Adjunct Professor Terry Slevin, CEO, Public Health Association of Australia
In 2006 then Shadow Minister for Health Julia Gillard gave a landmark address to the National Press Club of Australia (NPC) where she outlined Labor’s vision and commitment to prevention in Australia. 17 years later, the Australian Labor Party could realise this vision with the establishment of the Australian Centre for Disease Control (ACDC).
Unfortunately, however, many of the challenges and opportunities that Gillard spoke of in 2006 remain true today. Take for instance the underfunding of prevention relative to overall health expenditure. This issue must be addressed as part of, and in conjunction with, the ACDC’s establishment, to improve Australians’ health.
In 2006, Gillard said:
“PREVENTION can be the cure to many of the problems we face today – it holds the key to a successful response to demographic change and it is the key to the sustainability of our health budget…
“Yet despite the evidence of the long-term returns from investing in prevention, the majority of public spending still goes on treating existing problems when they become chronic conditions…if we truly seek to address fiscal sustainability, we need to change the mindset which currently sees billions being spent on managing diseases rather than preventing them in the first place.”
Almost two decades later, inadequate spending on prevention is still a challenge. Even during the 2020/21 financial year, as the pandemic was getting into full swing, total Government spending on public health was, according to the AIHW just 3.7 per cent of the total health budget, well below the modest 5 per cent recommended in the National Preventive Health Strategy.
A health system centred on prevention
Gilliard also emphasised that prevention must be at the centre of the healthcare system.
“It is time to move PREVENTION from the periphery to the centre of the health system. It can be done and is happening in other countries.”
She cited an example from the UK where “preventative health programs now have their own goals, targets, budgets and economic analyses to support them, separate from but integrated with the health care and treatment system.”
If our current Labor Government believes this should still be the case then, prevention also needs to be at the heart of the ACDC, with accompanied sustainable funding, measures, and targets.
“Aussie kids at its very heart”
The Hon Gillard went on to say, “A health system with prevention at its centre would have the health of Aussie kids at its very heart.”
Gillard used the speech to launch Labor’s 2006 Blueprint on Children’s Health Policy, Goals for Aussie Kids. Gillard recognised that setting children up with good health from birth was crucial. The ethos she articulated aligns with many of the current goals of Australia’s National Preventative Health Strategy 2021-2030 that we’ve yet to see fully enacted.
Gillard said “Some of the goals can be delivered in their entirety within a relatively short time. Other goals will require incremental implementation over a longer time frame. The most aspirational and inspirational of these goals will require long-term commitments and may only be fully achieved over a generation.”
The long-term aspect of preventive health (that results might not be seen for many years) means it’s often difficult for governments to enact effective preventive health policies, and also have them stick.
Could the ACDC be part of a preventive health legacy?
Many incumbent Australian Governments have been involved in advancing several preventive health initiatives in Australia, including while Labor has had the balance of power.
Take some of the preventative successes of the last couple of decades. The nation’s longest serving federal Minister for Health, Neal Blewett (minister 1983-90), is rightly acknowledged as overseeing the birth of Australia’s successful policy towards HIV in the 1980s.
The National Cervical Screening Program (NCSP) was introduced in 1991 during the Hawke/Keating governments under Health Ministers Neal Blewett and Brian Howe. By 2002, it had reduced the incidence of the disease by half (from 13 to 7 cases per 100,000 women).
Major advances in tobacco control, including increases in tobacco excise and the introduction of plain packaging were made by the Rudd and Gillard Labor Government, with Nicola Roxon and later Tanya Plibersek as Health Ministers. These policies are widely acknowledged as helping drive down smoking rates.
Current Health Minister Mark Butler has already demonstrated a commitment to prevention through major announcements in tobacco control funding and tackling the challenges of e-cigarettes in his own press club address.
When PM Anthony Albanese promised to establish a ACDC as a part of his pre-election campaign, he laid down an opportunity for his Government to own a landmark legacy in health in Australia. According to the pre-election commitment, the organisation “will work to prevent non-communicable (chronic) as well as communicable (infectious) diseases”.
And as stated now on the Australian Department of Health & Aged Care’s ACDC webpage, “The Australian CDC will also provide national leadership in preventive health across both communicable and non-communicable diseases.”
Creating an Australian CDC will not only bring us up to speed with other OECD countries who have a dedicated disease control entity, it’s also an opportunity for us to bring prevention to the heart of how we manage health in Australia, including enacting and funding the National Preventative Health Strategy.
As Gillard so succinctly said 17 years ago, “Prevention is important because it improves and saves peoples’ lives. No-one wants to be sick or to die before their time.”
We hope that as the final touches of the establishment of the CDC are thrashed out in the coming months, that the words of former PM Julia Gillard around PREVENTION are echoing in the Governments’ ears.