As announced by the Minister for Health, the Hon Greg Hunt MP in June 2019, the Australian Government is developing a 10-year National Preventive Health Strategy and has been seeking consultations from stakeholders.
At Birth for Humankind, we think it is imperative that a preventative approach considers that giving newborns and children the best start in life begins during preconception and pregnancy. To ensure equity for all Australians, an increased focus on communities who are experiencing the greatest inequity and social disadvantage is required. We are also committed to a collaborative, multi-disciplinary approach across sectors.
Our full response to the submission questions is below.
Birth for Humankind’s Submission to the National Preventative Health Strategy Consultation
Submitted: 22 September 2020
Questions are taken from the National Preventative Health Strategy Consultation Paper, For full details of the consultation visit the Department of Health website.
Are the vision and aims appropriate for the next 10 years? Why or why not?
Birth for Humankind believes the proposed vision of the National Preventative Health Strategy is an admirable and ambitious 10-year goal. To ensure that the strategy can meet its goal to improve the health of all Australians we suggest the following additions and adjustments.
Vision:
The strategy rightly aims for improved “health of all Australians”, it is recommended that the vision explicitly call out the need to focus on populations that are systemically marginalised and disadvantaged and who are known to experience poorer health and wellbeing outcomes.
There is clear evidence that investment in health equity for the most vulnerable populations, improves health and wellbeing for all. As noted in the aims “the burden of ill health is not shared equally”. Recognising and highlighting current inequity within the vision of the National Preventative Health Strategy must set a precedent that focus and investment in addressing inequity and achieving improved health and wellbeing for all requires higher levels of investment and engagement with the most disadvantaged and marginalised groups.
Aims:
Australians have the best start in life
Achievement of this aim requires an understanding that a healthy start to life does not begin at birth, but includes support for women during preconception and pregnancy, as the critical foundation for physical and mental health and wellbeing for children and for families. International evidence shows that when a pregnant woman feels safe, supported and prepared for pregnancy, labour, birth and early parenting and receives appropriate childbirth education and continuity of support, it significantly improves maternal and child health outcomes. This is even more critical where a pregnant woman is experiencing socio-economic disadvantage. When women receive social and emotional support from a known, trusted care giver there is:
- reduced likelihood of medical intervention at birth
- reduced likelihood of the child spending time in neonatal intensive care
- improved mother-child bonding, and ongoing impacts for psychosocial connections, breast feeding rates etc
A safe, supported home and community environment for newborns and children has a lasting preventative impact on health and wellbeing of future generations and therefore it is critically important that providing appropriate, integrated support for new families – especially those experiencing social or financial disadvantage who are at risk of poorer health outcomes – is closely integrated with any interventions to support children’s healthy development.
Investment in prevention is increased
Whilst further investment in prevention over the treatment of illness and disease is very much welcomed, this must be coupled with a thorough integration of existing programs and interventions in the health and social support sector with the mainstream preventative health strategy. A multidisciplinary, joined-up approach will more efficiently achieve goals and address foundational community issues.
Are these the right goals to achieve the vision and aims of the Strategy?
Birth for Humankind recommends that as well as focusing on interventions to prevent illness and disease, there needs to be more recognition of the foundational conditions, societal and environmental enablers and barriers that promote or prevent achievement of mental and physical health and wellbeing for all Australians and how these affect different communities.
Whilst some goals allude to this (i.e. Goal 3), this framing and approach should be considered across all aspects of the strategy. Ultimately, the vision cannot be achieved by preventing illness and disease alone.
We suggest that the following additions be incorporated to successfully deliver on the vision and aims of the strategy:
Different sectors, including across governments at all levels, will work together to address complex prevention challenges
Whilst cross-sector collaboration is critical, the strategy has limited concrete actions or planning to show how sectors outside of the traditional health sectors that are commonly engaged in health prevention initiatives will be included.
This is particularly important when considering social support and community development sectors. Close and meaningful engagement with these stakeholders, especially grassroots and community-led organisations and initiatives that have a practical understanding of community challenges can support and mobilise communities to achieve health goals through locally generated solutions.
Prevention will be embedded in the health system
This is an admirable goal to “support prevention in our primary, community and acute care settings”. However, there is need for more explicit recognition of a cross-sectoral approach to prevention to reduce the risk of siloing preventative interventions.
For example, investing in continuity of maternity care models, group midwifery practice or doula support models are proven preventative interventions to reduce the risk of medical interventions and complications at birth (which may be considered by the maternal health sector). They are also proven to reduce the likelihood of perinatal depression and anxiety (which may be managed by psychology and counselling sector). Ensuring that women and their children’s basic needs such as housing, access to medical care and food security are also key aspects that impact on perinatal mental health. Therefore, improving perinatal mental health, requires a preventative solution beyond the scope of the psychological and counselling sector, but out of the view/remit of the maternity sector that is focusing on the pregnancy and birth. Therefore, integrated preventative health planning is required.
Where should efforts be prioritised for the focus areas?
Birth for Humankind recommends that priority should be given to understanding where there are commonalities for non-adherence to current health promotion advice related to all the six focus areas. In doing so this will determine any cross-sectional challenges that can be addressed holistically, to improve the efficiency of delivering the strategy and encouraging integrated approaches to addressing common challenges.