Related Articles

35 Comments

  1. 1
    Avatar

    Gavin Mooney

    Yes Fran, agreed and I think we have to keep banging the public health drum that this is a low taxed country, that poverty and inequality are the big killers and the way to address these is through higher taxes.

    Reply
  2. 2
    Avatar

    Clare Phillips

    I agree, prevention is better than a cure and the emphasis needs to be on the social determinants of health and health equity. So let’s support the work currently being done in this area in SA, rather than reducing it to a minimum. The evidence is there, now we need some strong political leadership.

    Reply
  3. 3
    Avatar

    Louise Townend

    If the McCann review is implemented the impact on the health of South Australians – particularly those from communities which already bear a disproportionate burden of economically related ill health – is likely to be extremely negative, both in the short and long term. Comprehensive Primary Health Care, including community health and health promotion, are cost-effective as well as efficacious and socially just ways of promoting the health of all South Australians. Instead of cutting the funding to these vital services a Government with ‘health for all’ at its core should advocate for increased funding through a fairer taxation base such as that adopted in several Scandinavian countries which enables them to boast that their citizens enjoy the best health in the world. Let’s make THAT vision a reality!

    Reply
  4. 4
    Avatar

    Jane Littleton

    The McCann report seems to undervalue lower cost community support that helps keep the disadvantaged and poorer parts of the community from needing more expensive care. Over the last 5 years the government has supported already wealthy specialists with pay rises. They now plan to penalize the most disadvantaged by cutting services that help them to improve their quality of life thus saving the government the cost of more expensive treatment that are needed without smaller preventative programmes.

    Reply
  5. 5
    Avatar

    Kaye Mehta

    I totally agree with Fran’s analysis of the situation. How can McCann and SA Health possibly have confidence in preventing chronic disease and hospital admissions by cutting the very programs that promote health, and prevent illness, such as community-based nutrition programs? The programs they are cutting, such as Community Foodies, have spent years building engagement with the community to change health behaviours – it is outrageous to think that with a single person’s review based on poor understanding of health determinants, all this good work will be stopped. The savings are miniscule compared to the rest of the health budget, and the damage to the community’s health is potentially great. Putting the onus on Medicare Locals to pick up the work gives no guarantee to the community that services will continue.

    Reply
  6. 6
    Avatar

    Rosemary Neal

    The health implications of cutting prevention and early intervention services are clearly indicated in a chart entitled “Adverse Childhood Experiences and Health and Well-Being Over the Lifespan” on Page 42 of the Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery, 2012 (Funded by the Australian Government Department of Health and Ageing): http://www.asca.org.au/displaycommon.cfm?an=1&subarticlenbr=366 (You need to register to download the document but it’s just so that ASCA can track where the document is going.)

    Reply
  7. 7
    Avatar

    Gwyn Jolley

    I agree. It is clear that the McCann review was set up as an excuse to cut SA state funding to health promotion. This is very short-sighted and ignores the long term benefits of keeping people healthy. Services and practitioners do not seem to have been consulted as the decision was already made. Instead of cutting funds to community based services that address the needs of the most disadvantaged, government should be looking to control huge increases in medical costs and a tax system that allows the very wealthy to avoid paying their share.

    Reply
  8. 8
    Avatar

    Emma Tonkin

    It is encouraging to hear this response from Professor Baum and to know that someone with her wealth of experience is weighing in on this complex issue. It is extremely disturbing to me to see the years of work and research into health promotion fall by the wayside due to a short-sighted report from a single observer with a poor grasp of the complexities of chronic illness prevention and the social determinants of health and disease. I was shocked at the clear ignorance of the substantial evidence linking health promotion with chronic disease management, hospital avoidance and population health in the report. Cutting funding to health promotion would constitute a considerable step backwards for all three objectives.

    Reply
  9. 9
    Avatar

    Amy Teasdale

    Health promotion is vital in the prevention of chronic disease and hospital admissions. It empowers communities to make better choices relating to their health. By reducing spending in this area, the government think they are saving money, but clearly they are not looking long term. Disease prevention should be the focus of the government otherwise health spending will continue on its unsustainable, upward trend.

    Reply
  10. 10
    Avatar

    Anaf Julia

    We need health investment through tax reform, not further austerity measures imposing an unfair burden on the least advantaged

    Reply
  11. 11
    Avatar

    Elizabeth Becker

    Health workers in the Community and Primary Health area have built up partnerships with community members for many years to foster healthier communities and provide real pathways to better health for community members, beyond mere information provision. The cuts anticipated by this review will have a deep impact on this low cost and high impact work. Fran’s comments are very welcome in shining a light on these important issues.

