Submission to Treasury, ‘Measuring what matters’ consultation

Existing cross-government frameworks, including national plans, already provide the foundations for the architecture of the wellbeing agenda. To achieve its aims, The Australian Government also needs to go beyond measurement to implementation, including through collaborative approaches to intersecting challenges, and investment to realise its agenda.

Summary

Health Justice Australia welcomes the Australian Government’s commitment to measuring wellbeing and developing a wellbeing framework in the context of its Budget policy.
Wellbeing provides an opportunity to recognise that where challenges intersect, so too must their solutions. A framework of wellbeing needs to take account of the way health, legal and social problems intersect in people’s lives.
Wellbeing also provides a shared goal through which we can put people at the centre of policy and budget decisions and bridge the silos that fragment service responses to people’s intersecting needs.
In developing this framework and accompanying indicators, the Government must consider what wellbeing means to people and communities. Centring Aboriginal and Torres Strait Islander understandings of wellbeing should be central to this framework.
In developing wellbeing indicators, we recommend that existing cross-government frameworks provide an existing architecture of the wellbeing agenda, including national plans.
To achieve a wellbeing agenda, the Government should also recognise the need to go beyond measurement to implementation, including through ensuring relationships that enable collaborative approaches across policy areas; across government, services and communities; and investment to realise this wellbeing agenda.

The opportunity of a wellbeing agenda to address intersecting needs

Health Justice Australia welcomes the Australian Government’s commitment to a wellbeing agenda. From our role supporting services to address people’s complex and intersecting health, legal and social needs, we see clearly that policy frameworks and service delivery must work better together, with each other and with the communities they support. A wellbeing agenda provides the shared vision and framework to enable this.

The promise of a wellbeing agenda is that policy frameworks and service delivery work with communities around intersecting, complex need, recognising that just as challenges intersect, so too must their solutions.

We identify the following key benefits of wellbeing as a framework. (1)

Wellbeing takes account of intersectionality in people’s lives and provides a focus that can be shared across services and sectors. Multiple and intersecting health, legal and social problems can interact in ways that are complex to untangle. For this reason, a siloed focus on a single issue (supported by narrow outcome measures) can fail to take account of these other influences. For instance, health clinics seeking to address repeat hospital admissions for respiratory problems are poorly equipped to tackle underlying drivers such as poor quality ventilation in public housing, but they can partner with legal or other services who have that capability. As a shared goal, wellbeing can break down departmental or jurisdictional silos, providing a coherence around the different parts of people’s lives and experiences that intersect.
Wellbeing is a goal that matters to people and communities. When people are consulted about what they want from services and policies, they identify wellbeing as a goal that matters to them. ‘Wellbeing’ can connect policy, service delivery and investment decisions to the things that matter for the people and communities in whose interests those decisions are made.
Wellbeing puts people at the centre. Person- or client-centred service design is a key strategy to ensure that services are responsive to needs, capabilities and contexts of clients with more complex and intersecting issues. Prioritising measures of service quality and utility that reflect value as it looks to those client groups is a key way to retain person-centred service delivery.
Wellbeing provides a benchmark or point of comparison. The increasing use of measurements of wellbeing enable us to compare progress globally, nationally, at community and at program levels. (2)

We recognise the importance of Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, which is reflected in tools such as the Growth and Empowerment Measure. (3) We also identify the need to consider community wellbeing to shift health inequity in society. (4)

In developing a wellbeing framework, there is an opportunity also to consider the wellbeing of the practitioners, as well as the clients, of services. Health Justice Australia’s work with practitioners, especially during the COVID-19 pandemic, has highlighted the risks of isolation and burnout among health, legal assistance and other practitioners. As the World Health Organisation identifies it, burnout is an ‘occupational phenomenon’ through which the structures of work shape and impact upon the mental wellbeing of people in the workplace.

Government and other funders play a key role in determining the structures of work, for instance through the levels of funding that they provide to health and human (including legal assistance) services. Consequently, governments need to understand how the impact of their decisions in terms of organisational capacity and impact directly on the wellbeing of the workforces they rely upon to achieve service outcomes in the community.

