Last week, Minister for Health, Greg Hunt, announced an Expert Steering Committee to oversee the development of a 10 year National Preventive Health Strategy.
Plans to develop this strategy were announced earlier this year with a mixed reaction from the sector.
While most experts and groups supported a greater commitment to prevention, some stakeholders raised concerns about the Government’s apparent narrow focus and lack of commitment to addressing the underlying drivers of poor health.
Key points that were mentioned by stakeholders included a failure to explicitly recognise the important role of social determinants in health and the lack of any strategy to address the health impacts of climate change.
It’s also worth noting that the Government has not attached any funding to the Strategy so it is unclear whether it will involve a commitment to increase spending on preventive health from Australia’s current low base of $89 per person annually.
This is 1.34 percent of our total health budget and much less than many comparable countries, such as Canada and the UK. As stated below, the Public Health Association of Australia recommends that this be increased to around five percent of total health spending.
Below Croakey Editor, Jennifer Doggett, revisits the comments on the strategy from stakeholders in the light of the Minister’s announcement and the additional details provided about the priority areas and Expert Steering Group membership.
Jennifer Doggett writes:
More details of the Government’s preventive health agenda have emerged with the announcement of an Expert Steering Group for the planned National Preventive Health Strategy.
In his announcement the Minister mentioned that the Strategy will aim to “help Australians improve their health at all stages of life, through early intervention, better information and targeting modifiable risk factors, and the broader causes of poor health.”
While this could indicate that the Government is taking a comprehensive approach to health and well-being, the priorities for the strategy nominated by the Minister suggest a more narrow focus. Those priorities are:
- Cancer and chronic disease population screening (current and emerging opportunities)
- Nutrition and obesity
- Public education and research
Note: the press release also adds that the Government has committed to reducing Australia’s smoking rates below 10 percent by 2025, but does not make it clear whether this is also part of the Strategy.
The importance of social determinants
The four priorities (above) for the Strategy highlight the importance of taking a social determinants approach to health promotion and illness prevention.
All four areas specified by the Minister are strongly influenced by social and economic determinants and cannot be approached effectively without taking these into account.
For example, cancer screening rates are generally lowest among the most disadvantaged socio-economic groups and cancer treatment outcomes for common cancers are poorer for those in the lowest socio-economic quintile compared with the highest.
Under-immunised children for no specified reason are over-represented in the lowest ten percent of socio-economic postcodes.
Rates of obesity and overweight are higher among low income communities.
Health literacy is also higher among people with high incomes (63%) than among people on low incomes (21%).
Looking at these statistics, it is clear that there is a significant overlap in the target groups for all four priority areas of the Strategy. This reflects the findings of research on the social determinants of health which indicate that the most effective approaches to improving health and well-being are to target disadvantage and inequality, rather than specific health behaviours.
If the Government wants to achieve optimum outcomes, it should use an evidence-based approach which takes a social determinants approach involving targeted communities in genuine and respectful partnerships.
Views from stakeholders expressed in reaction to the Minister’s initial announcement are worth re-visiting, given their relevance to the priority areas for the Strategy.
Dr Cassandra Goldie, CEO of the Australian Council of Social Service, urged the Government to address income inequality, saying:
We could do a lot for the health of the nation if we ensured that everyone can afford to eat three meals a day and keep a roof over their head.”
Goldie also urged action on the health impacts of climate change, which she noted is recognised by the World Health Organization as one of the greatest threats to human health.
Summer May Finlay, a Yorta Yorta woman, public health practitioner and contributing editor at Croakey, also stressed the need for the strategy to address poverty, food security poor housing and the living conditions that contribute to preventable conditions such as Rheumatic Heart Disease. She said:
We need to go back to Bob Hawke’s goal of eradicating child poverty. If we want to genuinely have preventative health strategies, we should be aiming for that.”
Jo Walker, a director of the Climate and Health Alliance, called for a focus on primary prevention strategies, including:
…addressing emerging threats from climate and health related issues, for example, air pollution, water quality, heat stress, energy use and sources, sustainable food systems, changing patterns of disease.”
Mrs Janine Mohamed, CEO of the Lowitja Institute and chair of Croakey Health Media, said she would welcome greater investment in comprehensive primary healthcare as part of the strategy.
She said the Aboriginal Community Controlled Health Organisation (ACCHO) sector provided an “amazing blueprint” for informing development of the strategy.
Fran Baum, Matthew Flinders distinguished professor of public health at Flinders University, called for “a national health and wellbeing strategy that encourages all sectors to work for health” and said it was disappointing to see no focus on the social determinants of health or the need to set a goal to reduce the glaring health inequities in Australia by race and class.
Dr Tessa Boyd-Caine, CEO of Health Justice Australia, highlighted the need to address the social determinants of health saying:
The pathway to prevention of poor health lies in well-coordinated and connected services that respond to community needs and that recognise the many factors beyond the medical that affect people’s health.”
CEO of the Public Health Association of Australian (PHAA), Terry Slevin, said the strategy:
…must focus on those with the greatest need and those at greatest disadvantage because we know that poverty and minority vulnerabilities have a profound impact on health outcomes.”
Slevin also called for a national target of five percent of Australia’s health budget to focus on prevention.
Steering group membership
Members of the Expert Steering Committee, chaired by Health Department Deputy Secretary Dr Lisa Studdert, include experts across the public health, research and health promotion fields.
The Minister also announced that there will be a wider consultation process which will provide other groups and individuals with the opportunity to provide input into the development of the strategy.
It is a large and diverse group, with strong representation from organisations representing consumer and cross-sector interests, including Consumers Health Forum, Health Issues Centre and National Rural Health Alliance.
While the inclusion of these groups is a positive, there are some notable omissions.
The Catholic health and welfare sector is not represented, which is surprising given the history of the Catholic sector in working with marginalised communities and its practical experience in cross-sectoral approaches to addressing disadvantage.
Also, given the importance of closing the health gap between Indigenous and non-Indigenous Australians, it is disappointing that only one group representing Aboriginal and Torres Strait Islanders was included.
Hopefully the Steering Group will seek input from other key organisations with expertise in Aboriginal and Torres Strait Islander health, such as The Lowitja Institute and Central Australian Aboriginal Congress, as part of its broader consultation strategy.