The irony was not lost on Margo Saunders, a public health policy consultant in Canberra. While the PM et al have been busy ensuring the health debate remains firmly stuck on hospitals, another news story has been providing a powerful reminder of the need for a more effective approach to prevention.
“On the day when media attention was fixed on health care, you simply can’t go past the fast food giant’s marketing coup which will have the Weight Watchers seal of approval joining the Heart Foundation’s tick on particular products – products which, according to US studies, people are happy to see on the menu and then ignore.
McDonald’s strategy provides a double halo effect: the veneer of healthy choices for consumers and a ‘we-may-be-part-of-the-problem-but-can-be-part-of-the-solution-so-don’t-regulate’ message for government. However, forgive us for being more than a bit cynical in noticing that today’s saturation television advertising was all about Big Macs and hash browns.
As noted by others in Croakey, the Australian Institute of Health and Welfare estimates that potentially preventable hospitalisations represented just over 9 percent of all hospitalisations in 2007–08, or about 441,000 hospitalisations in public hospitals, with an average cost of about $4 230 per episode of care. Modifiable risk factors account for about one-third of Australia’s total burden of disease, and preventable diseases and conditions are estimated to absorb around 70 percent of the health budget – while about two percent of the health budget is committed to prevention.
The Government’s report issued yesterday refers to a $872 million investment in preventive health programs ‘to be rolled out in schools, workplaces and local communities with a high incidence of chronic disease’ which will focus on reducing lifestyle risk factors such as smoking and obesity and increasing physical activity and healthy eating.
This funding would no doubt be more effective if it weren’t so outclassed by the promotional budgets for tobacco, alcohol and energy-dense, nutrient-poor food. We also need to know more about the basis for the various initiatives or why we should be confident that this money will be well spent. The Government’s continuing reluctance to curb the marketing enthusiasm of tobacco, alcohol and junk food companies and its rhetoric about ‘lifestyle risk factors’ and ‘healthy eating’ are falling short of a visionary, or even serious, approach.
According to Sir Michael Marmot, ‘If we could do something about prevention, we could empty the hospital wards.’ Prevention, however, is something that we are still waiting to hear more about – including a comprehensive response to the Taskforce’s recommendations and passage through the Senate of the legislation to establish a National Preventive Health Agency – an agency which will have the ability to advise but not to regulate.
By far the scariest thing about yesterday’s proceedings was the report on these pages (by a fellow Croaker) that the Prime Minister, in response to a question, suggested that it’s hard for governments to invest in prevention because the benefits won’t be seen for 10 years or more. Did he really say that?
If he did, it’s all the more reason that we need to be looking – urgently – for different models for preventive health.
There is the mounting evidence from the UK and elsewhere to suggest that trying to address key issues in public health through education and persuasion simply don’t work, and may contribute to increasing inequalities. What we need, the analysts argue, are strategies such as regulation and fiscal interventions, as well as the old social engineering (now repackaged for reluctant regulators as ‘nudge’ theory). The Australian version of this means that we need something other than prevention programs built on the expectation that 22m people can be persuaded to do the right thing.
When the National Preventative Health Taskforce, which focused on tobacco, alcohol and obesity, delivered its blueprint for making Australia: The Healthiest Country by 2020, Minister Roxon declared that prevention is not just a trendy idea of the moment, but ‘It’s about saving people’s lives.’
Well, Minister, here’s your chance. We’re waiting.”