Terry Slevin, PHAA CEO
At the PHAA Preventive Health conference in Melbourne In July 2019 the Australian Minister for Health Greg Hunt launched a project to create a National Preventive Health Strategy for Australia. After many months of expert input, drafting and consultation, the Government has now released the penultimate version of its work, the official draft of the Strategy.
It’s good. While most government health strategy documents can be dry and lack funded commitments, this 70-page text shows that a real understanding of population health and disease prevention, driven by social, economic, cultural and commercial determinants of health, has been grasped.
Commitment to funded programs is still lacking. The last round of state and federal budgets were a failure for disease prevention measures in Australia. The 2021 federal Budget is probably already being finalised now (March 2021), while this strategy is still unfinished. We remain hopeful but not certain that a genuine injection of resources into preventive health will be announced in the May budget.
Regardless of those all-important funding announcements, the conceptual directions being established are sound. There is much in this strategy document which should be welcomed and supported.
PHAA encourages all interested individuals and organisations to contribute to the finalisation of the Strategy, suggest improvements where appropriate, and to support calls for strong implementation and funded programs. When finalised, and assuming no major diversion from the core principles, we call for the National Strategy to transcend state-federal divisions of responsibility and to be given cross-partisan political support.
Some Selected Highlights
Recognising key importance of prevention:
[Page 4:] “Preventive health action is the key to achieving a healthier Australia by 2030…”
Recognising the problem of inequity in health:
[Page 8:] “Aim 3. Health equity for target populations. The burden of ill health is not shared equally amongst Australians. This Strategy will result in overall greater gains for parts of the Australian community who are burdened unfairly due to the wider determinants of health.
- Target: Australians in the two lowest SEIFA quintiles will have an additional three years of life lived in full health by 2030
- Target: Australians in regional and remote areas will have an additional three years of life lived in full health by 2030
- Target: The rate of Indigenous-specific general practitioner health checks increases 10% year-on-year across each age group”
Committing to prevention being at least 5% of total health expenditure:
[Page 8:] “Aim 4. Investment in prevention is increased. Health expenditure is currently spent primarily on the treatment of illness and disease. Investment in prevention needs to be enhanced in order to achieve a better balance between treatment and prevention in Australia, as outlined in Australia’s Long Term National Health Plan.
- Target: Investment in preventive health will rise to be 5% of total health expenditure by 2030.”
Recognising the central role of a public health workforce:
[Page 8:] “Principles: Enabling the workforce. The health workforce is enabled to embed prevention across the health system. Action must enable the health workforce to engage in promoting health and preventing illness through multi-disciplinary health care and utilising full scope of practice for all health professionals. This includes ensuring that the workforce is available, fully trained and capable of providing safe and responsive care.”
Recognising the essential role of the environment as a driver of health:
[Page 13:] “The natural environment … and the built environment … [both] play an integral role in shaping the health and wellbeing of Australians, especially the natural environment which includes climate change, extreme weather events, ultraviolet (UV) radiation, biodiversity, and air pollution.”
Recognising the enormous economic value of disease prevention:
[Page 20:] “Preventable ill-health is putting enormous pressure on the Australian healthcare budget. In 2015–16, the cost of healthcare goods and services was $10.4 billion for cardiovascular diseases, $8.9 billion for injuries and $8.9 billion for mental and substance use disorders. By preventing these conditions, governments can avoid future costs
to the healthcare budget related to managing the complex treatment and care of these conditions.”
Learning from past successes:
[Page 23:] “Australia is recognised as an international leader in many areas of prevention. There is much that we can learn from our past success to guide our future strategy. Success in prevention has not occurred by chance. It has involved sustained commitment by governments, passionate non- government organisations, community members and a determined response by members of the public. It has also involved long-term, multi-sectoral and multi-lateral partnerships to achieve continued success.
There are many positive stories in Australia when it comes to prevention, particularly our experience in tobacco control, our response to the HIV epidemic, skin cancer prevention, road safety, our introduction of national cancer screening programs, and our innovation in immunisation.”
[See also PHAA’s Top Ten Public Health Success Over The Past 20 Years.]
Recognising the need for a new funding mechanism, including a Prevention Fund:
[Page 32:] “The most effective preventive health efforts in Australia have come from evidence-based approaches that have received sustained investment and commitment by governments, the health sector and the community. Enhanced governance structures are required to create a more resilient prevention system. This includes:
- an independent, expert-led mechanism that will advise the Australian Government on current, emerging and future priorities in prevention; and
- a governance mechanism within Government, and across relevant portfolios, that have an influence on the health and wellbeing of Australians.”
[Page 33:] “The priorities for preventive health action are informed by a national, independent governance mechanism that is based on effectiveness and relevance.
- Preventive health and health promotion activities in Australia are sustainably funded through an ongoing, long-term prevention fund – rebalancing health action.
- The governance mechanism will provide advice on the direction of the prevention fund.”
Identifying and addressing conflicts of interest
[P 36] “Consistent with the WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases, public health policies, strategies and multi-sectoral action must be protected from undue influence by any form of vested commercial interest. Real, perceived or potential conflicts of interest must be proactively identified, acknowledged and managed for all aspects of preventive health work, not just in the space of preventing and managing chronic conditions.”
Policy Achievements by 2030. “Public health policies, strategies, and multi-sectoral action for prevention are protected from real, perceived or potential conflicts of interest through a national evidence-based approach and transparent stakeholder engagement processes”
Others may of course have other highlights! Many may wish to see further improvements.
Ultimately preventive health efforts will make meaningful progress when both good public policy and resources are committed. Many of the sentiments in the Preventive health Strategy are important and welcome. However, unless real action follows this is destined to remain another worthy document which does not advance the health of Australians one iota.
To make the final Strategy even stronger, contribute via the Department of Health consultation site by 19 April.
Terry Slevin as CEO of PHAA served on the Expert Advisory Committee contributing to the development of the National Preventive Health Strategy.
Terry Slevin is the CEO of the Public Health Association of Australia, and is also Adjunct Professor in the School of Psychology at Curtin University and Adjunct Professor in the College of Health and Medicine at the Australian National University.