This year has been indelibly marked by the public health crisis of COVID, and the public has had to take a crash-course in the prevention of infectious disease. Australians have quickly learnt to take simple preventive steps like increased hygiene and social distancing. Our political leaders have in most cases listened to the health experts who have advised them on controlling the spread of COVID-19. Countries where that has not happened have suffered disastrously.
All evidence and logic points to the prevention of disease as the best form of health policy when dealing with coronavirus and other public health issues, yet preventive policies and investments still remain elusive and sometimes entirely absent at the state, territory and federal levels.
The current ACT election campaign is a case in point. As hundreds of gaudy corflutes compete along the roadsides, and promises big and small are made about buses, trams and car rego fees, voters who have had their lives upturned by the pandemic might also rightly expect to see a more nuanced set of health policies proposed this election. But so far, they will be hard-pressed to find a single policy aimed at preventing illness.
Instead, we see run-of-the-mill, treatment-focused health promises. ACT Labor has pledged five new nurse-led walk-in centres at a cost of $2.5-$5 million each, in addition to 400 extra healthcare workers as part of a $240 million package. It claims this initiative is part of keeping Canberrans out of hospital. New hospital services for older people and a southside hydrotherapy pool are other proposals under a re-elected Labor government.
The ACT Liberal party is on the same track with its proposal of $5 million for a hydrotherapy pool at a wellness centre located in Deakin – which it similarly called a preventative health service.
Let’s be clear here, none of these policies are what public health professionals mean when they talk about prevention or keeping people out of hospital. These services are important in their own right, but they are not the sort of public health policies that will benefit Canberrans most.
Real preventive policy goes much further upstream and cuts to the core of what makes people sick. It targets things like unhealthy eating, high alcohol consumption and a lack of physical activity, or failing to receive early-life vaccines. It means creating a healthy environment for people to live, study, work and play in; and protecting the natural environment which is essential to our survival and wellbeing.
Where are the policies that strive to prevent some of our biggest killers such as cancer, diabetes and heart disease? Policies that exceed the generic targets for strengthening healthcare and hospitals and instead contribute to a flourishing and healthy ACT population that has a decreased need for these downstream treatment services? Comprehensive polices that will help to mitigate and adapt to the health impacts of climate change, or that will reduce alcohol consumption and drug use?
The ACT currently allocates around 2.5% of its health budget to prevention, and this amount has decreased proportionally in the last few years. Many OECD countries spend around 5% of their health budget on prevention, and this serves as a simple benchmark for where ACT funding should also sit. Canberrans pride themselves on living in one of the world’s best and most liveable cities, yet on this front we fall short.
Labor’s pledge of $200 million for youth mental health is positive, but it must be asked where is their same level of commitment to the other aforementioned areas of health?
We also need to ensure there is ongoing and coordinated investment in equitable public welfare systems and address the social determinants of health. Before the pandemic hit, more than 37,000 Canberrans lived in low-income households, which means that now there are likely to be even more people in the ACT struggling to cover basic costs. Social and income inequality translates into poor health, whether it is through lack of nutrition, increased alcohol and substance use, poor housing, or reduced access to health care, it leaves people more vulnerable to health issues in almost every way.
The ACT Liberals’ announcement that ACT needs a commission into poverty is not unwelcome; but it has to be asked what useful purpose it will serve in the absence of substantive policy that aims to address the structural drivers of inequality.
The ACT has been highly successful in containing the spread of coronavirus here, and this good work must be continued through listening to public health experts. But this workforce has been taken for granted in most Australian jurisdictions, and now more than ever we are seeing the need to boost it significantly through increased funding, training and resources.
Improving investment in the public health workforce advances the capacity to tackle the tsunami of chronic disease we face with our aging population. It also serves to allow us to better plan for and respond to future infectious disease outbreaks and readies us for future surge capacity needs.
If we are to successfully rebuild and improve our city after COVID-19, we must consider community health and well-being far beyond the traditional policy frameworks of disease treatment. The notion of prevention is nothing new in the world of public health – it is at the heart of principles for keeping a population healthy from the beginning of life. At a time when all Canberrans are stepping up to help prevent the spread of an infectious disease, it’s time our elected representatives similarly stepped up for prevention.
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.
Photo by Eliza Shields