A person’s health is the result of a complex interplay of their genetics, lifestyle and environment. ‘Health’ is more than just being free of illness. The World Health Organization defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ (WHO 1946). This recognises that health is multi-dimensional, and a person’s health is linked to their wellbeing.

Health, welfare and wellbeing are interrelated

Health is a determinant of wellbeing. A person’s health status plays a role in their ability to participate in work, education or training and engage with their community and social networks.

Health is both a protective and a risk factor. For example, a person may suffer isolation or loneliness because of poor health (see Social isolation and loneliness), while good health may enable them to earn a sufficient income to support themselves and live independently, placing them at lower risk of poor outcomes such as poor housing conditions, overcrowding and homelessness.

Conversely, the circumstances in which a person lives and works can impact on their health. A number of social factors act together to strengthen or undermine health. These factors are also strongly related to wellbeing, as shown in Understanding welfare and wellbeing, Figure 1. Factors include educational attainment, employment status, social exclusion (social disadvantage and lack of resources, opportunity, participation and skills) (McLachlan et al. 2013), the built environment and living arrangement (see the Australia's welfare snapshots relating to housing, employment and work and education).

Health inequalities

Health inequalities (avoidable differences in health outcomes and life expectancy across groups in society) arise because of the conditions in which a person lives and works (CSDH 2008).

Social inequalities and disadvantage are closely linked with health inequalities and the dramatic differences in health experienced across groups in society (CSDH 2008). It is estimated that closing the gap between the most and least socially disadvantaged groups would spare 0.5 million Australians from chronic illness, save $2.3 billion in annual hospital costs and reduce Pharmaceutical Benefit Scheme prescription numbers by 5.3 million annually (Brown et al. 2012).

One example of the link between social inequalities and disadvantage can be seen through health disparities in educational attainment. People with lower levels of education have higher rates of death due to cardiovascular disease. If all Australians aged 25–74 had the same cardiovascular disease death rate as people with a Bachelor degree or higher in 2011–12, the total cardiovascular disease death rate would have declined by 55%, and there would have been 7,800 fewer deaths (AIHW 2019b).

Health and welfare services

The health system is one part of a network of systems working to create positive wellbeing for all Australians. It plays a role in the prevention and treatment of diseases and other ill health and injury to maintain health—not just treat illness—to help people remain as healthy as possible for as long as possible.

The health system is linked with other sectors, especially welfare. An example of the relationship between health and welfare at the service level is the ‘no jab, no pay’ policy. This encourages parents to vaccinate children by requiring them to comply with immunisation requirements in order to receive Child Care and Family Tax payments (Department of Health 2018).

While health and welfare services are generally distinct but complementary, in some settings the boundaries are less clear, with services intersecting both health and welfare. For example:

  • The aged care system aims to promote the wellbeing and independence of older people and their carers, as well as protect the health and wellbeing of care recipients (SCRGSP 2018; see Aged care). While aged care is generally regarded as a ‘welfare’ service, some aged care services may typically be considered a ‘health’ service. For example, recipients of the Commonwealth Home Support Programme may be eligible for allied health support services such as physiotherapy, speech pathology and nutritional advice (Commonwealth of Australia 2018).
  • People with permanent and significant disability may access disability support services. Support available for those eligible is wide ranging and includes some health-type supports, such as home modifications, allied health and the provision of aids and equipment (NDIA 2019; see Supporting people with disability).

Many issues involve both health and welfare services, requiring people to navigate multiple systems and providers. Family, domestic and sexual violence (FDSV) is one example of this. FDSV can have a serious impact on a victim’s health, but also on other aspects of their life that determine wellbeing. In 2016–17, 4,600 women and 1,700 men were hospitalised due to family and domestic violence (AIHW 2019a) and 121,000 people who sought homelessness services in 2017–18 had experienced family and domestic violence (AIHW 2019c). Services and initiatives across sectors work to support the wide reach of FDSV. For example, many people who have experienced violence from a current partner report having taken time off work as a result (ABS 2018). This can result in less income or loss of employment. New government initiatives include the introduction of paid domestic violence leave (SGV 2017).

Health and welfare data

Health and welfare data are hugely valuable. Their strong evidence base enables better decision making and improved outcomes for Australians. People-centred data are needed to understand the experiences of the population and various cohorts within it across health, housing, education and skills, employment, income and finance, social support, and justice and safety.

Data linkage (a process combining information from multiple databases, while preserving privacy) is increasingly being used to link across health and welfare data sets. An example is the National Integrated Health Services Information Analysis Asset, which brings together aged care data with health services data (AIHW 2018). Linked people-centred data are beneficial for insight into an individual’s situation, support pathways, interactions and experiences with welfare services, interaction between health and welfare systems, and health and welfare outcomes. See ‘Chapter 1 An overview of Australia’s welfare’ in Australia’s welfare 2019: data insights.

Where do I go for more information?

See Australia’s health for more on this topic.

For more information, see:

References

ABS (Australian Bureau of Statistics) 2018. Personal Safety, Australia, 2016. ABS cat. no. 4906.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2018. Approved AIHW linkage projects. Canberra: AIHW. Viewed 12 April 2019.

AIHW 2019a. Family, domestic and sexual violence in Australia: continuing the national story 2019. Cat. no. FDV 3. Canberra: AIHW.

AIHW 2019b. Indicators of socioeconomic inequalities in cardiovascular disease, diabetes and chronic kidney disease. Cat. no. CDK 12. Canberra: AIHW.

AIHW 2019c. Specialist homelessness services annual report 2017–18. Cat. no. HOU 299. Canberra: AIHW. Viewed 21 August 2019.

Brown L, Thurecht L & Nepal B 2012. The cost of inaction on the social determinants of health. Report no. 2/2012: CHA-NATSEM second report on health inequalities. Canberra: National Centre for Social and Economic Modelling. Viewed 14 February 2019.

CSDH (Commission on Social Determinants of Health) 2008. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization. Viewed 5 February 2019.

Commonwealth of Australia 2018. About the Commonwealth Home Support Programme. Viewed 12 March 2019.

Department of Health 2018. No Jab No Pay new requirements fact sheet. Canberra: Department of Health. Viewed 27 February 2019.

McLachlan R, Gilfillan G & Gordon J 2013. Deep and persistent disadvantage in Australia. Canberra: Productivity Commission. Viewed 14 February 2019.

NDIA (National Disability Insurance Agency) 2019. Supports funded by the NDIS. Canberra: NDIA. Viewed 12 March 2019.

SCRGSP (Steering Committee for Review of Government Service Provision) 2018. Report on government services 2018. Canberra: Productivity Commission.

SGV (State Government of Victoria) 2017. Include an entitlement to paid family violence leave for employees. Melbourne: SGV. Viewed 14 February 2019.

WHO (World Health Organization) 1946. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946. New York: WHO.