“Equity is at the cornerstone of a healthy community. Nationally and internationally, the wealthier a person is, the healthier they are”, writes columnist MICHAEL MOORE.

We all know someone who lives a healthy lifestyle – exercises regularly, eats well, maintains a healthy weight, drinks in moderation, is appropriately vaccinated and regularly visits his or her doctor. At times we strive to be like this.

It is appropriate for individual adults to take responsibility for their own health. However, the framework in which that responsibility is exercised fits into a range of “determinants of health”. These determinants are the factors that influence everyone’s health and wellbeing.

The reason for examining determinants of health is to be able to influence governments to make better decisions to improve the health of the populations. Such determinants of health include social, economic, commercial and educational.

Equity is at the cornerstone of a healthy community. Nationally and internationally, the wealthier a person is, the healthier they are.

On a statistical basis, as an example of economic determinants, the life expectancy for people living in an upper middle-class suburb in a city can be very different from that of

a person living in a lower-class suburb.

The school that is attended reflects a similar story. Educational attainment is statistically aligned to health. Prof Neil Davies, in the British Medical Journal wrote: “Education is a key component of social inequality and, in higher-income countries, higher attainment is strongly linked to lower mortality risk”. 

The public education system in Australia has played a key role as a determinant of health.

However, in Canberra, the public education system seems to be falling further behind the private education system. As enrolments increase in the private-education system, they are decreasing in the public system.

The social determinants of health may also include upbringing as an Aboriginal or Torres Strait Islander person, or someone from a refugee or migrant background.

These are statistically based social determinants. There are, of course, individuals who rise above the challenges and grow beyond those statistical limits, and who often serve as role models. 

However, it takes a special personality to grow beyond their upbringing and the “range of determinants” that have driven their growth. Rather than concentrating on the few who do grow beyond these limitations, such issues ought to be addressed for the greater good through structural reform – particularly by governments. 

Another aspect of economics are the commercial determinants of health. Consider the food that is available near to where a person lives. The price of fruit and vegetables compared to junk food offerings and fizzy soft drinks in outer suburbs of big cities and in remote settings. 

Individuals are not only called on to make difficult decisions for their families, but healthy choices are also much more complicated for some through a range of decisions by manufacturers and advertisers.

The impact of gambling on health is well documented. However, Australian governments seem largely hogtied when it comes to the simple structural reform of banning advertising. This worked well with regard to tobacco and could also apply to gambling.

The World Federation of Public Health Associations has distilled these issues in the Global Charter for the Public’s Health. The charter identifies the core services for structural reform that will improve community health and expectation of longer lives.

Protection – safeguarding health through a One-Health approach includes regulating health practices, reducing hazards, preparing for emergencies, and securing essential health conditions. 

Prevention – preventing diseases and injuries through accessible health services, vaccination, emergency preparedness and early intervention in emerging public health issues. 

Promotion – promoting well-being by addressing health determinants and encouraging community involvement in health-related decisions

For governments, The Charter also emphasises how to achieve these three core services. They are:

Good Governance – establishing effective public health systems through policy development, multi-sectoral collaboration, and ethical frameworks. 

Effective Advocacy – leading public health initiatives through community engagement, informed policy-making and communication strategies that build trust and promote healthy behaviours. 

Capability Building – developing a skilled and diverse public health workforce, ensuring adequate resources, and creating sustainable career pathways. 

Accurate Information – Delivering evidence-based public health data and research, utilising emerging technologies and maintaining robust data management systems.

Concentrating on improving individual health has an important place. However, as Johns Hopkins School of Public Health frames population health, it is about “saving lives – a million at time”.

Governments can play a key role in establishing a healthy environment and healthy determinants. However, the responsibility of the individual remains the single most pertinent determinant of health.

Michael Moore is a former member of the ACT Legislative Assembly and an independent minister for health and is a past president of the World Federation of Public Health Associations. He has been a political columnist with “CityNews” since 2006.