The American Journal of Bioethics

Running head: NATIONAL PRIMARY HEALTH CARE STRATEGIC FRAMEWORK
NATIONAL PRIMARY HEALTH CARE STRATEGIC FRAMEWORK
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1NATIONAL PRIMARY HEALTH STRATEGIC FRAMEWORK
Introduction
The National Primary Health Care (PHC) Strategic Framework was introduced by the
Department of Health in 2013, with the purpose of ensuring positive outcomes of health across
the entire Australian population. The third strategy focusses upon the deliverance of early
interventions, screening, health promotion and disease prevention services across the Australian
population, based on the social determinants of health (Department of Health, 2013). The
following paper will thus focus upon the current health issue of poor health outcomes of socially
disadvantaged groups in Australian by comparing with above PHC Strategy and the primary
health principles developed by the World Health Organization (WHO).
Discussion
National PHC Framework Strategy and Public Health Issue
With this respect, Strategic Outcomes 3 of the National PHC Strategic Framework targets
the improvements in deliverance and planning of healthcare services based on the prevalence of
factors like education, housing, employment, transport and infrastructure influencing the health
of individual and groups. Strategic Outcome 3 also emphasizes the need to incorporate social and
economic based partnerships while addressing the healthcare needs of individuals whose health
is influenced by social determinants (Department of Health, 2013).
Despite the acknowledgement and consideration of the important role of social health
determinants in the Australian population’s health status, disparities and gaps in healthcare
continue to be a major public health issue inflicting the nation (Bentley et al., 2016). According
to the National Rural Health Alliance, approximately 31% of gaps and disparities in healthcare
across the Australian population were contributed by socioeconomic issues like lack of health

2NATIONAL PRIMARY HEALTH STRATEGIC FRAMEWORK
service accessibility, unemployment and education. Additionally, the Alliance also reported that
factors like levels of education, average income, remoteness of location and lack of employment
choices and opportunities are the key contributors of poor outcomes of health and high burden of
disease across disadvantaged, minatory communities such as Indigenous Australians and rural
populations (National Rural Health Alliance, 2019).
Social Determinants of Health
Equity is a key social determinant of health and implies that, existing healthcare services,
resources and products must be equally accessible, accountable and affordable for all individuals,
irrespective of their educational levels, employment status, socioeconomic status, race, culture,
gender or age. When healthcare organizations so not take into consideration the social health
determinants of equity in their healthcare services, then it is likely that economically or socially
underprivileged minority communities will be deprived of basic health resources which further
paves the way for poor health outcomes (Fisher et al., 2016). However, Strategic Outcome 3 of
the National PHC Strategic Framework addresses these issues via implementation of a number of
healthcare policies and programs. For example, policies like ‘Closing the Gap’ aims provide
equitable and culturally competent healthcare promotion services to Indigenous populations via
the recruitment of Liaison Officers (ALOs) in healthcare organizations. Additionally, programs
such as the ‘Bi-Cultural Community Health Program’, the ‘Refugee Health Nurse Program’ and
additional healthcare professionals like ‘Community Engagement Officers’ aim to address the
specific health needs of individuals who are homeless, belong to refugee communities or belong
to culturally, linguistically and ethnically diverse populations (Department of Health, 2013).
Justice as a social determinant of health, implies that healthcare organizations must
deliver services which are fair for all individual and communities. For example, lack of funding

3NATIONAL PRIMARY HEALTH STRATEGIC FRAMEWORK
from federal to remote or local governments denies disadvantaged populations their basic right to
receive appropriate healthcare technology and diagnostic services as compared to privileged
communities (Preda & Voigt, 2015). Strategic Outcome 3 of the National PHC Strategic
Framework specifically addresses this social health determinant by encouraging and assisting
governments to use telehealth and broadband internet services for the purpose of identifying and
assessing the health needs of local and remote communities. Additionally, the PHC Framework
also encourages governments to make use of technologies like social media as well as remote
health monitoring software and applications for the purpose of facilitating live health monitoring
and health information accessibility to remote, disadvantaged populations (Department of
Health, 2013).
Epidemiology
The Australian Institute of Health and Welfare’s (AIHW, 2016) 15th biennial health
report published in 2016, demonstrates key epidemiological findings which reflect the
prevalence of health inequities as a result of social health determinants in Australian. As per this
report, approximately 20% of Australians belonging to socioeconomically underprivileged
groups were 1.6 at risk of belonging to the 20% of Australians who were inflicted with chronic
health conditions like diabetes and cardiovascular diseases. Further, socioeconomically
underprivileged Australians were reported to have deceased life expectancy of less than 3 years
as compared to affluent Australian groups. Additionally, individuals who were unemployed were
reported to be 1.6 times at risk of cannabis usage as compared employed individuals. Further,
individuals belonging to low socioeconomic groups were twice at risk of delaying disease
reporting and engaging in reduce healthcare expenditure as compared to socioeconomically
privileged (AIHW, 2016).

