Who will be the first chief of the Australian National Preventive Health Agency?
It is such an important job and this will be such a landmark appointment, let’s hope there are many outstanding candidates. The Minister for Health will make the appointment, but has to run it by state and territory health ministers, according to this bill introduced to the House of Reps today. Given the agency’s focus on tobacco, alcohol and obesity, you’d think it would be someone with expertise from across those areas.
Whoever it is will have their work cut out.
As well as developing an annual operational plan, a three-year strategic plan, providing advice to federal, state, territory and local governments, and working with the Agency’s advisory council, they will have to:
- every 2 years, starting in 2011, to publish a report on the state of preventive health in Australia
- conduct educational, promotional and community awareness programs relating to preventive health
- make, on behalf of the Commonwealth, grants of financial assistance relating to preventive health
- develop partnerships with industry, non governmental organisations and the community sector
- develop national standards and codes of practice relating to preventive health matters, and
- manage schemes that provide awards to participants to recognise excellent performance in matters relating to preventive health.
Meanwhile, the recent release of the National Preventative Health Strategy has prompted Todd Harper, Chief Executive of VicHealth (the Victorian Health Promotion Foundation), to reflect upon some of the lessons from the history of prevention.
It’s timely, given that the agency’s establishment will hopefully come to be seen as a significant landmark in public health history.
“If we could time shift back a few decades, most of us would be shocked at how ‘normal’ some risky behaviours were. Casual attitudes to drink driving and seat belts, for example, contributed to a catastrophic toll of road deaths.
With the wisdom of hindsight, laws that were then damned as being ‘nanny state’ laws are now seen as ‘no brainers’ – they are so obviously beneficial.
But it took a visionary approach –‘wisdom of foresight’ in the form of preventative health campaigns – to drive the attitude and behaviour changes that have become our cultural norms.
These campaigns changed our culture so effectively that most of us now see drink driving as dumb and wearing seatbelts as automatic. And Victoria’s road toll statistics have vindicated those seatbelt laws, having fallen from 1061 deaths in 1970 when seat belts became compulsory to 331 in 2003 – a 69% reduction.
We have come a long way from the days when panel beaters worried about a loss of business from safer driving regulations.
In hindsight, that preventative health foresight of the 1970s and ‘80s was enormously valuable. It led to investments in our future health that now deliver huge returns to all Australians in the form of lives saved and illnesses avoided, with all the associated economic, social and personal benefits. Tobacco control programs are an outstanding example. Since 1971 they have cost $176 million and generated estimated benefits worth $8.4 billion – a benefit/cost ratio of 50:1.
Yet health promotion continues to be under funded in proportion to its benefits, with just less than 2 per cent of our health budget spent promoting health.
Australia could be a very different country if we could make that wisdom of foresight one of our national characteristics – and reflect it in our funding. This is the challenge raised by the Preventative Health Taskforce in its final strategy.
The Taskforce’s recommendations map the way to a healthier Australia by setting out the evidence, the targets, and the enormous potential benefits of following the strategy’s course for such key areas as obesity, tobacco and alcohol.
Fortunately, to help us reach those targets, we have a bank of wisdom from which to draw, deposited by successful preventative health campaigns in Australia and overseas in areas such as tobacco control, HIV, and road safety. At the core of such campaigns are complex questions. How do we change our culture? How do we make it ‘normal’ to live in ways that promote health, not disease? How do we steer communities away from the chronic diseases that burden our health system, our economy and our daily lives?
Common to successful preventative health campaigns is an integrated approach that requires the resourcing of research. This is the foundation for the education, legislation and policy reform that ultimately leads to long-term cultural change.
The Taskforce’s recommendations on alcohol exemplify this multi-facet that truly encourage and reward healthy choices, through:
• economic levers such as taxation or subsidies
• legislative and regulatory measures
• boosting support for local communities and individuals, and
• increasing awareness that can over time influence our values of what is important in our general community.
Our tobacco campaigns have proven that pricing, for example, is an effective measure that can be applied to reducing alcohol consumption. Economic studies in other countries have found that a 10% price increase results in reducing total consumption across the population by an average of about 5%. And when alcohol prices rise, problems recede, including binge drinking, motor vehicle accidents, cirrhosis mortality and violence.
Other important across-the-board lessons from HIV/AIDS and road safety, along with tobacco, are that preventative health works most powerfully when it is politically non-partisan and involves the community at every step along the journey to achieving cultural change.
With tobacco and road safety we now have a community that understands the power of prevention, so much so that they expect, even demand, action from Governments. The community understands that without such action all of us pay the price: loved ones suffering preventable deaths and disease, paying the costs of treating the sick, lost workforce productivity or through pain and suffering caused by other people’s actions – smoking and drunk driving for example.
Governments have obliged recognising the wisdom and political gains to be made from smokefree laws and introducing drug driver testing.
This approach takes time – developing the knowledge and support needed is a long-term effort; which is why the Federal Government must implement the taskforce recommendations without delay. The National Preventative Health Strategy offers a once-in-a-generation window to exercise ‘the wisdom of foresight’.”
PS – quick query from Croakey: does anybody know why we’ve got a preventative health strategy and taskforce, but a preventive health agency?
It’s a Melb-Syd thing, like “kestionair” and “kwestionair” (or the other way round). Keeps mug punters on the outer.
We might not know who the new boss of the preventive health agency will be but we can be certain that who ever s/he is that they (and their staff) will cost us (the tax payer) a fair whack. That’s fine, of course, if the benefits of the new agency outweigh its costs so measuring this, on an ongoing basis, is vital – we all know how good organisations are at justifying their existence once established. What I would like to see as part of the CEO’s job description is a real commitment to evidence-based preventive health policy making across the spectrum of the agency’s work, and not the usual self-serving evaluations where all roads lead to more money being spent on the same old strategies (eg a finding that the target group hasn’t changed behaviour = campaign clearly not comprehensive enough = more money needed to boost campaign reach; or alternatively, a finding that the target group has changed behaviour = campaign clearly working = more money needed to promote even more behaviour change).
Exactly, Jennifer. If I’d reduced my bulk, from, say, 150kg to 85kg, had the tape measurements and photos to prove it, had a verifiable exercise regimen, and all on the advice tendered by one visit to the GP, then I hope I could plug all that prevention data into the national record. I’d be happy for ANPHA to take the credit, as long as I can take my good record to the health insurer and get a discount. Otherwise, you know, it’s hard work contributing to the strategy, it’d be easier to just loll around till I’m 250kg, because I know if I break a hip, there’s a whole team of health professionals gearing up to transport the morbidly obese.
In this age of peer-reviewed, evidence-based practice, I would cite Johnson (2006) in response to your, perhaps rhetorical, post script:
“The preventative medicine [web] sites almost all fall into one of four categories: (1) sites that obviously mean preventive medicine, but the words have been misspelled or mistakenly interchanged, (2) sites that promote alternative or nonscientific modalities or treatments, (3) sites that are based in the United Kingdom or one of its Commonwealth members, and (4) sites dealing with veterinary preventive medicine.
Johnson, M.B., “Out, damn’d ‘at’; out, I say!”: “preventative” versus “preventive”. Am J Prev Med, 2006. 31(5): p. 451-2.
I heard from a very reliable source that the strategy was “preventative” because that is the word that the PM used his election statement on the matter. More correct heads have apparently prevailed in the naming of the legislaiton – mayhap the Office of Parliamentary Counsel insisted when it was drafting??