You would never guess it from reading newspapers in Australia, but many governments around the world are broadening their horizons beyond hospitals when it comes to improving people’s health.

Their focus is no longer simply on the equitable provision of health services, but also the equitable promotion of health. They are looking at the broad social and economic forces that influence a population’s health and what governments can do to ensure good health is distributed as fairly as possible across the population.

In other words, they are trying to tackle the forces which mean that people at the top of the social pile tend to have better health than those in the middle of the pile who tend to have better health than those at the bottom of the pile.

Consider this recent statement from Norway’s equivalent of our Federal Health Department:

Although individuals are partly responsible for their own health, the health of the population is, not least, the result of development trends and political choices beyond their control. Some of the causes of social inequalities in health are therefore to be found in social conditions. Political decisions that create and maintain social differences may thus contribute towards creating and maintaining social inequalities in health.

The quote is taken directly from the Norwegian Directorate for Health and Social Affairs’ Plan of Action to Reduce Social Inequalities in Health.

The document discusses in some detail the state of inequalities in Norway (of which we could only be envious) and gives a detailed analysis of their causes from a political, economic, educational, behavioural and biological perspective. Effective ways of reducing inequalities are identified and include “measures that promote social equalisation, such as changes in housing policy and tax policy”.

Similarly, the Canadian government has established a reference group to address the social determinants of health there.

But the issue barely rates a mention in Australia, not even in the hothouse pre-election climate. The Australian Government has rejected even dialogue with Professor Fran Baum from Flinders University, Adelaide, who is one of the World Health Organisation’s Commissioners on the Social Determinants of Health. Even our cousin across the Tasman, the New Zealand Government, has invited Prof Baum to discuss with them the social determinants of health and the implications for NZ policymaking.

The best the Australian Government can come up with is a military invasion of the Northern Territory to address the health and social problems of Aboriginal children, not to mention its portrayal of complex environmental and social problems such as obesity as the responsibility of individuals.

There has been a conspicuous absence of mention, debate or even a brief recognition of the social determinants of health and health inequities from both the government and the opposition, let alone any commitment to tackling those inequalities using evidence-based strategies.

Why do we not emulate Norway and other Scandinavian countries? Are we ignorant and uninformed, or do we simply do not give a damn about fairness?