Below Croakey’s Melissa Sweet gives an overview of some of the key issues, including concerns that without proper funding and implementation commitments, it will be “another worthy document which does not advance the health of Australians one iota”.
Melissa Sweet writes:
OMG. The Federal Health Department has released a publication that finally utters the words so many have been waiting SO long to hear.
The draft National Preventive Health Strategy cites a contributor saying that “climate change is likely to be the biggest challenge to health, wellbeing and economic prosperity”.
The document goes on to note that human health is dependent on planetary health, and that environmental issues, such as extreme weather events and significant changes in climate systems, have had, and will continue to have, an impact on the health and wellbeing of all Australians.
“This is particularly true for Aboriginal and Torres Strait Islander peoples, who have close cultural, spiritual and social connections to the land. In order to prepare for future challenges and address the health of the planet, the impacts of climate change on physical and mental health need to be understood, especially through a health equity lens,” it says.
But don’t get too excited. These words don’t come until page 40 and although climate change is mentioned a number of times throughout the document, the draft strategy does not convey a strong sense of urgency about the climate crisis and how it will undermine all other efforts in health prevention without urgent action.
The draft strategy addresses many of the criticisms directed at an earlier consultation paper.
It acknowledges the importance of the wider determinants of health, including the cultural determinants of health, and calls for a health equity lens to be applied to all preventive health action. It also recommends a “a systemic and structured approach to embedding the consideration of health across all policies”.
But while the document mentions critical public health concerns as racism and poverty, it does not set targets for addressing these concerns. Nor does it recommend anti-racism strategy programs and targets, though it does set a goal of improved cultural safety in the health system.
Under the goal of protecting mental health, it sets a single target, of “towards zero suicides for all Australians”. Surely there could be targets here of reducing experiences and structures of racism and other forms of violence (another issue not adequately explored) and trauma.
And, as we approach the 30th anniversary of the Royal Commission into Aboriginal Deaths in Custody’s recommendations, there is nary a mention of addressing incarceration rates. Some sections would benefit from a human rights-based re-write.
It is strange also that so little mention is made of “regulation” given it’s such an important element of the public health toolkit as evidenced by the tobacco control success story told in the document, as per the diagram below.
This omission is notable as the document acknowledges the importance of the commercial determinants of health, “factors that influence health which stem from the profit motive”.
But instead of ‘regulation’, we read: “The commercial sector could play a pivotal role in positively shaping the health outcomes of Australians by aligning their strategies to the health and wellbeing goals of society.”
Yeah, right. Juukan Gorge. Facebook. Dan Murphy’s/Woolworths. Coca-Cola. Nestlé. McDonald’s. Fossil fuel companies. ETC
The document says the COVID-19 experience has shown Australians and the world how interconnected our health is, and brought concerns about health inequities and their determinants to the fore:
…ultimately, if some Australians are suffering in poor health, then we are all impacted.
This has never been more apparent than it was in 2020 when the emergence of the COVID-19 pandemic highlighted the inequities that some population groups are exposed to on a daily basis.
The pandemic forced Australians to understand and acknowledge that the health of the community has ramifications for the health of all.”
The document says the pandemic has revealed weak points in how we think about ‘health’ or ‘public health’ and in some instances, how it is funded.
Ultimately, it should be about improving the health of communities and the population.
Instead, there is a strong emphasis on the health of individuals, and the doctors and medicines that help us to recover when we, as individuals, get sick.
The COVID-19 pandemic has highlighted that there needs to be a shift in this thinking to a whole of population focussed approach – a collectivist approach that is focussed on preventing disease, injury and illness for all Australians.”
The strategy says COVID-19 has also brought to light the importance of partnership approaches and involving communities in decision making processes.
The strength and leadership of the Aboriginal Community Controlled Health sector during the pandemic meant that locally-led, holistic, comprehensive, and culturally appropriate health care continued to be delivered to communities, in spite of lockdowns and other restrictions, it says, and this sector-led response has been instrumental in reducing the impact of COVID-19 in Aboriginal and Torres Strait Islander communities.
“The lessons from the COVID-19 pandemic will continue to emerge over the next decade. It will be important to understand and learn from these lessons in order to ensure Australia, and the world, are less vulnerable to future public health challenges,” the document says.
The document is informed by the principles of multi-sector collaboration, enabling the workforce, community engagement, empowering and supporting Australians, adapting to emerging threats and evidence, and applying an equity lens.
