Public Health invisible in the Victorian Budget

Terry Slevin and Anna Nicholson

As Victorians return to restrictions tonight to manage another COVID19 outbreak, now is the very best time to, as a matter of urgency, take a longer term view on the state’s capacity to respond to public health emergencies into the future.

The public health workforce generally prefers to appear invisible, as it can mean that what we are doing our job of preventing illness. But it is becoming clear we cannot afford to be invisible when it comes to pandemics and it seems increasingly, at budget time.

The Victorian government’s public health infrastructure has been under immense scrutiny during the pandemic, which uncovered shortfalls in the state’s public health workforce, training, and funding commitments. Much to our disappointment, the 2020 budget last year failed to address these issues.

This week, we welcome the establishment of three new senior positions in the Victorian Department of Health. Recruitment has commenced for two Deputy Chief Health Officer positions in Intelligence Case Contact and Outbreak Management for a period of 3 years and one Deputy Chief Health Officer position in Public Health for a period of 5 years.  These senior leaders are sorely needed.  But just as these are vital, so too is the need to create the training pathway for Victorians to take to effectively prosecute such important roles.

This pathway won’t be possible without new and substantial investment by the Victorian Government in its public health workforce.

Last week, the Public Health Association of Australia (PHAA) pored over the 2021-22 Victorian budget with initial dismay this critical investment had yet again been overlooked in a health budget that focusses on hospitals, paramedics and a further $1.3 billion to continue the state’s COVID-19 response.

The most we have been able to confirm from the Victoria Department of Health is that $39Million is committed to the operation of the new Public Heath Units. Exactly how that $39Million will be committed remains unclear. We have asked, and we welcome more detail.

These public heath units – if properly resourced and staffed – have the capacity to enormously contribute to the health and wellbeing of the people they serve.  They draw upon local knowledge, circumstances and relationships to quickly respond to local needs in a timely and constructive manner.

But skilled trained public health staff don’t grow on trees.

Since mid-way through 2020 when the state was hit by a second wave of COVID, there have been calls to address the shortfalls in the public health workforce in Victoria. No one doubts the state was caught short. And that occurred after years of neglect and disinvestment. But it truly beggars belief that the 2021 Victorian budget could not find a modest investment – we estimated around $5million p.a. when fully ramped up – to start to address the chasm of capacity of the state’s public health workforce.

Traineeships and training positions for medical and non-medical public health workers of today create the epidemiologists, biostatisticians, contact tracers, health communications specialists, data intelligence officers and other experts and leaders who address the public health emergencies of tomorrow.  Meetings, documents, plans and proposals have flowed.  But where are the dollars to match?

Let’s be clear, no investment in the Victorian public health workforce equals no capacity improvement for future state public health responses. This then puts Victoria at risk of a repeat of 2020 – or worse.  And there is still no end in sight for the current pandemic, as this week’s new  COVID-19 cases show.

Investment in a stronger public health workforce in Victoria also brings benefits in terms of addressing the enormous tide of non-communicable disease, which still looms large during the pandemic as one of Australia’s greatest health challenges. More than 70% of the burden of disease in Victoria is due to chronic diseases like cancer, cardiovascular disease, diabetes and the like, and a large proportion of these are preventable. Preventing COVID infections is possible through public health measures, and preventing many chronic diseases is equally possible with strong policy and funding commitments.

Less than a year ago, Victorians went into a lockdown that almost closed the state’s economy.  It is an experience that will be remembered for decades to come.

How could it possibly be that a Victorian budget is brought down in 2021 without addressing this fundamental area of health and wellbeing? It strikes us as a question every Victorian should be asking their government.  And the question should continue to be asked until it is adequately resolved.

Historically, public health only receives 2.2% of all health expenditure in Victoria. This figure is comparable to other states and territories, but is well below PHAA’s benchmark of 5%, or $1 in every $20 spent.

We will look with interest to how the 2021 Victorian budget’s newly announced Early Intervention Investment Framework for future budgets will be applied, and whether this will lead to increased expenditure on public health, and preventive health in particular.

Beyond the direct boost to public health, the 2021-22 Victorian budget includes a ‘transformative’ $3.8 billion for mental health reform, raised through a Mental Health and Wellbeing levy to be paid by businesses with more than $10 million in wages. This is one of several commendable measures that have been well received by peak bodies.

Other notable investments include funding three-year old kinder for every child in every local government area; free and public IVF services; continuation of the Doctors in Secondary Schools program; funding to reduce barriers in female participation in sport and local government; $21 million for walking and cycling (but $265 million for roads), and $46 million to introduce a zero-emissions vehicle purchase subsidy.

These are broadly welcome commitments with potential longer term public health benefits, but without a much-needed injection of funds into the state’s ailing public health workforce, Victorians will remain vulnerable to future public health crises in the pandemic and beyond.


Dr Anna Nicholson is the Victorian Branch President of the Public Health Association of Australia (PHAA) and Adjunct Professor Terry Slevin is the PHAA Chief Executive Officer.


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