Stopping the river of illness at its source

Despite all the sophistication of our healthcare system, and our high living standards, we are a country facing some very serious health problems.

Ever increasing girths, more people requiring treatment for life-threatening illnesses such as diabetes and cancer, an explosion in alcohol related injury, and increasing rates of depression. How come we didn’t get on top of these “epidemics” before they emerged?

For all the surgery, weight-loss programs, vitamin supplements, appetite suppressants, anti-depressants, marketing campaigns for low fat foods, and all manner of therapies, the evidence is staring us in the face … many of these problems are getting bigger.

Like many countries, the issue is we waited until the problems emerged and now we are scrambling to put into place the prevention approach required. And because we are dealing with large numbers of people at immediate risk of illness and disability, our prevention efforts are focused on keeping these people out of hospital.

What can we learn from the successful prevention efforts of the past to rein in the health problems of today?

We have shining examples of success: HIV-AIDS prevention efforts of the 80s and 90s contained the spread of a virus that in other parts of the world had a devastating impact on their populations; our road safety programs have reduced the road toll by about two-thirds over the past 30 years; our tobacco control efforts have been shown to keep people out of hospitals and save the healthcare system at least $500 million every year; and coronary heart disease deaths have fallen by more than 60 per cent in the past three decades.

More than $50 billion is spent nationally on coping with chronic diseases, many of them largely preventable, such as depression, heart disease, cancer and diabetes.

If we start to apply the lessons we have learnt from past prevention efforts to the big health issues of today, we might actually be able to turn around the health prospects of Australians.

These successful prevention programs applied a mix of awareness and education campaigns, policy and legislation changes to help protect people from exposure to harm, and provided additional counselling and support for people who needed it. We used the tax system to discourage use of harmful products like tobacco and kept taxes off products like condoms which saved lives.

Importantly, they were all funded at significant levels over a long period of time, and were carefully monitored and evaluated for their results.

These efforts also involved strong partnerships between governments and with the non-government organisations like AIDS Councils, the Heart Foundation, Quit and statutory organisations like VicHealth and the TAC.

If we really want to get serious about prevention of illness, we need to increase resources dedicated to prevention and health promotion programs. According to the Australian Institute for Health and Welfare only a tiny fraction of Australia’s 2005-06 health budget was spent on public health (2 per cent), despite the fact that many of the most cost-effective approaches are the prevention approaches.

The vital question is: how to achieve a better balance between curative health and the range of prevention and health promotion activity required to halt the tragedy of unnecessary illness unfolding before us?

Re-directing money and energy from healthcare to health is challenging because we have come to expect a hospital bed and affordable treatment when we need it. But we need to stop the river of illness at its source.

The recent announcement by the Victorian Government of a world-first workplace health screening program, to be funded by WorkSafe surplus funds, is a great example of leadership and a creative solution to finding additional funds for prevention. The country is in great need of these kinds of partnerships that provide additional funds, and take us outside of a narrow healthcare system paradigm.

We need leadership that can help us achieve a vision for better health. This vision needs to embrace more than the effective management of those who are already ill or at immediate risk. A “system for health” must provide us with mechanisms for increasing investment in promising health promotion initiatives and build the evidence for what works best.

The National Prevention Summit held in Melbourne on 9 April was launched by the Federal Minister for Health and Ageing, the Hon. Nicola Roxon. It established a set of principles to guide an approach to prevention that will facilitate not only healthcare reform, but also a broader community approach.

Now more than ever, we need to draw on the creative insight of leaders from all around the country from a wide range of community sectors, to explore how we can collectively develop a health system that truly embraces the full range of prevention and health promotion approaches required.