    Reply
  12. 12
    Avatar

    Kerryn Eades

    Some amazing work in health promotion is currently being done and to think it will be cut without considering the ‘bigger’ picture and long term benefits of cost effective program’s such as community foodies. Health promotion initiatives empower people with the knowledge and skills in order to live healthy lives and minimise the time spent in hospital across the life span. Protecting out future generations and economy requires emphasise on health promotion initiatives.

    Reply
  13. 13
    Avatar

    Esther Connell

    Conclusions drawn in the McCann Report are confusing and demonstrate an ignorance of the understanding of the role of health promotion in improving chronic disease management, hospital avoidance and population health. It seems this report is an elaborate excuse for cutting the health budget and shifting responsibilities onto the Commonwealth government. This is a very disturbing step backwards, especially with the aging population and increasing prevalence of chronic disease.

    Reply
  14. 14
    Avatar

    paul.laris -

    The real irony here is that these measures will actually exacerbate the very problem they are supposed to be addressing. McCann is trying to meet the growing costs of hospital care for chronic illness by cutting the services and resources which work to minimise its incidence. So yes, there will be (relatively minute) savings to shift into hospitals in the short term, but at the cost of a likely increase in the demand for those services over coming years. in a way, this is a transgenerational transfer of illness. More $ now for chronic illness among baby boomers, and less healthy middle and old age for gen x and y. Evidence-free policy making!

    Reply
  15. 15
    Avatar

    David Phillips

    I agree, prevention is better (and cheaper) than a cure!

    Reply
  16. 16
    Avatar

    Toby Freeman

    South Australia has the greatest rates of overweight and obesity in Australia- http://www.adelaidenow.com.au/news/south-australia/south-australia-is-the-fattest-state-in-the-nation/story-e6frea83-1226531621534. It’s going to get worse if these recommendations are accepted, with cuts to a range of nutrition programs.

    As others have noted, the community engagement work that will be lost if these recommendations are accepted will mean those most marginalised and who find health services most difficult to access can be expected to be more alienated by the health system, and experience poorer health.

    The only forseeable outcomes of these cuts will be greater hospital expenditure, more obesity, and greater health inequities in our state.

    Reply
  17. 17
    Avatar

    lawless angela

    The McCann review appears to ignore the substantial body of research linking primary health care and health promotion with positive health outcomes. The evidence would suggest that a strengthening of PHC, rather than the cuts recommended, is required to improve population health, chronic disease management and hospital avoidance.

    Reply
  18. 18
    Avatar

    Matt Fisher

    A recent report from the Australian Institute of Health and Welfare on Health Expenditure in Australia 2010–11 appears to reinforce Prof Baum’s message that State budget savings arising from cuts to public health programs as recommended by the McCann report are marginal and may be soon swallowed up by expenditure growth in other areas.

    The report defines Public health services as those “aimed at protecting and promoting the health of the whole population or specified population subgroups and/or preventing illness or injury in the whole population or specified population subgroups.”

    Looking at annual growth in total Australian health expenditure over the last 10 years, the report finds that the spending on public health services has made a negative contribution to spending growth since 2007-08 (p. 117).

    In national recurrent expenditure on health in 2010-11, the proportion spent on public health was 1.6%, while public hospital spending amounted to 31.5%, and contributed 35.4% of the growth in expenditure, in the same period.

    According to the report, South Australian spending on public health programs has fallen since 2008-09, while spending on public hospital services increased by around $300 million (pp. 133-135).

    Surely, maintaining or even increasing spending on programs to promote health and reduce disease would be a cost-effective investment as part of a suite of policies to manage the real drivers of growth in the State’s health costs.

    Reply
  19. 19
    Avatar

    Jim Douglas

    Well done Fran Baum in challenging the recommendations of the McCann Report.How short sighted to cut funding to Primary health Care at a time that we need it most.If Mc Cann had any understanding of the importance of Community Inclusion and Social Capital he would not cut funding.As recent as today we read of homelessness and a lack of support of those who are doing it rough,the value of community gardens, veggie swaps,healthy life style community centres as meeting places for new arrivals and countless health and welfare benefits by having a place to go and meet.This is another ‘Shifting the Costs” exercise that only every show up as a once off so called “saving’ in the Budget to make a few feel good.. Mc Cann should hang his head in shame for being used as another head kicker for the Government.