It presents a series of policy goals for 2030 under “seven enablers to mobilise a prevention system”:
- leadership, governance and funding
- prevention in the health system
- partnerships and community engagement
- information and health literacy
- research and evaluation
- monitoring and surveillance
These policy goals include:
- Priorities for preventive health action are informed by a national, independent governance mechanism that is based on effectiveness and relevance.
- Preventive health and health promotion activities in Australia are sustainably funded through an ongoing, long-term prevention fund.
- A health lens is applied to all policy through ongoing, cross-sectoral partnerships, led by the health sector, at all levels of governments, to address the determinants of health.
- The inherent preventive health capabilities of primary health care professionals, including GPs, allied health, pharmacists and nurses, are better supported and integrated within health services.
- Improved cultural safety across the Australian health system to improve access to appropriate and responsive health care for Aboriginal and Torres Strait Islander peoples, and the prioritisation of care through ACCHSs.
- Enhanced continuity of care for patients, within the primary health care system, is supported through a voluntary enrolment mechanism – allowing practices to plan and monitor individual health risks.
- Social prescribing is embedded in the health system at a local level with a focus on self-care support
- Regional prevention frameworks are established to achieve sustained collaborative referral and monitoring arrangements.
- Communities are supported to collaboratively deliver place-based, evidence-informed preventive health action that is response to local circumstances.
- Public health policies, strategies, and multi-sectoral action for prevention are protected from real, perceived or potential conflicts of interest through a national evidence-based approach and transparent stakeholder engagement processes.
- A national health literacy strategy is developed and Implemented, and guides health service improvements
- A systematic approach to the prioritisation of preventive health research is established.
- The development, testing and evaluation of preventive health interventions in Australia are enhanced.
- A set of nationally agreed prevention monitoring indicators, including definitions and measures of the wider determinants of health, are established and monitored.
- A national prevention monitoring and reporting framework is utilised by all levels of government.
- A national strategic plan addressing the impacts of environmental health, including horizon scanning to identify and understand future threats, is developed and implemented in alignment with this Strategy and the work of the Environmental Health Standing Committee.
- Evidence-based approaches to identify and address current and emerging pressures on the most vulnerable parts of the health system caused by climate change, are developed and implemented.
- The provision of tailored, culturally appropriate and accessible information for all Australians is prioritised during an emergency response to ensure effective messaging and distribution of public health advice.
- A national framework is implemented in all states and territories to distribute close to real-time, nationally consistent air quality information, including consistent categorisation and public health advice.
The document says a “Blueprint for Action” will be developed with implementation details, including how existing health infrastructure will be leveraged to reach policy goals and targets – including that investment in preventive health will rise to be five percent of total health expenditure by 2030.
Associate Professor Lesley Russell, a Croakey columnist and contributing editor, said:
It is clear that some real efforts have been made to address the concerns and omissions in the consultation paper.
But it is equally clear that without a detailed accompanying action plan, with timelines and responsibilities for implementation, reporting and evaluation clearly spelt out and an adequate, sustainable, long-term source of funds, this strategy will remain fine words on paper.
It’s critical that we see champions emerge and coalesce around finalising the strategy and ensuring its implementation: ideally the leader should be not just the Health Minister but also his federal and state colleagues in a whole-of-government approach. We await evidence of Minister Hunt’s ardent support for prevention.”
The Public Health Association of Australia (PHAA) welcomed the draft, saying it demonstrates “a real understanding of population health and disease prevention, driven by social, economic, cultural and commercial determinants of health”.
The PHAA was glad the Strategy included a priority to identify and manage “real, perceived or potential conflicts of interest for all aspects of preventive health work”.
“This is a strong step in the right direction for ensuring health policy is evidence-based and informed by experts, not industry players focused on profits over people,” said CEO Associate Professor Terry Slevin.
Slevin also raised concerns about a lack of commitment to funded programs. He said:
The last round of state and federal budgets were a failure for disease prevention measures in Australia. The 2021 federal Budget is probably already being finalised now (March 2021), while this strategy is still unfinished. We remain hopeful but not certain that a genuine injection of resources into preventive health will be announced in the May budget.
Ultimately preventive health efforts will make meaningful progress when both good public policy and resources are committed. Many of the sentiments in the Preventive health Strategy are important and welcome.
However, unless real action follows this is destined to remain another worthy document which does not advance the health of Australians one iota.”
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