No One Left Behind? the Role of Social Policy in Viral Hepatitis

(A report back from Dr Kylie Valentine - No one left behind? The role of social policy in viral hepatitis - the Australasian Viral Hepatitis Conference)

Kylie had a fascinating talk outlining the role of social policy in viral hepatitis. She determines social policy as society’s responses to “big picture” questions of how best to distribute resources through taxation, income support, programs and services. Social policies outline what a society regards as important and fixable problems, what those problems are and thought to be, and what is not a priority. Social policy research tells us about how different groups of people are affected by these choices and priorities, and how policies and policy domains interact.

There are few things that policy research can tell us regarding hepatitis. And there are issues. 

Inequality in Australia 2018. 

  • Top 20% of households have five times the disposable income of the lowest 20%; 
  • The lowest 40% income group rely on social security or low wages; 
  • Australia has higher inequality than most other wealthy nations; 
  • The average wealth of a household in the wealthiest 20% ($2.9 million) is five times that of the middle 20% ($570,000) and almost a hundred times that of the lowest 20% ($30,000). 

Australia’s mental and physical health. 

There is strong evidence of a socioeconomic gradient in the incidence of multimorbidity. The National Mental Health Survey reported that mental health conditions are more likely in people: 

  • Who live outside major cities; 
  • In the lowest socioeconomic quintile; 
  • Who are not employed; 
  • Who lives alone and/or who have a disability causing a profound or severe limitation. 

Universal programs are not universal benefits. 


  • Financial constraints are a barrier to achieving higher immunization coverage, despite being free; 
  • The proportion of children in the lowest SES decile who were partially vaccinated and fir whom there was no recorded objection, was 20-50% higher than a recommended medical test, treatment, or follow-up; or had a medical problem but did not visit a doctor or clinic in the previous year because of cost (Fielding, J.E. et all, 2017); 


  • An average of 73% of selective school students came from the highest quarter of socio-educational advantage in 2016 (Ho, C. and Bonnor, C., 2018); 
  • Socio-educational conditions are having a stronger net impact on school performances than they were before the First Gonski Review (Bonnor, C., and Shepherd, B., 2016). 


Based on The Spirit Level Study (Wilkinson, Pickett, 2009) comparing index of health and social problems (including life expectancy, math and literacy, infant mortality, homicides, imprisonments, teenage births, trust, obesity, mental illness and social mobility), Kylie concludes that health and social problems are worse in more unequal countries, and Australia has high income inequality in comparison with Canada, Germany, Norway, Japan and many other countries. 




Author bio: 

Dr Denys Volkovets is a GP in rural Tasmania. Prior to this, he worked as a general practitioner and medical administrator in public and private healthcare facilities overseas. His areas of interest are holistic medicine, dermatology and skin cancer, mental health, sexual health and chronic medical conditions.