Todd Harper, CEO of Cancer Council Victoria, gives us an insight into his personal discussions with the late Professor Gavin Mooney and how Australia can learn from the public health agenda of New York city Mayor Michael Bloomberg.
Of course, Gavin Mooney was an excellent economist. But that’s not what was important about Gavin Mooney. Like all well schooled economists he understood the role of the market in maximising profits and how this drove an efficient allocation of a society’s limited resources. What is important about Gavin Mooney is that as an economist, he understood profit maximisation was rarely enough.
I had the privilege of completing a postgraduate diploma and a Masters in Health Economics under his supervision. This finished in 2010 but we remained in sporadic contact. When I first heard of his death in such dreadful circumstances, I couldn’t believe it could be Gavin. But of course it was true and led me to reflect on his remarkable contribution and my experiences with him.
He was generous and empowering, but loved an opportunity to challenge, argue and probe. I enjoyed my all too brief experiences with Gavin and respected his recognition that in health, profit maximisation rarely delivers outcomes that maximise health, particularly for the most disadvantaged.
Imagine a tobacco, car or gun industry encouraged to maximise profits without regulation from governments to achieve outcomes that placed a premium on public order, safety and health.
Gavin and I collaborated on a proposal to tackle obesity and alcohol problems – problems delivered in part by industries that rightly seek to maximise profits but do so in a way that delivers poor outcomes for society – chronic disease, death, and alcohol related violence. Gavin and I argued that when these industries were free to promote the illusory health benefits of sugary ‘high fibre’ cereals, or low carb beer, for example, and governments didn’t step in to provide more balanced health information to consumers, it was hardly surprising our nation’s diet was compromised.
Chronic illness linked to lifestyle factors such as obesity and alcohol use is rising exponentially. One in three cancers are linked to lifestyle factors such as poor diet, no exercise, being overweight or obese and drinking too much alcohol and smoking. But while expenditure on health over the past decade has grown in real terms at an average of 5.3% per year and average expenditure per person has more than doubled in the past 10 years, spending on prevention of chronic diseases like cancer has remained at less than 2% of the total health budget despite many prevention measures being recognised as being very good value for money.
Sadly it is also a familiar story – prevention or health promotion are the first victims in pursuit of economically efficient rather than socially desirable outcomes that deliver better health and disease prevention.
But funding of prevention programs has not just stagnated in Australia, our public health system is being actively dismantled by states such as Queensland which recently cut a swathe through its public health and health promotion programs. Nationally too, we’ve seen $13 million cut from education campaigns tackling obesity – at a time when two-thirds of the Australian population is overweight or obese.
Junk food and alcohol manufacturers are given almost unfettered access to promote their wares to younger audiences, and are afforded significant opportunity to inform health policy and programs. The current compromise over food labelling is just one example where industry has managed to quash the option that best informs people about what they’re consuming. Yes, individuals are responsible for their own health but the current environment does make it hard for people. Fast food is cheap, junk food companies freely sponsor junior sport and supermarkets dedicate aisles to biscuits, chips and lollies instead of core foods.
The tragedy is that when properly funded, prevention strategies and policies do make a real impact.
In fact, in some areas Australia has been leading the way globally. Years of concerted effort by federal and state governments with investment in anti-smoking advertising, policies restricting the marketing of cigarettes and smokefree dining and bars have resulted in Australia’s smoking rate plummet. The recent introduction of plain packaging by the Federal Government is another area where Australia is leading the rest of the world. Effective prevention demands and rewards bold leadership. Bipartisan leadership in the early days of the HIV/AIDS epidemic ensured well-funded education, and critical policy reform in areas such as needle exchange programs, to maximise Australia’s prevention efforts. Road safety and occupational health and safety are further examples of the rewards of well-funded education programs and supporting regulatory reform that can support health gains.
Modern political will in prevention can also be seen at work in New York City which has built a prevention system based on our past successes in HIV and tobacco, and is getting the results. Cuts to smoking rates due to legislative changes, taxes and hard-hitting campaigns have led to a significant drop in cancer rates between 2002 and 2010 – a drop of 27.1% overall.
They have also been hard at work embedding early detection of HIV into their primary care networks, resulting in more New Yorkers able to be tested and of those who test positive, more than 90 per cent are being linked to care and treatment within 90 days. The mortality rate from HIV infection is declining at a faster rate than other causes of death in New York City; the rate is down by 11.3 per cent from 2009 to 2010 and 53 per cent from 2001 to 2010.
NYC through its visionary mayor Michael Bloomberg has also been at the forefront of campaigns and programs to tackle the drivers of obesity. Cutting the size of soft drinks, hard hitting social marketing campaigns and fast food menu kilojoule labelling are all contributing to New Yorkers being more aware of what they’re consuming. Industry is free to maximise profits but within some game changing rules that give greater empowerment to consumers to find the truly healthier options.
These prevention initiatives have played a part in the average life expectancy of a New Yorker rising by three years since 2001 to 80.9 years. Now Mayor Bloomberg has his sights on gun law reform – taking a similar public approach to end the cycle of tragedy and intransigence.
In Australia, our life expectancy is 81.9 years, no mean effort by international standards, but we face the real possibility that our life expectancy could soon drop. Considering our obesity rates this isn’t an unlikely scenario.
This is where I enjoyed many discussions with Gavin Mooney about how to balance the profit maximising activities of the alcohol and junk food industries; and the need to tackle health problems where industry had failed to deliver the health gains society needed, and worse exploited its customers through its pervasive advertising, particularly advertising aimed at children
Today, Australian governments don’t do enough to empower people to take control of their health through sustained investment in public education, better regulation of labelling on alcohol and junk food products to provide important health information at a glance, and finally, once and for all, get alcohol and junk food companies out of the faces and minds of children by restricting TV advertising during children’s most popular TV programs.
My hope is for a new year’s resolution from Australian governments to take a bite of the big apple approach to health because these are times when maximising profits is not enough.