How COVID-19 spurs the case for health prevention

When we first decided that prevention was to be the theme of this edition of Health Voices, COVID-19 was yet to invade the world stage. Then as it escalated into the pandemic, prevention seemed, at first, to be likely to be overwhelmed as an issue demanding much attention right now.

But as these articles convey, prevention is an ideal that does not go away, even in the face of the malignancy of COVID-19.  Indeed, we can now see that preventive health will have saved many lives affected by COVID-19, and lack of preventive practices has doomed the lives of many thousands of others.

We had decided to feature prevention in this edition to empower consideration of this oft-understated corner of health policy in response to the 10-year target for preventive health set by Health Minister, Greg Hunt.  Of course, right now the Minister will have much on his mind in pursuing more immediate prevention steps to quell the spread of the virus.

However, we believe the balance sheet of lives lost and saved in the Australian experience with COVID-19 will bear out the need for a much more active and long term preventive health architecture in the future. Just as the Government has dedicated many billions of dollars to shore up the economy, there must be a reckoning that spending significantly more on prevention health policy into the future will bear huge dividends in healthier lives and healthier budgets.

The watershed impact of COVID-19 must surely press home the message of the need for a fresh era in health policy to adopt challenging policies now in areas like obesity for long term benefits.

It is encouraging that Lisa Studdert, the chair of the National Preventive Health Strategy Expert Steering Committee says the committee will consider carefully the lessons of COVID-19.  “It is important that post the pandemic we examine measures put in place to consider where they may provide opportunities for use in preventing chronic conditions such as the wider use of telehealth services,” Dr Studdert says.

As Claire Hewat writes, had we been more successful over recent decades in tackling preventable conditions such as obesity, type 2 diabetes and hypertension there would be fewer people in Australia (and elsewhere) at higher risk right now. Australia has a proud history in prevention activities. Our response to the HIV / AIDS crisis led the world, our record on addressing cigarette smoking is enviable and ‘Slip, Slop, Slap’ is now part of the lexicon. “Unfortunately, the responses to some of the more complex and thorny issues have been piecemeal and some have been derailed by short-term economic interests trumping long term costs; and by a variety of vested interests including some which might come as a surprise to many” Ms Hewat says.

Australia should adopt the same time-proven approach to prevention as we do to the financing of medicines and medical benefits under Medicare, says Terry Slevin. “Why not establish a similar structure for financing disease prevention, also supported by independent expertise with the clear objective of reducing the preventable disease and injury burden on Australians based on the best available evidence? Such a scheme might pay for itself, because preventive health efforts can reduce the unsustainable growth in costs incurred treating illnesses and injury.”

And gauging our unhealthy habits tells a different story to what most Australians think about their health, says Sharon McGowan.  Nearly 90 percent of Australians rate their health as excellent, very good or good. But the risk factors show almost two in three Australian adults and around one-quarter of our children are overweight or obese. Unhealthy foods contribute more than one-third of our daily energy intake. Nine out of 10 people don’t eat enough fruit or vegetables, and around one in three adults have high blood pressure. Many in the community are unaware of their risk or are untreated. Reducing risk factors could dramatically lower disease burden. For example, if all Australians were a healthy weight, we could reduce burden from diabetes by 53 percent, chronic kidney disease by 38 percent, stroke by 22 percent, coronary heart disease by 25 percent and up to 38 percent for certain cancers.

And we need to start early as Sharon Goldfeld urges. Investing in early childhood, especially the first 1000 days, pays off with prevention of adverse adult health and social outcomes, and substantial benefits to society and human capital. Australia spends $15.2b each year on crisis services for children and young people. “This represents a missed opportunity to make smart investments in early intervention, to improve the lives of children and young people by preventing or reducing the severity of these issues, and reducing pressure on government budgets and increasing savings in the long term.”

Political will is necessary to drive change in promoting healthy diet and challenge the corporations whose activities and profits would be curtailed, writes Jane Martin.  “Now is the time to commit to building a healthy and resilient population and we should not let this crisis go to waste.”

Georgia Gardner calls for the Health in All Policies framework advocated by WHO. When public policy decisions are not grounded in a health and wellbeing framework, there are major risks, she says. Covid-19 shows how individual and community health is impacted by decisions outside of the health sector.  Policies in areas like telecommunications, financial support and rental affordability and cuts to social service provision have had repercussions for people’s health.

And for Aboriginal and Torres Strait Islander communities, there is an appetite for health promotion, prevention and education that is a cultural fit and engages with people in a positive way, says Adrian Carson. The Deadly Choices program of the Institute for Urban Indigenous Health is well positioned to ensure that Aboriginal and Torres Strait Islander communities are informed and up to date, not just about healthy lifestyles, but also prevention and recognition of COVID-19 symptoms, he says.

Yvonne Zurynski argues that after we emerge from the COVID-19 crisis, and we deal with the enormous social and economic impacts, including increased unemployment, we must ensure that we look after the wellbeing of all Australians. “Health professionals have the opportunity to embrace social prescribing as part of their suite of treatment options to keep patients well in the community. As health consumers, it’s important to always discuss options with our healthcare providers and be ready to embrace social prescriptions on our preventive health journey,” she says. 

For prevention to become a more intrinsic element of the wider social policy we need to have forums where people of various backgrounds can be educated more about better health outcomes, writes Shalon Hunte. It is not enough to only have poster campaigns because they do not take into account different perspectives. “Unless we are able to come together as a group to communicate ideas and share knowledge it will make it much harder for Australia’s effort on prevention to advance,” she says.

And importantly, our political leaders will need to change their ways for this advance to take place, says Peter Martin.  “There should be fewer photo opportunities for politicians and bureaucrats opening buildings or turning sods and more emphasis on good news stories where fewer patients and even less money spent on health make the headlines,” he writes.