The case for putting health promotion first

Information is important and there is a valuable role for social marketing campaigns. But, as data on health and deprivation consistently highlights, access to nutritious and affordable food, rewarding jobs, decent housing, and parks and other places where people can enjoy outdoor recreation are also fundamental to improving health. This will take more than a few punchy TV advertisements. "Health goes with wealth", and deprived areas are often without the facilities, services and jobs that make for good health.

Dr Hall argues that the capacity of individuals to lead healthy lives is determined by their socio-economic and cultural circumstances and that these must be "addressed directly". All government departments need to understand the role they have in contributing to the health and wellbeing of all of the population. There also needs to be better integration between different levels of government.

The Department of Human Services is currently working with local councils on a Health Impact Assessment developmental program to help understand the health implications of decisions made locally. VicHealth’s work on promoting the role of urban planning in improving health is another example of the cross-departmental links that can lead to governments taking action to help individuals make healthier choices.

There needs to be more evidence of "what works", both for medical treatments and public health interventions. This will be important as the proportion of public money spent on health continues to rise.

Current barriers to promoting health

The Federal Government itself acknowledges "when it comes to saving money on health, prevention can certainly be better than cure". So why is there such a mismatch in health spending? Decades of experience in trying to increase the role for promoting health points to a number of answers.

Intervention versus individual choice

Suggesting what people should eat or how they should exercise can quickly lead to accusations of a "nanny state" where individuals are pressured into living in a certain way. There is a presumption that governments have little room to manoeuvre when it comes to promoting healthy lifestyle choices.

However, research in the UK on consumer attitudes to health suggests that individuals are not concerned about being involved in decisions about health spending. Niall Dickson, Chief Executive of the King’s Fund, which carried out the research, points out that people "did not oppose government intervention and the 'nanny state' debate. What most people want is a sensitive balance between encouragement, enabling, exhortation and enforcement".

Media watch

An awkward dance happens between the media and government where both accuse the other of failing to make more progress on airing public health debates. The media sees itself as reporting what the public wants to know, while government believes it is at the mercy of a press that won’t report news that isn’t headline grabbing.

Former federal health minister Michael Wooldridge argues if there isn’t a clearly identifiable victim to a health story - "which is the case in most of public health" - then it is "very hard to get any media". Nor is the vision, so essential for television, as compelling for public health. There are no dramatic shots of doctors running along corridors and ambulance helicopters ferrying patients to hospital.

Powerful interests