In December last year Professor Fran Baum wrote New SA report shows why governments are failing to control health spending for this blog in response to the McCann Review of Non-Hospital Based Services. In that article Professor Baum lamented the lack of understanding of community services and primary health care that leads to questionable funding decisions.
This week the SA government announced the implementation of many of the reviews findings. Below Kaye Mehta, senior lecturer, Nutrition & Dietetics, Flinders University reminds us why the funding cuts and service changes announced will cost us all in the future.
Ms Mehta writes:
The South Australian government’s announcement on Friday 21 March to cut $14.7 million of community-based health services (euphemistically called non-hospital health services) is a travesty of wise budgetary management.
This funding cut has followed progressive dismantling of the state’s community health services which were the site of creative and innovative health promotion and illness prevention programs that used to earn us international recognition.
As obesity and chronic diseases have consumed more and more of the state budget the government has reduced its funding of health promotion and prevention and ploughed its precious funds into treatment programs.
The shame is that at least two-thirds of chronic diseases are preventable; and throwing money at treatment can never hope to reduce the problem of chronic disease – it is only health promotion and illness prevention approaches that can hope to do this.
The government’s decision to cut funding of health promotion programs displays lack of courage and vision to take a long-term view and to invest in creating a healthy population rather than respond to short-term demands for more clinical services to treat our unhealthy population.
Unhealthy eating habits and subsequent obesity are major contributors to chronic diseases and our government has unwisely decided to axe some important community nutrition promotion programs that are delivering positive healthy eating outcomes.
Programs such as Start Right Eat Right which promotes healthy eating practices in child care settings focus on building a healthy population from the early childhood years. A visionary government would commit to establishing healthy eating habits early in life.
Even the apparent reprieve given to the Community Foodies program following strong pubic outcry of their imminent demise, is potentially a poisoned chalice. Passing the Foodies program to the non-government sector shows a startling lack of understanding about what expertise allowed this program to achieve its fantastic nutritional and health outcomes.
The success of the Community Foodies program is entirely due to its design and implementation by dietitians, social workers and community development workers who have specific expertise in nutrition science, community education, and community capacity building. These personnel are health workers and the Community Foodies program is a health program underpinned by health objectives. Taking it out of the health sector and into the non-government sector does not guarantee the program the same access to health expertise.
This is nothing short of condemning it to failure and smug justification that it did not deserve to have continued funding in the first place. Even more damning is that the Foodies program is coordinated by a state-based team but implemented by dietitians and other health workers employed by health services across South Australia. Continuing to fund the state coordinating team albeit in the non-government sector but removing capacity of state-employed health workers to implement the program is nothing short of ripping out its heart while continuing to hook it up to a life support system. The program has little chance of maintaining its successful track record and will almost surely be de-funded after a short time.
So the government’s announcements appear logical on the surface but on closer analysis spell the end of health promotion programs and a shameful legacy to this state on its mandate of building a healthy community.
The utter waste of this decision is that the state will lose the health promotion expertise we have been recognised for and it will take enormous additional investment to re-build this workforce. The policy wheel will almost certainly turn to re-instating a health promotion and illness prevention workforce because it is highly unlikely that we will achieve a healthy state by investing in illness.