SA: The Heaps Unfair State: Why have Health Inequities Increased in South Australia and How Can This Trend be Reversed?

FOREWORD
In 2008, I delivered the final report of the World Health Organization’s Commission on the Social Determinants of Health which I had chaired. In our report, the Commission called for global action on the social determinants of health to achieve health equity. The key insight we presented was that the conditions of daily life, in which people are born, grow, live, work and age, and the inequities of power, money and resources, are responsible for health inequities around the world. Therefore, action to improve health equity has to involve all sectors of government and society. Our view was always that where health inequalities can be avoided by reasonable means, they should be. Addressing health inequities is a matter of social justice.... Professor Sir Michael Marmot

SA: The Heaps Unfair State has been produced by the Southgate Institute for Health, Society and Equity and the South Australian Council of Social Service. It provides the evidence for a concerning growth in inequities in the state of South Australia since the 1980s. It details an explanation for why this has happened and what can be done to change it. I was alarmed when I read this report, which tells a sorry tale of how easily a region that has done comparatively well in reducing inequities in the past can slide backwards as a result of a confluence of factors that affect the health and wellbeing of the community, particularly those in the most disadvantaged situations.

We know what works to make a difference and ensure that we can achieve a fairer distribution of health. This is not new. Where external factors such as global, political and economic trends place greater stresses on a local community, our policy responses need to shore up protections for the whole community, in particular the most disadvantaged. The story told in SA: The Heaps Unfair State shows very clearly the consequences of these protections being undermined.

While we can’t necessarily control global impacts, we can respond with policies and actions that will make a difference. When the Commission on the Social Determinants of Health released our final report, we argued that it is possible to close the health gap in a generation, and we made recommendations for how this could be achieved through working together to address the social determinants of health. SA: The Heaps Unfair State shows that we cannot be complacent. While it is
possible to close the health gap, it can also widen. It is important to understand why and how this can happen, and to sustain policy and actions on the social determinants of health to continue to seek a fairer distribution of health in our society.