Terry Slevin
The Australian Government is currently consulting on its National Preventive Health Strategy. The most important message they need to hear is that It’s Time for Action.
The establishment of a process to develop the Strategy was announced with some fanfare at the PHAA’s Preventive Health conference in Melbourne in June 2019. In my capacity as PHAA CEO, I was happy to be invited to be among 25 members of an expert steering committee. Consultations were held in various parts of the country – remember when we used to fly around and physically gather in big rooms to talk about such things! – on a range of topics within the scope of the strategy and consultation documents were circulated with input invited.
All that work has resulted in a draft Consultation paper on which further input by all people is invited through a series of questions. Reading the paper, there are some important principles articulated to form a valuable strategy which we all hope will boost the investment in and action on preventive health in Australia.
PHAA invited its members to contribute to its response to the Consultation paper, and several dozen subsequently became involved, highlighting that many believe this an important opportunity. The views of PHAA members are many and varied; most members have a detailed level of expertise in particular aspects of public health, and they are of diverse backgrounds and experience. This leads to a kaleidoscope of ideas on how preventive health should look in Australia, but one theme is overwhelmingly consistent: no more mere words, it’s time for action!
Actions speak louder than words
Almost everyone has expressed some form of ‘strategy fatigue’. No one wants to look back in 12 or 18 months’ time and conclude that yet another glossy document full of high-minded ideas had been produced, only to gather dust on shelves or occupy a spot on a website somewhere along with many other long forgotten unenacted strategies.
In my own participation in this strategic process, one core theme that I have promoted from the beginning is the need for a real investment, and a related implementation mechanism for public and preventive health.
Governments have the capacity to advance the interests of the people they serve in a range of ways, but they primarily come down the policies they enact, and the investment of public resources that they choose to make. This is a clear case where a boost in funds for preventive health efforts is essential.
We have written in many places about the need to an improvement in the paltry 1.6% of Australian health dollars currently committed to public and preventive health. Yes, less than $2 in every $100 spent on ‘health’ in Australia goes towards actually maintaining good health – the rest all goes toward treating illness. It was never a sensible balance, and is especially ludicrous as we battle the health crisis of the century in COVID-19.
One remarkable takeaway from how we as a people have reacted to COVID is that we are prepared to wear many privations – economic costs, restrictions of liberty, changed working patterns, family separation – to protect health and wellbeing. Governments should set their strategies in response to the underlying values of society, and the message here is clear: people place a very high value on human health. Why then, were we running a sub-2% rate of preventive investment in health and calling it a ‘health system’?
There is no political barrier to changing this. The Sustainable Health Review conducted by the Western Australian Government in 2018-19 resulted in a target of 5% of the state’s health budget being committed to preventive health efforts by the year 2029. No-one has suggested there was any political downside to their approach. It sets a clear, achievable target to rebalance WA’s health system and ensure the resources necessary to boost preventive health efforts are available.
All jurisdictions, including the Australian government, can and should follow suit. The public will reward such policies.
How does strong implementation work?
Implementation is not just about short-term money decisions. It’s a scientific process that needs to unfold reliably over multiple years through steady, sustained resourcing that is matched with evidence-based decisions and evaluation. Any boost in investment requires the means to ensure it is channelled appropriately.
Australian leaders have designed such enduring policy solutions in the past to great benefit. The Pharmaceutical Benefits Scheme (PBS) and its independent expert overseer of proposed medicines, the Pharmaceutical Benefits Advisory Committee (PBAC), is a tried and tested model that PHAA has promoted as part of a new approach to preventive health implementation. A similar entity to the PBAC for preventive health would guide decisions on the best investments, and its recommendations would be implemented by machinery designed to give effect to decisions.
This model would require commitment and ongoing maintenance with reliable funding – preventive health results do not happen overnight. Many years, if not decades, of work are required to achieve important public health outcomes. This is clearly shown in PHAA’s 2018 report, Top 10 Public Health successes over the last 20 years.
Just as the PBAC manages our investment in pharmaceutical drugs, independent panels maintain the Medical Benefits Schedule at the heart of Medicare, and the NHMRC and MRFF manage our national investment in health research, we need a long-term commitment to the government machinery to assess, allocate and sustain vital preventive health investments.
What to focus on
Prioritising areas of focus for preventive health investment will be ongoing. We can and will spend a lot of time and energy debating priorities in important areas that the strategy consultation paper mentions like obesity, cancer screening, tobacco, alcohol, skin cancer prevention, and many more. But what is essential first is to set up the principles by which the decisions are made, and then ensure they are prosecuted by an independent expert group with the capacity to assess needs and provide evidence-based recommendations.
Some of these principles are emerging in the consultation paper. Strategic priorities such as focusing on those with the greatest need, early childhood, ensuring coordination across government, influencing and working with the systems which drive health outcomes, are already mentioned.
Other issues, such as the pervasive health effects of climate change, are currently underemphasised in the strategy development. The inclusion of mental health and suicide prevention in strategies about our overall wellbeing is also undercooked. And the vital national imperative to focus on providing Aboriginal and Torres Strait Islander people with the opportunities and resources to create their own healthy communities deserves more emphasis.
But all of these areas of focus inevitably link back to how well the resourcing and implementation mechanisms work. That’s what PHAA members are clearly saying – whatever specific area of health expertise we come from – we all have an interest in making government and its processes adopt a strong culture of implementation, implementation, implementation.
Keep going, government
PHAA supports what Minister Greg Hunt and the Australian Government is doing here, and we also welcome that it is attracting support across the political spectrum. We will always keep supporting the development of good strategy for preventive health by all policy leaders.
Because without a healthy society, any vision for a strong economy and quality of life for us all will be incomplete. The pandemic has made us all appreciate how much our health is an essential building block to the rest of our lives.
So, let’s get the words right. But action, REAL action, in the form of investment, is the vital next ingredient.
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.