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Where is health promotion in the reform agenda?

Assistant Professor Michael Sparks, an office holder with the Australian Health Promotion Association and the International Union for Health Promotion and Education, writes:

“In the recently released National Health and Hospitals Network for Australia’s Future, the Australian Government has demonstrated a lack of understanding of the importance of integrating health promotion within the full spectrum of health.

The policy focuses on settings for treatment and cure while ignoring health promotion and disease prevention.  This perpetuates the view that the Government is attempting to treat the symptoms of increasing health demand without attempting to understand and deal with the causes.

Likewise, there is no mention of how health promotion and disease prevention could be incorporated into multi-disciplinary primary health care teams and no indication of the importance of incorporating promotion and prevention into the core business of hospitals and primary health care services.

The policy articulates the need to “Keep people healthy in the community” but indicates no role for health promotion in this.  As such it seems this policy is less focused on re-orienting health services to being more health promoting and more about shifting the provision of services from hospitals to community-based clinical services.

While there is mention of the overdue National Preventative Health Agency and its funding for a limited gamut of ‘lifestyle’ campaigns, the document reinforces the absence of critical thinking on the importance of more comprehensive community-based health promotion efforts that evidence shows can help people take control of the determinants of their health and decrease their need for treatment and care services, whether primary care or in a hospital setting.

This argument should not be interpreted as opposition to many of the themes in the proposed policy, but an indication of limited thinking that further reinforces the artificial and inefficient divide between promotion and treatment.  Improving infrastructure, efficiency  and health outcomes are noble goals for any government, but missing the key role of health promotion in achieving these goals shows limited consultation with ‘experts’ and demonstrates a limited understanding of the benefits of integrating health promotion with other health services and providers.

There is a clear role for health promotion in primary care, in General Practice, and in hospitals as community settings.  This policy document provided an ideal opportunity for the Government to demonstrate its appreciation of the role of health promotion within the primary care and hospital setting and to underscore the need for greater integration of community health promotion needs with community clinical setting needs.

Let us hope that future Government announcements on ‘prevention’ will include some measures to ensure that community-based health promotion (and not just expensive mass media campaigns on ‘lifestyle’ issues) will be given the focus they deserve.

A future policy that locates and acknowledges the importance of health promotion in the spectrum of health and health services is long overdue in this country.  There remains an opportunity for this Government to embrace such an approach, to discuss the ways and means of achieving a health system that is not only a treatment and care system but one that embraces empowering members of the community to live healthier lives that require fewer interactions with clinical services.”

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