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    Simon Chapman

    In 35 years in public health, I have never seen such a massive commitment to prevention. This will all take a while to sink in, but it is an historical announcement that will provide unprecedented momentum to three key areas in public health. Lung cancer rates today are now at 1962 levels thanks to the population-focused policies and programs we have followed. The first cases were reported in the surgical literature in the 1930s and 80 years later, we are looking at the retreat of the largest cause of cancer death.
    One concern is where the national agency will be located. If it is in Canberra, that will severely limit the number of serious people who will be prepared to join it. Have I missed this? Has its location been disclosed?

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  2. 2
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    Simon Chapman

    PS: can someone PLEASE tell the gvt to stop using this dreadful “preventative” word. It is “preventive”.

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  3. 3
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    Patrick McGorry

    Tonight’s budget has deepened concern within the mental health sector that the Government has not yet acted on the Prime Minister’s commitment to a “historic reshaping of mental health services” made at the COAG health summit last month.

    Government commitments to expanding access to mental health services for young people are positive in direction, but very limited in scale. Even when the Government expresses full confidence in evidence based models like headspace (for mild to moderate mental ill-health) and EPPIC (for psychosis), the funding is inexplicably meagre. The investment will shave a mere 3% from the waiting list of 750,000 young Australians currently locked out of the mental health care they and their families desperately need. Australians expect the Government to remedy this in the coming months.

    At a time of major new health investments, the Government has yet to explain why it is pumping all its precious fuel into acute health while mental health is left to run on fumes. Mental health services are expected to address 14% of Australia’s health burden with a meagre 6% of our health expenditure, well below comparable developed nations. Yet, rather than address this problem, the Government has widened the gap. This trend must be reversed. With political will, Australia can still meet the 2012 target of 9-12% of the health budget that was recommended by the 2006 Senate Select Committee on Mental Health.

    Unless we see a change of heart, confidence in this government’s ability to adequately address mental ill-health across Australia will continue to drain away Yet there is still time for the Australian Government to show the leadership it has promised on mental health.
    The mental health sector overwhelmingly wants the Government to use the coming weeks to outline its guiding vision for mental health reform, commit itself to ending the unequal access to quality care between physical and mental health and make good faith funding commitments towards achieving this vision. There would be universal community and professional support for this kind of leadership. The millions of Australian families struggling with mental ill-health without access to care desperately need to see that kind of action soon.

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  4. 4
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    Todd Harper

    Investment in social marketing campaigns to encourage and support smokers to quit is welcome, as is the national risk factor survey, and some of the sports initiatives to encourage participation by children, culturally diverse groups and women are a good step.
    While some of the initaitives aren’t new, they are welcome – the food labelling review by Neal Blewett, Indigenous smoking initiatives, plain packaging of the tobacco products, and sponsorship alternatives to alcohol.
    For prevention, there is much more wore work to do on reforming the alcohol taxation system, sustained investment in advertising campaigns on alcohol use, overhauling regulation of alcohol and junk food marketing, and increasing investment in prevention over time but this budget makes some good (and welcome) initial steps in that long journey…

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    Doctor Whom

    Well Medicare Local sure threw me. As usual bugger all detail and sadly I suspect that Medicare Local does reflect a limited view of Primary Care and planning.

    I’ve feared all along that Canberra sees Primary Care as ”the things that lone clinical professionals do in private practice”

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  6. 6
    Croakey

    Croakey

    Professor Stephen Leeder asked for this comment to be posted on his behalf:

    “It is indeed gratifying to see a formal response from the federal government to the National Preventative Health Taskforce report, especially in that it takes many of the excellent recommendations made by the taskforce and puts money behind them. Many people feared that when Mr Rudd made his early announcements about hospitals and health service financing he was neglecting prevention and the broader health field. “This is just a hospital plan, not a health plan!” they shrieked. I stated repeatedly to those working themselves into a lather over this omission that Mr Rudd and his government would in time deal with the issue Mr Rudd had a political agenda to pursue and he is, first and last and appropriately, a politician. Mr Rudd’s personal commitment to prevention, articulated at Summit 2020, was real.

    As Simon suggests, there is a lot of detail to be worked through but there may be relatively few devils lurking. The Preventive Services Agency is back on the agenda, and much is expected of it in providing sound advice for future preventive strategies. The response to obesity carefully takes several thousand careful aerobic steps around the food industry, but what we eat and who makes a buck on it is intensely market driven and is responding to consumer weariness with obesogenic products and general societal boredom with obesity. It is has become more waist and not at all hip, so to speak. In my view food market solutions to this problem may emerge in response to changing community attitudes, helped by an occasional pill and surgical trim and tuck. The proposed social marketing strategies, if well conceived, may help. Horrah for the proposed biennial health survey as well.

    All that said, this response is something to lift spirits that flagged in recent months over the health agenda pursued by the current federal government.

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    Fran Baum

    Yes there is some commitment to disease prevention and the government is to be congratulated on that. There is still no response to the broader social determinants of health and health equity – there is much more that could be done to reduce poverty and to support low income people. A concerted program of work on reducing health inequities that reflect social determinantswould be very welcome otherwise there is a risk that money invested in disease preventions will increase inequity (as has been the case with quit smoking campaigns).

    A national program of local healthy and sustainable community initiatives linking local governments, regional health services and community interests would really allow a HEALTH agenda to flourish whereas what’s on offer is risk factor reduction. Locally generated projects could focus on social determinants of unhealthy behaviour and on the things that encourage people and their communities to flourish.
    I fear that the PHC agenda is simply too GP-centric. We need models that build on the best of the community health movement and develop models of care that are multi-disciplinary, community run and which don’t only think about the care of individuals but also care for and promote the health or whole communities and do this by taking a broad public health perspective.

    I agree with Simon – please stop talking about Preventative Health and instead use the terms “disease prevention” and “health promotion”.

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  8. 8
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    Fran Baum

    In terms of mental health Ian Hickie and Patrick McGorry have posted really good analysis of the issues and yes there needs to be much more money in this area. I’d like to add that community health centres would be ideal for the local delivery of mental health services – they should be integrated with services for the rest of our bodies instead of entrenching the crazy division between our bodies and our minds. Real health reform would embrace this and see truely comprehensive primary health care services. They would also, of course, provide publicly funded dentistry services.

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  9. 9
    Croakey

    Croakey

    Doug Tutt asked for this comment to be posted:

    Of course there’s lots of good news. But we have to remember just announcing money never solved anything. The critical thing will be how to operationalise preventive health work, avoid some State’s bureaucracies ( of course they want to stay in control and be the ‘managers ‘ of the new hospital initiatives), and keep preventive health money away from the same agencies administering the red financial hole of clinical services- or it will creatively accounted disappear to acute yet again. I think most of us who’ve been around in preventive health for a while are familiar with that.
    So we need an arms length operational agency/ies ( not just a policy/funding one which appears to be the one currently proposed) separate from demands of clinical ops and with more flexibility for action than exists in Govt Depts.

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