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As Victorians head to the polls, what are the health issues at stake?

Introduction by Croakey: This Saturday voters in Victoria will decide whether to return the Andrews Labor Government for a third term.

While the polls suggest that a Labor victory is likely, they are also flagging a shift away from both of the major parties, in favour of the Greens and independents, including some Teals.

Croakey editor Jennifer Doggett explores the response from health groups and experts to the election commitments of the major parties, the role of the media in the campaign and implications for health policy at the federal level.


Jennifer Doggett writes:

The Victorian election is taking place against the background of a global pandemic and has been described by some commentators as a referendum on Premier Dan Andrews’ management of the COVID-19 pandemic, which included extended lockdowns, curfews and significant outbreaks in quarantine hotels and aged care facilities.

While the pandemic will inevitably impact the election – in some cases directly by preventing candidates from campaigning – it is not clear how the complex and diverse impacts of COVID-19 across the community will affect voting on Saturday.

The polls indicate that voters are making a distinction between their views on the pandemic response and their support for the Premier. For example, despite 60 percent of voters saying that the lockdowns were too long, Andrews is still attracting 40 percent support as preferred premier – a lead of 12 percentage points over his rival Matt Guy.

Another trend in the polling – similar to that evident in the 2022 federal election – is a shift away from a two-party system towards minor parties and independents, including the Greens and some Teal candidates running in traditionally Liberal seats in inner eastern metropolitan seats.

Even if Labor is returned, a larger cross-bench with a significant Green and Teal presence could significantly change the political landscape in Victoria.

Media coverage

The media plays a major role in shaping public views about policy issues and this campaign has continued the mainstream media’s concentration on hospitals and doctors when reporting on health.

Community health organisation, cohealth, has written in Croakey about the media’s focus on hospitals and doctors when writing about health issues, at the expense of broader issues, such as prevention, allied health and community-based care.

The importance of regional media, which has played such an important role in recent natural disasters including bush fires and floods, has also been recognised in the campaign, with Labor committing to place a full page public notice each week in regional papers to provide certainty for their businesses.

The Murdoch media’s platforming of conspiracy theories about Andrews is also worth noting.

A rise in extremism

One reason for the Opposition’s apparent failure to attract voters away from Labor could be its support for candidates with extremist views, including Renee Health, standing for the upper house. Heath has close ties to an ultra-conservative Christian church and Timothy Dragan, candidate for the outer metropolitan seat of Narre Warren North, who has expressed racist views on reconciliation and who is anti-abortion and a climate change denier.

Journalist Bernard Keane, writing in Crikey, has claimed that this is part of a broader trend of Coalition parties in Australia borrowing the “tactics, ideas and slogans” of right-wing extremism in the US extremism.

“While the Victorian Liberal Party is the centre of this shift towards a far more extreme and dangerous political environment, it is only going where other branches of the Coalition have gone before it,” he said.

Another recent example of extremist language in the campaign are the comments from upper house MP Catherine Cumming (previously an independent now standing for the Angry Victorians Party), who declared at an anti-lockdown rally on 19 November 2022 that she wished for the Premier to be turned into a “red mist” (a term used in the military to describe the blood spatter from a sniper attack).

Keane warns that platforming of extremist views increases the risk of real world impacts, including violence against politicians:

Urge the killing of a politician often enough, loud enough and with enough amplification, and eventually the message will reach someone at risk of acting on it.

And if it comes from a mainstream, legitimate source — a Liberal Party candidate, for example, or a serving politician — that increases the odds still further.”

Stakeholder calls for action

In relation to health, advocates and experts have called for increased action on prevention and public health, including a focus on workforce, mental health and social determinants.

Writing for Croakey, public health physician Dr Laksmi Govindasamy supported calls from public health groups for an increase in spending on preventive health to five percent of total government health expenditure by 2030 (up from two percent in 2021/22) – see below for more detail.

Govindasamy also called for a minimum five-year funding for Local Public Health Units (LPHUs) to deliver health promotion, protection and prevention activities. Currently, funding for LPHUs has only been guaranteed until 2022-23, which Govindasmy argues will make it difficult for them to expand their remit to include locally tailored prevention efforts and attract and retain public health workforce.  She also has called for a multidisciplinary Public Health Officer Training Program to build a sustainable public health workforce in Victoria.

Other health leaders have echoed Govindasamy’s call for a focus on prevention and public health, stressing the importance of investing in community-based services.

For example, Dr Louise Flynn, General Manager of Support After Suicide program at Jesuit Social Services, previously told Croakey that her organisation was calling for increased access to mental health services in the community in order to address emerging mental health issues before they become acute.

Emma King, CEO of Victorian Council of Social Service, suggested the Government should prioritise and “formalise the role of community health” which she says are “trusted and embedded” in communities.

“Community health services have a strong focus on the prevention of illness, operating with a social determinants of health lens, King said, and the “health literacy that they build is pretty phenomenal,” she said.

