isolation and not as a team), trouble finding the needed service, delayed services, service duplication, providers not adapting to digital health technology for better health outcomes, lack of proper access to the services, language and cultural barriers, patients feeling disengagement and frustration.
Furthermore, perhaps the biggest challenge for the sector is to promote the prevention of chronic health conditions. The diseases are mostly caused by modifiable risk factors including lifestyle and diet. By addressing these factors, one can avoid morbidity and mortality (early death) to a large extent (Schmidt, 2016). (Bailey et al., 2019)’s study conducted on people residing in New South Wales showed that most of them have unhealthy behaviour patterns with 74.8% reporting that they do not consume adequate servings of fruits, 57.6% reporting that they do not engage inadequate physical activity, 19.3% agreeing that they have chronic alcohol consumption problems, 34.1% reporting binge alcohol consumption, and 11.8% reporting that they are smokers. Of these, 2/3rd had multiple risk behaviours. These risk factors are more prevalent in Aboriginal communities. There is a reported gap of 66% in risk factor burden between Indigenous and Non-Indigenous Australians as of 2018 (AIHW, 2019).
Challenges in the Sector
Figure 2
Source: (ABS, 2018)
With the help of its key stakeholders, the policy addresses the issues of equity, access, partnership and collaboration, evidence-based prevention and management of chronic conditions, access to health services, a person-centered approach, transparency, accountability, sustainability, and shared responsibility (Australian Health Ministers’ Advisory Council, 2017, p.14).
Furthermore, the policy focuses on preventing chronic diseases for a healthier nation by promoting healthy behaviour, partnership for sharing expertise and responsibility, exhorting Australians to maintain healthy behaviors through times of environmental, social, or developmental change, and initiating early and appropriate intervention for chronic disease treatment (Australian Health Ministers’ Advisory Council, 2017, p.18).
Another objective is to provide support and care to chronic diseases patients and improve their quality of life through continuity of care, active engagement, complete information sharing, accessible health services, and support systems (Australian Health Ministers’ Advisory Council, 2017, p.30). Finally, the policy addresses the challenge of health disparity between Indigenous and Non-Indigenous Australians by targeting the priority populations and implementing actions to empower them (Australian Health Ministers’ Advisory Council, 2017, p 43).
Social determinants of health include non-medical factors that influence a person’s or community’s health outcomes. They are forces such as development agendas, economic policies, social policies, political systems, and social norms that shape the living conditions of people (WHO, 2022).
Figure 3
Source: (Australian Health Ministers’ Advisory Council, 2017, p.12)
The policy’s strategic priority area 3.1 addresses the need to develop a health framework that is inclusive for priority populations. The policy establishes that healthcare services must be culturally responsive toward Torres Strait Islander People and Aboriginals who are believed to be holistic with spirituality, culture, and land. The policy states that these people must be provided with a workforce that is culturally competent, communicates with them respectfully, and establishes good relationships with them. It also proposes that health services should be provided at local levels so that these people do not need to move away from their families and community and that these people are made an essential part of the health care team whenever or wherever possible. For this, the policy acknowledges the need to collaborate with the non-Indigenous people community, their leaders and elders, speaking bodies, healthcare professionals, and the community-controlled sector. The policy ensures that the mainstream health services are accessible, inclusive, responsive, and respectable towards the culture and health needs of Non-Indigenous Australians (Australian Health Ministers’ Advisory Council, 2017, p.45).
Accessible healthcare services can be defined as the services that are acceptable, appropriate, affordable, and physically available. This access can be hindered by various individual, educational, cultural, and economic factors. The policy, in strategic priority area 2.3, recognizes that proper distribution of health services and workforce helps in improving access, time, quality, and affordability.
To further improve accessibility, the policy advocates that the health sector (1) must identify the ways in which health and related support services can be aligned to provide better care for people with chronic conditions; (2) must work in true partnership to improve accessibility and affordability of health services; (3) work to provide innovative options for service delivery (Australian Health Ministers’ Advisory Council, 2017, p.35). The policy also acknowledges the role that digital technology can play in improving health services access by directly addressing the geographical and economic barriers (Seixas et al., 2021). Digital tools can be helpful in providing individualized services through videoconferencing, telephone, and other health platforms. Nevertheless, without proper technical skills, digital health is not possible. A digitally proficient health workforce is crucial to ensure the effective use of e-technologies to provide access to health services and information to people with diverse levels of health services.
Conclusion
To conclude, public policies are made with the aim to address a problem affecting the public. They help to improve the health outcomes of a nation. Chronic health diseases are a major cause of morbidity and mortality worldwide and in Australia. The National Strategic Framework for Chronic Conditions is a policy framework designed to provide Australians with adequate and proper chronic health services to improve health outcomes. The key players of the policy include various government and non-government bodies, healthcare professionals, clinical experts, academics, researchers, and the community. With the help of these stakeholders, the policy tries to address various health challenges in the health sector including prevention of chronic disease, affordability, accessibility, and cultural and economic barriers to health services. The policy and related health services aim to address various (social determinants such as social inclusion and access to quality and affordable healthcare services) of health to improve health outcomes for the whole of Australia including both indigenous and non-indigenous Australians with chronic health conditions.
References
ABS. (2018, December 12). Chronic conditions, 2017-18 financial year | Australian Bureau of Statistics. Www.abs.gov.au. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/chronic-conditions/latest-release#:~:text=Endnotes-
AIHW. (2019, May 2). Behaviours & risk factors – Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports-data/behaviours-risk-factors
Australian Health Ministers’ Advisory Council. (2017). COAG National Strategic Framework for Chronic Conditions. https://www.health.gov.au/sites/default/files/documents/2019/09/national-strategic-framework-for-chronic-conditions.pdf
Bailey, J. M., Regan, T. W., Bartlem, K. M., Wiggers, J. H., Wye, P. M., & Bowman, J. A. (2019). A survey of the prevalence of modifiable health risk behaviours among carers of people with a mental illness. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-7577-4
Beks, H., Binder, M. J., Kourbelis, C., Ewing, G., Charles, J., Paradies, Y., Clark, R. A., & Versace, V. L. (2019). Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-7463-0
Keleher, H. (2016). Policy for Health. In Understanding health (pp. 286–299). Oxford University Press.
Schmidt, H. (2016). Chronic Disease Prevention and Health Promotion. Public Health Ethics Analysis, 3, 137–176. https://doi.org/10.1007/978-3-319-23847-0_5
Seixas, A. A., Olaye, I. M., Wall, S. P., & Dunn, P. (2021). Optimizing Healthcare Through Digital Health and Wellness Solutions to Meet the Needs of Patients With Chronic Disease During the COVID-19 Era. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.667654
WHO. (2022). Social Determinants of Health. World Health Organisation; WHO. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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