In a recent article, health policy analyst Lesley Russell suggested that Australia could learn from the achievements of public health champions in the US like Michael Bloomberg, and that we should be seeking to have public health leaders elected into positions of influence.
In responding to her article, Todd Harper, the CEO of Cancer Council Victoria, suggests that it is difficult to advance public health in Australia without addressing the argy-bargy between federal, state and local governments over where responsibility lies for public health initiatives.
We need the financial and governance structures in place to support our leaders in achieving real change, he says.
How the system works against effective public health action and leadership
Todd Harper writes:
Lesley Russell argues that public health is “the poor cousin to healthcare” because there are no political champions for the cause – and certainly now is a time for champions. The wealthy philanthropist and public health-minded Michael Bloomberg is transforming health in New York and, in doing so, is inspiring others around the world.
Despite some laudable gains in areas like the plain packaging of tobacco products, public health in Australia continues to struggle for the attention that it deserves.
Public health fails to attract the investment it should partly because of a lack of leadership, but also because it battles to sustain the interest of governments beyond the next crisis in the health care. Our federal system divides responsibility between state, federal and even local governments; emancipating any of them from taking the leadership needed.
Stuck on a stubbornly low share of health spending, what can be done to boost the resources that public health needs to make long-lasting gains?
It is always a hard-sell when the challenge of public health issues like obesity and alcohol can’t be solved in a single electoral cycle – just like tobacco and road safety couldn’t be. The leadership of the Climate Council reveals a possible new way of fundraising for public health, given the entrenched problems of climate change also can’t be solved in this electoral cycle or, perhaps, even in this generation.
Crowd sourcing is an engaging form of philanthropy that matches passion and democratic view of the world that can appeal to a broad and diverse public motivated to address a specific issue, rather than people who identify with a specific brand. While not strictly crowd sourcing, the incredibly generous response of donors to the Victorian Bushfires and the Boxing Day Tsunami shows how communities can respond to a clear and present need.
It remains to be seen, however, whether the Climate Council can sustain such activity year after year to sustain the ‘nuts and bolts’ of the operation after the euphoria of their bold establishment. Many will wish them well, because if they succeed it will shine a light for many others who have not been able to sustain such an approach.
Public health funding has not, by and large, captured the enthusiasm of crowd sourcing yet, nor to a significant degree, the enthusiasm of philanthropy. There certainly is a well-placed enthusiasm for philanthropy that respond to pressing health or social needs, or the excitement and promise of research.
Public health is not yet as appealing to donors perhaps because the returns are often years away and while we know it improves our society as a whole the direct benefit to individuals is difficult to quantify. Will someone who quits smoking today after seeing a social marketing campaign thank us in 30 years’ time for a lung cancer that never eventuated?
Given those limitations of philanthropy, we can look to private funding. Again, the prospects there aren’t great.
Unlike other parts of the health care system (ie. pharmaceuticals and medical services) where property rights are well defined and reimbursement mechanisms firmly established, much of public health has ‘public good’ characteristics that make it hard for private interests to own, and obtain a financial reward from laws that promote health, or public education campaigns which have been mainstays of public health.
So that leaves Governments and, unfortunately, recent federal healthcare reforms have not focussed on public health.
There is a need for Governments, state, federal and local, invest more in an area that time and time again, has delivered the goods. Those politicians and public servants who first agreed to fund SunSmart at adequate levels in the 1980s deserve recognition.
We know SunSmart has been successful because we have been able to, over the decades, measure some of its many benefits. It has prevented more than 103,000 skin cancers in Victoria between 1988 and 2003 – resulting in 1000 averted deaths. The program not only works, but is also extremely cost-effective with a $2.30 net saving for every dollar spent. (See references below this article).
Such success can and does happen, but thanks to our federalised model we often face arguments about who is going to pick up the tab. State governments are keen to see a national approach to such issues, but the Australian government is equally keen for states to take responsibility for local issues.
We know government partnerships are so often critical to the success of long-term public health campaigns – but the vision and leadership on such issues doesn’t have to start there.
Nobody is arguing about the seriousness of the obesity epidemic facing our nation, but where is the united approach from governments taking charge by providing adequate and sustained funding for health promoting obesity campaigns and reforming our incessant promotion of unhealthy products to children?
The Australian National Preventive Health Agency (ANPHA) was set up on January 1, 2011 to drive such national health campaigns. Yet, less than three years later the media is reporting that its future is under threat. We should be looking at a reformed and re-invigorated ANPHA that has the political, community, scientific and financial mandate to drive change.
The best source of new funding for public health initiatives would come from a reformation of our taxation system that provides financial incentives for consumers who make healthier food and beverage choices, and makes funds available to sustain much needed public health investment.
We do need strong leaders, and I know we have them – but we also need the financial and governance structures in place to support our leaders in achieving real change.
• Todd Harper is CEO of Cancer Council Victoria and tweets as @ToddHarperAUS
Shih ST, Carter R, Sinclair C, Mihalopoulos C, Vos T. Economic evaluation of skin cancer prevention in Australia. Prev Med. 2009;49(5):449-53. Epub 2009/09/15.
Vos T, Carter R, Barendregt J, Mihalopoulos C, Veerman L, Magnus A, et al. Assessing cost effectiveness in prevention (ACE-Prevention): Final report. Brisbane & Melbourne University of Queensland & Deakin University, 2010.