4NATIONAL PRIMARY HEALTH STRATEGIC FRAMEWORK
World Health Organization
The Principles of PHC postulated by the World Health Organization denote the
importance of using appropriate healthcare technology in delivering culturally competent,
feasible and affordable care across communities (WHO, 2019). Strategic Outcome 3 of the
National PHC strategic Framework clearly demonstrates compliance to this principle via
educating local governments on the usage of social media, remote health monitoring devices,
internet services and telehealth strategies (Department of Health, 2013). The PHC principles by
WHO also necessitate the adherence to a multi-sectorial approach where healthcare professionals
must collaborate with additional disciplines to address the comprehensive health needs of
populations (WHO, 2019). Strategic Outcome 3 addresses this principle by encouraging the
inclusion of additional health professionals like ALOs and Community Engagement Officers
who can specifically mediate between health professionals and diverse minority populations
(Department of Health, 2013).
Reflection
Practice Standard 2.5 of the Nursing and Midwifery Board of Australia (NMBA) guides
registered nurses (RN) on the importance of the advocating for patients for the purpose of
acquiring legal assistance (NMBA, 2016). This nursing standard clearly demonstrates
compliance with Strategic Outcome 3 provisions of including additional social and health
professionals (like ALOs) within the healthcare plans of individuals (Department of Health,
2013). Similarly, NMBA Practice Standard 4.1 guides RNs to engage in holistic patient
assessments which demonstrates compliance with Strategic Outcome 3 provisions of focusing on
social health determinants (Department of Health, 2013; NMBA, 2016).

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Conclusion
Thus, this paper provides an extensive yet elaborate discussion on the National PHC
Strategic Framework’s emphasis on prioritizing the social determinants of health for the purpose
of ensuring positive health outcomes across the nation. Despite the prevalence of such strategies,
disparities in healthcare due to individuals’ socioeconomic status continue to prevail in Australia.
To conclude, RNs can play a key role in addressing these disparities by engaging in collaborative
practice, patient advocacy and patient empowerment.

6NATIONAL PRIMARY HEALTH STRATEGIC FRAMEWORK
References
AIHW. (2016). Australia's health 2016, Chapter 4 Determinants of health - Australian Institute
of Health and Welfare. Retrieved 23 December 2019, from
https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/
determinants.
Bentley, R. J., Pevalin, D., Baker, E., Mason, K., Reeves, A., & Beer, A. (2016). Housing
affordability, tenure and mental health in Australia and the United Kingdom: a
comparative panel analysis. Housing studies, 31(2), 208-222.
Department of Health. (2013). NATIONAL PRIMARY HEALTH CARE STRATEGIC
FRAMEWORK. Retrieved 23 December 2019, from
https://www.health.qld.gov.au/__data/assets/pdf_file/0027/434853/nphc_strategic_frame
work_final.pdf.
Fisher, M., Baum, F. E., MacDougall, C., Newman, L., & McDermott, D. (2016). To what extent
do Australian health policy documents address social determinants of health and health
equity?. Journal of Social Policy, 45(3), 545-564.
National Rural Health Alliance. (2019). Social Determinants of Health. Retrieved 23 December
2019, from https://www.ruralhealth.org.au/advocacy/current-focus-areas/social-
determinants-health.
NMBA. (2016). Nursing and Midwifery Board of Australia - Professional standards. Retrieved
23 December 2019, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards.aspx.

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Preda, A., & Voigt, K. (2015). The social determinants of health: Why should we care?. The
American Journal of Bioethics, 15(3), 25-36.
WHO. (2019). Primary health care. Retrieved 23 December 2019, from
https://www.who.int/health-topics/primary-health-care#tab=tab_1.