Revisiting the ability of Australian primary healthcare services to respond to health inequity
Toby Freeman A E , Fran Baum A , Angela Lawless A , Sara Javanparast A , Gwyn Jolley A , Ronald Labonté B , Michael Bentley A , John Boffa C and David Sanders DA Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
B Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario K1N 6N5, Canada.
C Central Australian Aboriginal Congress Aboriginal Corporation, PO Box 1604 Alice Springs, NT 0871, Australia.
D School of Public Health, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa.
E Corresponding author. Email: toby.freeman@flinders.edu.au
Australian Journal of Primary Health 22(4) 332-338 https://doi.org/10.1071/PY14180
Submitted: 19 December 2014 Accepted: 21 March 2015 Published: 26 August 2015
Abstract
Equity of access and reducing health inequities are key objectives of comprehensive primary health care. However, the supports required to target equity are fragile and vulnerable to changes in the fiscal and political environment. Six Australian primary healthcare services, five in South Australia and one in the Northern Territory, were followed over 5 years (2009–2013) of considerable change. Fifty-five interviews were conducted with service managers, staff, regional health executives and health department representatives in 2013 to examine how the changes had affected their practice regarding equity of access and responding to health inequity. At the four state government services, seven of 10 previously identified strategies for equity of access and services’ scope to facilitate access to other health services and to act on the social determinants of health inequity were now compromised or reduced in some way as a result of the changing policy environment. There was a mix of positive and negative changes at the non-government organisation. The community-controlled service increased their breadth of strategies used to address health equity. These different trajectories suggest the value of community governance, and highlight the need to monitor equity performance and advocate for the importance of health equity.
Additional keywords: health disparities, health equity, health services accessibility, social determinants of health.
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