Strategies to address health inequity: government responses, community-led responses, individual action; the role of the Ottawa Charter; empowerment of groups experiencing inequity

The previous dot points covered who experiences inequity and why. This dot point covers what works in addressing inequity, organised across government, community, and individual levels.

The framework: who is responsible for what

Closing health inequity gaps requires coordinated action across levels.

• Governments set the structural conditions (laws, funding, policy frameworks).
• Communities lead the design and delivery of services that work for them.
• Individuals make health choices within the conditions that shape them.

The mistake to avoid is overweighting any single level. Asking individuals to take responsibility for inequities that are structurally produced is unfair and ineffective. Asking government to fix everything ignores community capacity. Asking communities to fix everything ignores the structural environment.

Government responses

Universal programs

• Medicare. Universal access to subsidised primary care. Direct equity impact through bulk-billing and means-tested rebates.
• Pharmaceutical Benefits Scheme. Subsidised medications. Caps maximum patient cost.
• Public hospitals. Free emergency and inpatient care for Medicare-eligible patients.
• Education and welfare. Universal access to schools, Centrelink supports, public housing.

Targeted programs

• Aboriginal and Torres Strait Islander Health Programme. Specific funding for Indigenous health, much delivered through ACCHOs.
• Closing the Gap framework. Inter-governmental targets across health, education, justice, housing.
• Rural Health Workforce Strategy. Federally funded rural placements and bonded medical positions.
• Specialist mental health programs. Headspace, Better Access, Lifeline funding.
• Refugee Health Network programs in some states.
• National Disability Insurance Scheme. Individualised funding for people with disability.

Legal and structural reform

• Anti-discrimination law. Federal and state laws prohibiting discrimination on the basis of race, sex, sexual orientation, gender identity, disability, age, religion.
• Fair Work and workplace protections. Conditions, minimum wage, leave entitlements.
• Tobacco control legislation. Plain packaging, advertising bans, excise. The strongest evidence-based public health legislation in Australian history.
• Mandatory food labelling, salt reduction agreements, alcohol regulation.

Health promotion infrastructure

• National Preventive Health Strategy 2021-2030.
• State-level health promotion agencies (NSW Health, VicHealth, Health Promotion Queensland, etc.).
• Mass media campaigns on smoking, road safety, alcohol, mental health, immunisation.

Community-led responses

Community-led work is consistently more effective than mainstream-delivered alternatives for groups experiencing inequity. The pattern is well-documented:

Aboriginal Community Controlled Health Organisations (ACCHOs)

The strongest Australian example. Community-owned primary care designed by and for Aboriginal and Torres Strait Islander communities. Around 145 ACCHOs nationally. Consistently outperform mainstream services on engagement, outcomes, and cost per outcome.

Refugee and CALD community organisations

Australian Refugee Health Practice Network, multicultural community health centres, language-specific support services. Reach communities mainstream services struggle to engage.

LGBTIQ+ community organisations

ACON (NSW), Thorne Harbour Health (Victoria), Q+ Group (Queensland), Living Proud (WA). Community-controlled health services with strong outcomes in HIV prevention, mental health support, and primary care for LGBTIQ+ Australians.

Disability-led organisations

Self-advocacy groups and community-controlled disability services. NDIS reforms have shifted resources but the community-led model continues.

Rural community-led health

Rural communities have organised their own services where mainstream services are absent - community pharmacies, women's centres, men's sheds, suicide prevention coalitions.

Why community-led works

Several reasons consistently emerge from evaluation:

• Trust. Communities trust their own institutions more than government agencies.
• Cultural safety. Services delivered by community members are inherently culturally safe.
• Local knowledge. Communities know their own challenges better than external service designers.
• Workforce. Community organisations recruit from their own community, addressing workforce shortages.
• Accountability. Community boards mean community members hold service standards.

Individual action

Individual action is the third leg of the response. The framing matters: individuals act within the conditions government and community set, not in isolation.

Health literacy and self-care

• Understanding one's own health risks.
• Following health professional advice.
• Self-care behaviours (sleep, nutrition, physical activity).
• Help-seeking when needed.

Advocacy

• Speaking up about own and community health needs.
• Engaging with policy processes, public consultations, community boards.
• Voting in ways that reflect health values.

Peer support

• Supporting friends and family in their health journey.
• Participating in community organisations.
• Reducing stigma in conversation and behaviour.

Limits of individual action

The strongest critique of individual-action framing is that it can blame the victim. A young Aboriginal woman in a remote town with no GP cannot reasonably be held individually responsible for skipping her annual health check. Individual action is the right framing for changes that are within the person's control; it is the wrong framing for inequities that require structural response.

The Ottawa Charter as the integrating framework

The Ottawa Charter (introduced in Core 1) is the WHO's framework for organising responses across levels. Its five action areas map onto the equity work:

• Developing personal skills. Individual health literacy, school education, community workshops.
• Creating supportive environments. Built environment, social environment, workplace conditions.
• Strengthening community action. ACCHOs, refugee services, LGBTIQ+ organisations, rural coalitions.
• Reorienting health services. Bulk-billing reforms, targeted Medicare items, rural workforce strategy.
• Building healthy public policy. Tobacco control, food labelling, gender equality legislation, disability rights.

The Ottawa Charter framing is particularly useful in equity-focused extended responses because it explicitly links structural action to community and individual action. Strong responses use the Charter as scaffolding rather than treating it as one bullet point.

Empowerment

Empowerment of groups experiencing inequity is the consistent theme across the strategies that actually work.

What empowerment looks like in practice:

• Self-determination. Communities decide their own priorities and design their own services.
• Funding to community organisations rather than mainstream-delivered programs.
• Workforce representation. Health professionals from the communities being served.
• Voice in policy. Affected communities have seats at policy tables (Voice to Parliament referendum 2023 attempted this for Indigenous Australians; despite the referendum failing, Indigenous Health Equity Council and similar bodies continue to operate).
• Co-design. Services designed with affected communities rather than for them.

Empowerment is not just polite consultation. It is structural shift of decision-making power from government and mainstream organisations to the communities the work serves.

How this dot point pulls the option together

A typical HSC extended response on equity strategies is "Evaluate the role of governments, communities and individuals in addressing health inequities in Australia". Strong responses:

1. Treat the three levels as complementary rather than alternatives.
2. Cite specific examples at each level (named programs, named organisations, named individual behaviours).
3. Use the Ottawa Charter as the integrating framework.
4. Recognise empowerment as the consistent ingredient.
5. Make an explicit judgment with reasoning - what is working, what is not, what should happen next.

The most-marked-down responses overweight individual action or treat the three levels as fighting each other. The well-marked responses recognise the layered architecture and the empowerment principle that runs through it.