In 2018, with our focus turned to the 2019 federal election, the Public Health Association of Australia (PHAA) launched the “Top Ten successes in Public Health in the past 20 years”.
Even before seeing our list, most audiences can pick 5 to 7 of the 10 items on it, so obvious are some of the success stories. The reduction in tobacco use, the reach and impact of immunisation, road safety, gun control, cervical cancer screening and vaccination, and others are widely known. While there might be arguments for success stories omitted, or some that might have been based on work outside the time frame there have been few challenges to the notion that these are wonderful hard-earned achievement that have benefited the health of Australians.
None of these health challenges are in the ‘job done’ category, so all still need constant attention and investment to ensure the benefits are maximised. Most need further work to ensure the benefits flow to the most disadvantaged populations. None the less, these are genuine wins for Australian society, and demonstrate what can be achieved with commitment, investment and sustained evidence-based action.
Fast forward to just after last year’s federal election, and in June 2019 we saw Health Minister Greg Hunt announce at PHAA’s Preventive Health Conference in Melbourne the intention to establish a ten year National Preventive Health Strategy (NPHS) for Australia. Some people had the “Not another strategy!” response, which is perhaps understandable given the recent plethora of health strategies that had been developed. Investment and action were what was required, not more documents, many people said. Setting aside the scepticism, I signed up for the Health Department advisory group to offer input to the NPHS.
Disease prevention is of course enormously important. The World Health Organisation (WHO) suggests that worldwide 80% of premature heart disease, stroke and diabetes can be prevented, as can 40% of cancer deaths. There are many well established risk factors linked to these chronic disease where more effort is needed.
The Australian Institute of Health and Welfare (AIHW) tells us that:
“Tobacco smoking, obesity & excessive alcohol consumption increase the likelihood of developing numerous chronic diseases. Insufficient physical activity, dietary risks and high blood pressure are also key chronic disease risk factors.”
None of that will be news to anyone.
There are some who argue that a focus on risk factors is all “old hat”, and we need to move on from this approach. But that does not change the realities of these being key drivers of ill health.
For those unfamiliar, these ‘determinants of health’ are the broader circumstances in which people live. These are often factors over which they can exercise little or no personal control, which drive health outcomes for individuals and communities. They are frequently linked to disadvantage, inequity and the uneven distribution of resources. They include the industries aggressively maximising sales of things that harm our health.
Or they are environmental factors like the presence of racism, or factors like the very basic of the state of the planet on which we live. This one is pretty simple – if the earth which sustains our lives is in trouble – so are we.
Perhaps a way forward is to set some specific and achievable goals.
One challenge in tackling the development of the NPHS is to grapple with is the breadth of the health, social and economic factors a single strategy can realistically seek to influence. Can such a strategy meaningfully look to take on some of Australia’s, indeed some of the world’s, most fundamental, challenging and wicked policy problems? Problems that require fundamental government, even society wide change.
And if it does seek to do so, will it be set up to fail to make any meaningful and measurable step forward on any of these enormous issues? Perhaps a way forward is to set some specific and achievable goals.
Going back to the achievements listed in the Top 10 Successes report, these were clear identifiable and focused case studies of preventive health efforts in action.
What if there were meaningfully more resources invested in tackling similar challenges over the next 10 years? Governments express their priorities – at least in part – by the way they invest policy and financial resources.
What if – instead of the current 1.5% of national health spending that goes into preventive health, governments invested 5% of health spending into preventive health efforts? One dollar in every $20. The Western Australian government has made that commitment through its “Sustainable Health Review” released in 2019. Their goal is to reach that point by 2029.
Nationally, we have a Pharmaceutical Benefits Scheme which guarantees financial resources to drugs which benefit our health. Crucially, the Scheme is supported by the Pharmaceutical Benefits Advisory Committee, an independent group of experts using transparent criteria to assess the safety, efficacy and cost effectiveness of any drug seeking to be financed by the scheme.
We have a similar structure in the Medical Benefits Scheme which lies behind our investment in the Medical Services we can access.
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.
There needs to be a long-term, lasting structural change.
If we were to establish such a system, a fundamental criterion should be the application of the lens of equity, and the principle that preventive efforts should provide the most possible benefit to those who need to most assistance and support.
There needs to be a long-term, lasting structural change. We cannot sustain an effective and ongoing preventive health effort in Australia without ongoing and meaningful commitment of resources. And these resources and expertise can be applied to preventing chronic or non-communicable disease, infectious disease and injuries.
The present moment of a global health crisis is an ideal point in our history to structurally and meaningfully commit to an ongoing effort to prevent disease. Evidence seems to be emerging linking increased prospect of infection and poorer outcomes for those with SARS COV2 and people who are obese, or people who are smokers.
Australia does have a proud history of world leading efforts in preventive health. We have strong expertise and a small but passionate workforce who have devoted their professional lives to preventing diseases.
We can and should aim to enhance the health of Australians – now and long into the future. Investment in preventive health is a proven way forward toward this objective.