Infrastructure is sexy, but prevention would do greater good
THE Government’s recent announcement that $2.5 billion of the $17 billion surplus will go to health is welcome recognition that escalating health costs and community expectations demand additional funding from all governments.
Once again, however, prevention has missed the coach to the funding ball. Announcing the Health and Medical Infrastructure Fund, the Treasurer said that the earnings from the fund ‘‘ will be available for new capital and medical facilities such as surgical theatres and high technology medical equipment’’. The fund is ‘‘ a new investment which will put Australia at the cutting edge of health treatment in the years ahead’’.
Prevention, as so often, falls out of the lexicon when new funding is allocated. Hospitals and equipment are sexy; preventing death and disease is not.
The Australian Government spends $46 billion a year on health, but in 2004/5 the health department spent only $468 million on public health (less than the food and drinks industries spend on promoting their products), with a further $395 million in special purpose payments to the states and territories.
The commonwealth department’s direct expenditure on public health is just over 1 per cent of its recurrent health spending.
Thanks in large part to public health activity, Australian life expectancy is about as good as it gets — apart from indigenous Australians, where the life expectancy gap remains catastrophic. But we are now failing to deal with the diseases of affluence. While we know much of the action required to reduce tobacco, obesity and alcohol problems, these public health priorities alone cost our community over $50 billion each year.
There has been plenty of rhetoric about public health over the years, but the funding and determination needed to improve health and life expectancy, and to address our worst inequities, are in short supply.
To take one example: there is overwhelming evidence that media campaigns can have a significant impact across problems ranging from HIV/AIDS to immunisation, and from nutrition to smoking. Yet public health is sent into battle with funding that commercial advertisers would use for small change, while alcohol and junk food promotion rules the airwaves, and even tobacco companies find new ways of promoting their lethal products. The federal Government received $6.76 billion in tobacco tax last year, but spends less on all its public health media campaigns than McDonald’s spends on advertising.
Some years ago an American writer on drug issues, Mark Worden, wrote about ‘‘ popular and unpopular prevention’’. Popular prevention is what governments love: rhetoric and action in soft, politically attractive areas while ignoring hard targets such as adequate funding or powerful commercial interests. ‘‘ Tough on drugs’’ is more appealing than ‘‘ tough on obesity’’; announcing local alcohol treatment programs is easier than curbing the drinks industry’s rampant promotional expenditure.
‘‘ The problem with popular prevention,’’ writes Worden, ‘‘ is not merely that it is trivial, but that it diverts resources and attention from more important and productive prevention areas. One may safely assume that unpopular prevention will remain difficult and unpopular, and popular prevention will remain attractive, popular, cosmetic and inconsequential.’’
Despite Worden’s pessimism, there is growing public recognition of the importance of prevention, and the forthcoming election could be a landmark in the move from popular prevention in Australia. Kevin Rudd has issued a policy paper that recognises prevention as not only a health priority, but ‘‘ a first order economic issue’’, and promises to put it ‘‘ front and centre’’. There is a commitment to a prevention taskforce, and the coming weeks will show if ground-breaking rhetoric can be matched with the crucial funding commitment.
The federal Government has relied primarily on popular prevention over the years, but is yet to announce its prevention policies for the election — indeed, it has yet to show much of the activity promised through the Council of Australian Governments: the long-awaited media campaign on obesity is still under wraps.
Preventive measures once thought to be unpopular often become popular once introduced. For years governments were terrorised by claims from tobacco companies that action on smoking would bring them down. Now we know that bans on tobacco promotion, protecting non-smokers, even tax increases have overwhelming public support.
We cannot continue to get public health on the cheap: 1 per cent of commonwealth health expenditure is not enough. Tobacco still kills nearly 16,000 Australians every year. More young Australians are drinking at risky levels. The rising tide of obesity may see this generation of Australian children as the first to face reducing life expectancy. The indigenous life expectancy gap in Australia remains close to two decades, despite dramatic reductions in other countries with indigenous populations.
The challenge for both parties is that we know what to do in these and other areas. It will not break the bank, but requires political determination and realistic funding. A ‘‘ prevention fund’’ from the $17 billion surplus would be a welcome start. Mike Daube is professor of health policy at Curtin University and national president of the Public Health Association of Australia