Emergency physician, Dr Simon Judkins, has written of his frustration that the growing health workforce crisis in rural Australia s not being addressed in the Victorian election.

He argued that rural healthcare was already neglected and chronically under-resourced prior to the pandemic and has taken a “massive hit” since then, leaving it further behind healthcare in urban areas.

Just as we have seen the health and wealth gap increase over recent times, we have also seen the metropolitan and rural divide widen in health.

While it is recognised that city and suburban health services have been impacted significantly, the further away from the CBD you get, the harder it is.”

Judkins has also questioned why Australia – with the information and means to do so – is not doing more to  support public health funding, training, expertise?

His view is that it’s about “industry, lobbying, expensive high-tech interventions, politics, photo opportunities and votes. And a society which is largely focused on their personal interests, rather than the benefits to the broader community.”

Fluoridation in regional Victoria has also been on the agenda of local health leaders in the town of Heathcote, who have been urging the Victorian Government to allocate funding for fluoridation in their local water supply in the lead-up to the election.

While 90 percent of Victorian residents have access to fluoridated water, some towns like Heathcote remain without its benefits.

Associate Professor Matt Hopcraft and CEO Australian Dental Association Victorian Branch, and Peter Maine, Chair of Advance Heathcote Inc told Croakey that “State Government funding remains the major barrier to implementation”, which could help reduce the number of decayed, missing or filled teeth among children in Heathcote, currently two times higher than the state average.

Indigenous health

Indigenous organisations have also been calling for a broad focus on community based prevention and public health in their election wish lists.

The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) has developed a wide-ranging election platform, focusing on infrastructure for Aboriginal Community Controlled Organisations, justice and health, self-determination, racism and discrimination and social and emotional well-being, including an Aboriginal and Torres Strait Islander Suicide Prevention Taskforce.

The Victorian Aboriginal Legal Service (VALS) has stressed the need for culturally safe primary healthcare, with CEO Nerita Waight stating that this could “prevent somebody from ending up in dire circumstances”.

In addition to improving access to culturally safe care, the VALS election plan includes:

  • funding for VALS to support all Aboriginal and/or Torres Strait Islander people who want to use its services
  • bail and sentencing reform
  • independent detention oversight
  • raising the age of criminal responsibility
  • ending Victoria’s overreliance on prisons and police, and
  • creating a better future for Aboriginal and Torres Strait Islander children in Victoria.

The need to address racism at the local community level was also raised by James Liang, Member of the Centre for Multicultural Youth’s Youth Advisory Group, who wrote in The Age that he would love to see an incoming government invest in youth-led approaches to create local solutions that focus both on prevention and remediation.

“Tackling racism involves different things in different communities. Some communities need more dialogue, others require culturally sensitive support systems to debrief racist incidents,” he said.

Major party election commitments

However, the commitments of the major parties have not reflected these calls; instead, they focused on new hospitals and health services, amounting to a total spend of more than $6 billion for Labor and around $4.5 billion for the Coalition (see here for the election platforms of Labor, Coalition and the Greens)

Source: Parliamentary Budget Office

While some spending on hospitals is warranted, due to ageing infrastructure and demographically-driven demand, this spending has left very little room for any other area of healthcare in the campaign, as this word cloud from the Parliamentary Budget Office, demonstrates.

Source: Parliamentary Budget Office

Outside of hospital spending, there are only some small-scale commitments to community-based care; for example, Labor has funded community paramedics and GPs in emergency departments, and the Opposition has allocated funding to private dentists to reduce waiting times in the public sector.

To be fair, Labor has made some major commitments on shifting care from the hospital to the community setting in previous budgets – initiatives still in the process of being implemented.

Other health policies

Neither of the two majors differ significantly on their pandemic policies.

Victoria has not reactivated any restrictions in response to the 4th COVID-19 wave, currently being experienced by Victoria. The Government recommends mask wearing for people with COVID-19 and for those around people at higher risk but has not introduced mask mandates or mandatory isolation periods.

The Opposition has not differentiated their position on mask mandates and isolation periods from that of the Government. However, Opposition leader Matt Guy has engaged in some dog whistling on vaccinations in one advertisement which states:

Remember when Andrews forced us to get the jab or lose our job?”

Both parties support the current ban on fracking and the legislation embedding the ban in the state’s constitution to make it more difficult for this to be reversed in the future.

However, the Government has accused the Opposition of paving the way for a re-introduction of fracking (which has previously been supported by the Coalition).

In relation to emissions policies, the Greens have the most ambitious target, committing to replacing coal and gas with 100 percent renewable energy powering the state by 2030 and to 75 percent carbon emissions reduction target by 2030, and net zero by 2035. Teal candidates also support a net-zero by 2035 target.

In contrast, Labor has announced new targets for renewable energy in Victoria’s electricity supply of 65 percent by 2030, and 95 percent by 2035. It has also set an emissions reduction target of 75-80 percent by 2035, and brought forward its net-zero emissions target by five years to 2045.

