Anna Nicholson
The 2020-21 Victorian state budget is a mixed affair for public health.
There is much to congratulate the government on, with what seems to be record investments in the social determinants of health.
VCOSS CEO Emma King described the budget as ‘inequality crushing’ , thanks to the bumper $5.3 billion on social and affordable housing, $870 million for mental health, relief for power bills, extending state-supported care to the age of 21, and a jobs and training package that prioritises women and young people. In particular, the ‘big build’ will result in a 10% increase in social housing in the next four years.
Direct public health expenditure is mostly limited to pandemic response and recovery, with a whopping $2.9 billion for COVID-19 response and a further $5.2 million to create a single digital solution to Covid-19 reporting.
The coronavirus pandemic has placed the public health workforce in the spotlight like never before. Before this year, few people outside the public health community knew about the roles of epidemiologists, vaccine researchers, public health advisors, or the myriad other workers involved in advising on and implementing Australia’s covid response.
The pandemic has also exposed the chronic underfunding of public health in Victoria. Investment in a recovery workforce is commendable, with new positions and training programs in mental health, child protection, alcohol and other drugs, family violence and sexual assault, and targeted support for Aboriginal Community Controlled Health Organisations are all very welcome. However, as best we can tell with the level of detail available, the 2020-21 budget provided very little investment in the public health workforce more broadly.
We have been informed that $88.9 million (of the $2.9 billion budget line labelled Covid-19 response) for 20/21 is for public health units. And that “this includes training of staff for the public health units specifically”. The difficulty is that line falls off quickly to $37M in 21/22 and $6m in the following two years. It is difficult to see ongoing funding for regional Public Health units being covered by those amounts. Perhaps these funds are elsewhere in the budget, but that remains unclear.
This seems a missed opportunity to acknowledge the phenomenal contribution of the public health workforce in Victoria, as well as to correct chronic shortfalls in training and investment. PHAA CEO Terry Slevin has highlighted several ways that this could occur, including structured public health training programs and placements. There is also an opportunity to equip newly established Public Health units with the mandate and skills required to act on health promotion and prevention, as well as the control of communicable disease.
Although the 2020-21 budget goes some way to building back better, including through investing in the root causes of inequality, it does little to support a long-term agenda of public health capacity, health promotion and prevention. We know that investment in public health is essential to reduce the burden of non-communicable and communicable disease.
Next year, PHAA Vic Branch will launch a new 5% prevention campaign, Focus on Five, calling on the state government to increase investment in public health expenditure to 5% of the health budget (or 1 in every 20 dollars). This commitment is essential for a more effective and sustainable approach to health expenditure.
PHAA Vic Branch invites PHAA members in Victoria to join our Focus on Five committee. For more information, contact Bronwyn Carter: Bronwyn.Carter@latrobe.edu.au
Dr Anna Nicholson is the President of the PHAA Victoria Branch. She is a public health practitioner from regional Victoria. Anna has a background in public health research, policy and program evaluation, and systems interventions for chronic disease prevention. Anna completed a PhD in public health at Menzies School of Health Research in Darwin in 2016.