Voices of Australia podcast – Episode 10 article
In Episode 10 of Voices of Australia, SFRI CEO Anthea Hancocks unpacks the interdependency of health and social cohesion with two highly respected public health physicians. Healthcare leader and infectious disease expert, The University of Melbourne’s Associate Professor Kudzai Kanhutu together with Professor Benjamin Cowie – Professorial Fellow, The University of Melbourne and Infectious Diseases Physician at Doherty Institute discuss the critical nature of access to primary healthcare and learnings gained from the healthcare response during Covid-19 through the lens of social cohesion. With an insightful discussion, A/Prof Kanhutu and Professor Cowie analyse aspects of the current healthcare system and where there is room for improvement as it relates to building a cohesive community.
Key takeaways:
- How are health and social cohesion related?
Kudzai said health and cohesion are bound together. People can’t be well in a community that isn’t well itself. If people are healthy they can extend the hand of care to others and create connections which builds cohesion. Ben agreed and built upon this by saying health is a state of ‘complete’ where the physical, mental and social aspects of life are well. It’s not just about the absence of disease. Social wellbeing is part of what health is and not just a determinant – it makes a fundamental contribution to someone’s health.
- The use of space and layers of social cohesion
Anthea raised social cohesion at the neighbourhood level and Kudzai said that in her view, understanding social cohesion was about space and how people relate to space. Kudzai pointed out that you might live in close proximity to someone but unless you’re at the same life stage and using the same spaces in the same way, you might not have a connection. She maintained that social cohesion has layers and that space and how people relate to it are drivers of social cohesion.
Ben added to this by saying we need to look at liveable communities that build social cohesion. That includes access to schools, healthy foods, recreation facilities. Seeing people regularly at the local market for example builds connections.
- The role of mapping in a community
Ben and Anthea discussed the valuable process of mapping access to GPs as part of the pandemic response. The identification of ‘GP desserts’ was fundamental to building the local health response.
Anthea queried whether it would be equally useful to map other facilities such as swimming pools and fresh food markets to see what communities can easily access in their day to day lives. Kudzai said it would be interesting to see how far people are travelling for essentials. Many people just get on with life with few signs of what’s being undertaken to maintain a well household. Kudzai said mapping would enable a deeper understanding of how people ‘make do’ which would likely assist with early detection of dysfunction.
- Healthcare services: access, awareness and experience
Anthea raised the notion of ‘access’ and ‘awareness’ in relation to healthcare. Access referring to availability of options and those perceived as options based on cultural background. Awareness referring to knowledge of services but also being cognisant of when medical attention is needed. Kudzai said it’s really important that we make a distinction between awareness and experience when it comes to the services. It is one thing to be aware of the service availability and another to choose not to use it because of a damaging prior experience that wasn’t culturally appropriate. Kudzai said many services are not fit for purpose so we need to more closely observe and monitor to make sure they’re not doing more harm than good.
Ben queried Kudzai’s experience with the cultural concierge’s employed during the pandemic. Kudzai was of the opinion the service was underinvested and rolled out too quickly leaving gaps. Many of the concierges became the ‘go to’ people in their communities effectively providing an on-call service they weren’t supported to fulfil. In some cases the role became a burden.
- Building on the learnings in a post pandemic world
Ben noted that in Victoria there is a positive and continuing investment in the public health response at the local level in some areas. This stems from the creation of nine public health units charged with the response to communicable diseases and broader health promotion activities. The units were initiated during the pandemic and are continuing to deliver in different aspects of health such as mosquito borne diseases, flood responses as it relates to health and day to day work with community.
Ben also noted that the strong and respectful partnerships with local councils, schools, community champions and faith leaders have not continued in the same way post pandemic. He raised some concerns that the genuine two-way discussions around health care delivery haven’t persisted and some of those key partnerships and important lessons have been lost.
Kudzai said spaces for regular meetings and listening to key stakeholders are essential. She said in the same way the corporate community manages their stakeholders, an active directory is needed to maintain a level of contact and connection with community to ask how things are going and discuss available grants and support.
- Tackling mental health at the local level
Anthea raised mental health as being a fundamental aspect of health but noted the challenges associated with not enough people being trained or having relevant lived experienced.
Kudzai said there are some groups setting up services to enable people to gather and chat when they would otherwise have nowhere else to go. She also maintained that the right patient to clinician fit is more important than an individual having lived experience. Kudzai was of the view that it’s good to have people with lived experienced but that most clinicians can learn to empathise and connect with individuals. POLA Psychology was referred to as a key service provider who was developing guidelines for clinicians to be more culturally aware in a mental health setting.
Ben said a significant risk factor for physical and mental ill health is loneliness and this should be an area of focus. He also noted that most mental health presentations occur in the primary health care setting so if that service is missing then it’s likely mental health doesn’t get addressed.
- Individuals can take positive steps towards community cohesion
Kudzai said people can initiate positive change in their own areas by mapping and understanding exactly what spaces and services exist in the community. This might involve meeting with council to see what’s on offer or listening to community to find out what’s needed. People can find ways to help and initiate change by asking questions and gaining greater insight into their community.
Ben agreed and noted that volunteering is at its lowest ebb likely as a result of life stressors associated with cost-of-living challenges. He also pointed out that engaging in a positive and constructive way with other people can make a difference to the harmony and cohesion of a community. Being open and disagreeing with people in a kind and respectful way can help reduce some of the polarisation and conflict currently being experienced.
To hear more from A/Prof Kanhutu and Professor Cowie about the interplay between health and social cohesion, watch here or listen here.