    Reply
  20. 20
    Avatar

    Michael Bentley

    Is South Australia not interested in the causes of the causes of poor health? They will only be exacerbated if the recommendations of the McCann review are implemented.

    Reply
  21. 21
    Avatar

    Raymond Bange

    Soft targets are nearly always the first to feel the impacts of cutbacks and those expenditures that don’t have an immediate visible impact on the community are likely to be the first to be affected.

    We have seen this in the past with changes to funding of vocational and tertiary education and the funding of research and development. Cutbacks are not evident for some years and then there is great anguish as the realisation dawns that Australia does not have the skllls base that it needs and is being passed by emerging nations who have invested in the future.

    Primary health care is a little like that – prevention is much more difficult to sell as a principle in the face of other immediate demands that capture public and political attention.

    I trust that powerful advocacy and public opinion will help to maintain an appropriate focus on this aspect of community healthcare and wellbeing.

    Reply
  22. 22
    Avatar

    Colin MacDougall

    Totally agree with Professor Fran Baum. the McCann review is nothing more than a bureaucratic report continuing decades of cost shifting between Australian and State governments. It fails miserably in a pretence to be a scientific document using evidence. It does not use evidence in a rigorous and scientific way. It fails also in addressing global health concerns about health and equity. Rather, it dresses up ideology and internal bureaucratic wrangling in a porous veneer of psuedoscience. The problem is that acute services have a history of overspending. The McCann solution is to ignore that overspending, and pay for it by cutting community based services. The McCann review fails its own standards. It purports to analyse against evidence but fails to deliver. The real solution is to apply the criteria about evidence and value for money to the services that blow the budget in the first place. Thinly disguised attempts at cost and blame shifting have never succeeded as serious policy debate. Best to consign this review as a worthy addition to the shelf containing ideologically inspired documents that fail to deliver on rigour and intellectual honesty. Does McCann really believe that his recommendations can improve population health equitably by cutting the already bleeding community health sector? I urge SA Health and the Minister of Illness Services to be honest. If you want to cut community services please have the political courage to do it. Don’t hide behind sham reviews. Just do it and go to the electorate with a platform of cutting community services. If you want to shift costs to the Commonwealth government please negotiate that through COAG. Please do not hide behind a blatantly partisan review with flawed methodology. It is deeply ironic to see a party called Labor gazump the modus operandi of neo-liberal governments intent on cutting government services. It should not be the way a government that badges itself as in the social democratic tradition behaves. Too many people have watched too many episodes of Yes Minister and the Hollow Men to believe this latest parody of public service. I urge the Minister for Illness Services to disclose the total cost of this flawed review.If the McCann review is implemented, the great irony is that a so called Labor government will have achieved what successive conservative administrations could not: namely dismantling community services that promote the social democrat cause.

    Reply
  23. 23
    Avatar

    Angela Roesler

    The awarenss programs promoted by the Primary Health Service are pivitol in supporting communities to develop resilience in many areas of their lives. The diversity of the programs available works because not ‘one size fits all’. I work in the community sector in regional South Australia and have personal experience with many of the programs/services that are in jeopardy….and this WILL flow through and impact on isolated communities that are disadvantaged. The process of this review was not inclusive of those involved with the programs at community level and the proposed cuts directly conflict with SA Strategic Plan on more than one target. Primary Health Service programs do reach our community, make a difference, prevent Chronic Disease and there IS evidence of this……we cannot let this happen! Our communities deserve to be supported to reach their full potential!

    Reply
  24. 24
    Avatar

    Delany Toni

    Thank you for your well informed view Fran. The McCann Review demonstrates a complete lack of awareness about what supports wellbeing. It also reflects a lack of understanding about the links between health promotion, community based support and illness prevention. Furthermore, the strategies proposed in the report are so short sighted that, if implemented, they are likley to increase burden on hospital services now and well into the future. There is an abundance of evidence about how prevention activities support the management of chronic health problems and hospital avoidance. It is unfortuante that this evidence has been overlooked during the preparation of a review that uses a supposed “lack of evidence” as a basis for cutting much needed programs in SA. I can only guess that the same narrow view was applied during the search for evidence as that applied during the writing of recommendations.

