What’s in the budget for health? See for yourself…

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?

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.

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”

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”.