In­fra­struc­ture is sexy, but pre­ven­tion would do greater good

The Weekend Australian - Travel - - Health - MIKE DAUBE

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

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