    Reply
  25. 25
    Avatar

    Katy Osborne

    Thanks for your well-argued case Fran. Hard to believe the McCann review is so short-sighed and can’t see how health promotion contributes towards hospital avoidance and reducing chronic disease. The savings outlined in this report are so tiny as compared to the overall ‘blow out’ in the health budget, and cutting health prevention activities will be so much more expensive in the long-term!!

    Reply
  26. 26
    Avatar

    Katrina Reschke

    It amazes me that we are still having the same argument with whichever government of the day about adequate funding for health promotion activities as we have been for the last 30 years. As an employee of a program directly affected by funding cuts as a result of the McCann report I am angry and shamed that we still “don’t get it”! Short term solutions to balance budgets do not create long term solutions to health inequalities. As has previously been mentioned those South Australians hardest hit by the McCann report will continue to be the biggest drain on our health dollar. Working on a program that was providing accessible chronic disease self management support to Northern Adelaide Metropolitan residents helped to reduce the load on already strained outpatient services. Most of these people will now “fall through the cracks” until they next present at an Emergency Department because despite significant Medicare subsidies to GPs to provide early risk factor counselling/detection and chronic disease self management they mostly do not have the time or the inclination – so much for hospital avoidance!

    Reply
  27. 27
    Avatar

    Health Promoter

    Interesting that McCann suggests that the Australian Breastfeeding Association will pick up the work in breastfeeding health promotion. Does Warren McCann not realise that Minister Hill has only funded the ABA until June next year, and was otherwise going to cut all their funding until a bunch of nursing mums came to parliament to protest. This is just one of many assumptions in McCann around other people (e.g. Medicare Locals) are going to do this work anyway, so why should the State do it. Total cost shifting – but getting it so, so wrong.

    Reply
  28. 28
    Avatar

    jules ferguson

    I have been a consumer advocate in the southern region of Adelaide for many years and have now witnessed a health service that is short sightedly focused on the medical model and not totally focused or committed on a primary health care model.

    What happens when this occurs….a budget blow out!

    We have the KPMG report which states SA Health needs to work smarter to make savings that will better sustain a health service as the population ages.

    McCann obviously doesn’t see that prevention is better than cure and in the long run WILL save $$$$$$$.
    Surely he should see that prevention is better than cure and the emphasis needs to be on the social determinants of health and health equity. The research links primary health care and health promotion with positive health outcomes and shows that it strengthens PHC and improves population health and hospital avoidance, so will be cost effective.

    I am dismayed at the thought of recommending cuts to health promotion and PHC services including community foodies, eat well be active and so on as budget measures. The savings are minor compared to the rest of the health budget which has blown out due to not enough emphasis on health promotion. Is this just an excuse for cutting the health budget and shifting responsibilities onto the Commonwealth government for political gains.

    How can McCann and SA Health possibly have confidence in preventing chronic disease and hospital admissions by cutting the very programs that promote health, and the prevention of illness obtained from a short-sighted report from an individual with a poor grasp of the complexities of chronic illness prevention.

    How can SA Health seriously think that the Medicare locals will pick up the slack! They are over worked and under resourced as is! Try to get a GP appointment in a timely manner!

    I trust that the powers above will see this review with its short sighted recommendations as total rubbish and will have the foresight to ask the hard work dedicated people working at the grassroots of PHC as well as asking the consumers who use the services.

    The rhetoric comes to mind here-Patient centered care and health literacy. Hopefully comes to SA health too!

    Reply
  29. 29
    Avatar

    Jess Thomas

    I hope that the SA Government can see McCann’s recommendations for what they really are. A complete ‘shift the buck approach’ to try and balance the health budget. The health of South Australians is more important than a cost shifting exercise. Shame on you McCann for your short sighted views. As Professor Baum states, we need more emphasis on prevention and improving population health not just more hospital beds. If we slash funding to health promoting programs, as McCann suggests, how will we cope with the increased rates of poor health in the future? These cuts will hurt those who needs access to health promoting professionals and programs the most. Another kick in the guts for disadvantaged groups.

    Prevention is much cheaper than cure. Pay less now or more later, I just hope the politicians can see further then the next election. Strong political leadership is required to ensure the health of many South Australians. If your purpose is a more efficient health system all the evidence points to investments in primary health. Please do not go backwards, for you are gambling with the health of South Australians.

