Adjunct Professor Terry Slevin, PHAA CEO
As 2024 staggers to a close, Australia’s public health community has several reasons to feel a sense of achievement.
It is time to reflect on what has probably been the best year for advancing public health causes in at least a decade.
The good news is that the burden of disease in Australia has fallen by 10% over the past 20 years, according to the AIHW Australian Burden of Disease Study 2024 released today.
Public health measures are playing an important part in helping us to be healthier and live longer.
Let’s make two lists – firstly the things achieved in 2024, and secondly the agenda of things that are on the boil but not yet won. The first list is pretty good.
What we’ve achieved
The Australian Government launched an ‘interim’ Centre for Disease Control (CDC) this year, and finally confirmed its policy approach to legislating for the permanent body in 2025. This institutional change is far more than bureaucratic reorganisation.
The Australian CDC can be a vehicle for many public health initiatives, as the key adviser to Government and director of public health initiatives in communicable disease control, and hopefully in chronic disease prevention. We may well look back on 2024 as the year that the gears shifted into place for public and preventive health within Australia’s federal government. But implementation of the CDC will require significant investment for health protection, disease prevention, community health and wellbeing.
We also saw the delivery of the COVID-19 Response Inquiry Report, which helped firm up the resolve of the Government to create the Australian CDC. This major report gives a clear-eyed analysis of Australia’s needs to prevent and prepare for health emergencies.
At the state level, South Australia took a large institutional step forward in 2024 with the creation of Preventive Health SA – which has the potential to become the most significant state public health agency in the nation.
It will complement existing bodies in Victoria (VicHealth), Western Australia (Healthway), and Queensland (Health & Wellbeing Queensland). We hope that other jurisdictions will similarly recognise the importance of focusing on prevention. We have been making the case at the Special Commission of Inquiry into Healthcare Funding in NSW that our most populous state should follow that lead.
National control of the world’s biggest killer – nicotine products – has also taken giant steps forward in 2024. Following a momentous revision of federal tobacco control laws in late 2023, almost all state and territory jurisdictions have been revising their tobacco control legislation. This has resulted in the most vigorous round of revisions to national and state tobacco control laws since the early 1990s.
At the centre of these changes was a world leading federal law reform: the legislation to control retail sales, importation, and manufacture of vaping products across Australia. This new national regime also fed into the state and territory tobacco law reform efforts, ensuring a comprehensive nationwide approach to vaping regulation.
Tobacco and other nicotine products have never been better regulated by law than they are at the end of 2024.
The above reforms are all major, unambiguous wins for public health. But a number of smaller wins, or battles that may bear fruit next year, are happening elsewhere.
What we’re still fighting for
2023 saw the most significant Australian parliamentary report ever issued into gambling and its public health harms: the ‘You Win Some, You Lose More’ Report.
In the face of intense lobbying by the gambling industry and its allies, the Government has so far failed to act. But pressure from many advocates, including the public health community, continues to mount.
Battles are occurring in several states over local gaming machine and other regulation, and the year ends with at least one state – Victoria – making substantial progress on poker machine regulation. At the end of the year, we saw deplorable backsliding on this issue in Tasmania.
Federal Parliament produced another major report in 2024 – the Health and Aged Care Committee’s Inquiry into the state of diabetes in Australia. Pressure is on the Government to take real steps to curtail growing obesity rates and other drivers of diabetes.
We welcomed the announcement from Food Ministers to begin the groundwork for implementing a mandatory Health Star Rating system. There is a real sense that decision-making may step forward during 2025. Sugar claims on food products also came under scrutiny, with the new definition for added sugar meaning that over 400 high sugar products will soon no longer be able to claim that they have “no added sugar”. Work is still needed to see this over the line.
The federal health department completed a study into options for the regulation of advertising of unhealthy foods, and this work is winding its way into recommendations for health ministers to consider. Also in Parliament, independent MP Sophie Scamps has twice put forward a bill to ban junk food advertising to children.