The Liberal Opposition has promised to legislate an emission reduction target of 50 percent by 2030 and is committing to a $1 billion hydrogen strategy. It also endorsed net-zero emissions by 2050.

Criticism from stakeholders

A focus on hospitals in the campaign has drawn criticism from health groups and commentators, who have argued that spending should be shifting towards prevention rather than acute care.

cohealth has contrasted the big spending on hospitals to the neglect being experienced by the community sector.

While acknowledging the importance and “political lure” of hospitals, cohealth’s communications and media adviser, Lanie Harris, has argued in Croakey for a balancing of pledges for new hospitals with more funding for services that keep people out of hospital.

“Of course it’s not an ‘either/or’ scenario. We need well-funded hospitals for very unwell patients, but if we don’t adequately resource community-based health services, then we will be missing opportunities to prevent many of those people ending up in hospital,” Harris said.

cohealth is located just four kilometres away from the promised ‘largest hospital in Australia’ in a run-down building which has provided health services for 45 years to 12,000 people very year.

In recent storms, the leaking building posed a risk to clients and staff.

cohealth has been calling for State Government investment for nearly five years to enable the redevelopment of the health centre but, so far, these calls have not been answered.

Emeritus Professor Stephen Duckett is Chair of the Board of Eastern Melbourne Primary Health Network. He has written in The Age about the obsession of politicians with hospitals, particularly in the context of an election campaign.

Hospitals have impressive machines with flashing lights and provide almost unlimited opportunities for turning sods and cutting ribbons. The public understands hospitals and so promising more hospitals is an easy policy to explain and promote.”

Duckett argued that despite this superficial appeal, the public should not be blamed for politicians’ failure to bring the public along about good health policy over the last decade, and the lack of a compelling public vision of what good health policy should be.

“Unfortunately, 2022 looks like another election where neither major party is offering a 21st-century vision for a better health system. Instead, we have policies that promise more of the same old expensive solutions of more and more hospital beds seemingly without end,” he said.

Oncologist and columnist Dr Ranjana Srivastava wrote in The Guardian that Australia needs a “rethink” of health policy, which should be based on talking to “actual providers from cleaners and clerks to doctors and nurses, who will tell them that honest healthcare trumps shiny buildings”.

Srivastava says it is tempting to hope that new hospitals will fix old problems but that in reality the “if you build it they will come” sentiment could result in worse outcomes by deflecting attention from general practice and other community-based services which deliver comprehensive, coordinated care for chronic diseases and at the end of life.

Public health election scorecard

An overall assessment of the major parties’ election platforms has been developed by the PHAA’s Victorian branch, in partnership with the Australian Health Promotion Association and Australasian Epidemiological Association.

Their 2022 Victorian Election Scorecard analyses the parties’ policy platforms against a joint Election Platform, which seeks a commitment to six key public health priorities:

  1. Invest 5% of total government health expenditure on preventive health by 2030.
  2. Commit to a minimum of five-year funding for Local Public Health Units (LPHUs) to deliver local health promotion, protection, and prevention activities.
  3. Develop a Victorian Public Health Officer (PHO) Training Program.
  4. Invest 5% of total government mental health expenditure on prevention by 2030.
  5. Support the self-determination of Aboriginal Community Controlled Health Organisations.
  6. Establish a state-based Victorian Sustainability Health Unit.

The assessment found that despite the calls for action on prevention and public health, the promises of the major parties focuses strongly on hospitals and acute care.

“Although billed as an election contingent on health policy, with major parties engaging in a “health spending arms race,” it is disappointingly apparent that there has been inadequate consideration of public health and prevention,” PHAA said.

The election scorecard shows that there is no difference between Labor and the Coalition and that only the Greens have made any substantial commitments against the six priorities nominated by the public health groups.

Federal implications

The election may also have broader implications for the rest of Australia.

The focus on hospitals at the expense of primary and community-based care reflects structural faults within our health system.

State governments are limited in their ability to address the upstream causes of hospitalisation, given that the federal government controls many of the relevant levers in the aged and primary care sectors.

When state election campaigns become bidding wars on hospital spending, it’s clear that Australia needs a more collaborative to resource allocation within the health sector.

Also missing in the election campaign is a clear plan for the future of the health system and the health workforce, including how to engage the community in setting priorities. Again, these are issues that can only be addressed by working across state and federal boundaries.

A continuing Labor Government in Victoria, led by a Premier from the same faction as the Prime Minister, should support collaboration across state and federal boundaries on these issues.

In conjunction with Labor governments in a majority of states and territories (possibly all but Tasmania after the NSW election early next year), it could provide a rare opportunity for major structural reform of our current fragmented approach to health system funding and service delivery.


See here for other articles in Croakey’s coverage of the Victorian election 2022.

 

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