The road forward for preventive health

Australia has a world leading health system and ranks among the healthiest countries in the world, with the sixth highest life expectancy amongst Organisation for Economic Cooperation and Development (OECD) countries.[1] A key feature of any good health system is that it is underpinned by strong preventive health policies and programs. As the old mantra goes, prevention is better than cure.

The COVID-19 pandemic has brought unprecedented attention to public health and the importance of prevention. Never have we heard these topics discussed daily by all our political and community leaders, from one end of the day to the other. It will be important to reflect on the learnings from this experience for prevention efforts more broadly – a challenge for the months ahead.

Over the years Australia has made great progress in many areas including tobacco control where we have long been world leaders. Australian governments at the state and federal level have introduced a comprehensive range of measures including: social marketing campaigns, tobacco excise increases, smoke-free laws, measures to prohibit and restrict tobacco advertising and promotion, introduction of graphic health warnings, tobacco plain packaging and measures to support smokers to quit.

This comprehensive and sustained approach has reduced daily smoking prevalence among Australian adults from 22.4% in 2001 to 13.8% in 2017-18.[2], [3]We have also focussed on programs to prevent the uptake of smoking and support smoking cessation amongst Aboriginal and Torres Strait Islander people.[4]

Relentless incrementalism has been the strategy and similar journeys have been taken for road safety and skin cancer amongst others.

Australia is also world-leading on immunisation with 94.78% of five-year-old children fully immunised. [5] This is a record level, however we continue to strive for even higher rates.

Despite these successes, preventable chronic conditions remain the leading cause of illness, disability and death in Australia.

We are also aiming to be the first nation to eradicate cervical cancer thanks to our National Cervical Screening Program and the early, comprehensive introduction of the vaccination for Human Papilloma Virus (HPV) through the National Immunisation Program.

Despite these successes, preventable chronic conditions remain the leading cause of illness, disability and death in Australia. We know the prevalence of chronic conditions and the burden of disease is rising for the Australian population overall, and parallel to this, the life expectancy of Australians is increasing. This translates to more years of life lived with the burden of chronic conditions and poor health detracting from the quality of life, imposing personal and family costs and costs to the health system.

The National Preventive Health Strategy – to be developed for a ten-year period from 2021 – will have at its core, the goal of supporting all Australians to live well for longer.

The strategy will consider the opportunities to improve health, and setting the trajectories for ongoing good health, at all stages of life. Early intervention and early childhood are key concepts, amongst others. The inequitable burden of preventable chronic conditions in Australia, particularly for Aboriginal and Torres Strait Islander people must also be addressed.[6] Experience has told us that successful programs in one community do not necessarily translate to other communities and that we need to work collaboratively with communities, drawing on their immense cultural strengths, to develop and implement programs.

Drawing from the lessons of our previous successes – the “relentless incrementalism” of gains made in tobacco control (and which needs to be continued) – the strategy will seek to identify the next big wins while also realistically considering the way our society and communities have changed in the past ten years, and indeed, in the past 10 weeks!

We must also look beyond the health system to the challenges and opportunities that exist in other sectors – education, transport, sport, to name a few. 

The Strategy will also look to be aligned to other long-term health plans under development at the Federal level including for primary health care, mental health, and health workforce ensuring a joined-up approach where touch-points and synergies can be harnessed. With more than 85% of Australians seeing a GP at least once a year (and the number of visits per year increasing) such opportunities for conversations about, and support for, preventive health must not be overlooked.

We must also look beyond the health system to the challenges and opportunities that exist in other sectors – education, transport, sport, to name a few. Cross-sectoral work has always been challenging for governments but the reality remains, this is how citizens live their lives and it is beholden on us, as specialists and leaders in our fields, to continue our efforts in this regard.

To return to our current situation, COVID-19 has clearly affected vulnerable populations and those with underlying chronic conditions disproportionately. In Australia, people likely to be at higher risk of serious illness if they contract the virus are: Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical condition; people 65 years and older with chronic medical conditions; people 70 years and older; and people with compromised immune systems.[7]

The management of the COVID-19 outbreak has demonstrated the need for governments, health sector industry and the community to work collaboratively. Communication is key in achieving a balance between motivating risk-mitigating behaviours and reassurance that evidence based measures will reduce the impact of COVID-19. Human behaviour is not only important for COVID-19 but other health challenges. Australians have demonstrated that behaviour change can occur rapidly when required. 

Governments around the world have made significant investments in health systems and reforms to manage 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.

The Federal Department of Health is fortunate to be ably guided in the development of the National Preventive Health Strategy by an Expert Steering Committee which I am honoured to chair.[8] When work resumes in the coming months we will consider these issues carefully. Timelines for planned consultation processes will be reset to ensure there is adequate opportunity for all to contribute, accounting for the significant burden the response to COVID-19 has placed on many of those we need to consult with. While much has changed, I am certain the resolve of government, our assembled experts and the community to pursue every opportunity for a renewed prevention agenda will be unchanged.

[1] Australian Institute of Health and Welfare 2019. Deaths in Australia. Cat. no. PHE 229. Canberra: AIHW. Viewed 06 April 2020

[2] NHS 2014-15

[3] NHS 2017-18

[4] Tackling Indigenous Smoking

[5] Childhood immunisation – 5-year-olds (accessed 5-5-20)

[6] AIHW Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011

[7] Australian Government Department of Health Advice for People at risk of Coronavirus (COVID-19)

[8] National Preventative Health Strategy