A study by the National Centre for Social and Economic Modelling (NATSEM) at the University of Canberra, commissioned by Catholic Healthcare, found that action to address the Social Determinants of Disadvantage that drive poor health outcomes would lead to:

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• 500,000 Australians avoiding suffering a chronic illness;

• 170,000 extra Australians entering the workforce, generating $8 billion in extra earnings;

• Annual savings of $4 billion in welfare support payments;

• 60,000 fewer people needing admission to hospital annually, resulting in savings of $2.3 billion in hospital expenditure;

• 5.5 million fewer Medicare services would be needed each year, resulting in annual savings of $273 million;

• 5.3 million fewer Pharmaceutical Benefit Scheme scripts would be filled each year, resulting in annual savings of $184.5 million each year.

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A PWC Australian study found that an investment of an average of $9 million per annum over 14 years in diabetes prevention in Western Sydney could produce a financial benefit of $578m on top of the improvement to individual health.

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The King’s Fund in the UK found that reducing falls in the home would save around £435m (AUD$746m) annually in hospitalisation costs.

 

On the other side of the equation, a PWC report on the social determinants of disadvantage that contribute to poor health outcomes found the estimated direct cost of medical care attributable to people being overweight and obese has increased 61 percent from 2000 to 2008, and is expected to be 68 percent by 2025.

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Similarly, investment in strategies to address the social determinants of disadvantage that contribute to crime have also been analysed.  "Perry Preschool is a two year pre-school enrichment program for children in poverty, it involves weekly home visits by a teacher. Its most recent evaluation estimated the costs and benefits of the life outcomes of participants at age 27. Measuring a range of benefits stemming from both a reduction in crime and a general improvement in life opportunities, the program was found to be cost-beneficial. The benefit-cost ratio was estimated to be 7.16. Thus, for every dollar spent on the program, society and/or program participants gained roughly $7 worth of benefits. An economic evaluation of the benefits of the Perry Program in terms of criminal justice and victim costs avoided revealed a benefit-cost ratio of 2.16. Thus, for every tax dollar spent on the program, it is estimated that society and potential victims of crime will save approximately $2 in future avoided costs"

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There is substantial and consistent evidence that tells us that addressing the social determinants of disadvantage return significantly more to the public purse in the long run.

 

Yet there remains barriers to effective action, despite the rising costs of hospitalisation, incarceration and etc for the community.

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As noted by PwC:

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"For all the investments already made in healthcare, countries have not been able to bring about the necessary societal shifts to encourage habits that could prevent chronic conditions from developing. Between 1990 and 2010 in the OECD, for example, smoking rates dropped 31%. But alcohol use fell only 8%, and the rate of daily vegetable consumption increased by just 2%.Consumers shoulder some blame, as 43% of respondents to PwC’s 2019 HRI global social determinants of health consumer survey said they bore the greatest responsibility for addressing the behavioural, social and economic factors contributing to their health. But that doesn’t mean they are doing anything about it, or that they even know what to do".

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Further, PwC argues:

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"The social determinants ... often-ignored social factors such

as employment; housing; income inequality; and level of access to clean water, education and transportation — undermine progress and can swamp the .. systems that ignore them. Because even the most advanced .. interventions are rendered ineffective when people struggle with social isolation, income inequality, poor nutrition and pollution. As social factors counteract .. best practices, .. systems often remain focussed on creating solutions at the wrong interaction point: after people are already sick and in crisis".

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The question is not whether we should address these determinants, or in many case how we should address them.  The primary barrier to addressing the social determinants of disadvantage is the appropriate mechanisms that empower and resource communities, while also ensuring governments are able to meet their accountability and fiscal obligations.

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