The case for putting health promotion first

Developed countries abolished many debilitating illnesses through public health measures like sanitation and medical interventions like immunisation. But now other diseases plague these affluent countries, largely as a consequence of lifestyle. The current economic system doesn’t necessarily promote a healthier lifestyle. The things that make us unhealthy and inactive (fast food and cars, for example) sell far better than those that make us active and healthy, and it’s for this reason that VicHealth CEO Rob Moodie describes obesity as a "market success".

Within this system it is the industries that are focused on curing illness, rather than promoting health, which benefit. Many of these are powerful interests that will fiercely resist changes to the present healthcare system because they could lose profits and influence.

Political cycles

Promoting health through prevention strategies takes time. Former Cancer Council Victoria director Dr Nigel Gray had to present his case for a hypothecated tax on tobacco to eight health ministers before he found one who was sympathetic. Government ministers are unlikely to even notice policies that can’t demonstrate some kind of outcome within their political lifetime.

Right isn’t always might

Professor Wooldridge argues "in many cases public health advocates feel so passionately about the correctness of their cause that they just can’t understand why others can’t see the justice of their case". Past experience of promoting public health suggests that evidence, while important, is not enough. According to Dr Moodie, the skills required in public health today are more than the traditional specialist areas such as epidemiology and sociology. "Public health advocates also need to be able to work within existing political and economic systems, and understand how decisions are made and how to influence this decision making," he says.

Promoting health in the future

Australia’s current health care system is, according to the Productivity Commission, "beset by widespread and growing problems". One commentator argues "so much of the debate is about the funding of health services through Medicare when the real problem is a health delivery system which is badly out of date".

Dr Hall believes, while the Victorian State Treasury hasn’t yet followed the path of the UK, the economic case for reviewing the allocation of health funding to prevention is "on the agenda". Dr Moodie argues it is time for public health advocates to "invade the Treasury" and to highlight the potential returns of spending more on promoting health. Otherwise, it may take a full-blown health spending crisis before the benefits of spending more on prevention and less on cure become obvious.