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The health of populations and individuals is substantially determined by the conditions in which people are born, grow, work, live and age, known as the social determinants of health (SDH). These factors are key drivers of people’s health and health inequities. Studies in Australia have shown a higher prevalence and death rate of chronic kidney disease (CKD) in socioeconomically disadvantaged populations who experience poorer SDH. We aimed to examine to what extent strategic health plans (also referred to here as 'policies') developed by the Australian Health Departments uptake the evidence of the social determinants of health and take actions to address them.
We searched Federal and state/territory health department websites for current strategic health plans up to March 2023 using the search terms: chronic kidney disease, kidney policies, kidney disease in rural Australia, and renal services. Policies were selected if they applied specifically or non-specifically to CKD. The search was extended to other government agencies for strategic health plans. We examined the extent to which policies capture the evidence for SDH in its written content, with a framework that described whether policies only acknowledged the relevance of the SDH or also describe specific actions to address SDH. We also examine the intended consequences of the policies with a framework that examined whether they aimed to address structural (e.g. income or cultural factors) or intermediary (e.g. healthcare access or behavioural factors) SDH.
We identified 40 strategic health plans relevant to patients with CKD, of which 13 were Federal and 27 were state or territory-based government policies. In the written content, we found that 38 policies provided acknowledgment of the impact of the social determinants, and within them, 32 proposed actions to address them. When we examined the intended consequences of all the strategic health plans, we found that the majority aimed to tackle intermediary determinants (Figure 1): 39 (99%) provided actions to improve health access, 32 (84%) behavioural lifestyle conditions, 13 (32%) psychological issues, and 9 (22%) addressed material and financial factors. We also found that only half of these strategic health plans proposed actions on structural determinants of CKD (Figure 2): the majority (99%) included cultural factors, almost a half (50%) addressed ethnicity, around one-third (33%) included employment, one-quarter (25%) tackle education, and only one incorporated income.
Almost all policies acknowledge the importance of the social determinants of CKD. The policies mainly seek to tackle the intermediary determinants with an emphasis on improving access to services and lifestyle factors but have a more limited approach to addressing the structural determinants. This might be explained by the challenges of implementing intersectoral policies required to tackle structural determinants such as income, employment and education. Thus, policies that attend to both the structural and intermediary determinants and take an intersectoral approach are required to respond to the inequities and burden experienced by people with CKD in Australia. A similar abstract was submitted at the 58th Australian and New Zealand Society of Nephrology (ANZSN) Annual Scientific Meeting 2023.