An election on health lacking vision beyond hospitals: why Victoria must invest in Public Health and prevention

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Image on left says "#Vote For Public Health, six priorities to ensure Victorians are healthy in future." On the right are the logos of the PHAA, Australian Health Promotion Association, and the Australasian Epidemiological Association.

PHAA Victoria Prevention Subcommittee

The PHAA’s Victorian branch, in partnership with the Australian Health Promotion Association and Australasian Epidemiological Association, have released their 2022 Victorian Election Scorecard. This assesses the policy platforms of the major parties – Labor, the Coalition (Liberal/National) and the Greens  – against our joint Election Platform, which seeks a commitment to six key public health priorities:

  1. Invest 5% of total government health expenditure on preventive health by 2030.
  2. Commit to a minimum of five-year funding for Local Public Health Units (LPHUs) to deliver local health promotion, protection, and prevention activities.
  3. Develop a Victorian Public Health Officer (PHO) Training Program.
  4. Invest 5% of total government mental health expenditure on prevention by 2030.
  5. Support the self-determination of Aboriginal Community Controlled Health Organisations.
  6. Establish a state-based Victorian Sustainability Health Unit.

Although billed as an election contingent on health policy, with major parties engaging in a “health spending arms race,” it is disappointingly apparent that there has been inadequate consideration of public health and prevention.

Preventive health investment

Currently only 2% of the health budget is invested in preventing illness and disease. Although a new hospital may seem an important announcement, the current pressures of the acute care system (on both patients and staff) demonstrate the value of prevention as an evidence-based way to avoid the need for hospitalisation. It also supports community health and wellbeing. Reorienting the health system towards prevention is cost effective, with the return on investment of $14 for every dollar invested in public health initiatives.

As celebrated in PHAA Victoria’s Ten Successes to Guide a Healthier Future Report, public health achievements improve the lives of millions in Victoria by preventing premature death and morbidity. Unfortunately, none of the major parties’ policies align with this recommendation.

Local Public Health Units

Disappointingly, some major lessons from the COVID-19 pandemic have not been fully funded or enacted. For example, LPHUs were introduced in October 2020 to support a new model of decentralised public health response to COVID-19, but the current government has not budgeted funding beyond June 2023. We welcome that LPHUs have been given remit to expand their scope to include locally tailored health promotion and prevention efforts. However, they need long-term funding certainty to become established pillars of the Victorian health system, and to attract and retain the public health workforce.

Victorian Public Health Officer Training Program

Similarly, while the pandemic showed a public health workforce shortage in Victoria, there has been no funding or development of a PHO training program. The current Victorian Public Health Medical Training Program admits just two medical officers per year. The national Finkel review into contact tracing recommends that all states and territories employ a permanent highly trained workforce for contact tracing and outbreak management, as well as an additional surge workforce that is trained and ready for public health emergency response. Indeed, PHO trainees play an important role providing surge capacity in other jurisdictions’ public health emergency responses.

PHAA Victoria estimated that a three-year training program to support at least 10 medical and non-medical PHOs per annual cohort would cost only $7 million per annum. Comparatively, according to the Victorian Parliament’s Inquiry into COVID-19, a six-month contract with Helloworld, an Australian-based travel company, to provide contact tracing call centre services was valued at $7.62 million and did not go to public tender. A PHO Training Program would represent a long-term investment into rebuilding a stronger multidisciplinary public health workforce, and supports the development of the next generation of public health leaders. Despite these benefits, as seen in the scorecard, the major parties have not fully committed to ongoing funding for LPHUs or a PHO Training Program, although the Greens stated that they will provide in principle support.

Mental health

The recent Royal Commission into Victoria’s Mental Health System called for protected funding to tackle the underlying causes of mental illness and to keep our community mentally well. Mental health conditions are increasing in prevalence, particularly among young people, with 39.6% of those aged 16-24 years reporting a mental health condition in the last 12 months (up from 26.4% in 2007). These impacts have likely been compounded by the COVID-19 pandemic and health protection response.

To address the crisis uncovered by the Commission, and ensure our mental health system can meet future demand, wherever possible we need to do more to prevent mental health conditions from first occurring. The establishment of a Mental Health Promotion Office in the health department, and a Statewide Wellbeing Plan is a good start, however their increased funding is essential to improve the mental health and wellbeing of all Victorians.

As the scorecard demonstrates, while the Greens recognise that prevention of mental health conditions is frequently overlooked, they made no specific funding commitment. Neither the Labor nor the Coalition parties’ election platforms made any specific commitments towards investing in 5% of total government mental health expenditure on prevention.

Aboriginal Community Controlled Health Organisations

Self-determination is a fundamental requirement to achieving health equity for Aboriginal and Torres Strait Islander communities. This can manifest through Aboriginal Community Controlled Health Organisations (ACCHOs), which play a vital role in the provision of culturally safe and effective healthcare. The lifetime health results of interventions delivered by ACCHOs is 50% greater than mainstream health services. On average, investment in ACCHOs is extremely cost effective with the cost-benefit of $1.19 per dollar spent, though in remote areas this can be up to a four-fold improvement.

Both in Victoria and in other jurisdictions, ACCHOs played a key role in supporting successful pandemic responses to COVID-19, demonstrating the primary importance of self-determination and community-led leadership. There should be a bipartisan commitment to ongoing and sustainable investment in and support for the ACCHO sector. However, as the scorecard highlights, only the Greens have a policy commitment to support Victoria’s Aboriginal Community Controlled Organisations.

Victorian Sustainability Health Unit

Climate change represents this century’s greatest global health threat.,Not only because of the urgent need to adapt to climate crisis-related health harms here now, but because of the requirement to simultaneously rapidly transition to a zero carbon health system. Australia’s health system contributes about 7% of the national carbon footprint, of which 44% is derived from public (34%) and private (10%) hospitals. To date, Australia’s transition to renewables remains unacceptably slow. In just the last two years Victorians and our health system have had to respond to two unprecedented climate change related catastrophes: the 2019-20 summer heatwaves, bushfires, and associated lingering smoke, and the 2021-22 torrential rains and floods.

Following the global best practice model of the United Kingdom’s Greener NHS Programme, and interstate examples in Western Australia and New South Wales, Victoria should establish a Sustainability Health Unit. This Unit can lead a coordinated, state-wide approach to monitor and decrease carbon emissions from the health sector to reach net-zero by 2030. As noted in the scorecard, only the Greens’ Election Platform includes a plan to create a sustainable Healthcare Unit in the Department of Health to tackle hospital waste, cut healthcare emissions, and transition hospitals to 100% renewable electricity by 2030. Neither Labor nor the Coalition have any specific commitments towards establishing such a unit.

All Victorians should be supported to live healthily in communities and environments that support them to remain well. While the headlines continue to focus on the acute care system, the current political discourse fails to prioritise sustainable and long-term public health investment. Gaps and failures in public health policy and prevention this election cycle almost inevitably contribute to future acute care needs. We urge you this November to #VoteForPublicHealth.

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