February 5, 2016

The public value of personal health and wellbeing

Exercise more! Eat well! Be happy! There are a million and one articles on the internet that push people to improve their individual health and wellbeing and we now recognise that achieving a state of health and wellbeing is about so much more than merely the absence of disease or injury. The World Health Organisation (WHO) suggests health is a continuum incorporating a complex combination of physical, mental and social factors.

Not only is a state of wellbeing individually beneficial but healthy and happy people have significant flow on benefits for society as a whole. But what goes into achieving good health and wellbeing across a community? In this article, we’ll look at why it’s important for a community to be happy and healthy, the systems that currently exist to support wellbeing, and what we should be doing to maintain and improve these.

To good (physical) health …

Winston Churchill described healthy citizens as “the greatest asset any country can have.” This assertion is supported by economic analysis, with research showing that countries with weak health and education conditions struggle to achieve sustained growth. In fact, where a 10% improvement of life expectancy can be made an associated 0.3 – 0.4% bump in annual economic growth can be expected. There are many drivers behind this correlation but healthy populations tend to mean greater numbers of people in a position to participate in the workforce (employment opportunities permitting).

t is interesting to note Chinese investment paying heed to this research on the link between health and productivity. Spending on healthcare delivery in China has increased steadily in recent years and, additionally, investment in biomedical research has increased by between 20 and 25% per year. If this trajectory continues, China will quickly overtake the United State in health spending both in absolute terms and as a proportion of GDP.

Not only is the health of a community important for a productive economy but it underpins inclusivity and connectedness in communities. Without good health, people can lose access and connection to each other and may lack the ability to provide mutual support.

… and (mental) health

In recent decades, mental health has slowly become recognised as having just as significant an impact on a nation’s economic development, prosperity and productivity, as physical health. Having mental health challenges can significantly affect a person’s capacity to care for themselves and to continue in employment or education.

The causes of mental ill health are complex, with a variety of social, psychological and biological factors influence the mental health of an individual.

From a systemic, societal point of view it is particularly important to note that socio-economic factors such as poverty and low levels of education are linked to mental health risk (as with physical health). Other risk factors include alcohol and other drug use, homelessness, rapid social change, stressful working environments, discrimination, social exclusion, poor physical health, and risk of violence.

How is health and wellbeing supported in Australia?

We have all sorts of systems to support health and wellbeing systems in Australia. Direct spending on health is the one of government’s highest areas of expenditure, second only to social security and welfare. However, total health expenditure in Australia (combining both government and private health spends) represents about 9.5% of GDP compared with, for example, 17.7% in the United States.

Australia introduced its universal health insurance scheme, Medicare, in 1984. Typically, Medicare covers 100% of public in-hospital costs, 85% of specialist and 75% of general practitioner costs as well as free or subsidised treatment for some optometry, dental and psychology services. In some circumstances, such as when a patient has a chronic condition, Medicare rebates are available for treatment by other allied health professionals, such as physiotherapists, dieticians and speech pathologists. While Medicare coexists with a robust private health system, we need look no further than recent widespread opposition to the recently proposed GP co-payment to witness the Australian public’s enduring allegiance to Medicare and universal health as an important social ideal.

Systems to support health and wellbeing occur across a spectrum from preventative to reactive. Preventative systems are often grass roots, and surprising in their breadth when we think creatively and broadly. Alongside many more ‘traditional’ prevention initiatives such as SunSmart and the National Tobacco Strategy (generally focused on eliminating the ‘bad’), Australia has a great many promotional preventative initiatives such as Men’s Sheds, Our Watch, Healthy Spaces and Places, and Stephanie Alexander’s Kitchen Garden Foundation some of which might not even normally be recognised as a ‘health’ initiative.

Where to from here for Australia?

Australia does very well on many health indicators compared to other nations worldwide. However, as with many countries in the developed world, we must prepare for the heavy strain likely to be placed on healthcare networks by an ageing population, growing economic uncertainty and fiscal constraint. Additionally, it is vital that we continue to target our preventative efforts, for instance by looking at the leading causes of death in our country. According to WHO 2014 data the leading cause of death in Australia was coronary heart disease, with stroke the second leading cause and Alzheimers third. Cancers of the lung, prostrate, breast and colon-rectum occupied fourth to sixth as well as seventh. Suicide was the tenth most common cause of death.

The dollar value of prevention is high and increasingly recognised – even small improvements can have a significant impact. For example, Our Watch has highlighted that a 5% reduction in the prevalence of intimate partner violence in Australia (currently 27% of women across their lifetime as compared to 22% in Denmark) would prevent 6,000 new cases of violence related injury, illness and disability, as well as saving $38 million in health sector costs and $333 million in productivity costs over time.

Conceptualising health and wellbeing as fundamental goals for society

It is perhaps also worth thinking about how we emphasise health and wellbeing as fundamental goals for society. The Himalayan country of Bhutan, for example, has operated a ‘gross national happiness’ index for almost four decades. Similar initiatives have also been undertaken in British Columbia and Seattle.

To compile this index Bhutan surveys its citizens across nine key aspects of wellbeing:

  • Psychological well-being
  • Physical health
  • Time or work-life balance
  • Social vitality and connection
  • Education
  • Arts and culture
  • Environment and nature
  • Good government
  • Material well-being

Health and wellbeing are an incredibly important part of public value, and it is an extraordinarily complex space. Do you think we need to do more in Australia to place these goals at the centre of our public value dialogue? Please share your thoughts in the comments below, or reach out to anyone of us at Cube to continue the discussion!

This blog is the sixth of a series exploring the Public Value Compass. Make sure to follow us on LinkedIn for updates and articles on the other segments of the Compass.

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