Marketing of breastmilk substitutes is another area that has received substantial attention during 2024.
Following an application from the Infant Nutrition Council to the Australian Competition and Consumers Commission (ACCC) to extend the self-regulated Marketing in Australia of Infant Formula (MAIF) agreement that has been in place since 1992, the public health community called for a stronger regulatory framework in line with WHO recommendations.
The Government responded by committing to mandate regulation of the industry within the next two years. Now, we need to lean in to make this the best possible regulatory framework.
Indigenous health care, especially preventive health, continues to receive targeted funding through Aboriginal Community-Controlled Health Organisations, which play a vital role in strengthening health outcomes for First Nations’ people. While significant progress has been made, more efforts and resources are needed to close the gaps in health outcomes for First Nations’ people.
In a promising development, the highly successful Tackling Indigenous Smoking Program has secured renewed three-year funding. This program will continue to save lives, empower communities, and contribute to closing the gap in life expectancy through culturally safe and community-led tobacco and vaping resistance.
The campaign to reduce child incarceration has taken slow steps forward in the ACT, Victoria and Tasmania – while tragically, new governments in the Northern Territory and Queensland are undoing progress, with new laws returning to incarcerating children as young as 10.
The historic National Plan to End Gender Based Violence was also released in 2024, a program agreed by all jurisdictions to guide actions towards ending violence against women and children in one generation. As with so many government policy statements, implementation is what matters. There are profound challenges to address the many underlying social drivers of violence.
There has also been progress in the implementation of the National Climate and Health Strategy. The new National Health, Sustainability and Climate Unit (to be placed within the Australian CDC) has made some initial steps, such as the establishment of an inter-jurisdictional, cross-portfolio advisory board, and governance arrangements to guide implementation of the Strategy. However, further advocacy in 2025 must focus on securing funding.
Internationally, the World Health Organization has come closer to agreeing on a Pandemic Treaty. Following determined efforts by a wide range of NGOs, including the World Federation of Public Health Associations, considerable consensus was reached at the World Health Assembly in Geneva on regulations that recognise infections know no borders.
Finally, 2024 has seen moves to address the root cause of many public health problems in Australia – the political influence of unhealthy industries. There have been non-government bills before Parliament this year to regulate corporate lobbying, as well as political donations from unhealthy industries such as tobacco, gambling, and alcohol.
Meanwhile, a complex Government bill that appeared late in 2024 includes an impressive new scheme of transparency for almost all political donations. However, this bill must wait until next year.
Our agenda in 2025
2024 has seen battles happening on many public health fronts and some historic wins.
So, what should be our agenda in 2025?
The AIHW Australian Burden of Disease Study shows our health profile changing in ways which should guide our next steps in public health policy.
Statistically, we are living a little bit longer, but spending more years in ill health, especially towards the end of our lives.
Yet crucially, the diseases that burden us in these later years have their origins earlier in our lives – in our consumption practices and activity levels – which are largely preventable.
Prevention – not merely treatment of diseases in our older years – remains the fundamental key to a good national health policy.
“36% of disease burden in Australia in 2024 could have been avoided, due to modifiable risk factors.” – AIHW
While tobacco consumption has for decades been the largest driver of disease and death, we can celebrate that in 2024, for the first time, it is no longer the leading driver of disease in Australia.
From 2025 onward, the policy challenges with the greatest potential to improve our lives relate to food and other consumption behaviours.
As a community, public health advocates should focus on policy interventions to regulate what we consume, as well as to redirect the unhealthy social, commercial, and political forces that needlessly drive us into poor health.
Reducing the marketing of unhealthy food, sensible and honest food labelling, a health levy on sugary drinks, and funding programs that will help drive down rates of overweight and obesity are all achievable.
It’s time for all public health advocates to celebrate as the year ends. Congratulations and thanks to those public health champions who have played a role in driving progress towards a healthier Australia.
So please, everyone – take a well-earned rest before renewing the fight for more policy progress in 2025.
Image: Pexels / Kampus Production
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