Are we governing for health and wellbeing or are we governing for profit? The answer to that questions over the next few years could determine whether life expectancy, which has steadily gained in Australia for decades, begins to fall, says Professor Fran Baum, Director of Southgate Institute for Health, Society and Equity at Flinders University.

“Health inequities, particularly over the last 25 years, are increasing in Australia and I predict that, for some groups at least, we're likely to have declining life expectancy in the next five years,” she says. ”It's already happened in the US and UK for lower socioeconomic people and I think we won't be far behind.”

While governments and oppositions may haggle over healthcare budgets, that is to miss the point, says Professor Baum.

“Health care is just picking up the bodies at the bottom of the cliff,” she says. “What we're trying to do is take people away from the cliff and give them a good life so they don't ever go near the edge.”

Professor Baum has been studying the social, political and economic determinants of health since the 1980s with international acclaim. This year, Southgate Institute was designated as the World Health Organization Collaborating Centre on Social, Political and Commercial Determinants of Health Equity.

“There's a number of studies that show that standards of health care are not the main contributors to life expectancy. It's what happens in the rest of our lives – how we're employed, the kind of housing we have, our access to education. These are much more powerful determinants of life expectancy than care.”

Estimates suggest the healthcare system contributes about 20% to a person’s life expectancy, genetics a similar amount, but around 60% comes from broader social determinants.

Professor Baum hopes that the COVID-19 pandemic may open people’s eyes to the choices our policymakers make between short-term profit on the one hand and the best wellbeing and health options for the populations.

“I think we're seeing as a result of this pandemic that what's good for health in the long term is also good for the economy,” she says. “Some issues, like opening a coal mine, might benefit us in the very short term.

"But in the long term, there's going to be a lot of health disbenefits of that coal mine.”

“When we did a study of Mitsubishi closing in Adelaide, people would say things like, ‘it was my family’. They clearly got a lot more out of their workplace than just the pay: a lot of companionship, friendship, a sense of belonging somewhere.

“Gig economy jobs don't give you that.”

While the prospect of changing the mindset of governments at a macro level may be a daunting long-term project, there are changes that can be made at a more local level. Professor Baum is currently studying the role urban planning can play with public health.

It is an area where she has a long history, having worked with the World Health Organization (WHO) since about 1990, as variously an advisor or consultant. On a project called Healthy Cities, Professor Baum encouraged local governments and mayors to adopt the type of health approach that WHO has been developing around the world, with Southgate as a collaborating centre.

“If we look at outer suburbs in Adelaide, they really don't support good health outcomes. They don't have local shops with fresh food, they’re hard suburbs to work around, families often have to have two cars to make that area work because there isn't good public transport.

“So we've been funded this year by Wellbeing SA and Flinders to develop an instrument called the Healthy Urban Neighbourhoods Transition Tool.” 

This will allow an evidence-based assessment of a suburb providing a framework to suggest ways in which it could become healthier.

“That might be by widening the footpath so that's easy for people to walk, or seeing if there can be ability to, say, open a café, or a place for people to go and meet.”

That makes policy imperatives more palatable to politicians.

“If we wanted an infrastructure project, it could be upgrading those suburbs and maybe subsidising some small business that employs local people to make a place more liveable. It wouldn't take that much. You want to encourage what's known as ‘active transport’, where people either walk, cycle, or walk to public transport. You need to have footpaths where you can use wheelchairs or push chairs to make it easier to walk places, or planting trees of course – just these little things would really upgrade service.”

For those who say there is not enough political will to make these changes happen, Professor Baum points to the renewable energy transformation of South Australia. She is about to publish a paper of a study into how government managed to push ahead with renewables in a hostile atmosphere.