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Cuts to community-based health services short-sighted

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.

 

Comments 8

  1. Anne Ferber says:

    Once again another example of short-sighted, budget focussed ELECTED politicians in a LABOR government that don’t ‘give a toss’ about the long term health ramifications their decisions have upon the people of our state. Obesity, Diabetes, Arthritis, and some Cancers – PREVENTABLE illnesses costing our state billions $$$. WAKE-UP Weatherill and Snelling, do your homework! So you think the health budget has blown out… let’s wait and see what it looks like in 2018 without health prevention intervention!!!! The best is yet to come! Can the state coffers afford not to try and prevent these illnesses in the future?

  2. Sue O'Brien says:

    It is disappointing that politicians are not looking at the bigger picture and realising that prevention is better than cure, Community Foodies and community health workers are making a difference to families their loss will significantly impact children and families health and well being.

  3. Wayne Roesler says:

    Spot on Kaye! With Community Foodies progam now being put up for tender to a NGO, there is a very real fear that the expert support, resources, professionl development and the credibility of the program with be lost and this is exactly what has made the Community Foodies program the success that it is. There needs to be a committment by SA Health in the tendering process to include the Community Foodies program managers, they have intimate knowledge of the program and the expertise gained over the programs life of 10 years – this has to be seen as a valuable tool by SA Health and to not utlise this would be disrespecting South Australian communities that have and are reaping the benefits now of the successful Community Foodies program.
    South Australians should be very concerned about what implications will be seen in the future without the Government now investing in preventative and early intervention helath programs and strategies…..no crystal ball needed to know that the health budget will take a hammering when preventable illnesses and chronic disease rates rise! Angela Roesler, Murraylands Community Foodie

  4. Margaret Ferris says:

    In Response to the article:
    ‘Cuts to community-based health services short-sighted’
    I absolutely agree. The diverting of resources from wide reaching, community-involved Health Promotion focused programs – to Treatment of the often preventable illnesses resulting from unhealthy health-related lifestyle habits is analogous to ‘shifting deckchairs on the Titanic’..or perhaps:- giving everyone a deckchair instead of stocking the lifeboats and seeing that as many people as possible know how to lower them safely into the ocean (and maybe even have more chance of keeping a clear head over panic). And, the unfortunate culture of upping middle management levels whilst cutting out or hobbling the experts on the ground which has dominated over the past 10-20 yrs (marketisation, placing financial profit as the ruling imperative of every aspect of life) has dismantled the real efficacy, certainly integrity of more and more of our public (and private) institutions. Here we go again.. unless politicians and beurocrats can get a wider, longer view. I’m aware that our hospitals and general practise medical clinics are also in need of more funding (who isn’t?) and, call me ‘Optimistic'(!) but I’m surprised to find that the concept of ‘Preventative Medicine'(from the 60s-70s)seems to be taken less, rather than more seriously than it was 40 years ago.
    I hope 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 reconsidered and reversed.

    Margaret Ferris

  5. Fran Baum says:

    Thanks Kaye for noting the impact of the implementation of the SA McCann Review. What is so sad is that South Australia has been a world leader in terms of its community health services and community health movement. These services and movement built on the foresighted Community Health Program funded under the Whitlam Government. The CHP established ground breaking community health services like the Noarlunga Health Village which led to the internationally recognized Noarlunga Healthy Cities initiative and Onkaparaginga community injury prevention program and the women’s health centers in Adelaide which were trail blazers in the provision of health care to women which was respectful and effective. These centers were governed by community boards of management which linked them to the health concerns of the community and saw good use of scare resources. When I spoke internationally about these services people were always impressed. Internationally visitors (including the then WHO’s Ilona Kickbusch and Canada’s Health Promotion guru Prof Ron Labonte) always expressed deep admiration at the work of our community health centers. (see more about the work of these community health centers in my book The New Public Health).
    In the past 5 years The South Australian Labor Government has systematically undermined this program through a continual series of cuts. Only an entirely short-sighted view of health can make any sense of this. It is highly likely that we will see adverse consequences on the health of South Australians and especially that of those with the worse health status. We will also see adverse consequences on our health budget because the preventive work ( especially the good community development work) these centers did has not been replaced and means people will suffer more il health. Their community development and health promotion work cannot be can not be easily replaced because it depends on skills and community trust andpartnerships that had developed over many years. Painstakingly careful work went into working along communities ( as opposed to ineffectively telling people how to be healthy) and developing their skills to make themselves healthier – the community foodies described by Kaye is but one example. Just one more was an occupational injury program with small business to reduce eye injury ( and it did this a removed the demand for emergency dept for eye injury just one example of the cost saving). All this valuable community capital squandered by a short-sighted government.

    What South Australia now needs a robust “Restore our community health services” campaign to make our State government come to its senses and see beyond a very narrowly defined dollar sign as a driver of its health policy.

  6. Anaf Julia says:

    The importance of the trust and commitment of partnerships across health and other sectors at the community level that have been built up over many years should not be underestimated. These have contributed to better outcomes for health and well-being by building a bigger picture for how best to respond, coordinating different players with complementary skills and knowledge, bringing in shared resources that can be strategically funnelled in a cost effective way, and building mutual capacity across the sectors.

    The implications of dismantling these partnerships are enormous – both the financial loss of their cost effective operations in support of health, and the loss of shared knowledge and expertise… a truly blinkered view of how to achieve short-term ‘savings’.

  7. Ursula Rose says:

    Reflecting on Kaye’s article has me thinking of what government can and cannot do. It is a key driver and reinforcer (both) of the tone and attitudes of a society. There are many examples of the important role government has played in creating social change – in big and small ways. Anti-smoking legislation, the introduction of social welfare over the decades, universal health care schemes for example. Social policy implementation by the public sector has been an important part of this.
    Community Foodies is an example of the way that government has supported creative partnerships within communities to improve health. By supporting the program in the public sector, it says that this is something that we should all be concerned about and can support. It says that the whole society has a role to play in supporting each other to stay healthy. Moving the program to the non-government sector says something different altogether. It says that it is really only a program for the ‘needy’, who can be supported through a charity model. It does not reinforce the broad role all of us play in creating the society that we live in.
    The values that underpin the McCann review do not reinforce ideas of fairness, prevention, and mutual responsibility for assisting each other to stay well. The McCann review, and the cuts it heralds, are great news for junk food purveyors, and those who see the individual as the only entity that needs to take responsibility.
    The state government does not join the ranks of inspirational leaders who have helped to move the society in more positive directions through decisions that only it can take. It joins forces with mean-spiritedness, unimaginative government, and the senseless cutting down of highly creative and effective work by its own workforce. It is deeply disillusioning and disappointing.

  8. liz hetzel says:

    A well written explanation of why this preventative approach is so effective and essential to preserve. It seems irresponsible, short sighted and completely nonsensical that this funding has been so severely compromised, in fact withdrawn. Surely someone in the SA health government advisory team is listening to people who have expertise and understand preventative health…..or, it appears not.

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