The prevention of burnout among health, legal assistance and other practitioners is a valuable outcome in its own right. It is also a factor that is likely to shape or influence the outcomes achieved by those workers and the services they provide, because practitioners who are struggling themselves are unlikely to be able to respond appropriately to complex problems in the lives of the individuals and families they help.

We endorse the suggestion in Treasury’s Budget Statement that it will be important to add indicators that address inequalities in wellbeing for key groups where those are not already captured by the OECD Framework, such as for Aboriginal and Torres Strait Islander communities, rural and regional Australians, LGBTQI+ people, and culturally and linguistically diverse people. The framework will also need to recognise the intersections between these groups and their impact upon inequality, which is often missed in indicators that focus on each group separately.

The architecture of a wellbeing agenda is already in place

To achieve its wellbeing agenda, Health Justice Australia recommends the government draw on cross-government frameworks to invest in and measure outcomes for individual and community wellbeing. This includes through existing priorities and commitments to eliminate violence against women, Close the Gap and the National Preventive Health Strategy.

These policy frameworks have involved extensive consultation and drawn input from stakeholders across industry, service systems, consumer advocates and the community broadly. They provide the architecture of a wellbeing agenda underpinned by a coherent, unifying set of policy directions, including a focus on person-centred services.

The foundations of a wellbeing agenda already exist in key cross-government frameworks, some of which are named in the Treasury’s Budget Statement on Measuring What Mattters:

Health: National Preventive Health Strategy (2021-2030) recognises the policy levers beyond healthcare that affect health equity and the cross-portfolio collaboration necessary to achieve it. Supported by National Mental Health and Suicide Prevention Agreement, National Children’s Mental Health and Wellbeing Strategy, and the National Men’s and Women’s Health Strategies (2020-2030). Justice: National Legal Assistance Partnership (2020-2025) provides the support to tackle legal needs that, left unaddressed, often undermine health and wellbeing. Supported by National Plan to Respond to the Abuse of Older Australians (Elder Abuse) (2019-2023).
Social Services: National Framework for Protecting Australia’s Children (2021-2031) and the next National Plan to End Violence against Women and Children provide the mechanisms to support women and children to be safe at home. Australia’s Disability Strategy (2021-2031) is a key supporting policy.
First Nations: Closing the Gap Agreement and Constitutional Recognition are critical processes to improve wellbeing for Australia’s First Peoples. Supported by a new National Plan for Aboriginal and Torres Strait Islander family safety and National Aboriginal and Torres Strait Islander Health Strategy (2021-2031).

Achieving a wellbeing agenda requires more than measurement

For indicators of wellbeing to support a wellbeing agenda, the indicators need to be not just measured, but also used to inform decision making. For example, shared wellbeing indicators should shift funding flows toward shared outcomes, and should inform service design to support a focus on wellbeing.

Relationships that enable collaborative approaches across government and across policy areas are needed to support the impact of the wellbeing agenda. These include:

A ministerial leadership structure that drives cross-government collaboration, shared investment, and accountability towards wellbeing outcomes.
Establishment of cross-government mechanisms to identify shared wellbeing outcomes that take account of diverse experiences among individuals and communities and the contribution to wellbeing made both within and across policy and portfolio areas.
Collaborative mechanisms that support cross-government interaction with representatives from health and human (including legal assistance) services and the communities they support.

The realisation of a wellbeing agenda also requires investment. Expenditure that is well designed and targeted will enable these policy directions and the measurement of their impact, identifying the contribution of investment across policies and portfolios towards shared, cross-government wellbeing outcomes. This investment includes:

building the capability to partner across otherwise ‘siloed’ service and system settings, such as health and justice
developing the capacity and capability within government departments to develop, refine, implement and evaluate policies that improve wellbeing among different groups of people
enabling and supporting (including through appropriate resourcing) health, social and community services to collect, record, share and use data, including where governments requested this data from services to report against wellbeing indicators
recognising and reflecting, through appropriate service design and resourcing, the impact of funding and policy decisions on the wellbeing of the workforce delivering services to improve wellbeing.