The social, economic and commercial determinants of health and wellbeing and the sustainability of health, aged care and human services systems

Good public policy matters. The effect of it is most clearly seen in its absence. The evidence for the impact of the broad social and commercial determinants of health and wellbeing has been available for about 70 years but both small p ( the politics of the interpersonal judgements we all make about human nature, worth, choice and agency ) and big P politics ( political ideologies that drive micro and macro-economic decisions and the choices governments make about investments on our behalf) have meant it has been ignored for large parts of recent history. The current piecemeal, siloed configuration of government will not solve for the emerging, inter-related, socio-economic landscape. Indeed, without change, the current architecture of government and administration will, arguably, exacerbate the challenges of fiscal sustainability. There is persuasive evidence, as well as contemporary and historical experience about what shapes and promotes health and wellbeing. We also know that things can be turned around relatively quickly with both positive human and economic returns.

The ageing of the population is argued to be one of the most powerful threats to the sustainability of health and human service systems and will have substantial impacts on productivity, economic growth and the health of Australia's fiscal outlook. The pace of discovery accelerating due to AI and quantum computing, the availability of new and advanced diagnostics, therapeutics and technologies will likely mean that lifespan will continue to extend intergenerationally. The only exception to this in the recent past has been in those developed countries such as the UK and the US where lifespan for the first time has stalled or gone backwards, in large part, as a result of failures in public policy. Without systemic interventions that aim to extend healthspan not just lifespan, budgets will continue to be stretched not just in the short term but for the foreseeable future and health and human services will likely become even more unsustainable. These dynamics all point to the need for a different policy frame and institutional architecture which is explored in this paper.