Curing an ailing system

In late June Kevin Rudd and Nicola Roxon released Labor’s health policy Fresh ideas for Health and Future economy (The Age, June 29, 2007) which focused on preventative health care. It was immediately labelled as a wish list by Tony Abbott.

Well, what should we be wishing for in our health system? Given it’s an election year what should we be demanding from our political leaders to improve our health?

Let’s start with having a health system, not only an illness system - one that actively creates good health from birth and maximises our health to the grave.

It needs to be smart, balanced, fair and simple. Let me explain.

Smart

We need to drastically change our systems thinking. Our money and effort is focused on illnesses after they’ve happened. We now need to ask at every step in the chain of illness, how could have this been avoided or prevented? How can, for example, the complications of diabetes be minimised if they occur; if they haven’t occurred then how can they be prevented; and how can the diagnosis of diabetes be prevented in the first place?

Smart systems prevent. We have had some great promotion and prevention successes in Australia - immunisation, tobacco control, road trauma, cancer prevention, reduction of cardiovascular disease to name a few. And they have had great results at very reasonable cost. But we only invest less than 3 per cent of our health budget on organised health promotion and prevention programs.

The Labor policy’s focus on preventive health care seems to be a move in the right direction. For example, it talks of one of the blue chip investments in health - tobacco control. It quotes Susan Hurley’s work showing that a 5 per cent reduction in smoking prevalence will save $1 billion from the Commonwealth coffers over the long term. So will Labor invest $100 million in anti-smoking programs needed to get the 5 per cent decrease, save the $1 billion and save an enormous amount of death and disease?

Early family life and early education have profound effects on our health. Smart systems invest heavily in early childhood development - which is not only in maternal and child health services but in universal child care, kindergartens and public primary education.

Smart also means investing in research and development - the amount invested in health services research (to know what can be improved) is miniscule compared to the budgets of the hospital systems. It means investing into researching the causes and solutions to our epidemics of physical inactivity, poor nutrition and their consequences of diabesity.

Balanced

This is the art and politics of health. We need both public and private funds to support our health system. Our publicly funded health system needs to be maintained and enhanced - universal cover for treatment, care and prevention services, complemented by targeted programs for those with the poorest health.

Look to the US and we see a system out of kilter, publicly under-funded with the private system driven by voracious pharmaceutical and technology companies. Among comparable countries they have the highest costs of services, it is the least fair and has the poorest outcomes. We need the private system in Australia, but complementary to a supported and valued public system.

If you are ideologically opposed to a public system the best way to make sure it doesn’t work is to under fund it. There has been a sad and entirely preventable rise in poor dental health since the Commonwealth government pulled out its dental health scheme - and of course it has impacted most on the poorest.