    Reply
  30. 30
    Avatar

    Janet Haydon

    I too agree with the sound and highly valued comments from Professor Fran Baum. There is plenty of evidence for the value of health promotion, locally, statewide, nationally and internationally which appears to be being ignored. You only have to see that people are living longer, smoking rates have dramatically reduced, but of course this means that there is a bigger strain on the hospital system – with more people around that need health care in thier later years – it is clear that our government prefer to ensure that our populations die younger as it would be economically better!

    If there are no measurable outputs or evaluations for some of these programs then we should be working towards building evidence for these programs, not just useing it as excuse to close it down. The results based accountability tool might be useful here for some – as the document clearly notes that there is often client feedback noting improvements – but this is clearly not enough for these short term thinkers.

    Reply
  31. 31
    Avatar

    Stephenson Amy

    Thank you Melissa for taking the time to say very concisely what I believe all community health and health promotion professionals in South Australia are thinking. Even though I have only worked in the area for a short time since graduation, I already see the immense benefits taking the time to get to know a community and helping them address the root causes of their health problems can have. Start Right Eat Right are just finishing a study with UniSA showing the significant improvements in children’s diets once their childcare centre becomes SRER accredited while at an individual level, the incredible feedback we receive everyday on the work local Community Foodies and Health Promotion Officers are doing is inspiring. It breaks my heart that one man, can overlook what is so obvious to all of us working in this area and have these potentially devestating consequences for the people of South Australia, especially those who are already at a disadvantage. I wish someone could explain to me how they expect to decrease hospital admissions or chronic disease rates in South Australia without a co-ordinated state wide approach? We as a state have invested so much time and money into getting true primary health care to the this point and they are happy to just throw it all away. Can’t we all just see the day someone from my generation reaches the top in 10-15 years time and says ‘wow, I’ve got this great idea, why don’t we try to stop people from getting sick before they get to the hospital, we’ll call it prevention’…. like no-one ever thought of it before…

    Reply
  32. 32
    Avatar

    Margaret Nelson

    Perhaps those left in public health and community health (diminished as it is) could take this opportunity to direct all the families and communities, who have been supported to build up their lives and communities, (instead of going into crisis) to take their issues to parliamentarians offices. And all the sick and needy people who have previously been supported through community health, to crowd the hospitals even more. We cant really measure what we’ve prevented if its been prevented, we can only measure numbers apparently and that’s all that matters. So isn’t it time to send community people to the offices of pollies, and the sick back to hospitals? Overcrowding? it doesnt matter because they wont admit anyone anyway. But they will get numbers. And to all the people who built up community health over the years. Thank you. Who dealt with loving kindness in transferring hope and belief, better health, brighter futures, developed educational opportunities and supported our families to better health with their children, thank you. And indiginous communities to gather and support each other in their learning, and refugees to know someone wants to support them to have a new beginning, (after living in the horrors that they have), thank you. And at a smidgeon of the cost of the medical system, with 100% more commitment and passion, I am deeply grieving your loss. RIP community health. Thank you Thank you Thank you.
    What has happened to the Labor party?

    Reply
  33. 33
    Avatar

    Kassi Rogue

    John Hill stated in his resignation “health spend is at record high level of $4.9 billion and we now employ more Dr’s and nurses than at any time in our state’s history”. This is nothing to be proud of when cuts are being made so drastically to primary health care. Slowing the progression of just one person’s diabetes and delaying their commencment to dialysis by 1 year saves the system $70,000. Not everything can be measured by $$, just ask someone on dialysis how their quality of life is? How can all these PHC projects be cut with nothing to replace them-as much as McCann wants us to believe Medicare Locals will there is no sign of this.

    Reply
  34. 34
    Avatar

    Denise Manson

    Great to have Professor Baum’s evidence based analysis, but frankly blind freddie could see how shortsited this proposal is, very small short term savings for very large, long term costs, not to mention the cognitive dissonance of constantly receiving government health promotion advertising, while programs are cut. Having just completed cultural awareness training on Aboriginal and Torres Strait Islander attitudes towards health, which are entirely community focused, it seems we still have much to learn

    Reply
  35. 35
    Avatar

    Elizabeth Witton

    I am shocked at this review. Cutting (relatively inexpensive) community-based programs for health promotion and disease prevention does not add up to long term budget savings. Quite the opposite. McCann should be ashamed of this review, it is unintelligent and unimaginative and apparently supports the idea that it is OK to abandon disadvantage citizens by removing the very programs that help address their particular needs.

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

© 2015 – 2021 Croakey | Website: Rock Lily Design

right-share-menu

Follow Croakey