Terry Slevin – PHAA CEO
What if Australia invested in Preventive Health? A reflection on the 2022 Budget
If well researched strategies for preventive and public health stated in the 2021-2030 National Preventive Health Strategy were to be given credence, and be implemented, it would have been reflected through investments announced in the 2022 Budget.
If the Australian Government thought that public and preventive health investment, and its economic benefits were important, it would have been clear in the 2022 Budget.
If they had applied the clear logic that building fences at the edge of a cliff (prevention) is better than just placing more ambulances at the bottom, then it would have been clear in the 2022 Budget.
It’s unfathomable that, while passing the two-year anniversary of COVID-19’s global pandemic declaration, the clear link between preventive health interventions (including vaccinations), and the economic wellbeing of people in Australia, was either given a short-term lifeline, ignored, or brushed aside by the Australian Government.
Preventive health investment could bring $3.5 billion net revenue
Our pre-Budget submission, showed the potential for modest public health expenditure to give $3.5 billion net revenue. Through shortages in food, workforce, RAT tests and more, COVID-19 has shown that to have a healthy economy, we must have a healthy population.
The message could not have been clearer: Off the back of a pandemic that changed the world, which is continuing with over 50,000 cases a day reported in Australia this week, NOW is the time to be prioritising public and preventive health.
National Preventive Health Strategy
A recent and important public health strategy is the National Preventive Health Strategy (NPHS). Released in December 2021, the NPHS – in its own words…
“….presents a powerful opportunity for Australia to build a sustainable prevention system for the future – building on previous successes and momentum, addressing the increasing burden of disease, reducing health inequity and increasing preparedness for emerging health threats.”
Coinciding with a once-in-a-century pandemic – which shows no signs of abating – preparedness for emerging health threats seems a worthwhile and legitimate challenge to lead the priority list.
Other priorities listed by the NPHS are also vital, albeit less linked to communicable diseases. For example,
- Better Start in Life – improvements in the proportion of young people (under 25), children and Aboriginal and Torres Strait Islander babies living in full health
- All Australians live in good health (at least an additional two years in full health)
- Health Equity – Priority populations live an additional three years in full health, including people living on low incomes; living in regional and remote Australia, and Aboriginal and Torres Strait Islander peoples.
What priorities did the NPHS articulate, and what might the investment look like if the Australian Government meant to achieve it?
Preventive Health lens on the 2022 Budget
Assessing the 2022 Budget through the lens of the National Preventive Health Strategy 2021-2030, we compared the Strategy’s priority areas, and the potential investment opportunities available to implement these, with the actual investment announced in the 2022 Budget on 29 March 2022.
Here are a few examples of NPHS priority areas, investment opportunities for each area, and the corresponding Budget announcements.
5% of health expenditure for prevention and public health
Investment Opportunities:
- In 2021/22 approx. $98.3 billion was spent on health by the Australian Government. Of that, less than 2% was spent on public and preventive health (approx. $1.966b).
- To reach 5% by 2030 for prevention and public health (in 2022 dollars), the 2030 amount invested would be $4.915b.
- To progressively move to that target, investment in prevention and public health must increase by 15% pa (i.e. $2.27b in 2022/23).
- In the 2022/23 Budget, this would mean an additional $295m would be available to meet the cost of implementing much of the other NPHS strategy areas.
2022 Budget Announcement: No evidence of meaningful increased preventative health expenditure.
Ensure the best possible allocation and use of the boosted investment in preventive health through a “governance mechanism”
Investment Opportunities: Establishment of the NPHS Implementation Program ($3m pa)
2022 Budget Announcement: Zero evidence of investment.
Tobacco and nicotine addiction, Tobacco revenue measures
Investment Opportunities: National Tobacco Campaign ($46m pa), National Smoking Cessation Strategy ($10m pa), and equalising the excise tax on the “roll your own” tobacco plus adding 12.5% to current tobacco excise would generate on average $609m pa over the next 4 years.
2022 Budget Announcement: Zero evidence for investments
Improving diet
Investment Opportunities: National Livelighter program ($40m pa)
2022 Budget Announcement: National Nutrition Strategy ($0.7m over 4 years), and a study on unhealthy food and drink advertising aimed at kids ($0.5 million over two years).
Improving diet revenue measures
Investment Opportunities: Introduction of a sugar-sweetened beverage tax would reduce consumption of energy dense nutrient poor sugary drinks and generate much needed revenue at a level of approx. $700m pa.
2022 Budget Announcement: Zero initiatives announced.
Improving Immunisation coverage
Investment Opportunities include developing the National Immunisation Strategy (2019-24) implementation plan ($5m), and National Immunisation Program investment to strengthen the program and its service delivery, and community engagement and participation ($30m pa)
2022 Budget Announcement: Zero announced.
Public Health Workforce measures
Investment Opportunities: To establish a national Public Health Officer Training Program (PHOTP) to serve the entire population, and ensure a pipeline of training for the next generation of public health experts ($50m pa)
2022 Budget Announcement: Zero announced.
A note on an Australian Centre for Disease Control and Prevention* (not part of the NPHS)
While an Australian Centre for Disease Control and Prevention was not part of the NPHS 2021-2030, for over a decade PHAA and other organisations have been advocating for better coordination and management of communicable diseases, with a CDC model having a range of benefits. Estimated cost when fully established is $200m pa.
2022 Budget Announcement: Zero announced.
Positives for Prevention
There were other positive initiatives announced in the 2022 Budget to help implement the NPHS in specific areas, including $40.7m over three years for bowel, breast and cervical cancer screening, money for alcohol and drug services, and other public health issues, including funding for a study on unhealthy marketing to children, and physical activity initiatives.
However, the amount of investment announced goes nowhere near far enough to mitigate and prevent the increasing burden of a wide range of diseases in Australia.
Other initiatives announced in the 2022 Budget seem to be positives related to preventive health and the NPHS. This includes investment to make telehealth permanent, and investment in suicide prevention initiatives, but these deserve closer scrutiny from those more expert in these fields to determine their true strengths.
Read Mental Health Australia’s media release regarding the 2022 Budget, and the announcement of $46.7m for Suicide Prevention initiatives here.
Read Royal Australasian College of General Practitioners’ 2022 Budget media release here.
Read the National Aboriginal Community Controlled Health Organisation (NACCHO)’s media release on Aboriginal and Torres Strait Islander Health in the 2022 Budget here.
What has the Australian Government really learnt from COVID-19?
Despite the salutary lessons of the COVID-19 Pandemic and its impact on Australia – and the world – the 2022 Budget demonstrates no real commitment or long-term view of advancing public health in Australia.
The absence of meaningful financial commitment to major sentiments expressed in the National Preventive Health Strategy (NPHS) leaves yet another worthwhile plan unfulfilled.
The failure to invest in the long-term health of people living in Australia will have ramifications for current and future generations.
The repeated assurances from government that there will be investment in public and preventive health have come to nothing.
Whoever forms government come 2022 election night must not ignore the crucial area of public and preventive health, and the opportunities it provides for both health and economic wellbeing.
See other Budget-related Intouch posts:
- Where will the 2022 Budget take us?
- Public health measures can help balance the Budget
- Building a national approach to preventive health investment
- Before hitting the brakes on unhealthy products, let’s take our foot off the accelerator